PEDIATRIC MIDTERM EXAM LATEST ACTUAL EXAM
Cerebral Palsy feeding problems - ANSWER: Abnormal bite
Poor lip closure
Weak suck
Poor coordination of sucking
Drooling is one of most common problems
Special spoons and size of bolus can help reduce drooling
Children typically benefit from dietary modifications
Down Syndrome feeding problems - ANSWER: - Large tongue with protrusion
- Low muscle tone (hypotonia)
- May require specialized bottle & later utensils/cups/plates
- Predisposed to cardiac, respiratory and gastrointestinal problems
- 10% of children have celiac's disease
- Benefit from providing breaks to prevent stuffing
- Base feeding schedule on sleep/wake schedule
Fetal Alcohol syndrome feeding problems - ANSWER: - Poor growth in womb leading
to low birth weight
- Decreased muscle tone & coordination resulting in sucking difficulty
- Delayed cognitive and oral motor skills
- Fatigue easily
- May benefit from nutritional support through NG tube
- Children's ability to swallow may decrease over time
What is the primary basis for feeding disorders in newborns? - ANSWER: Low Birth
weight
How do OTs Work in Feeding? - ANSWER: - Oral Aversion
- Tube to Oral Transition
- Poor Oral Motor Skills
- Poor Hand to Mouth Coordination
- We work with nutritionists, GIs and psychologists for poor weight gain, nutrition
and psychological factors impacting feeding
Prevalence of Feeding Problems - ANSWER: - 10% to 25% of all children
- 40%-70% in premature infants
- and 70%-80% in children with developmental disabilities or cerebral palsy
Selective Eating - ANSWER: has been associated with impairment in emotional,
physical, and social domains
Why do children have feeding problems? - ANSWER: Medical Reasons (86%)
What are the most common medical reasons? - ANSWER: - 60% GERD
, - 11.8% Food allergy
- 1.5 % Pancreatic/Liver Diseases
Detecting GERD - ANSWER: - frequent refusal to eat or drink
- irritability or behavioral problems during eating
- will start feeding and then be finished 3-4 minutes into feeding when you know the
child is still hungry
- arching of the back and/or turning the head to one side to elongate esophagus
- Frequent burping
Detecting Dysphagia - ANSWER: - irritability or behavioral problems during eating
- difficulty controlling food in the mouth or excessive mouth movement during
chewing
- needing to swallow a few times to get food down
- repeated drinking while or immediately after chewing or swallowing
- Tucking chin while swallowing
- frequent gagging, spitting or vomiting during or after eating or drinking
- extended feeding periods (longer than 30-40 minutes)
- weight loss of unclear origin or failure to gain weight appropriately
Detecting Aspiration - ANSWER: - Temperature before and afterfeeding
- Use Pulsox before, during andafter feeding
- Request a Modfied BariumSwallow (MBS)
- Request a Fiberoptic Endoscopic Evaluation (FEES)
- Coughing, burping, hiccupping during/after eating or drinking
- watery eyes (tearing) during or after eating or drinking
- frequent bouts of pneumonia or other chronic respiratory problems
Four phases of swallow - ANSWER: 1. Oral Prep
2. Oral Phase
3. Pharyngeal Phase
4. Esophageal Phase
Phase 1 of swallow - ANSWER: Oral Prep
- food is introduced into the mouth
- the lips close
- the tongue, teeth and cheeks break down the food
- a bolus or mass is formed
- Voluntary control
OT's role in phase 1 of swallow (oral prep) - ANSWER: 1. Assessing hunger,
environment, positioning
2. Improving hand to mouth coordination
3. Reduce size of bolus, placement of bolus & delivery
4. Sensory Issues? Behavior Program necessary?
5. Improving quality of chewing through improved oral motor skills(Lips, jaw, cheeks,
tongue)
Cerebral Palsy feeding problems - ANSWER: Abnormal bite
Poor lip closure
Weak suck
Poor coordination of sucking
Drooling is one of most common problems
Special spoons and size of bolus can help reduce drooling
Children typically benefit from dietary modifications
Down Syndrome feeding problems - ANSWER: - Large tongue with protrusion
- Low muscle tone (hypotonia)
- May require specialized bottle & later utensils/cups/plates
- Predisposed to cardiac, respiratory and gastrointestinal problems
- 10% of children have celiac's disease
- Benefit from providing breaks to prevent stuffing
- Base feeding schedule on sleep/wake schedule
Fetal Alcohol syndrome feeding problems - ANSWER: - Poor growth in womb leading
to low birth weight
- Decreased muscle tone & coordination resulting in sucking difficulty
- Delayed cognitive and oral motor skills
- Fatigue easily
- May benefit from nutritional support through NG tube
- Children's ability to swallow may decrease over time
What is the primary basis for feeding disorders in newborns? - ANSWER: Low Birth
weight
How do OTs Work in Feeding? - ANSWER: - Oral Aversion
- Tube to Oral Transition
- Poor Oral Motor Skills
- Poor Hand to Mouth Coordination
- We work with nutritionists, GIs and psychologists for poor weight gain, nutrition
and psychological factors impacting feeding
Prevalence of Feeding Problems - ANSWER: - 10% to 25% of all children
- 40%-70% in premature infants
- and 70%-80% in children with developmental disabilities or cerebral palsy
Selective Eating - ANSWER: has been associated with impairment in emotional,
physical, and social domains
Why do children have feeding problems? - ANSWER: Medical Reasons (86%)
What are the most common medical reasons? - ANSWER: - 60% GERD
, - 11.8% Food allergy
- 1.5 % Pancreatic/Liver Diseases
Detecting GERD - ANSWER: - frequent refusal to eat or drink
- irritability or behavioral problems during eating
- will start feeding and then be finished 3-4 minutes into feeding when you know the
child is still hungry
- arching of the back and/or turning the head to one side to elongate esophagus
- Frequent burping
Detecting Dysphagia - ANSWER: - irritability or behavioral problems during eating
- difficulty controlling food in the mouth or excessive mouth movement during
chewing
- needing to swallow a few times to get food down
- repeated drinking while or immediately after chewing or swallowing
- Tucking chin while swallowing
- frequent gagging, spitting or vomiting during or after eating or drinking
- extended feeding periods (longer than 30-40 minutes)
- weight loss of unclear origin or failure to gain weight appropriately
Detecting Aspiration - ANSWER: - Temperature before and afterfeeding
- Use Pulsox before, during andafter feeding
- Request a Modfied BariumSwallow (MBS)
- Request a Fiberoptic Endoscopic Evaluation (FEES)
- Coughing, burping, hiccupping during/after eating or drinking
- watery eyes (tearing) during or after eating or drinking
- frequent bouts of pneumonia or other chronic respiratory problems
Four phases of swallow - ANSWER: 1. Oral Prep
2. Oral Phase
3. Pharyngeal Phase
4. Esophageal Phase
Phase 1 of swallow - ANSWER: Oral Prep
- food is introduced into the mouth
- the lips close
- the tongue, teeth and cheeks break down the food
- a bolus or mass is formed
- Voluntary control
OT's role in phase 1 of swallow (oral prep) - ANSWER: 1. Assessing hunger,
environment, positioning
2. Improving hand to mouth coordination
3. Reduce size of bolus, placement of bolus & delivery
4. Sensory Issues? Behavior Program necessary?
5. Improving quality of chewing through improved oral motor skills(Lips, jaw, cheeks,
tongue)
