SAF E T Y - the fe e ding pla n sho uld suppo rt a nd ma inta - - PowerPoint PPT Presentation

• SAF

E T Y - the fe e ding pla n sho uld suppo rt a nd ma inta in the c hild’ s he a lth

• OPT

I MAL NUT RI T I ON - this is e sse ntia l a s the fe e ding pro c e ss is hig h e ne rg y

• utput
• F

ARSI GHT E D - the implic a tio ns o f c urre nt tre a tme nt o n future fe e ding a nd o ra l func tio ns must b e c o nside re d

F E E DING

Or

• motor

/ pha r yng e a l func tion Motor c ontr

• l

Postur e Communic a tion De ve lopme nta l le ve ls Cog nitive le ve l Dr ug s GOR Constipa tion Ne ur

• log ic a l Issue s

Ca r dia c Issue s Vision He a r ing T a c tile Be ha viour : F a tig ue ; E ndur a nc e ; Sta te Ma inte na nc e Soc ia l fa c tor s Ave r sive e xpe r ie nc e s

• I

nfa nts a nd c hildre n with c a rdia c pro b le ms fre q ue ntly ha ve fe e ding diffic ultie s tha t re sult in fa ilure to thrive

• Po o r e ndura nc e , fa tig ue a nd hig h nutritio na l

ne e ds a re ke y limiting fa c to rs

• Asso c ia te d pro b le m a re a s
• I

nc o -o rdina tio n o f swa llo wing

• Po o r o ra l fe e ding skills
• I

nc re a se d re spira to ry e ffo rt

• With inc re a se d risk fa c to rs
• fo r a spira tio n
• Ong o ing diffic ulty with suc k-swa llo w-

b re a the sync hro ny

• Ca n b e thro ug ho ut a fe e d
• Ca n de ve lo p during a fe e d
• Ofte n re la te d to e ndura nc e a nd fa tig ue

pro b le ms

• Stre ss c ue s
• I

nc re a se d swe a ting

• Co lo ur c ha ng e
• Cha ng e s in sta te
• I

nc re a se d re spira to ry e ffo rt

• I

nc re a se d he a rt ra te during fe e ds

• F

la ring o f the na re s / he a d b o b b ing

• Wo rrie d fa c ia l e xpre ssio n
• E

xtra ne o us mo ve me nt, he a d turning

• Pe rsiste nt fe e d re la te d de sa tura tio ns
• Co ug hing a nd / o r c ho king
• Po o r we ig ht g a in

 Ra pid de te rio ra tio n o f no rma l suc king

pa tte rn

 I

nc re a se d g a g

 Histo ry o f re pe a te d c he st infe c tio ns  “Sna c king ” o r fe e ds running into e a c h

• the r with re sulting fa tig ue

• Bre a st F

e e ding is the GOL

D ST ANDARD

• Bre a st fe e ding suppo rt is fro m the L

a c ta tio n Co nsulta nt

• I

f the re a re o ro -mo to r diffic ultie s o r q ue rie s re g a rding swa llo w sa fe ty, the SL T b e c o me s invo lve d

• Bo ttle fe e ding , like a ll fe e ding , is a

le a rne d pro c e ss

• T

he re a re a lwa ys two pa rtie s invo lve d: it is a fe e ding DYAD

• Co mmunic a tio n within tha t dya d is

e sse ntia l

• F

e e d to e a rly c ue s

• A b a b y g e ts stre sse d with fe e ds

fo r a re a so n

• All fe e ds sho uld b e e njo ya b le fo r

b o th pa rtie s

Che c k sta te o f te a t:

• Split x- c ut
• De te r

ior ate d te at te xtur e

• Che c k fo r a nte rio r lo ss

• Che c k te c hniq ue
• T

e a t pa rt e mpty ta king in a ir

• Po o rly suppo rte d
• Bo ttle we ig ht o n

mo uth

• Utilise ne o na ta l

re fle xe s tha t suppo rt fe e ding e g Pa lma r g ra sp F le xe d po sitio n

• F

OCUS o n the ta sk in ha nd

• L

OOK AT POSI T I ONI NG

• Ho w is the he a d po sitio ne d?
• I

s the trunk suppo rte d?

• I

s the b a b y swa ddle d?

• T

umb le fo rm c ha ir

• AL

WAYS faste n str aps

• use at angle se t by

the r apist

• ne ve r

le ave unatte nde d

• Hig hc ha ir – use

ro lle d up to we ls o r na ppie s fo r side suppo rt

 Po sitio ning

› F

• r MOC

› F

• r Ba b y

 T

iming

› Cue b a se d fe e ding

 Vo lume

› Sma lle r mo re fre q ue nt fe e ds

 F

e e ding e nviro nme nt

 E

a rly disc ussio n with fa mily

 NO fo rc ing  T

hinking a b o ut the tub e c o ming o ut sta rts whe n it g o e s in

 VF

SS (Vide o fluo ro sc o pic Swa llo w Study) is pe rfo rme d to e va lua te swa llo wing func tio n

 T

his is ve ry diffe re nt to a Ba rium Swa llo w

 A Ba rium Swa llo w is to ide ntify Ga stro

re la te d pro b le ms e .g . Re flux

 A Ba rium Swa llo w do e s no t invo lve a SL

T

• Pe rsisting stre ss c ue s
• Pe rsiste nt fe e d re la te d de sa tura tio ns
• Co ug hing a nd / o r c ho king
• We t so unds during fe e ds
• Po o r we ig ht g a in
• “Sna c king ” o r fe e ds running into e a c h o the r with

re sulting fa tig ue

• I

nc re a se d g a g

• Re pe a te d c he st infe c tio ns



[Cha rt a d a pte d fro m: F a c to rs tha t ma y a ffe c t fe e d ing the c hild with ne uro lo g ic a l impa irme nt (Re illy e t a l in So utha ll, A a nd Sc hwa rtz, A (e d s)(2000) F e e d ing pro b le ms in Child re n: a pra c tic a l g uid e . Oxfo rd . Ra d c liffe Me d ic a l Pre ss 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.



Ca b re ra , Pro d ha n, Bhutta . 2010. Nutritio na l Cha lle ng e s a nd o utc o me s a fte r surg e ry fo r c o ng e nita l he a rt d ise a se .



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.