Anatomy & Physiology
What are the structures in the aerodigestive tract?
lips, mandible, maxilla, floor of mouth, cheeks, tongue, hard/soft palate, anterior surfaces of the tonsillar pillars pharynx, larynx, and esophagus.
describe the oral prep/transit phase of the swallow
oral prep/transit: voluntary, bolus is formed, lip closure to prevent spillage, propulsion of bolus to pharynx via tongue, soft palate elevates (less than 1 second)
what are the primitive reflexes, and their integration timelines?
rooting (head turns toward touch on cheek/mouth): 3-6 mos
tongue protrusion (tongue protrudes w/ touch to tongue or lips): 4-6 mos
tongue transverse (lateral tongue motion w/ touch to tongue): 6-9 mos
phasic bite (closing with pressure on gums): 9-12 mos
gag (palate/pharynx contracts w/ touch): persists
autonomy
individuals ability to make their own choices for their health, in children the parents/caregivers hold this.
Laryngopharyngeal reflux (LPR) (aka extra-esophageal reflux (EER))
regurgitation of stomach contents through the UES into the pharynx, larynx, mouth, nose, paranasal sinuses, lungs
what are some anatomical differences between infants and older children?
infants: tongue fills mouth, edentulous (no teeth), tongue rests between lips and sits against the palate, cheeks have sucking pads (fatty tissues within the buccinators), small mandible. no oropharynx, larynx is 1/3 adult size, half true vocal fold cartilage, narrow epiglottis, higher larynx
older children: larger mouth, dentulous (has teeth), tongue rests on floor of mouth and behind teeth not against the palate, buccinators are for chewing only, normal mandible size, elongated pharynx w/ oropharynx, flat/wide epiglottis, by 2 y.o larynx is in adult position.
describe the pharyngeal phase of the swallow
begins voluntary then becomes involuntary, pharyngeal constrictors contract to propel bolus to the pharynx, larynx closes via epiglottis, UES opens.
what are some motor milestones related to feeding readiness?
neck and trunk control, midline orientation of head and neck, putting hands together at midline, sitting independently, grasping and picking up objects,
beneficence
positive and direct steps to help others
airway anatomical/structural abnormalities
choanal atresia, nasal stenosis, laryngomalacia, VF paralysis, laryngeal cleft, vallecular cyst
what systems are required for proper feeding and swallowing coordination?
respiratory, nervous, muscoskeletal, GI
describe the esophageal phase of the swallow
begins when bolus enters UES, peristalsis moves food down the esophagus, ends when food passes through the LES
what are some age appropriate feeding skills and textures for infants? (for answer: read age groups for me to give)
0-3 months: liquids only (formula/breastmilk)
4-6 months: purees
6-9: soft solids & cup drinking
10-12: self finger feeding
nonmaleficence
"do no harm" / avoiding causing or inflicting harm
craniofacial anatomical/structural abnormalities
cleft palate, midface hypoplasia, pierre robin sequence
what is the laryngeal positioning across development?
higher in infants (C2-C3), and goes to normal positioning by 2 years of age.
what are some aspiration risk points during the phases of swallowing?
poor bolus control, delayed swallow initiation, reduced laryngeal closure, weak pharyngeal contraction
what are some age appropriate feeding skills in toddlers?
13-18: all textures, straw drinking
19-24: chewable foods w/ rotary chew. independent feeding
24-36: open cup drinking, solids, total self feeding
justice
fairness in all medical settings including health care resources and scarce resources and new treatments.
GI anatomical/structural abnormalities
TEF, esophageal atresia, pyloric stenosis, duodenal obstruction, rings/webs
what CNs are involved in swallowing?
Trigeminal (V), Facial (VII), Glossopharyngeal (IX), Vagus (X), Hypoglossal (XII)
aspiration potential is greatest in what phase?
pharyngeal phase
parental vs enteral feeding
parental: nutrition given via IV
enteral: nutrition given via GI tract
s/s to observe during feeding
coughing, choking, cyanosis, increase breathing rate, pauses, grunting, head bobbing, regurgitation, fatigue, prolonged feeds
Red flags requiring immediate medical referral
Cyanosis
Apnea
Seizures
Bilious vomiting
GI bleeding
Severe abdominal pain
Failure to thrive
Food impaction
Recurrent pneumonia