Feeding

a functional process which involves the interactions of a variety of factors including:

the child's environment, caregiver-child interaction, feeding techniques, utensils, positioning, swallowing, etc.

*everything that happens before you even put food in the mouth

Swallowing

Signs and Symptoms of Oral Dysphagia

• anterior leakage and drooling
• pocketing of foods
• lingual residue after swallowing
• leakage over the base of the tongue
• prolonged mastication
• prolonged oral transit time

Signs and Symptoms of

PEDIATRIC Dysphagia

• prolonged meal time (>30 to 40 minutes)
• excessive drooling or build up of secretions
• food remaining in the mouth after swallowing
• multiple swallowing needed to clear food from mouth
• open mouth swallowing
• tongue thrusts

Behavioral Signs of Dysphagia

(Pediatrics)

• excessive gagging or hypersensitivity
• texture preference
• refusal of oral feeding
• periods of coughing and choking
• hyperextension and rigidity
• "turkey swallow"
• difficulties securing food from spoon
• meals are unhappy
• positioning problems (pelvic dysfunction)

Aspiration

residue below the TVFs; causes patient to cough

General Signs of Aspiration

-increased respiratory rate with labored breathing

-pulmonary congestion

-cyanosis (blue-purpled colored skin)

-diaphoresis (sweating)

-persistent low grade fever

Signs of Silent Aspiration

-eyes and or nose watering or teating

-reddening of the face

-facial grimaces

-weak or absent cough

Penetration

• bolus entering the supraglottis to the level of the TVF
• may produce wet vocal sounds; gargled voice
• sits on top; doesn't enter TVFs

Signs and Symptoms of

Pharyngeal Dysphagia

OVERT:

-coughing, choking with swallowing

-difficulty initiating swallowing

-recurrent pneumonia

-change in voice quality

-nasal regurgitation

COVERT:

-unexplained weight loss

-change in dietary habits

-silent aspiration

Signs and Symptoms of

Esophageal Dysphagia

• sensation of food sticking in chest
• oral or pharyngeal regurgitation
• food sticking in throat
• drooling
• unexplained weight loss
• change in dietary habits
• recurrent pneumonia
• esophagitis- swelling of the lining of the esophagus
• sudden dysphagia
• cough late in swallow
• pain made worse by solid food
• change of diet to soft foods

Pediatric Gastrointestinal Problems

• emesis, regurgitation, and GERD
• failure to thrive
• weight or growth compromise
• poor nutrition

CVA

• cogition:

-poor awareness of foods

-poor sequencing

-impulsive

• apraxia of swallowing
• left or right side neglect

TBI

• delayed or absent pharyngeal swallow
• apraxia of swallowing
• disrupted laryngeal peristalsis
• reduced tongue base retraction

Pseudo-Bulbar Palsy

• weakness of the pharyngeal muscles
• decrease in mucosal sensitivity
• difficulties initiating swallowing due to poor cerebral input (unaware)
• increase reflexes and incoordination