Introducing 

Prezi AI.

Your new presentation assistant.

Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.

Loading content…
Loading…
Transcript

Reference

Delaney, A.L. & Arvedson, J.C. (2008). Development of

swallowing and feeding : prenatal through first year of life. Developmental disabilities, 14, 105-117.

Efficient feedings take about 20-30 minutes without stress to infant or feeder so that the infant consumes sufficient volume to gain weight

Feeding Recommendations

2.5oz formula or breast milk per pound of body weight per day over 7-8 feedings lasting 15-20 minutes at 2-3 hour intervals

Increase the amount of breast milk or formula by 1 oz per month until 6 to 9 months when they take 8oz per feeding 3-4 times per day

Deglutition includes the entire act from food placement in the mouth until the material enters into the stomach

Eating is primarily an oral phase function that includes food getting, placement of food in the mouth, bolus management, chewing, and moving bolus with the tongue to the pharynx

Eating/feeding requires active effort by infants who must have exquisit timing and coordination of sucking, swallowing, and breathing to be efficient.

Motor

Brainstem

Sensory and Taste

For every infant and child to have a stable airway and adequate nutrition and hydration

The GOAL.

Instead they:

Startle

Rapid swallow

Have moments of Apnea

Have Laryngeal closure

Infants typically cough when they aspirate!

Things to Remember as a Clinician

Myelination at 18-24 weeks gestation causes the appearance of opening and closing of the jaw, anterior tongue movement, and suckling as seen on ultrasound

CN V, VII, IX, X, XII and upper cervical nerves

Pharygeal swallow is one of the first motor responses that uses pharyngeal muscles and appears around

week 11

CN V, VII, IX, and X

Taste buds develop during weeks 11-13

Do not

Swallowing & Feeding Development

so what's on the menu?

Fetal swallowing regulates amniotic fluid volume and composition, recirculates solutes from the environment, and allows for the maturation of the fetal gastrointestinal tract

Complex oral-motor and upper airway

skills emerged earlier in FEMALES

Pharyngeal and laryngeal movements

were LESS rhythmic in MALES than FEMALES

Overview of Feeding and Swallowing

Development during the Fetal Period

Development between Birth to 6 months

Nutritive vs Non-Nutritive Sucking

Development between 6 months to Toddler years

Swallowing in Preterm Infants

Things to Remember as a Clinician

52 Weeks = 12 Months Chronologic Age

- 14 Weeks = 14 Weeks Early

____________________

38 Weeks = Adjusted Age in Weeks

9ish Months = Adjusted Age in Months

40 Weeks = Full Term

-26 Weeks = Gestational Age

____________

14 Weeks Early

For example, a child at 12 months chronologic age, 9 months adjusted age (born at 26 weeks gestation) and not yet sitting independently (expected by 6 months), is not expected to chew and swallow solid food

Postconceptual age (PCA) relating to the estimated day of fertilization

Postmenstrual age (PMA) relating to the first day of the last normal menstrual period

Preterm infants are typically age adjusted to PRENATAL age estimates for first 24 months of life

Professionals need to keep this in mind when establishing expectations for infant readiness to feed orally and advance textures

Preterm Infant Feeding

Prenatal age Estimations

  • Coordinated rhythmic sequences of sucking, swallowing and breathing are required to feed by bottle
  • One Suck to One Swallow Ratio
  • Structure facilitates nipple feeding
  • Mandible is disproportionately small compared to the skull
  • Tongue fills oral cavity and contacts all surfaces leaving minimal space for tongue movement
  • Fat pads in cheeks narrow the oral cavity
  • Positioning of the larynx is much higher and under the tongue base which supports suckling behavior
  • Soft palate and epiglottis are engaged

Prenatal through First year

Nutritive Sucking

  • NNS success is used as a marker for readiness to feed by bottle
  • Most infants are given NNS experiences through a pacifier

Anatomy

Non-nutritive Sucking

Nutritive vs Non-Nutritive Sucking

  • AAP recommends iron-fortified forumla or breast milk until 12 months
  • Cow's milk before 12 months increases risk of iron deficiency, anemia, milk protein allergy, gastrointestinal blood loss, and inadequate nutrition
  • Infants demonstrate readiness for transition feeding around 6 months
  • Transition to spoon feeding is an important milestone for developmental skills and nutritional well-being
  • Foods should be introduced one at a time in a specific order to observe potential food allergies
  • Gradually add food with textures
  • Children are expected to drink independently from a spout cup or straw by their first birthday
  • Jaw movement complexity increases with advanced textures

Feeding Recommendations

Homeostasis (0-2 months)

Attachment (3-6 months)

Separation/Individualization (6-36 months)

Transitional Feeding

Relationship Changes

Fetal Period.

Birth to Six Months

Six Months to Forever.

So what is swallowing anyway?

Birth to Six Months

Learn more about creating dynamic, engaging presentations with Prezi