safety - the feeding plan should support and maintain the ... · safety - the feeding plan should...
TRANSCRIPT
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SAFETY - the feeding plan should support and maintain the child’s health
OPTIMAL NUTRITION - this is essential as the feeding process is high energy output
FARSIGHTED - the implications of current treatment on future feeding and oral functions must be considered
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FEEDING
Oromotor /
pharyngeal function Motor control
Posture Communication
Developmental levels
Cognitive level Drugs
GOR Constipation
Neurological Issues Cardiac Issues
Vision Hearing Tactile
Behaviour:
Fatigue; Endurance; State Maintenance
Social factors
Aversive experiences
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Infants and children with cardiac problems frequently have feeding difficulties that result in failure to thrive
Poor endurance, fatigue and high nutritional needs are key limiting factors
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Associated problem areas Inco-ordination of swallowing Poor oral feeding skills Increased respiratory effort With increased risk factors for aspiration
Ongoing difficulty with suck-swallow-
breathe synchrony Can be throughout a feed Can develop during a feed Often related to endurance and fatigue
problems
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Stress cues Increased sweating Colour change Changes in state Increased respiratory effort Increased heart rate during feeds Flaring of the nares / head bobbing Worried facial expression Extraneous movement, head turning
Persistent feed related desaturations Coughing and /or choking Poor weight gain
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Rapid deterioration of normal sucking pattern
Increased gag History of repeated chest infections “Snacking” or feeds running into each
other with resulting fatigue
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Breast Feeding is the GOLD STANDARD Breast feeding support is from the Lactation
Consultant If there are oro-motor difficulties or queries
regarding swallow safety, the SLT becomes involved
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Bottle feeding, like all feeding, is a learned process
There are always two parties involved: it is a feeding DYAD
Communication within that dyad is essential Feed to early cues A baby gets stressed with feeds for a reason All feeds should be enjoyable for both parties
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Check state of teat:
Split x-cut
Deteriorated teat texture
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Check for anterior loss
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Check technique Teat part empty
taking in air
Poorly supported Bottle weight on
mouth
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Utilise neonatal reflexes that support feeding eg
Palmar grasp Flexed position
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FOCUS on the task in hand LOOK AT POSITIONING How is the head positioned? Is the trunk supported? Is the baby swaddled?
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Tumbleform chair ALWAYS fasten
straps use at angle set by
therapist never leave
unattended
Highchair – use rolled up towels or nappies for side support
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Positioning › For MOC › For Baby
Timing › Cue based feeding
Volume › Smaller more frequent feeds
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Feeding environment Early discussion with family NO forcing Thinking about the tube coming out
starts when it goes in
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VFSS (Videofluoroscopic Swallow Study) is performed to evaluate swallowing function
This is very different to a Barium Swallow A Barium Swallow is to identify Gastro
related problems e.g. Reflux A Barium Swallow does not involve a SLT
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Persisting stress cues Persistent feed related desaturations Coughing and /or choking Wet sounds during feeds Poor weight gain “Snacking” or feeds running into each other with
resulting fatigue Increased gag Repeated chest infections
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[Chart adapted from: Factors that may affect feeding the child with neurological impairment (Reilly et al in Southall, A and Schwartz, A (eds)(2000) Feeding problems in Children: a practical guide. Oxford. Radcliffe Medical Press p154) ]
Arvedson, J. (2008). Assessment of Pediatric Dysphagia and Feeding Disorders: Clinical and Instrumental Approaches. Developmental Disabilities Research Reviews 14: 118-127
Barlow, S.M. (2009). Oral and respiratory control for preterm feeding. Current Opinion in Otolaryngology and Head and Neck Surgery, 17, 179-186
Ross, E., Philbin, K. (2011). The SOFFI Reference Guide: text, algorithms, and appendices: a manualized method for quality bottle-feedings. Journal of perinatal & neonatal nursing 25 (4) 360-80. College of New Jersey, PubMed.
Ross E., Philbin, K. (2011). Supporting Oral Feeding in Fragile Infants. Journal of perinatal & neonatal nursing 28 (4) 349-357. College of New Jersey, PubMed.
Cabrera, Prodhan, Bhutta. 2010. Nutritional Challenges and outcomes after surgery for congenital heart disease.
Wolf L.S. & Glass, R.P. Feeding and Swallowing Disorders in Infancy. Evans-Morris, S. & Klein, M.D. 2000. Pre-Feeding Skills (2nd ed.). A Comprehensive Resource For Mealtime
Development.