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H) Management Positioning.... in Feeding

The document outlines various management techniques for feeding and swallowing in children, including postural and positioning techniques, oral-motor treatments, and non-oral feeding strategies. It emphasizes the importance of tailored approaches based on individual needs and readiness for oral feeding, as well as the use of specific utensils and modifications to enhance feeding safety and efficiency. Additionally, sensory stimulation techniques and the development of chewing skills are discussed to support children's feeding progress.

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Najiya Jakir Hussain
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19 views22 pages

H) Management Positioning.... in Feeding

The document outlines various management techniques for feeding and swallowing in children, including postural and positioning techniques, oral-motor treatments, and non-oral feeding strategies. It emphasizes the importance of tailored approaches based on individual needs and readiness for oral feeding, as well as the use of specific utensils and modifications to enhance feeding safety and efficiency. Additionally, sensory stimulation techniques and the development of chewing skills are discussed to support children's feeding progress.

Uploaded by

Najiya Jakir Hussain
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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H) MANAGEMENT:

POSITIONING, ORAL-
MOTOR TREATMENT,
TEAM APPROACH, NON-
ORAL FEEDING,
TRANSITIONAL FEEDING,
MODIFICATIONS IN FEEDI
NG
POSTURAL AND POSITIONING
TECHNIQUES

 Postural and positioning techniques involve adjusting the


child's posture or position to establish central alignment and
stability for safe feeding.
 These techniques serve to protect the airway and offer safer
transit of food and liquid. No single posture will provide
improvement to all individuals. Postural changes differ
between infants and older children.
TECHNIQUES INCLUDE

 chin down-tucking the chin down toward the neck;


 chin up-slightly tilting the head up;
 head rotation-turning the head to the weak side to
protect the airway;
 upright positioning-90" angle at hips and knees, feet
on the floor, with supports as needed;
 head stabilization-supported so as to present in a
chin-neutral position;
 cheek and jaw assist;
reclining position-using pillow support or a reclined
infant seat with trunk and head support; and
side-lying positioning (for infants).
The mother may feed the infant in cradle hold,
upright facing the feeder, in right or left side lying
position, or facing away from the feeder.
some authors recommend a single posture for
optimum swallowing, generally with the head tilted
forward at a 45º angle.
Maneuvers are strategies used to
change the timing or strength of
movements. of swallowing (Logemann,
2000). Some maneuvers require following
multistep directions and may not be
appropriate for young children and/or
older children with cognitive impairments.
EXAMPLES OF MANEUVERS
INCLUDE THE FOLLOWING:

Effortful swallow-posterior tongue base


movement is increased to facilitate bolus
clearance.
Masako, or tongue hold -tongue is held
forward between the teeth while swallowing;
this is performed without food or liquid in
the mouth to prevent coughing or choking.
Mendelsohn maneuver -elevation of the
larynx is voluntarily prolonged at the peak of the
swallow to help the bolus pass more efficiently
through the pharynx and to prevent food/liquid
from falling into the airway.
Supraglottic swallow -vocal folds are usually
closed by voluntarily holding breath before and
during swallow in order to protect the airway.
Super-supraglottic swallow -effortful breath
hold tilts the arytenoid forward, which closes the
airway entrance before and during the swallow.
ORAL-MOTOR TREATMENT:
Oral-motor treatments include stimulation to-or actions
of the lips, jaw, tongue, soft palate, pharynx, larynx,
and respiratory muscles.
Oral-motor treatments range from passive (e.g.,
tapping, stroking, and vibration) to active (e.g., range-
of-motion activities, resistance exercises, or chewing
and swallowing exercises).
Oral-motor treatments are intended to influence the
physiologic underpinnings of the oropharyngeal
mechanism in order to improve its functions. Some of
these interventions can also incorporate sensory
stimulation.
BECKMANN ORAL
MOTOR APPROACH
Provide assisted movements to activate muscle contraction
and to provide movement against resistance to build strength.
To increase functional response to pressure and
movement, range, strength and variety and control of
movement for the lips, cheeks, jaw and tongue using
assisted movement and stretch reflexes.
Development of oral motor skills enhances the progression
from breast milk or formula, then to pureed food and to
table foods as well as the skills needed to progress from
sucking a nipple to using a wide variety of utensils i.e.
straws, cups, spoons and forks.
NON-ORAL FEEDING:
NNS involves allowing an infant to suck without taking
milk, either at the breast (after milk has been expressed)
or with the use of a pacifier.
It is used as a treatment option to encourage eventual oral
intake.
Steps involved are:
Place a gloved finger or a pacifier in the infant's mouth.
Press firmly 4-6 times (1-2 times per second) on the
middle of the tongue.
Pause to see if the infant continues unassisted sucking.
Repeat as tolerated.
TRANSITIONAL
FEEDING:
NNS and Oral Feeding Readiness:
Rule of Thumb:
If the infant can produce non-nutritive suck, he/she may be able to
produce a nutritive suck.
If the infant cannot produce non-nutritive suck, he/she may be
able to produce a non-nutritive suck and is not ready for oral feed.
Repeated trials at oral feeding prior to infant readiness may
actually delay development of oral feeding skills.
Readiness for oral feeding-Toddlers and older children who are
beginning to eat orally for the first time or after an extended
period of non-oral feeding will need time to become comfortable
in the presence of food tube feeding:
 Tube feeding includes alternative avenues of intake such as
 nasogastric [NG] tube,
 transpyloric tube (placed in the duodenum or jejunum),
 gastrostomy (G-tube placed in the stomach or GJ-tube placed in the jejunum).
 These approaches may be considered if the child's swallowing safety and
efficiency cannot reach a level of adequate function or does not adequately
support nutrition and hydration.
 Physiologically stable preterm infants, are generally transitioned from tube
feeding to oral feeding at 32-34 weeks gestational age. This transition may
take days to weeks.
 Success in this transition, defined as adequate intake for growth and
maintenance of physiologic stability, depends on several factors:
 (a) the infant's neurological and physiological maturity, namely, the infant's
ability to remain engaged in feeding, organize oral-motor functioning, co-
ordinate swallowing with breathing, and maintain physiologic stability.
SENSORY STIMULATION
TECHNIQUES
Sensory stimulation techniques vary and may include thermal-tactile
stimulation (e.g., using an iced lemon glycerin swab) or tactile
stimulation (e.g., using a NUK brush) applied to the tongue or around
the mouth.
Children who demonstrate aversive responses to stimulation may need
approaches that reduce the level of sensory input initially, with
incremental increases as the child demonstrates tolerance.
Sensory stimulation may be needed for children with reduced
responses, overactive responses, or limited opportunities for sensory
experience.
Oral stimulation program:

• This program involves stimulating the face and oral cavity with
different textures, touch pressures, and temperatures.
• Provide the infant/child with opportunities to orally
explore a variety of toys.
• Encourage the infant to suck on fingers and/or a
pacifier during tube feedings.
• Rub the child's face with various textures
(soft/smooth-stiff/rough).
• Use a finger to apply firm pressure to the gums,
tongue, and teeth (if applicable). Start at midline and
work your way back. Repeat 3-4 times.
• Provide the infant with a toothette, small toothbrush,
or gloved finger dipped in water, formula, or breast
milk. Apply pressure downward, and then apply a finger
stroke.
DEVELOPING CHEWING SKILLS:
• This involves assisting the child learning to masticate
and manipulate new food textures without choking.
This is aimed at expanding the child's food repertoire
and developing normal feeding skills.
• Start by placing new soft solid textures. i.e. food strips
of fruit, inside gauze that is tied tightly together with
dental floss so you can pull it out if needed (sham bolus).
• Place food anteriorly on the tongue tip so the child can
identify the food.
• Next, move the food laterally (on molars) to encourage
tongue lateralization.
• Use external jaw support to assist with lip closure and
graded jaw movements.
• Experiment with different food flavors (spicy, sweet,
sour) and temperatures (very cold to warm) to increase
sensory input.
• Stroke up/down inside the cheek to promote chewing
behaviors.
• Once the child is accepting and lateralizing food in
gauze from midline of tongue to molars, introduce soft,
soluble solids. Go slowly modified.
MODIFICATIONS IN FEEDING:
• The combined goals of the feeding specialists and
parents for management and treatment usually
include
• 1) improving the infant's overall stability with
integrated developmental care
• 2) proper positioning in an incubator or crib,
proper positioning during feeding
• 3) use of appropriate latching skills and
positioning for breastfeeding
• 4) use of appropriate bottles and nipples.
• Present the infant opportunities to suck on
fingers and thumbs before bottle is presented.
• Avoid distracting movements by the feeder.
Try not to stimulate the infant by giving chin
support or touching the face unless necessary.
• Feed the infant in a side lying position.
• If the infant is supported well, a face to face
hold will help the feeder monitor the infant's
response. If the infant is disorganized, a cradle
hold will provide more support and organization.
UTENSILS FOR FEEDING
• Pacifiers: used in preterm babies to assist in non-
nutritive suck. They should match infant's oral cavity,
sensitivity and sucking needs.
• Nipples: they are characterized by material of
composition that determines the shape, size and flow
rate. Silicone nipples are clear, firm and likely to
collapse. Plastic nipples may be tan colored and will
collapse easily. Straight nipple requires more tongue
cupping, more consistent flow rate, more pressure
before it collapses. Orthodontic nipples is useful when
infant has flatter and larger tongue as it requires less
pressure to collapse, a less predictable flow rate.
DIFFERENT VARIETY OF NIPPLES:
• i. Stiffness: soft nipple may collapse easily and make it hard
for child to draw fluid (for child with weak suck). Too hard
nipples may tire infant easily (for children with
hypotonic tongue).
• ii. Size: too large or long can gag the child, too small may
frustrate the child.
• iii. Shape: standard nipples are oblong and work well for child
who can form a central grove. Long, thin nipples work when the
tongue is retracted to bring it forward.
• iv. Flow rates: depends on sucking strength and viscosity of
fluids. Nipples have 12 (slow flow) to 4 (fast flow) holes. Slow
flow rates are helpful for those with respiratory compromise,
weak suck and poor endurance. Fast flow rates for those with
intact pharyngeal swallow but early fatigue.
• Bottles: soft plastic bottles are flexible and can be
squeezed to assist rate of flow. Angle neck bottles allow
infant to eat in upright position, also good for side lying or
prone positions.
• Cup: sipper cups with a spout to support jaw and lip
closure but does not cause the child to tilt the head.
Shouldn't use cups that will break, crack or shatter if the
child bites down on edge.
• Spoon: the bowl of the spoon should be relatively flat so
that the child can remove food using the upper lip. Do not
let the child scape food with upper teeth. Spoon should
be hard, and the bowl should fit the child's mouth. Handle
should be of appropriate to the size of the child's hand.
THANK YOU
Reference:Pediatric Swallowing and Feeding
Assessment and Management
(Third Edition)
By Joan C. Arvedson, PhD
Linda Brodsky, MD
Maureen A. Lefton-Greif, PhD

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