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Neonatal Swallowing and Feeding Lamya Al-Abdulkarim, Ph.D., CCC-SLP, Mass. License, NOMAS Department of Rehabilitation

2. Learners objectives ?Identify issues related to swallowing function ? Determine underlying factors/etiology ? Differentially identify feeding and swallowing problems ? Determine if F/U evaluations/tests are needed ? Develop and/or implement treatment/intervention strategies to improve

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Neonatal Swallowing and Feeding Lamya Al-Abdulkarim, Ph.D., CCC-SLP, Mass. License, NOMAS Department of Rehabilitation

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    1. 1 Neonatal Swallowing and Feeding Lamya Al-Abdulkarim, Ph.D., CCC-SLP, Mass. License, NOMAS Department of Rehabilitation College of Medical Applied Sciences King Saud University lamyakrm@yahoo.com

    2. 2 Learners objectives ? Identify issues related to swallowing function ? Determine underlying factors/etiology ? Differentially identify feeding and swallowing problems ? Determine if F/U evaluations/tests are needed ? Develop and/or implement treatment/intervention strategies to improve or alter the factors that may influence a neonate’s swallowing and feeding disorder

    3. 3 Background and Overview The care giving model for preterm infants has evolved into a holistic framework integrating medical as well as early developmental interventions to support the neurobehavioral and physiologic organization of the neonate. Any patient represents an interrelated system

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    5. 5 Compressed oropharyngeal structures which is a natural protection from aspir. 2) Cheeks right against teeth. Sucking pads to keep mouth stable (no buckle cavity) 3) Mouth narrow and small 4) When open mouth: tongue up against alv. Ridge (normal) secondary to developing oral structureCompressed oropharyngeal structures which is a natural protection from aspir. 2) Cheeks right against teeth. Sucking pads to keep mouth stable (no buckle cavity) 3) Mouth narrow and small 4) When open mouth: tongue up against alv. Ridge (normal) secondary to developing oral structure

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    16. 16 Feeding Disorders in Neonates

    17. 17 Assessment of Feeding Skills in Neonates and Preterm Infants

    18. 18 Assessment of Feeding Skills in Neonates and Preterm Infants

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    21. 21 Assessment of Feeding Skills in Neonates and Preterm Infants

    22. 22 Team: MD, RN, Family, SLP/PT/OT Individualized, developmentally supportive approach to nipple feeding: 1) Observation of behavioral cues for infant stability or stress 2) Response to an infant’s cues to help her regain and maintain coordination 3) Parent education and training in feeding their infant

    23. 23 ? Develop a feeding plan for continuity ? Feed only after resting/sleep ? If an infant has an open-mouth posture indicating a mouth breather, try a pacifier to see if she is comfortable ? Provide appropriate oral experiences: (Ross, 2003) -Positioning w/ hands to face - provide nurturing experiences during gavage feeding - introduce appropriate smells, tastes - allow rooting to a finger or pacifier to maintain sucking abilities and association between oral and GI systems - avoid oral stimulation when infant is sleep - place milk on fingers to ? hand to mouth association (discuss with pulmonologist)

    24. 24 Modifying variables that affect sucking and feeding ? Imposed breaks: regulate sucks by allowing 3 to 5 sucks then pause and remove nipple ? Bolus size: first two minutes is the best time an infant would take most during oral feed. What is left could be given by gavage. ? Flow rate: - slow the flow to support organization of suck/swallow/breathe and burst rhythm - tipping of bottle: out of central tongue groove/ removal of bottle - nipple selection: material, shape, size, flow rate (Ross, 2003)

    25. 25 Support to the neonate during feeding based on her needs: - jaw - cheeks - position: upright, midline, swaddle, next to caregiver (Ross, 2003), no flexion (re. GER: 60% of premies,Tsou,et.al., 1998) - regulating feeds - holding rather than stroking or patting; rocking could be overwhelming - Self-regulation: hands to mouth, bracing feet, NNS, state ? Support timing and pacing of feeding schedule ? Oral feeding: - mean ~34 - 36 weeks - When moved to fully interval gavage (Lau, 2003) Important: infant’s abilities to tolerate nipple feeding should be the indicator to readiness to feed not gestational age (e.g.Hanlon, et.al., 1997;Meyer-Palmer, 1993)

    26. 26 ? Breast feeding: - according to needs and strength of an infant - positive oral experience - benefits: prolonged sleep, better transition, weight gain ? Skin to skin care: - during gavage feeding for positive associations w/ feedings ? Light/Noise ? Miminize moving infant w/ limited energy before feeding (Ross, 2003)

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    28. 28 From the NICU to home: - Date of discharge impacts cost of care and infant-family relationship. - Identified challenges by parents (Thoyre, 2001): Safety during feeding Determine adequate calorie intake When to advance feeding plans - Observations of the nurse - Educate about and help to recognize the stability or stress behaviors - Intervention strategies contingent upon an infant’s cues to help their baby feed - Nurse observes and monitors the infant and the parents during non-feeding and then feeding tasks (bottle/breast) - Team approach

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