Transcript The Basics of Feeding

The Basics of Feeding:
A Workshop in Pediatric Dysphagia
Part III
Stacy Antoniadis, MA, MPH, CCC/SLP
Lisa McCarty, MS, CCC/SLP
Julie McCollum Daly,BS, OTR/L
Cindy Straub, BS
Medical Problems Associated
With Feeding - By Symptoms
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Fatigue
Food refusal
Apnea during feeding
Difficult transitions
Spillage and drooling
Head tilting
Poor weight gain
Symptom with Etiologies:
Fatigue
• Cardiac
• BPD
• Chronic diseases
– leukemia
– cystic fibrosis
• Neuromuscular disease
– muscle weakness, cerebral palsy
– spinal cord injury, spina bifida
Symptom with Etiologies:
Food Refusal
• Chronic
– Gastro-Esophageal (GE) Reflux
– Allergies
• milk and food intolerances
– Hypersensitivity
– Pain
Symptom with Etiologies:
Food Refusal
• Acute
– Oral lesions
– Otitis media
– Pharyngitis
– Medications
Symptom with Etiologies:
Apnea During Feeding
• Prematurity
• Aspiration/penetration
• Cardiac/respiratory insufficiency
Symptom with Etiologies:
Difficult Transitions
• Developmental delay
• Hypersensitivity/sensory integration
disorder
• Autism
• Dysphagia
Symptom with Etiologies:
Spillage and Drooling
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Hypotonia
Hypertonia
Oral motor apraxia
Cleft lip/palate
Micrognathia
Developmental delay
Abnormal swallow
Symptom with Etiologies:
Head Tilting
• Back tilt
– poor oral motor control
– abnormal swallow
– impaired visual field or eye control
• Forward tilt
– poor head control
– abnormal swallow
• To one side tilt
– asymetric neurologic problem
• facial palsy, torticolis
Symptom with Etiologies: Poor
Weight Gain
• Inadequate diet,
diluted formulas
• Poor appetite
• Slow feeding
• Spilled food
• Hidden infections
• Cystic Fibrosis
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Cardiac insufficiency
Renal insufficiency
Malabsorption
Genetic
Hormonal deficits
Psychological/
relationship problems
Gastroesophageal Reflux
(GER)
• Symptoms
– food refusal, posturing, vomiting,
regurgitation, pain, irritability during feeding
• Diagnostic tests for GER
– pH probe
– endoscopy
– barium swallow (cookie swallow, modified
barium swallow)
– - milk scan
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- esophageal manometry
Observing GE Reflux
• Note the timing of
the swallowing
bursts.
• Note what happens
when facilitation is
offered.
• Note how the reflux
is triggered.
Gastroesophageal Reflux
(GER)
• Treatment
– Medical
• drugs
• positioning
• feeding therapy
– Surgical
• fundoplication
• pyloroplasty
• tube insertion (NG, J, gastrostomy)
Nutrition and the Child With
Developmental Disabilities
• Big concern is MALNUTRITION
– Three types:
• marasmus
• kwashiorkor
• marasmic kwashiorkor
Nutrition Research on
Children with Developmental
Disabilities
• Cincinatti University Affiliated Program
study (n=83 children with DD)
– most were under/over weight and had
feeding disorder
– some had nutrient deficiency
– other problems: unusual food habits,
metabolic disorders
Nutrition Research on
Children with Developmental
Disabilities
• Norwegian study
– growth stunting in children with
feeding problems, lack of appetite,
food aversions
Components to Nutritional
Assessment
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Anthropometry
Biochemical indices
Clinical indices
Drug/Nutrient interactions
Dietary indices
Factors Influencing Caloric
Intake
• Activity level
• Body composition
• Monitoring
Pathogenesis of Malnutrition
• Reduced nutrient intake
• Increased nutrient requirements
• Impaired nutrient absorption
Suggested Criteria for Referral
• Height or weight below the 10th or
greater than 90th percentile
• Cross over >2 growth channels
• Mechanical feeding difficulties
• Unusual food habits
• Inherited metabolic disorders
The goal of a nutrition
program is to establish
adequate intake for growth
and energy.
Next Steps After Identification
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Involve team and family
Consider ethnic dietary practices
Consider income level of family
Review of child’s illnesses/medications
ADA’s guidelines for disability areas
Adjust nutrition plan to meet family
needs
Feeding Safety Practices
Texture
• Definition
• Oral motor patterns
• Problems and options
Consistency
• Definition
• Safety issues
Temperature
• Serving/holding temperature
• Sensitivity to hot and cold food
• Safety issues
Positioning for Feeding
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Check for position
Head at midline
Position of person presenting food
Continue to recheck body and head
position
• Alternate positioning during meals
Mealtime
• Position and head alignment
• Presentation of food
• Meal time problems
– hyperextension, tongue thrust, vocalization
• When to offer food
• Checklist for food refusal
• Dangerous practices
Fluids
• Offering fluids
– every 3-4 bites
– do not hold to the end of meal
• Thickening liquids
– rice cereal, Thick-It, etc
• Dangerous practices
• Handouts for parents