developmental care, positioning, and postural alignment

• Swallow reflex:

• Volitional control:

• Swallow reflex: ~15 weeks gestation

• Volitional control: into early childhood

What are some high risk groups?

• Preterm and LBW-ELBW

• FTT

• CP

• congenital heart disease

• Trach

Preterm & LBW

• VLBW (<1500g): __% have feeding issues in infancy

• ELBW (≤25 weeks): __% had eating problems at age _

• Associated issues: oral-motor dysfunction, hypersensitivity, FTT, cognitive/motor delay

• VLBW (<1500g): 25% have feeding issues in infancy

• ELBW (≤25 weeks): 35% had eating problems at age 6

• Associated issues: oral-motor dysfunction, hypersensitivity, FTT, cognitive/motor delay

Failure to Thrive (FTT)

• __% have feeding problems

• __% show developmental delays

• AAP: Weight-for-length <80% of ideal

• 60% have feeding problems

• 55% show developmental delays

• AAP: Weight-for-length <80% of ideal

CHD and Genetic Syndromes

• 50% with ___________ need feeding tubes

• Feeding problems impact _____ and _______ outcome

• 50% with univentricular hearts need feeding tubes

• Feeding problems impact cognitive and school outcome

Tracheostomy

• Dysphagia in up to __%

• Oral phase: __%; Pharyngeal phase: __%

• __________, but underlying condition

• ______ (______): may improve swallowing

• Dysphagia in up to 80%

• Oral phase: 81%; Pharyngeal phase: 60%

• Not due to trach, but underlying condition

• Speaking valves (Passy-Muir): may improve swallowing

Motor milestones related to feeding 3-4 months 5-7 months 7-8 months 9 months 19-20 months

Age	Milestone

3–4 months

Trunk/neck stability, midline hand and head orientation

5–7 months

Reaching, grasping, cup use

7–8 months

Efficient finger feeding

9 months

Purposeful chewing, cause-effect play

19–20 months

Tool use, independent spoon/cup use

typical tone:

• Physiological flexion

• Reflexes intact and assimilating

• prone clearance to bilateral side

• Equal flexor in arms/legs

• Symmetry

• Trunk alignment during prone suspension

atypical tone:

• preference for one side of the body • Increased hip/knee flexion, extensor posturing

• Finger splaying, thumb adduction (suggests spasticity)

• Hypotonia indicated by slipping through axillary hold, extended limbs and in supine

• Asymmetries in posture, reduced movement on one side (suggests hemiplegia or early CP)

• early “rolling”

• signs of seeking stability outside of the trunk

reflexes

• Galant Reflex

• Stepping Reflex

• Moro Reflex

Which of the following is a risk factor for FTT in infants?
A) Excessive weight gain
B) Frequent vomiting
C) Normal tone
D) Full-term birth only

B

Which motor milestone supports purposeful chewing development?
A) Head control at 3 months
B) Cause-effect play at 9 months
C) Self-feeding at 6 months
D) Spoon use at 4 months

B

Myelination of feeding-related structures begins after birth

False – begins in utero (~4 months)

Speaking valves are proven to prevent aspiration in all children with tracheostomy.

False – they may help but evidence in pediatrics is limited.

Premature infants are at higher risk for oral-motor hypersensitivity.

true

Lissencephaly is an example of an acquired lesion affecting brain migration.

False – it is a genetic neuronal migration disorder

noonan syndrome

costello syndrome

russell-silver syndrome

DiGeorge syndrome

Opitz G/BBB syndrome

Prader-Willi Syndrome

Coffin-Siris syndrome

Mobius syndrome

hemifacial microsomia syndrome

pierre robin (nonsyndromic)

trisomy 18

angelman syndrome