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Developmental aspects of feeding

Developmental aspects of feeding. Maturation of feeding skills is completed by 3 years of age Integration of oral-motor, fine-motor, gross motor, sensory and behavioural skills Feeding involves co-ordination of oral-motor skills and effective swallowing

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Developmental aspects of feeding

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  1. Developmental aspects of feeding • Maturation of feeding skills is completed by 3 years of age • Integration of oral-motor, fine-motor, gross motor, sensory and behavioural skills • Feeding involves co-ordination of oral-motor skills and effective swallowing • Swallowing and breathing must be coordinated to prevent aspiration

  2. Swallowing • Transport of food into stomach without aspiration • Precise coordination and interaction between cranial nerves V, IX, X and the muscles of the oral cavity,pharynx and oesophagus • Pharynx is both airway and foodway Oral phase of swallowing Pharyngeal phase of swallowing Oesophageal phase of swallowing

  3. DysphagiaDifficulty with swallowing on an organic basis • Anatomic Upper airway Choanal atresia/ stenosis Mouth and oropharynx Cleft lip and palate Craniofacial syndromes Larynx, trachea, oesophagus Laryngeal webs / stenosis/ clefts Oesophageal atresia Tracheo-oesophageal fistula Oesophageal strictures/ webs Vascular rings – aberrant vessels Acquired anatomic defects - trauma

  4. DysphagiaDifficulty with swallowing on an organic basis • Neuromuscular Prematurity Central nervous system disease Cerebral palsy Bulbar paralysis Neuromuscular disease Oesophageal chalasia Muscular dystrophy • Inflammatory Stomatitis Oesophagitis

  5. Vomiting • Centrally controlled, complex interaction between GIT and CNS Autonomic symptoms and signs : vagus Sustained contraction of abdominal muscles to eject stomach contents forcefully • Triggers Central, local in throat, oesophagus, stomach • Clinical condition depends on Initiating cause Metabolic consequences of vomiting

  6. Age-related common causes of vomitingCauses of vomiting : C & W p 438 • First week of life Related to onset of feeding • Early infancy Related to reflux, anatomical defects and infections • Infancy Related to infections : gastroenteritis • Childhood Related to infections : food poisoning, gastro

  7. Vomiting : Pointers in History I • Age of onset and duration Common causes in different age groups • Character Vomiting versus regurgitation • Associated autonomic symptoms • Contents of vomitus • Relationship to meals, time of day, activities

  8. Vomiting : Pointers in History II • Medications? • Failure to thrive? • Dehydration or jaundice? • Local mouth and throat conditions? • Abdominal distension or peristalsis? • Persistent or paroxysmal coughing? • Cardiac failure? • Raised intracranial pressure?

  9. Do not assume regarding the cause of vomiting • Careful history most NB • Careful examination Nutritional state, including wasting Abnormal appearance or odour Neurological and development state Abdomen including distended or scaphoid, visible peristalsis stooling or absolutely constipated

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