Milestones
During what period/age would a child show the rooting reaction and reflexive suck-swallow?
Neonatal period
What are the major oral motor skills for eating/swallowing?
Sucking
Drinking
Chewing
Biting
Pace
Rhythm
Coordination of suck/swallow/breathe
What is the #1 issue with feeding?
Fear and anxiety
What type of texture should be introduced first when grading food textures?
Smooth
What are the possible clinical signs of aspiration?
Coughing or choking
Excessive drooling
Upper airway noise, particularly when feeding
Watery eyes
A child shows true sucking with increased control over jaw, lips, cheek, tongue, with up and down tongue movement. They eat a mostly liquid diet but the parent is starting to introduce pureed food. What age is this child?
4 months
What are some factors that should be considered during a feeding evaluation?
- Medical history
-Medications
-Current diet (food log)
-Positioning/seating
-Environment
-Utensils
-Caregiver concerns
-Behavioral observations
- Communication skills
-Respiratory status
Causes of fear in feeding:
Sensory processing, choking, motor planning, muscle weakness
External pacing, improving head position, and improving coordination with breathing are interventions for what feeding problem?
Swallowing
What are the steps to build a relationship with food?
Tolerates food
Interacts with food
Smells food
Touches food
Tastes food
Eats food
A child is 7-8 months old. What oral motor and feeding skills would you expect to see?
- Strong sucking pattern
- Munching on spoon
- Finger feeding
- Tongue lateralization
- Active lips to clean spoon
- Does raspberries
- Eats mostly soft/pureed foods
What factors should be assessed during an oral motor examination?
Cheek tone, tongue thrust, high arched palate, palatal cleft, non-nutritive suck/swallow coordination, tongue lateralization, tongue elevation and retraction, chewing patterns
Place in an infant seat
Use tilt in space wheelchair
Hold on thighs facing the caregiver
Place in a feeder chair
What are some examples of sensory interventions for feeding?
Wipe the infant's face with a warm washcloth
Use finger or pacifier rubbing gums in a rhythmic pattern
Apply pressure to the upper pallet
Encourage baby to suck on rubber toys
Introduce taste into oral stimulation by dipping rubber toy, NUK toothbrush or pacifier into baby food
Birdie is able to bite through a hard cookie, her lips are active in cup use and chewing, and she is able to transfer food from the center to sides of her mouth. What age might Birdie be?
9 months
At what age would a child show feeding skills such as demonstrating interest in using a fork and eating cereal with a utensil?
24-30 months
What should be considered when evaluating the oral phase of swallow?
How does infant move food/liquid to back of mouth?
Is tongue movement adequate to control liquids?
Signs of swallow
Rhythm of suck-swallow
What are some techniques to facilitate oral motor skills?
Handling of the facial and oral structures (supporting jaw with hands, etc)
Noise level
Appropriate utensils
Feet touching floor or solid object
Focus on social aspect
For school: eat in room to start and then join for social, feet on floor/backs to chairs
What are some interventions to address fear and anxiety in feeding?
Positioning
Deep pressure
Calm environment
Making expectations clear
Using visual supports
At what age does the skill of recognizing function of objects allow a child to start using a spoon and bringing it to the mouth?
12-14 months
What are some signs that a child is hyporesponsive to proprioception?
Seeks out movement/input to the joints
May grind teeth, press on chin or cheeks
Enjoys falling, crashing, climbing
Unable to grade movements (piercing with fork, "aggressive" towards others)
What are some adaptive positions for feeding?
Sidelying
Chin tuck
Trunk support
What are some ways to adapt the food/drink?
Thickened liquids
Advance textures
Puree table foods
Fork mash foods
Foods in shapes
Add spice
True or false: It is appropriate to introduce a spoon at 6 months of age.
True