pathophysiology of swallowing in infants (25)
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- 1.What are some common pediatric oral transport problems?
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⬢Failure in suckling to hold on to and maintain attachment to the nipple
⬢Refusal to feed
⬢Failure to develop more mature oral feeding modes
⬢Generalized oral motor dysfunction
⬢Tongue abnormalities
⬢Premature leak into pharynx - 2.What causes failure in suckling to hold on to and maintain attachment to nipple?
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⬢May be under tongue
⬢Weak tongue motion
⬢Early tiring - 3.What does failure to develop more mature oral feeding modes mean?
- ⬢The infant maintains suckle at an advanced age. He/she has not acquired volitional biting, chewing, and manipulation of a more complex diet
- 4.What causes generalized oral motor dysfunction?
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⬢ Deficient Buccal closure which causes drooling
⬢Abnormal tongue and jaw movement - 5.What is some tongue abnormalities associated with pediatric swallowing?
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⬢Atrophy
⬢Macroglossia - 6.What causes a premature leak into the pharynx?
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⬢Incomplete apposition of velum to the tongue during the oral phase
⬢Delay in onset of pharyngeal swallow - 7.What happens during a premature leak?
- ⬢The tongue does not actively move bolus posterior and soft palate function is abnormal as barium dribbles over tongue dorsum
- 8.What are some common pediatric pharyngeal phase problems?
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⬢Delayed onset in swallow
⬢Abnormal soft palate function-not raising
⬢Nasopharyngeal reflux
⬢Delayed onset in swallow
⬢Abnormal soft palate function-not raising
⬢Nasopharyngeal reflux
⬢Pharyngeal contraction/ Emptying deficit
⬢Pharyngeal contraction/ Emptying deficit - What causes delayed onset in the pharyngeal phase?
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⬢A lag time between the end of oral phase and beginning of pharyngeal pahse
⬢The bolus/liquid remains in pharynx and the air way may be open (aspirate) - What causes abnormal soft plate function during the pharyngeal phase?
- ⬢The soft palate does not raise
- What causes pediatric nasopharyngeal reflux during the pharyngeal phase?
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⬢Incomplete closure of a the nasopharynx at the beginning of the pharynx
⬢Limited anterior excursion of superior pharyngeal constrictor or passivant to meet velum
⬢Or lack of coordination of these functions - What causes pediatric pharyngeal contraction/emptying deficit?
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⬢Deficient posterior tongue thrust
⬢Weak or disordered posterior pharyngeal stripping wave
⬢Retention of Bolus - What causes pediatric laryngeal penetration?
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⬢Incompletely protected laryngeal airway during pharyngeal swallow
⬢Radiographically may see inadequate laryngeal elevation or paralysis of Vocal folds
⬢Incomplete closure of laryngeal vestibule
⬢Failure of epiglottis to buckle posteriorly
⬢Delayed triggering of pharyngeal swallow after pharyngeal filling - How does the cricopharyngeal sphincter contribute to pediatric swallowing problems during the pharyngeal phase?
- ⬢Abnormalities include absent, incomplete, or delayed opening or early closure
- What are some common problems associated with ped’s during the esophageal phase?
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⬢Secondary aspiration
Esophageal Abnormality
⬢Gastroesophageal Reflux - What is secondary aspiration?
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⬢It is aspirated material, either swallowed food of refluxed gastric contents
⬢It affects the respiration tract either by stimulating receptors in the mucosa or by directly interfering with function through the chemical/physical nature or volume of the aspirate
⬢Large particles may lodge in larynx causing choking or asphyxia
⬢Small particles reaching bronchi may result in air trapping, focal inflammation, aspiration, or pneumonia - What is esophageal abnormality?
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⬢Anatomical or functional
⬢Esophageal atresia
⬢Tracheoesophageal Fistula - What is gastroesophageal reflux?
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⬢The most common and controversial late esophageal stage event to complicate swallow.
⬢Can stimulate mucosal receptors in respiratory tract or interfere with function by the chemical/physical nature or volume of the aspirate - Who determines nutritional status and how to manage malnutrition of specific deficiencies?
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⬢Pediatrician
⬢The pediatrician exams oral/pharynx reflex-hyperactive= feeding difficulty or lack of ones contradiction to oral feeding - What should be noted during pediatric diagnostics of dysphasia?
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⬢Methods of feed-spoon ,cup, bottle
⬢Head, neck, body position in feed
⬢Consistencies tolerated
⬢Ability to chew
⬢Drooling
⬢Gagging, chocking, coughing (prior, during, following swallow)
⬢Amount of time to feed
⬢Size and type of nipple
⬢Regurgitation
⬢Vomiting
⬢Rumination - What diagnostic test can be use to diagnose peds?
- •Videofluoroscopy –procedure of choice in evaluation of oral, pharyngeal and esophageal anatomy
- What will the videofluoroscopy document?
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⬢ Aspiration
⬢ Oral/Pharyngeal incoordination
⬢Child for whom oral feed is contraindicated (silent aspiration)
⬢Determine which food characteristics that are swallow safe(size, consistency) - How are diagnostic procedures done?
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•Swallowing act recorded in lateral and if possible posteroanterior projections and include oral, pharyngeal, and esophageal stages
•Withhold meal prior to exam
•Child in position they commonly eat
•Nurse available for oxygen and suction is aspiration occurs
•Brium in bottle for infant –cup for older children
•Some instances a small amount of barium injected under fluoroscopic control through feeding tube in buccal, oral or nasopharynx
•Need multiple swallows - Treatment techniques
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⬢Postural techniques
⬢Food consistency modifications
⬢Modifications in feeding procedures
⬢Sensory stimulation - How is treatment options explored?
- ⬢Alternating textures, feeding tools, positions, and techniques