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The Basics of Feeding: A Workshop in Pediatric Dysphagia Part III

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. Fatigue Food refusal Apnea during feeding

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The Basics of Feeding: A Workshop in Pediatric Dysphagia Part III

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  1. The Basics of Feeding:A Workshop in Pediatric DysphagiaPart III Stacy Antoniadis, MA, MPH, CCC/SLP Lisa McCarty, MS, CCC/SLP Julie McCollum Daly,BS, OTR/L Cindy Straub, BS

  2. Medical Problems Associated With Feeding - By Symptoms • Fatigue • Food refusal • Apnea during feeding • Difficult transitions • Spillage and drooling • Head tilting • Poor weight gain

  3. Symptom with Etiologies: Fatigue • Cardiac • BPD • Chronic diseases • leukemia • cystic fibrosis • Neuromuscular disease • muscle weakness, cerebral palsy • spinal cord injury, spina bifida

  4. Symptom with Etiologies: Food Refusal • Chronic • Gastro-Esophageal (GE) Reflux • Allergies • milk and food intolerances • Hypersensitivity • Pain

  5. Symptom with Etiologies: Food Refusal • Acute • Oral lesions • Otitis media • Pharyngitis • Medications

  6. Symptom with Etiologies: Apnea During Feeding • Prematurity • Aspiration/penetration • Cardiac/respiratory insufficiency

  7. Symptom with Etiologies: Difficult Transitions • Developmental delay • Hypersensitivity/sensory integration disorder • Autism • Dysphagia

  8. Symptom with Etiologies: Spillage and Drooling • Hypotonia • Hypertonia • Oral motor apraxia • Cleft lip/palate • Micrognathia • Developmental delay • Abnormal swallow

  9. 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

  10. Inadequate diet, diluted formulas Poor appetite Slow feeding Spilled food Hidden infections Cystic Fibrosis Cardiac insufficiency Renal insufficiency Malabsorption Genetic Hormonal deficits Psychological/ relationship problems Symptom with Etiologies: Poor Weight Gain

  11. 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 • - esophageal manometry

  12. Observing GE Reflux • Note the timing of the swallowing bursts. • Note what happens when facilitation is offered. • Note how the reflux is triggered.

  13. Gastroesophageal Reflux (GER) • Treatment • Medical • drugs • positioning • feeding therapy • Surgical • fundoplication • pyloroplasty • tube insertion (NG, J, gastrostomy)

  14. Nutrition and the Child With Developmental Disabilities • Big concern is MALNUTRITION • Three types: • marasmus • kwashiorkor • marasmic kwashiorkor

  15. 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

  16. Nutrition Research on Children with Developmental Disabilities • Norwegian study • growth stunting in children with feeding problems, lack of appetite, food aversions

  17. Components to Nutritional Assessment • Anthropometry • Biochemical indices • Clinical indices • Drug/Nutrient interactions • Dietary indices

  18. Factors Influencing Caloric Intake • Activity level • Body composition • Monitoring

  19. Pathogenesis of Malnutrition • Reduced nutrient intake • Increased nutrient requirements • Impaired nutrient absorption

  20. 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

  21. The goal of a nutrition program is to establish adequate intake for growth and energy.

  22. Next Steps After Identification • 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

  23. Feeding Safety Practices

  24. Texture • Definition • Oral motor patterns • Problems and options

  25. Consistency • Definition • Safety issues

  26. Temperature • Serving/holding temperature • Sensitivity to hot and cold food • Safety issues

  27. Positioning for Feeding • Check for position • Head at midline • Position of person presenting food • Continue to recheck body and head position • Alternate positioning during meals

  28. 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

  29. 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

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