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 o 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

Or omotor / pha r yng e a l func tion Motor c ontr ol Postur e Communic a tion Be ha viour : De ve lopme nta l F a tig ue ; E ndur a nc e ; le ve ls Sta te Ma inte na nc e Cog nitive le ve l Soc ia l fa c tor s Dr ug s Ave r sive e xpe r ie nc e s F E E DING GOR Vision Constipa tion He a r ing Ne ur olog ic a l Issue s T a c tile Ca r dia c Issue 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 o 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  Hig hc ha ir – use  AL WAYS faste n ro lle d up to we ls o r str aps na ppie s fo r side  use at angle se t by suppo rt the r apist  ne ve r le ave unatte nde d

 Po sitio ning › F o r MOC › F o 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 (2 nd ed.). A Comprehensive Resource For Mealtime  Development.