Chapter 10 Disorders Affecting Feeding and Swallowing in Infants and Children

_____ % of all children but _____ % of developmentally delayed suffer from some sort of mealtime behavior difficulties

5, 85

What is the definition of mealtime behavior and feeding difficulties?

inability to consume sufficient calories for optimal growth and development

What are mealtime behavior and feeding difficulties sometimes associated with?

swallowing dysfunction

What do most mealtime behavior and feeding difficulties result from?

• medical conditions

• congenital abnormalities

• developmental delays

• sensory processing disorders

• environmental factors

What can indicate a feeding disorder in early infants ?

• irregular suck / swallow / breathe pattern

• changes in respiratory patterns during feeding

• irritability during feeding / refusals

• excessive drooling, gagging, emesis

• slow or delayed swallows with residue

• poor lip seal around nipple

• prolonged (>30 minute) mealtimes

What are the signs and symptoms of problems in older infants / children from parent reports or clinical observations?

• coughing, choking, gagging

• crying and arching

• vomiting

• difficult to feed

What are the other signs (mainly longterm) of feeding problems in older infants / children?

• poor weight gain

• incoordination of feeding and breathing and ongoing respiratory issues

• failure to transit through food types

• food aversion to specific textures or food groups

What are the key indicators of childhood feeding difficulties and behavioral feeding issues?

• restricted volume of oral intake

• limited range of food in diet

• limited range of textures in the diet

• prolonged mealtime duration

• battles or problematic behavior at mealtimes

• family stress related to the child’s eating patterns

What are the disorders that commonly affect feeding and swallowing disorders?

• prematurity

• respiratory and cardiac disorders

• gastrointestinal disorders

• neurologic disorders

• congenital abnormalities

• maternal and perinatal conditions

• iatrogenic complications

• miscellaneous complications

How long do most pregnancies last?

40 weeks

Babies born between 37 and 42 completed weeks of pregnancy are called _____

full term

Babies born < 37 completed weeks of pregnancy are called _____

premature

What are the physical stressors of preterm infants?

• breathing and feeding

• support their body against the effects of gravity

• dealing with comorbidities

What are the factors that can affect feeding in preterm infants?

• state control

• stress

• postural control

• oral motor control

• gut maturity and health

• physiological control

• respiratory rate

• heart rate

• endurance

• sucking, swallowing, and breathing coordination

What state control?

state control difficulties may be components of a variety of medical conditions common in preterm infants

What is stress?

might be related to feeding, internal discomfort, or external stimuli

What is postural control?

difficulty positioning for suckle feeds

What is gut maturity and health?

feeding intolerance is a common complication of preterm birth

What is physiological control?

poor physiologic responses to the work of feeding

What is respiratory rate?

lack of control over respiratory rate adjustment

What is heart rate?

physiologic instability during feeds

What is endurance?

ending the suckle feeding before taking the required volume

What is sucking, swallowing, and breathing coordination?

it can affect airway safety during feeding, as well as volume of intake

What is apnea of the newborn?

cessation of breathing that lasts for more than 10 seconds or is accompanied by hypoxia or bradycardia

What are the types of apnea in newborns?

obstructive, central, or mixed

What is obstructive hypoxia in newborns?

pharyngeal muscles collapse on each other because of low muscle tone tone or inflammation

What is central hypoxia in newborns?

CO2 increases in our blood which causes a chemical reaction

What is pulmonary hypoplasia?

the incomplete development of the lungs, resulting in a reduced number of brochopulmonary segments or alveoli

What does pulmonary hypoplasia most often occur secondary to?

other fetal abnormalities that interfere with normal development of the lungs

What is respiratory distress syndrome caused by?

caused by insufficient surfactant production

What is respiratory distresss syndrome?

children struggle to breather and are intubated

What is bronchopulmonary dysplasia?

inflammation and scarring in the lungs

What are the main causes of bronchopulmonary dysplasia?

pulmonary barotrauma, oxygen related injury, and infection

What is aspiration pneumonia?

primary aspiration of saliva, fluids, or foods, or secondary aspiration of esophageal or stomach contents

What is cyanotic heart defects?

deoxygenated (blue) blood bypasses the lungs and enters the systemic circulation, causing low O2 saturation and cyanosis

What is acyanotic heart defects?

oxygenated (red) blood mix with deoxygenated blood or obstruct outflow from the left heart

What does an acyanotic heart defect do?

places stress on the heart which has to pump more oxygenated blood through to keep up with any losses

What are the respiratory disorders?

• apnea of the newborn

• pulmonary hypoplasia

• respiratory distress syndrome

• bronchopulmonary dysplasia

• aspiration pneumonia

What are the types of heart defects?

• cyanotic heart defects

• acyanotic heart defects

What are the gastrointestinal disorders?

• necrotizing enterocolotis (NEC)

• tracheoesophageal fistula (TEF)

• congenital diaphragmatic hernia

• gastroesophageal reflux disease (GERD)

What is necrotizing enterocolitis (NEC)?

portions of the bowel undergo necrosis (tissue death)

How is nectrotizing enterocolitis (NEC) corrected?

surgical correction usually requires removing a section of the bowel, which results in a shortening of the gut length and reduced absorptive area (short gut syndrome)

What is a tracheoesophageal fistula (TEF)?

a fistula between the esophagus and the trachea

When does a tracheoesophageal fistula usually co-occur?

with esophageal atresia, in which part of the esophagus is not fully formed

How are tracheoesophageal fistulas corrected?

surgical correction is required to close any openings between the airway and esophagus, as well as to connect disjointed sections of the esophagus into a continuous tube

What is a congenital diaphragmatic hernia (CDH)?

• a congenital defect (hole) in the diaphragm allows abdominal organs (the stomach, intestines, or liver) to herniate (migrate) into the chest

• this occupies space in the chest, which can affect growth of the lungs and restrict blood flow to the lungs

How is a congenital diaphragmatic hernia corrected?

surgical correction is required to return abdominal organs to the abdominal cavity

What is gastroesophageal reflux disease (GERD) caused by?

abnormal relaxation of the LES, reduced gastric emptying, or abnormal pressure in the abdomen

What is the treatment for gastroesophageal reflux disease (GERD)?

generally via feed manipulation, proton pump inhibitors (PPI), histamine receptor antagonsis (HZRA), antacids and surgery

What are the neurologic disorders?

• microcephaly

• hydrocephalus

• cerebral palsy (CP)

What is microcephaly?

head circumference more than two SD below the mean for age and gender

What is hydrocephalus?

increased intracranial pressure inside the skull and progressive enlargement of the head

What is cerebral palsy caused by?

damage to the motor control centers of the developing brain, which can occur in utero, during birth, or after birth (up to 3 years of age)

Children with CP and dysphagia have a higher incidence of ________

• undernutrition

• growth failure

• and poor health

What are the typical feeding problems of someone with cerebral palsy?

• difficulty with lip closure

• inefficient suck

• incoordination of tongue movements

• aspiration risk

• tongue thrust

• tonic bite reflex

• oral hypersensitivity

What are the additional issues that come with cerebral palsy?

• GI problems

• GERD

• constipation

• dysmotility

• increased energy expenditure

• undernutrition

What is the treatment for cerebral palsy?

multipronged in collaboration with physical therapist and occupational therapist

What are the neurologic disorders?

• acquired brain injury

• seizures

What is an acquired brain injury (ABI)?

brain damage caused by events any time after birth

What are acquired brain injuries caused by?

either traumatic brain injury (TBI) or nontraumatic injury

What do acquired brain injuries usually result in?

some degree of physical, cognitive, or behavioral impairments

What are seizures?

brief episodes of abnormal or excessive neuronal activity in the brain

What are the causes of seizures?

epilepsy, high fever, metabolic disorders

What are used to treat active seizures?

benzodiazepine drugs

What are the congenital abnormalities?

• cleft lip

• cleft palate

• cleft lip and palate

• velopharyngeal insufficiency (VPI)

• down syndrome

What is velopharyngeal insufficiency (VPI)?

the soft palate (velum) is unable to close off the nasal cavity from the oral cavity because of structural deficiencies or functional restrictions

What are the characteristics of down syndrome?

• large tongue

• narrow roof of mouth

• mild to moderate intellectual impairment

• congenital heart defect

• feeding difficulties are common

• reduced muscle tone

What does reduced muscle tone cause increased risk for in individuals with down syndrome?

• GER

• impaired head and neck control

• postural stability

• weak suck

• tongue thrust

• congenital (1 in 10 to 20 infants)

• hyperglycemia / insulinemia

• infants feed slowly and tire easily

diabetes

lethargy, poor feeding, and irritable cries

jaundice

• includes alcohol, tobacco, and narcotics

• common effects = poor nutrition, spontaneous abortion, preterm labor, intrauterine growth restriction (IUGR), congenital malformations, developmental delays and cognitive disorders

drug/substance abuse

Who does tube feeding typically apply to?

preterm infants or children who cannot feed by mouth or not have sufficient skill or endurance to support full independent oral feeding

What are the complications of tube feeding?

altered oral sensitivity or oral aversion, inefficient feeding patterns, poor postural support, reduced control of the muscles of the mouth

What are the factors that can potentially affect feeding and swallowing safety in patients requiring mechanical ventilation or other respiratory support?

• neurologic injury and absent oral reflexes

• decreased level of alertness caused by sedation

• obstruction to swallowing mechanism caused by ventilation tubes

• desensitization caused by presence of ventilation tubes or high airflow

• positional restrictions

• increased work of breathing

What are the main causes of serious ingestional injuries?

household chemicals that burn the tissue they come into contact with causing pain swelling, necrosis, and fistulas

How do ingestional injuries cause feeding complications?

• impaired airway protection

• swallowing difficulties

• food aversion

• fear of choking

What is tonsillitis?

an inflammation of the palatine tonsils

What is a tongue-tie?

a congenital condition characterized by a tight lingual frenulum which may decrease mobility of the tongue tip

What is sensory processing disorder?

an abnormal interpretation of everyday sensory infomation

What are the most common categories of sensory defensiveness - hypersensitivity?

• picky eater

• hands off

• may present with food avoidances

• gags on certain foods

• unusual feeding behaviors

What are the most common categories of sensory under registration - hyposensitivity?

• sloppy or messy eater

• messy hands and face

• overfills mouth

• drools

• choking - poor oral processing of foods

• oral stimulation behaviors

  • prefers foods tot be rich in flavors and textures

What are the general treatment strategies of sensory processing disorders?

nonfood and food-based sensory preparation before meals, prepare feeding environment (minimize environmental distractions)

What is ASD?

markedly abnormal or impaired developments in social interaction and communication and markedly restricted and stereotyped patterns of behavior and interests

What feeding difficulties are most common in people with ASD?

• many have food selectivity

• GI tract issues: GERD and chronic constipation

• resistance to change

• ritualistic mealtimes

• sensory integration (SI) problems