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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
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.
For every infant and child to have a stable airway and adequate nutrition and hydration
Instead they:
Startle
Rapid swallow
Have moments of Apnea
Have Laryngeal closure
Infants typically cough when they aspirate!
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
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
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
Homeostasis (0-2 months)
Attachment (3-6 months)
Separation/Individualization (6-36 months)