Chapter 2 Feeding and Swallowing Peds

What is the primary goal of pediatric feeding and swallowing management?

To make feeding a safe, pleasurable, and nutritionally adequate experience while supporting the child's growth and the family's psychosocial well-being.

Why are pediatric feeding and swallowing disorders becoming more common?

Advances in medicine allow more premature and medically complex infants to survive, including children with genetic, cardiac, neurological, and gastrointestinal conditions.

What is deglutition?

The act of swallowing.

What is swallowing?

The process of moving food or liquid from the mouth through the pharynx and into the upper esophagus.

What is feeding?

The process of getting food or liquid into the mouth.

What is nutrition?

The process of obtaining nourishment needed to sustain life and support growth.

What is oral sensorimotor function?

All of the sensory and motor functions of the oral cavity and pharynx related to swallowing.

Why is feeding considered a dyadic process?

Because it involves interaction between the feeder and the infant/child.

Why is a multidisciplinary team important for pediatric feeding disorders?

Feeding disorders can involve multiple medical, developmental, nutritional, and psychosocial factors, so effective care requires multiple areas of expertise.

Which professionals may be part of a pediatric feeding team?

SLPs, occupational therapists, physicians, dietitians, and psychologists, along with the family.

What are important characteristics of an effective interdisciplinary team?

Family involvement, shared treatment philosophies, strong leadership, organized communication, and creative problem-solving.

What ethical principles are important in pediatric feeding and swallowing?

Autonomy, beneficence, nonmaleficence, and justice, with decisions focused on the child's best interests.

What laws are especially important for children with disabilities in educational settings?

IDEA (Individuals with Disabilities Education Act) and Section 504 of the Rehabilitation Act.

Why is the nose especially important for newborn feeding?

Newborns are preferential nasal breathers, so nasal obstruction can interfere with breathing during feeding.

What are the main functions of the nasal cavity?

It cleans, warms, and humidifies inspired air.

What is rhinitis?

Inflammation of the mucus lining of the nose.

What structures make up the oral cavity?

The lips, mandible, maxilla, tongue, hard and soft palate, and cheeks.

Why is the tongue important for feeding?

It is essential for bolus formation and oral transit and is controlled by multiple cranial nerves.

Which cranial nerves are important for swallowing and oral function?

V, VII, IX, X, XI, and XII.

What are the three major regions of the pharynx?

The nasopharynx, oropharynx, and hypopharynx.

What are the major functions of the larynx?

Airway protection, respiration, and phonation, in that order of priority.

Which laryngeal structures help protect the airway?

The arytenoid cartilages, epiglottis, and true and false vocal folds.

Why is the infant's high laryngeal position important?

It helps infants coordinate sucking, swallowing, and breathing and provides increased airway protection.

What are the functions of the upper and lower esophageal sphincters?

The UES helps prevent air from entering the esophagus, while the LES helps prevent stomach contents from refluxing into the esophagus.

How does infant oral anatomy differ from adult anatomy?

The infant has a smaller oral cavity, a relatively large tongue, smaller mandible, and fat/sucking pads, with anatomical features that support early sucking.

How does the infant tongue differ in movement from the mature tongue?

Early sucking primarily involves anterior-posterior tongue movement, rather than the more developed lateral movements seen later.

How does the tongue help create a negative-pressure suck?

The tongue rests against the palate, helping create the negative pressure needed for effective sucking.

Why can a poor latch interfere with feeding?

Incorrect tongue or oral positioning can interfere with the ability to create and maintain negative pressure for sucking.

What is micrognathia, and why can it affect feeding?

Micrognathia is an unusually small mandible; it can interfere with feeding and may contribute to airway compromise, such as in Pierre Robin sequence.

What is embryology?

The study of prenatal development of the embryo and fetus.

When is the embryonic period?

Weeks 1-8 of gestation.

What major developmental event occurs during weeks 4-8?

Major body systems form, and by the end of week 8 the embryo begins to have a recognizable human appearance.

When does the palate complete its development?

By approximately the 12th week of gestation.

When does the pharyngeal swallow begin to develop?

Approximately 10-14 weeks of gestation.

By approximately what gestational age can fetuses suckle and swallow to support nutrition orally?

By approximately 34 weeks.

What are the four stages of pulmonary development?

Pseudoglandular (6-16 weeks), canalicular (16-26 weeks), terminal saccular (26 weeks-birth), and alveolar (32 weeks-8 years).

Why is surfactant important for premature infants?

Surfactant helps the lungs remain open and function effectively during breathing; inadequate surfactant increases respiratory difficulties in preterm infants.

When does the fetal heart begin beating?

Around 21-22 days after conception/development.

When is the CNS especially vulnerable to teratogens?

Approximately 3-16 weeks of gestation.

What are the four phases of swallowing?

Oral preparatory, oral transit/transport, pharyngeal, and esophageal phases.

Which swallowing phases are voluntary and which are involuntary?

Oral preparatory and oral transit are primarily voluntary; pharyngeal and esophageal phases are involuntary.

What happens during the oral preparatory phase?

Food or liquid is accepted and prepared in the mouth, including bolus formation and manipulation.

What happens during the oral transit phase?

The tongue propels the bolus posteriorly toward the pharynx.

What happens during the pharyngeal and esophageal phases?

During the pharyngeal phase, the airway is protected while the bolus moves through the pharynx. During the esophageal phase, peristaltic waves move the bolus toward the stomach.

How is swallowing neurologically controlled, and why are premature infants at increased risk?

Swallowing is coordinated primarily by the brainstem/medulla and cranial nerves V, VII, IX, X, and XII. Premature infants have less mature coordination of breathing and swallowing, increasing their risk for feeding difficulties and aspiration.