swallowing and feeding in children

10th-12th weeks of gestation (1st trimester)

• Primitive pharyngeal swallow (9th -11th week)

• Thumb sucking (10th week)

• Nose and lips (11th week)

• Rooting reflex (12th week)

• Craniofacial structures fully developed (12th week) (cleft palate fused)

18th week of gestation (2nd trimester)

bronchial trees

23rd-25th weeks of gestation (2nd trimester)

• Upper/lower respiratory tract; surfactant (surface-active lipid) (24th week)

• Oropharyngeal structures fully developed (24th week)

• Respiratory rate of 44 cycles/min (25th week)

30th-33rd weeks of gestation (3rd trimester)

• Burst (12-15 sucks followed by a swallow)-pause (a few seconds) pattern

• Alveoli formation continues

alveoli formation continues until when?

8 years old

32nd-34th weeks of gestation (third trimester)

Coordinated nipple feeding

describe the tongue of a newborn infant

Tongue fills the oral cavity

describe the pads of a newborn infant

fat sucking pads

describe the mandible of a newborn infant

small and more retracted

describe the lips of a newborn infant

circular-shaped

what structures all come so close they come into contact with each other for a newborn infant

velum/tongue/epiglottis

describe the shape of the epiglottis of a newborn infant

omega-shaped

describe the nasopharynx of a newborn infant

curves down to the hypopharynx

describe the location of the hyoid/larynx of a newborn infant

located more superiorly (C2) level and anteriorly

describe the arytenoids and VFs of a newborn infant

large arytenoids and shorter VFs

glottis ratio of a newborn infant

cartilaginous, membranous 1:1 narrower

describe the breathing of a newborn infant

nasal

describe the reflexes of a newborn infant

active primitive oral reflexes

breathing after the first 3-4 months

Mouth + nose breathing

sucking pads and neck after the first 3-4 months

disappear; neck elongates

what enlargens after the first 3-4 months?

laryngeal vestibule, oral cavity, upper pharynx

angle between nasopharynx and oropharynx after the first 3-4 months

it starts to approach 90 degrees by adulthood

after the first 3-4 months where does the larynx descend to?

C2 (infancy), C5-C6 (young middle aged adulthood), C7 (80s)

describe the VFs after the first 3-4 months

longer

describe the glottis after the first 3-4 months

cartilaginous:membraneous = 1:2 in adults wider- no natural airway protection

Prominent from ____to ____ months; sucking begins to develop around __ months

suckling; birth to 6; 3-4

suckling is characterized by what tongue movements?

backward/foward

___suckles precede every pharyngeal swallow (before they actually swallow)

2-7

during suckling, where does fluid accumulate + the swallowing reflex is triggered?

anterior faucial arch or valleculae

during sucking, what are the movement of the hyoid and larynx like during the swallow?

Minimal forward movement of the hyoid and elevation of the larynx

Predominantly _____ breathing during suckling

nasal

what becomes more adult-like during suckling?

Velopharyngeal closure, laryngeal closure, tongue base retraction, pharyngeal wall contraction, and cricopharyngeal opening

where does the bolus collect during swallowing? what happens after?

Bolus collects at the top of the esophagus; esophageal peristalsis initiated by a large volume

In suckling, there is immature ____ so _____ is common

LES; reflux

sucking beings to develop at ___ months of age; prominent by __ months of age

3-4; 6

sucking is characterized by what tongue movements?

elevation/lowering movements

a prerequisite to nutritive sucking; how many sucks per second?

Rhythmic nonnutritive sucking; 2 sucks/sec

nutritive suck swallow = (rate and age?)

1:1; 1 suck/sec; 4th-6th months of age

what becomes more adult-like in sucking?

Hyoid bone/larynx shift downward; breathing/swallowing coordination

during sucking, ____ breathing supplements ____ breathing by 3-4 months

mouth; nasal

transition feeding development

nipple feeding → spoon-feeding → cup drinking → thicker foods

• suckling -> _____

• Nasal -> _______ breathing

• ____/___ upright

• _______ coordination

• ______/_____ movements of tongue and jaw

• Some ________/_________ begin to disappear

• sucking

• nasal/oral

• head/trunk

• hand-mouth

• rotary/lateral

• oral reflexes/primitive reflexes

A gradual change in _______ pattern used from suckling to sucking

tongue

Spoon feeding/cup drinking by ___ months; cup drinking at __ month after spoon-feeding

4-6; 1

__________ position and __________ coordination by 5-7 months, ready for __________/________

Upright sitting; hand-to-mouth; thicker food/self-feeding

Bite ____ months and chewing begins at ____ months; chewable foods should be introduced at _____ months

7; 10-12; 6-7

Chewing begins to mature after ___ years and becomes fully developed at ____ years

2; 3-6