Feeding

Phases of Swallowing

1. Oral prep

2. Oral Phase

3. Pharyngeal phase

4. Esophageal phase

Oral prep

chewing to form bolus

Oral Phase

bolus moves back and swallow is elicited

Pharyngeal phase

swallow is triggered, epiglottis covers airway and esophagus opens

Esophageal phase

bolus enter esophagus and into stomach

Chewing Pattern 3-6 months

Symmetric movements; munching (up and down)

Chewing Pattern 8-12 months

Vertical; Disassociation between jaw and tongue (independent of each other)

Chewing Pattern 12 months

Rotary; Diagonal jaw and lateral tongue movements

Chewing Pattern by 5 years

fully functional adult patterns

Comprehensive Eval for feeding includes…

Gathering info > hands on eval > structured observations > observe child eating

Food Texture Levels

1. Pureed

2. Mechanically Altered

3. Advanced

4. Regular Diet

Pureed foods

pudding like

Mechanically Altered

Minced/moist, requires some chewing

Advanced foods

Soft solids (bread, meat, cooked vegs, soft fruit)

Liquid Consistencies

Thin, Nectar, Honey

Thin liquids

Water-like and things that melt

Nectar consistency

like tomato juice i.e. smoothies, fruit nectars

Honey Consistency

Honey like; drips off spoon

What to do for tonic bite/tongue thrust

place food laterally

What to do for suckling

place finger on tongue

What to do for jaw weaknes

Non-nutritive chewing

What to do for fatigue/weakness

controlled flow cup; small straw or spoon

What to do for decreased lip closure

shallow bowl, spoon, shorted straw, 1 way valve

What to do for sensory registration

chilled spoon, bumps or ridges

What to do for impairment oral suction

shorter straw

What to do for neck postioning

chin tuck and U-shaped tongue

Feeding Mnemonic

Dont eat your PETS = Positioning, Equipment, Transitions, Sensation