SPHS 543 January 29, 2010

1. SPHS 543January 29, 2010 • Failure to Thrive (FTT) • Poor weight gain/growth failure • Below 3rd – 5th percentile • No gain for three consecutive months • Often causes overlap • Illness, disorder, feeding difficulty, parent/child interaction • May impact cognitive development

2. GastroesophagealREflux • The return of gastric contents, either food alone or mixed with stomach acid, into the esophagus. • Reflux is normal!

4. Barriers to reflux • LES – contains gastric contents; pressure differentials • Growth – longer esophagus, more upright, solid foods • Saliva • Acid neutralization • Clears refluxed materials • Polypeptide hormone • Respiratory protective systems • Cough/airway clearance (6 mos +)

5. GER • Delayed gastric emptying • Strictures • Esophageal spasm leads to odynophagia • Respiratory impact • Increased WOB • Lack of energy = slower digestion • Asthma subgroup • Pressure sensitive • constipation

6. GER or GERD? • Weight loss or inadequate weight gain (FTT) • Persistent irritability • Food refusal/selectivity • Posture -arching • Coughing/choking • Pain • Apnea • Sleep disturbance • Recurrent pneumonia

7. Causes of GERD • Food allergies/intolerance • Immature digestive system • Structural • Immature neurological system • Low tone

8. treatment • Non-medical • Thickening • Positioning Feeding frequency

9. Treatment • Medication • Improves gastric motility • Metoclopramide • Erythromycin • Lowers gastric acid production • Ranitidine hydrochloride • Proton pump inhibitor • Omeprazole, lansoprazole

10. treatment • Surgical • Fundoplication • Percutaneous endoscopic gastrostomy (PEG) • Jejunostomy feedings

11. treatment • Child/Family • Food as power

12. Normal development and feeding skills • Everything is connected • Gradual disassociation of movements • Tactile senses give way to visual and auditory • Drive toward independence

13. STability • Stability • Need a stable base from which to develop • movement (mobility) and functional skills • Central to distal • External (positional) stability • Supporting one body part against another • Against an external source • Achieve muscle balance on both sides of a joint

14. Stability • Internal (postural) stability • No reliance on external aid or support • Balance of contraction between agonist and antagonist muscles • Movement through space

15. Stability • Achieves external stability by lying supine • Initial success with a controlled reach

16. stability • Balance of co-contraction of shoulder • begins to develop internal control • Positional stability of elbow on floor • Weight shifts

17. mobility • Mobility develops from a proximal base of stability • Affects refined development of distal oral-motor skills • Dependent on neck/shoulder girdle stability • Dependent on trunk/pelvic stability

18. Proximal and distal • Relative terms • Head/neck distal to body • Jaw is proximal to distal lips, cheeks, tongue

19. Separation of movement • From gross motor to fine motor

20. Gross-to-fine progression • Present in all skill areas • Gradually develop isolation of a skill

21. Refined oral skills

22. Straight planes of movement to rotation • Straight planes first • Random, undirected • Alternate pulls from extensor or flexor muscles • Then lateral/diagonal planes and rotary skills • Gain stability by balancing extensor/flexor systems • Graded function • Lateral righting reactions

23. Tendency toward active movement of extensor muscles of neck and back • Gradual control of counterbalancing flexor muscles • Stability in head control

24. Rolling and weight shifting • Diagonal and rotary movements

25. Oral-motor skills • Parallel feeding and speech development • Develop from straight planes to lateral then rotary • Jaw opens and closes for munching • Lateral movement as food moves side to side • Circular rotational movement to grind food

26. Midline development • Four midlines in the body • Vertical • Horizontal • Two diagonals • Develop our sense of midlines through weight shifts over proximal joints • Experience plays a major role

27. Midline awareness of mouth • “Home base” resting place for the tongue • Newborn – tongue fills oral cavity • Grooved tongue = vertical midline • Tongue tip elevation = horizontal midline • Lateral movement = diagonal/rotational midline • ‘Center of mouth’ = defined sense of horizontal, vertical, diagonal oral midlines

28. Reversion to earlier patterns • As children acquire a new skill, some of the previously learned control and stability may be lost temporarily • Often seen in the development of oral-motor skills • Softer foods – munching with some tongue lateralization • Move to harder foods, may revert to forward-backward tongue pattern before using more controlled tongue lateralization

29. Revert to earlier patterns • May revert to suckle-swallow with introduction of spoon before using lips • May cough/choke with cup when previously handled bottle well

30. Economy/efficiency of movement • When two or more possibilities exist, the choice will be the one requiring the least effort • Rhythmicity and smoothness • Body rhythms • Timing • Coordination