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Pediatric Dysphagia

CSD 625

Kamaile Hiatt, M.S. CCC-SLP


PhD Student James Madison University

October 28, 2013


Module 1: Normal Anatomy, Physiology, & Development of Feeding

Respiration Activity
Breathe at the top of lung volume Watch for physiological reactions Without taking a breath, engage in instructed task Please try not to talk. Focus instead, on observing

Respiration Activity
What did you observe?

What did you experience?

How well were you able to do the task?

Respiration
Lungs are proportionately larger in infants Obligate nose breathers Belly breathing Normal respiratory patterns in feeding
Apneic moment Swallow on exhalation (most of the time) Trigger point for pharyngeal swallow

Respiration
Birth to 5 mos: 57-80 BPM 6-12+ mos: 41 BPM

Resting BPM depends on stage of alertness


Helps determine if in a state to feed Lung capacity increases with growth, decreases in respiratory rate

Respiration
Belly breathing: abdominal expansion w/minimal thoracic movement. *abnormal in infants 6 mos< Gulp breathing: short, rapid inhalations; may be associated w/extension of the mandible and rhythmic backward movement of head *looks like gulping air

Respiration
Reverse breathing: product of vertebral instability which causes belly breathing; rib cage flaring and sternal depression *tugging or retraction Irregular/shallow breathing Apnea: aperiodic cessation of breathing

Common Respiratory Issues


Incoordination of suck/swallow/breathe (abnormal after 1st month; more common in infants with neurological pathology) Pulmonary disease
Cystic fibrosis Mother with Myasthenia Gravis Werdnig Hoffman Premature birth

Common Respiratory Issues


Obstructive issues
Pierre Robin Laryngeal Cleft Tracheomalacia

Allergies
Obligate nose breathers Increased expenditure of energy

Asthma
incoordination

Common Respiratory Issues


Positive history of intubation Recurrent respiratory infection
Pneumonia RSV

Primitive Reflexes

Primitive Reflexes

Grasp Babkin Palmomental Moro (Startle) ATNR

Arvedson & Brodsky, Figure 3-10, p. 117

Video Example

Are feeding difficulties primarily caused by the environment?

Does a parents pickiness cause their childs pickiness?


Carruth, B.R. & Skinner, J.D. (2000) 17% mothers considered themselves Picky 4% pf their children were considered Picky @ 34, 42, 60, 72 AND 84 mos.

Esparo et. al. (2004) Parental psychopathology feeding problems More life events were associated with feeding issues AND Children with feeding issues were more likely to be hyperactive, had vocal tics, anxiety, adjustment problems, elimination problems, attachment and somatic complaints

Pridham et. al. (2001) AS the childs weight became less deviant, a Mothers feeding affect and behavior BECAME more positive There were NO significant associations with Mothers symptoms of depression in either group or across ages on the Mothers feeding affect or behavior

Wright & Birks (2000) the role of deprivation and neglect has been overstated p. 5

Wright & Burk (2000) contd Environmental variables held constant, children with significant weight difficulties have:
More infancy feeding problems; Delayed introduction to baby/finger foods; Parental report of child as a variable eaters, less hungry, less demanding

Poverty/Abuse/Low SES Feeding problems


We are not picking up on: problems in infancy problems in delayed introduction parental report

Kasese-Hara et. Al. (2002) Up until 3 years, typical children eat until they are full; Case children do not naturally adjust intake up & down.

Young children with feeding issues are different from their peers

Lets revisit Maria & Hartlee

Clinical questions: What are they doing? What should they be doing? Why?

Case Study Videos


Practice

The End