CSD 210 TEST QUESTIONS AND ANSWERS
LATEST UPDATE
Bottle feeding nipple characteristics
•SpecialNeeds Feeder: Soft, Feeder regulated, Long, Slit
•Mead Johnson: Soft, Feeder regulated, Long, thin, Crosscut
•Orthodontic: Soft, Fast, Broad, flat, Hole on top surface of tip
•Dr. Brown's: Soft, Slow to fast infant directed, Traditional Hole, Y-Cut
•Premature: Soft, Medium and fast, Traditional, Hole and crosscut
•Traditional: Medium, Low, Traditional, Hole and crosscut, several holes
Mead JohnsonTM Cleft Lip/Palate Nursing System
●Includes a bottle and a nipple, but any nipple can be used with the bottle
●Straight, long, and firm nipple
●Crosscut nipple
●Pliability of bottle allows assistive squeeze to increase flow
●Ability to monitor size of bolus being delivered by squeeze is poor
Dr. Brown's Specialty Feeding System
●Includes a bottle, nipple, and unidirectional flow valve
●Is vented to create a positive pressure flow, reducing air intake during feeding
●Is beneficial for infants with severe difficulty in expressing fluid during sucking
Allows baby to control pacing
●Comes in all different sizes for the bottles and nipples
Hole, "Y" cut nipple
SpecialNeeds Feeder
● This bottle/nipple unit is relatively expensive
● It has a straight, moderate length, and soft nipple.
● It delivers fluid by compression of the nipple alone.
● Nipple slit opening allows for adjustment of flow to three rates.
One-way valve decreases air intake
● Consider a parent's skills.
● The three lines gauge the flow – the more you compress, the more opening there is in
the nipple
Medela SoftCup System
● Bottle/soft cup unit
● Used for infants who cannot tolerate intraoral placement of nipple
● Allows presentation of liquid in measured amounts
Slit nipple
Angled Neck Bottle
● Helpful when positioning had to be very upright
● Allows for downward flow of milk without forcing baby to adapt extended head-neck
position
Pigeon Nipple and Bottle
, ● Nipple is "Y" crosscut, wide with one thin side and one thicker side
● Thinner side is positioned against the tongue for compression.
● One-way valve allows for flow into the nipple with no back flow.
● Flow rate can be adjusted with tightness of collar on bottle.
● Bottle is pliable for assistive squeezing.
Cleft lip and alveolus only
● Infant may have difficulty achieving an adequate lip seal on the nipple
Cleft palate only
● Depending on the extent of the cleft, the infant may have:
○ Inability to find palatal surface for compression of the nipple
○ Inability to generate negative pressure for suction
Nasal regurgitation
Cleft lip and palate
● Infant may have all the difficulties noted above, including:
○ difficulty achieving an adequate lip seal on the nipple
Videofluoroscopic Swallowing Study (VFSS) aka modified barium swallow (MBS)
●is generally performed by a radiologist and a SLP
● Barium contrast is added to liquids and solids to enable visualization of the swallowing
process under fluoroscopy
● The use of standardized liquid barium viscosities, such as the Varibar products, is
recommended to ensure study validity
● The videofluoroscopic study allows an overall view of the oral, pharyngeal , and
esophageal phases of swallowing as well as the interaction between the phases.
● Swallowing function, as well as the infant's ability to maintain airway protection during
swallowing, is carefully assessed through the videofluoroscopy study.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
involves the transnasal passage of an endoscope to the pharynx for viewing of the
pharyngeal and laryngeal structures; the focus of this study is on assessing the integrity
of airway protection during swallowing
Interdisciplinary Feeding Team Evaluation
● In severe cases of feeding/swallowing dysfunction, an evaluation by a team of feeding
specialists is indicated
● Usually consists of a core group of medical professionals that may include a
gastroenterologist, nutritionist, nurse, SLP, OT, behavioral psychologist,
otolaryngologist, pulmonologist, and consulting radiologist
Positioning the infant
● Semi-upright (at least 60o) is best.
● Facilitates control of jaw, cheek, lip, and tongue movements
● Allows gravity to assist with swallowing
● Helps prevent nasal regurgitation
Positioning the nipple
● Nipple is placed under palatal bone to aid nipple compression
Pacing intake
● Fluid must be provided in rhythm with the infant's sucking compressions.
● Feeder should modify pace when there are signs of stress:
○ Eye widening or changes in facial expression
LATEST UPDATE
Bottle feeding nipple characteristics
•SpecialNeeds Feeder: Soft, Feeder regulated, Long, Slit
•Mead Johnson: Soft, Feeder regulated, Long, thin, Crosscut
•Orthodontic: Soft, Fast, Broad, flat, Hole on top surface of tip
•Dr. Brown's: Soft, Slow to fast infant directed, Traditional Hole, Y-Cut
•Premature: Soft, Medium and fast, Traditional, Hole and crosscut
•Traditional: Medium, Low, Traditional, Hole and crosscut, several holes
Mead JohnsonTM Cleft Lip/Palate Nursing System
●Includes a bottle and a nipple, but any nipple can be used with the bottle
●Straight, long, and firm nipple
●Crosscut nipple
●Pliability of bottle allows assistive squeeze to increase flow
●Ability to monitor size of bolus being delivered by squeeze is poor
Dr. Brown's Specialty Feeding System
●Includes a bottle, nipple, and unidirectional flow valve
●Is vented to create a positive pressure flow, reducing air intake during feeding
●Is beneficial for infants with severe difficulty in expressing fluid during sucking
Allows baby to control pacing
●Comes in all different sizes for the bottles and nipples
Hole, "Y" cut nipple
SpecialNeeds Feeder
● This bottle/nipple unit is relatively expensive
● It has a straight, moderate length, and soft nipple.
● It delivers fluid by compression of the nipple alone.
● Nipple slit opening allows for adjustment of flow to three rates.
One-way valve decreases air intake
● Consider a parent's skills.
● The three lines gauge the flow – the more you compress, the more opening there is in
the nipple
Medela SoftCup System
● Bottle/soft cup unit
● Used for infants who cannot tolerate intraoral placement of nipple
● Allows presentation of liquid in measured amounts
Slit nipple
Angled Neck Bottle
● Helpful when positioning had to be very upright
● Allows for downward flow of milk without forcing baby to adapt extended head-neck
position
Pigeon Nipple and Bottle
, ● Nipple is "Y" crosscut, wide with one thin side and one thicker side
● Thinner side is positioned against the tongue for compression.
● One-way valve allows for flow into the nipple with no back flow.
● Flow rate can be adjusted with tightness of collar on bottle.
● Bottle is pliable for assistive squeezing.
Cleft lip and alveolus only
● Infant may have difficulty achieving an adequate lip seal on the nipple
Cleft palate only
● Depending on the extent of the cleft, the infant may have:
○ Inability to find palatal surface for compression of the nipple
○ Inability to generate negative pressure for suction
Nasal regurgitation
Cleft lip and palate
● Infant may have all the difficulties noted above, including:
○ difficulty achieving an adequate lip seal on the nipple
Videofluoroscopic Swallowing Study (VFSS) aka modified barium swallow (MBS)
●is generally performed by a radiologist and a SLP
● Barium contrast is added to liquids and solids to enable visualization of the swallowing
process under fluoroscopy
● The use of standardized liquid barium viscosities, such as the Varibar products, is
recommended to ensure study validity
● The videofluoroscopic study allows an overall view of the oral, pharyngeal , and
esophageal phases of swallowing as well as the interaction between the phases.
● Swallowing function, as well as the infant's ability to maintain airway protection during
swallowing, is carefully assessed through the videofluoroscopy study.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
involves the transnasal passage of an endoscope to the pharynx for viewing of the
pharyngeal and laryngeal structures; the focus of this study is on assessing the integrity
of airway protection during swallowing
Interdisciplinary Feeding Team Evaluation
● In severe cases of feeding/swallowing dysfunction, an evaluation by a team of feeding
specialists is indicated
● Usually consists of a core group of medical professionals that may include a
gastroenterologist, nutritionist, nurse, SLP, OT, behavioral psychologist,
otolaryngologist, pulmonologist, and consulting radiologist
Positioning the infant
● Semi-upright (at least 60o) is best.
● Facilitates control of jaw, cheek, lip, and tongue movements
● Allows gravity to assist with swallowing
● Helps prevent nasal regurgitation
Positioning the nipple
● Nipple is placed under palatal bone to aid nipple compression
Pacing intake
● Fluid must be provided in rhythm with the infant's sucking compressions.
● Feeder should modify pace when there are signs of stress:
○ Eye widening or changes in facial expression
