Pediatric Feeding Assessment :Pediatric Feeding Assessment Prepared for: Old Dominion Graduate Students Carrie L. Cilento, M.A.CCC-SLP Credit to: Angie Coggin, M.S. CCC-SLP; Jean Shelton, MD; Elaine Morgan, PNP


Pediatric Feeding Assessment :Pediatric Feeding Assessment Normal Feeding Milestones Birth Prominent oral reflexes-suckling Gentle flexor support of head/neck and extremities needed for feeding


Pediatric Feeding Assessment :Pediatric Feeding Assessment Normal Feeding Milestones 3-4 months Oral reflexes are less prominent Voluntary suck pattern begins Less head/neck support needed for feeding Spoon feeding begins if supported by Physician


Pediatric Feeding Assessment :Pediatric Feeding Assessment Normal Feeding Milestones 6-7 months Oral reflexes diminish Munching appears Holds bottle Reaches for food Sits supported in high chair


Pediatric Feeding Assessment :Pediatric Feeding Assessment 8-10 months Increased independent sitting for feeding Finger feeding


Pediatric Feeding Assessment :Pediatric Feeding Assessment 12-15 months Cessation of suckling pattern Holds cup Uses spoon Rotary chew


Pediatric Feeding Assessment :Pediatric Feeding Assessment Normal Suck 10-30 sucks/burst 1 suck/second Bursts followed by swallow and a breath Pattern maintained for 15-20 minutes Feedings should be completed in less than 30 minutes


Pediatric Feeding Assessment :Pediatric Feeding Assessment Feeding and Socialization Normal infant oral experience Use/extend reflexes of rooting, swallowing, non-nutritive and nutritive suck Nutritive suck should be ½ of the non-nutritive pattern Recurring opportunity to experience ingestion of bolus of food Experience sensations of odor, taste, temperature and texture Above occurs in association with gastric filling


Pediatric Feeding Assessment :Pediatric Feeding Assessment Normal infant oral experience, continued Recurring cycle of hunger and satiation associated with mouth activities Association with a responsive caregiver, competent to learn the infant’s signs and signals


Pediatric Feeding Assessment :Pediatric Feeding Assessment Normal Swallow Reflex Actions Associated with Swallow Rooting Suck reflex Swallow reflex Pharyngeal swallow Cough reflex- brainstem mediated Esophageal peristalsis


Pediatric Feeding Assessment :Pediatric Feeding Assessment Normal Swallow 18 muscles required to complete a normal swallow Swallowing stages Oral preparatory stage Oral stage Pharyngeal stage Esophageal stage


Pediatric Feeding Assessment :Pediatric Feeding Assessment Classification of Dysphagia Mechanical disorders Disorders of the motor unit Supranuclear impairment (above the brainstem) Disorders affecting appetite and feeding Developmental dysphagia


Pediatric Feeding Assessment :Pediatric Feeding Assessment Mechanical disorders Anatomical abnormalities Congenital Cleft lip/palate Tracheo Esophageal Fistula Craniofacial Abnormalities Vascular Ring


Pediatric Feeding Assessment :Pediatric Feeding Assessment Anatomical abnormalities continued Acquired: JRA, Tracheostomy Issues of work: cardiac anomalies, chronic lung disease


Pediatric Feeding Assessment :Pediatric Feeding Assessment Disorders of the Motor Unit Brainstem stroke or tumor Arnold Chiari Malformation-constriction of the foramen magnum Botulism Muscle disease (MD)


Pediatric Feeding Assessment :Pediatric Feeding Assessment Supranuclear Impairment Hemispheric Stroke Brain Tumor Cerebral Palsy Traumatic Brain Injury Degenerative Disorder of the CNS


Pediatric Feeding Assessment :Pediatric Feeding Assessment Metabolic Disorders Organic acid disorders Zinc deficiency Renal disease


Pediatric Feeding Assessment :Pediatric Feeding Assessment Developmental Dysphagia Oral aversion Texture hypersensitivity (autism) Texture hyposensitivity (spina bifida) Other (diaphragmatic hernia)


Pediatric Feeding Assessment :Pediatric Feeding Assessment Pre-Assessment Evaluation of sensory motor, structural components Observation of feeding and swallowing skills Recommendations


Pediatric Feeding Assessment :Pediatric Feeding Assessment Collect information from the Parent/Caregiver regarding…. Complaint Typical feeding schedule Positioning during feeding Utensils used Techniques Food preferences


Pediatric Feeding Assessment :Pediatric Feeding Assessment Length of feeding time/mealtimes Amount of food eaten per meal Who feeds the child/infant


Pediatric Feeding Assessment :Pediatric Feeding Assessment Behaviors Decreased attention Impulsivity Fatigue Agitation Manipulative behaviors


Pediatric Feeding Assessment :Pediatric Feeding Assessment Respiration Periodic apnea Gulp breathing Gasp breathing Reverse breathing Asynchronous breathing Stridorous breathing


Pediatric Feeding Assessment :Pediatric Feeding Assessment Alternative feeding methods Nasogastric (NG) Nasoduodenal (ND) Gastrostomy G-jejunostomy (g-j extension) Continuous Bolus


Pediatric Feeding Assessment :Pediatric Feeding Assessment Positioning Optimal head/neck support Upright Semi reclined Side lying


Pediatric Feeding Assessment :Pediatric Feeding Assessment State control Awake, alert Semi alert Light sleep Sleep Bundled Unbundled


Pediatric Feeding Assessment :Pediatric Feeding Assessment Oral Intake Formula type Food type Amount per feeding Frequency of oral feeding Duration History of intolerance


Pediatric Feeding Assessment :Pediatric Feeding Assessment Evaluation of Sensation Facial sensation Labial sensation Lingual sensation Palatal sensation


Pediatric Feeding Assessment :Pediatric Feeding Assessment Symmetry and Tone Face Lips Tongue Dentition/Mandible Palate Velopharynx


Pediatric Feeding Assessment :Pediatric Feeding Assessment Elicited movements Lips Tongue Dentition/Mandible Velopharynx


Pediatric Feeding Assessment :Pediatric Feeding Assessment Evaluating Oral Intake Environment Preparation


Pediatric Feeding Assessment :Pediatric Feeding Assessment Summary of Feeding and Swallowing Patterns Functional Deficits and Developmental Age Level Recommendations


Pediatric Feeding Assessment :Pediatric Feeding Assessment Further evaluation Modified Barium Swallow Study Fiberoptic Endoscopic Evaluation of Swallow


Pediatric Feeding Assessment :Pediatric Feeding Assessment NICU Competencies Children’s Hospital of Los Angeles Conversion of premature infant’s chronological age to a corrected/adjusted age. Term delivery is 37-42 weeks gestation Baby Holly was born on 11/12/2006. She was born at 25 weeks gestation. Today is 2/8/2007. How old is she chronologically? What is her adjusted age? 2 ½ months chronologically 37 weeks adjusted


Pediatric Feeding Assessment :Pediatric Feeding Assessment Pre-term deliveries Less than 37 weeks gestation


Pediatric Feeding Assessment :Pediatric Feeding Assessment NICU History Maternal complications, birth weight, mother’s age, pregnancy history, type of delivery, Apgar scores, birth complications, gestational age, diagnoses and procedures


Pediatric Feeding Assessment :Pediatric Feeding Assessment NICU Apgar Scores Given at 1 minute, 5 minutes, 10 minutes after birth Scores are derived from the following five items: Heart rate Respiratory effort Muscle tone Reflex irritability Color


Pediatric Feeding Assessment :Pediatric Feeding Assessment NICU Infection control Proper handling Physiologic responses to handling Color (cyanosis, duskiness, redness) Respiratory rate (tachypnea, apnea) Heart rate (tachycardia, bradycardia)


Pediatric Feeding Assessment :Pediatric Feeding Assessment NICU Normal values for neonatal heart rate: 120-180 bpm. Normal values for neonatal respiratory rate: 30-60 breaths/minute Normal values for neonatal oxygen saturation: 90-95%


Pediatric Feeding Assessment :Pediatric Feeding Assessment QUESTIONS????