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Flashcards in Ch. 5 Deck (47)
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1

Purposes of infant feeding:
-Satisfies _________
- Provides ________ for growth and development
- Provides ______-_______ and _____-____ stimulation
-Facilitates state ______ and maintain homeostasis
-Provides ______ and sense of well-being
-Enhances _______ and interactions with ______
-Serves as _______ for other functions, including speech

-Satisfies hunger
- Provides nourishment for growth and development
- Provides oral-sensory and oral-motor stimulation
-Facilitates state regulation and maintain homeostasis
-Provides calming and sense of well-being
-Enhances bonding and interactions with caregiver
-Serves as foundation for other functions, including speech

2

Oral anatomy of an infant is smaller and different than an adult:
-Oral cavity is _______ relative to _____ size.
-______ pads (fat inside cheeks) are ______.
-There are no _______.
-Tongue rests _______ to alveolar ridge and contacts lower_______.
-Temporomandibular joint does not allow much ________ of jaw
-Oral anatomy is well suited for _______ (extension-retraction movements of the tongue).

Oral cavity is small relative to tongue size.
Buccal pads (fat inside cheeks) are large.
There are no teeth.
Tongue rests anterior to alveolar ridge and contacts lower lip.
Temporomandibular joint does not allow much movement of jaw
Oral anatomy is well suited for suckling (extension-retraction movements of the tongue).

3

Pharyngeal anatomy of an infant is smaller and different than that of an adult:
-Pharynx is ________.
-Tongue ______, soft palate, and ______ walls are in ______ approximation.
-Larynx is _________ the size of an adult’s and is ______ in the hypopharynx.
-High position of the infant larynx causes the _______ to pass superiorly to the free margin of the soft palate and project into the _______.

Pharynx is short.
Tongue base, soft palate, and pharyngeal walls are in close approximation.
Larynx is one-third the size of an adult’s and is high in the hypopharynx.
High position of the infant larynx causes the epiglottis to pass superiorly to the free margin of the soft palate and project into the nasopharynx.

4

Anatomy relevant to infant feeding:
Pharyngeal anatomy is well suited for the _____-_____-_____ synchrony.
______, ______, _____relationship are ideal for the suck-swallow-breathe synchrony.

Pharyngeal anatomy is well suited for the suck-swallow-breathe synchrony.
Head, chin, neck relationship are ideal for the suck-swallow-breathe synchrony.

5

Oral Phase:
________ ______ and generation of negative ______ occur for sucking

nipple compression and generation of negative pressure occur for sucking

6

Pharyngeal Phase:
_______, velum, and posterior pharyngeal provide driving force for _____ _______ to esophagus

tongue base, velum, and posterior pharyngeal provide driving force for bolus transfer to esophagus

7

Esophageal Phase:
_____ _______ ______ opens for bolus transfer to _______; ______ ______ _____ opens to allow bolus entrance into ______

upper esophageal sphincter opens for bolus transfer to esophagus; lower esophageal sphincter opens to allow bolus entrance into stomach

8

Coordination of _____, ______, ______ is crucial to prevent _______.
Suck-swallow-breathe ratio during is generally ______ or _______.
Decreased _______ during feeding may be a problem for some medically compromised infants.

Coordination of sucking, swallowing, and breathing is crucial to prevent aspiration (entry of material into the airway).
Suck-swallow-breathe ratio during is generally 1:1:1 or 2:1:1.
Decreased ventilation during feeding may be a problem for some medically compromised infants.

9

Significant _____, _____, _____ growth takes place in the first 2 to 3 years of life.
Oral cavity becomes ________ with mandibular growth.
Tongue tip moves _____ _______ alveolar ridge.
Teeth _______.
Pharynx ________.
Neuromuscular, particularly ________ function matures.
Growth and maturation lead to changes in ________ ___________pattern.

Significant oral, pharyngeal, and laryngeal growth takes place in the first 2 to 3 years of life.
Oral cavity becomes larger with mandibular growth.
Tongue tip moves back to under alveolar ridge.
Teeth erupt.
Pharynx elongates.
Neuromuscular, particularly oral-motor function matures.
Growth and maturation lead to changes in feeding and swallowing pattern.

10

Cleft Lip and Alveolus only:
-Infant may have initial problems achieving an adequate _____ ______ on the nipple.
-Inadequate lip seal may cause difficulty generating ______ _______ for sucking.

Infant may have initial problems achieving an adequate lip seal on the nipple.
Inadequate lip seal may cause difficulty generating negative pressure for sucking.

11

Cleft Palate Only:
-Depends on the extent of the cleft
-Infant may be unable to generate ______ _______ for suction.
-Infant may be unable to find a hard palatal surface for ______ of the nipple.
-Infant may experience ______ _________.

Depends on the extent of the cleft
Infant may be unable to generate negative pressure for suction.
Infant may be unable to find a hard palatal surface for compression of the nipple.
Infant may experience nasal regurgitation.

12

Cleft lip and palate:
-Infant may have all the difficulties noted above (lip and alveolus only, palate only), including these:
Difficulty achieving an adequate _____ ______ on the nipple
Inability to generate _____ _______ for suction
Inability to find _____ ______ for compression of the nipple
Nasal _______

Infant may have all the difficulties noted above, including these:
Difficulty achieving an adequate lip seal on the nipple
Inability to generate negative pressure for suction
Inability to find palatal surface for compression of the nipple
Nasal regurgitation

13

Postoperative recommendations vary among centers:
-Some _______ sucking following surgery and may may recommend the use of ______ or _______ instead.
-Some recommend supplemental _____ _______ for a short time.
-Some allow ______ feeding after surgery.

Postoperative recommendations vary among centers:
-Some discourage sucking following surgery and may may recommend the use of cup or spoon instead.
-Some recommend supplemental tube feeding for a short time.
-Some allow unrestricted feeding after surgery.

14

Anomalies that can contribute to a feeding or swallowing problem:
_________ (small mandible)
_________ (large tongue)
_________ stenosis (narrowing)
_________ anomalies
_________ cleft
_____________ fistula
________ or cranial nerve involvement
_______ (posterior displacement of the tongue in the pharynx)
Midface _______
______ ________ or lung disease
_______ atresia

Anomalies that can contribute to a feeding or swallowing problem:
Micrognathia (small mandible)
Macroglossia (large tongue)
Pharyngeal stenosis (narrowing)
Vascular anomalies
Laryngeal cleft
Tracheoesophageal fistula
Cortical or cranial nerve involvement
Glossoptosis (posterior displacement of the tongue in the pharynx)
Midface retrusion
Congenital heart or lung disease
Choanal atresia

15

Conditions that often affect feeding and swallowing include the following:
________ __________ sequence
____________ syndrome
____________ microsomia

Conditions that often affect feeding and swallowing include the following:
Pierre Robin sequence
Moebius syndrome
Hemifacial microsomia

16

Most infants with a cleft are able to feed with __________ ________________
Infant’s performance during the ______ feedings determines which _______ _______and technique will be best.

Most infants with a cleft are able to feed with simple modifications.
Infant’s performance during the initial feedings determines which feeding method and technique will be best.

17

Breastfeeding trials should be __________.
With cleft lip, breastfeeding is usually not a ___________.
With cleft palate, it is very challenging due to difficulties with __________ and _______
Options with cleft palate include:
__________ nursing
Modified ________/_________
______________ breast milk should always be recommended if breastfeeding is not possible.

Breastfeeding trials should be supported.
With cleft lip, breastfeeding is usually not a problem.
With cleft palate, it is very challenging due to difficulties with compression and suction.
Options with cleft palate include:
Supplemental nursing
Modified nipples/bottles
Pumping breast milk should always be recommended if breastfeeding is not possible.

18

Characteristics to consider when choosing a modified nipple

Pliability
Shape
Length
Hole type
Hole size

19

Nipples:
___________ nipple
__________ nipple (as illustrated here)
__________ __________ Nipple
________ _________ nipple

Orthodontic nipple
Pigeon nipple (as illustrated here)
Ross® Premature Nipple
Standard traditional nipple

20

Specialized dipole and bottle systems:
_________ __________ Cleft Lip/Palate Nurser
____________ Cleft Palate Nurser
______________Feeder® (formerly the Haberman® Feeder)
__________ ___________ Feeder and Bottle

Mead JohnsonTM Cleft Lip/Palate Nurser
Ross® Cleft Palate Nurser
SpecialNeeds Feeder® (formerly the Haberman® Feeder)
Medela® SoftCup Feeder and Bottle

Table 5.1

21

Mead Johnson:
Bottle and nipple _______, but can use any nipple with ____________
__________, long, & ________ nipple
_____________ nipple
__________ of bottle allows assistive squeeze to increase flow
Ability to monitor size of ______ being delivered by squeeze is _________

Bottle and nipple unit, but can use any nipple with bottle
Straight, long, & 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

22

SpecialNeeds Feeder:
This bottle/nipple unit is relatively ________
It has a ________, moderate length, ____ nipple
It delivers fluid by _________ of nipple alone.
_______ ______ opening allows for adjustment of flow to _______ rates.
___________ valve decreases air intake.
Consider parent’s _______.

This bottle/nipple unit is relatively expensive.
It has a straight, moderate length, soft nipple
It delivers fluid by compression of nipple alone.
Nipple slit opening allows for adjustment of flow to three rates.
One-way valve decreases air intake.
Consider parent’s skills.

23

Medela SoftCup System:
_______/_______ unit
Used for infants that cannot tolerate________ placement of nipple
Allows _______ of liquid in _______ amounts

Bottle/soft cup unit
Used for infants that cannot tolerate intraoral placement of nipple
Allows presentation of liquid in measured amounts

24

Angled Neck Bottle:
Helpful when positioning has to be very __________
Allows for _______ flow of milk without forcing baby to adapt extended _______ position

Helpful when positioning has to be very upright
Allows for downward flow of milk without forcing baby to adapt extended head-neck position

25

Pigeon Nipple and Bottle:
-Nipple is ______________, with one thin side and one thicker side.
-_________ side is for positioning against infant tongue to extract liquid flow with compression.
-The Pigeon nipple is ________ (wider).
-________________ allows for flow into nipple with no back flow.
-Bottle is ________ to allow for assistive squeezing.
-Flow rate can be adjusted with _________ of collar on bottle.

Nipple is “Y” crosscut, with one thin side and one thicker side.
Thinner side is for positioning against infant tongue to extract liquid flow with compression.
The Pigeon nipple is larger (wider).
One-way valve allows for flow into nipple with no back flow.
Bottle is pliable to allow for assistive squeezing.
Flow rate can be adjusted with tightness of collar on bottle.

26

Positioning the Infant:
____________ (at least 60º) is best.
Facilitates control of _____, ______, ______, ______ movements
Allows ______ to assist with swallowing
Helps prevent _____ _________

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

27

Positioning the Nipple:
Place nipple ______ _______ bone to aid nipple compression

Place nipple under palatal bone to aid nipple compression

28

Pacing Intake:
Fluid must be provided in ______ with the infant’s sucking compressions.

Fluid must be provided in rhythm with the infant’s sucking compressions.

29

Feeder should _____ pace when there are signs of stress:
Eye ______ or changes in facial expression
Decreased ________
________ of feeding
_______ or ________
Signs of _______ air intake
Signs of ______

Feeder should modify pace when there are signs of stress:
Eye widening or changes in facial expression
Decreased alertness
Avoidance of feeding
Coughing or choking
Signs of excessive air intake
Signs of fatigue

30

Flow can be regulated by:
_______ nipple slightly _________
Partially ________ the nipple from the oral cavity

Flow can be regulated by:
Tilting nipple slightly upwards
Partially removing the nipple from the oral cavity