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Welcome!

Welcome!. Assessment and Treatment of Pediatric Dysphagia SPHSC 543 B Website: http://faculty.washington.edu/jul2/ Syllabus. Prevalence. Feeding disorders 25% in all children 80% in children with special healthcare needs and developmental delays ( Manikam & Perman , 2000)

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  1. Welcome! • Assessment and Treatment of Pediatric Dysphagia • SPHSC 543 B • Website: http://faculty.washington.edu/jul2/ • Syllabus

  2. Prevalence • Feeding disorders • 25% in all children • 80% in children with special healthcare needs and developmental delays • (Manikam & Perman, 2000) • Swallowing disorders • Unknown in pediatric population

  3. Adult vs infant • Small mandible • Tongue • Sucking pads till 4-6 months • Directionality of movement • Preferential nose breathers • Close proximity of tongue, soft palate and pharynx • Position of larynx • Preserved until 3-4 mos when anatomical changes start to take place

  4. Anatomical changes • Mandibular growth • Sucking pads absorbed • Oral cavity elongates • Lip valving • Neurological maturation • TMJ grading • New directionality • Teeth • Laryngeal descent

  5. Neural Control

  6. Embryonic period: Weeks 1-8 • 3rd week • By 4th week • By 7th week

  7. Fetal period: Week 9-Birth • Weeks 12-14 • Weeks 15-18 • Week 24 • Weeks 26-29 • Weeks 30-34 • Weeks 35-38

  8. Embryologic Abnormalities • CNS damage • Congenital malformations – both genetic (chromosomal abnormalities) and environmental factors with some a combination of both acting together • Upper airway anomalies/anatomic defects

  9. Problems • Cerebral palsy • Moebus • Treacher Collins, Pierre Robin, palatal clefting • Beckwith-Wiedemann syndrome, Down syndrome, ankyloglossia • Tracheo-esophageal fistula, diaphragmatic hernia, hypertrophic pyloric stenosis • Tetrology of Fallot, transposition of the great arteries, atrialseptal defect, ventricular septal defect

  10. Reflexes related to swallowing • Programmed responses to specific sensory input • Developed early in utero • Allow infant to seek out and obtain nutrition safely • Interplay generally more important than presence/absence • 2 categories of oral reflexes: • Assist in the acquisition of food • Protect the airway

  11. Adaptive • Rooting • Sucking • Suck-swallow response

  12. protective • Gag • Cough • Tongue protrusion

  13. Other reflexes • Phasic bite • Transverse tongue response

  14. Suckling and sucking • Nutrition • Calming • Exploration • Physiologic flexion

  15. Sucking • Positive pressure/compression • Negative pressure/suction • Pressures may be used differently between breast and bottle.

  16. Mechanics of Sucking • Tongue • Jaw • Lips • Cheeks • Palate

  17. Sucking pressure • Variable • Dependent on state • Fluid flow • Nipple characteristics

  18. problems • Anatomic defects • System dysfunction • Tone/muscular control • Oral pain

  19. Breastfeeding • “Ideal” food • Suck/swallow sequence similar to other nipple feedings

  20. Human breast

  21. Breastfeeding • Nipple elongates • Jaw and tongue elevation • Areola compressed • Milk expressed • Jaw lowered • Lactiferous ducts refill

  22. breastfeeding • Letdown reflex • Suck/swallow sequence • Bursts and pauses • Jaw and lips • Volume

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