Ann Tompkins, MS-­‐CCC/SLP Speech Language Pathologist Pediatric Specialist Department of PM&R Speech Pathology UC Davis Medical Center, Sacramento Objec&ves —  Review the Suck, Swallow Breathe Function —  Review what is important for chewing —  Feeding Milestones —  How clefts, low tone, cardiac conditions and other anomalies can affect feeding —  Red flags to look for during feeding as your child grows and what you can do! Ea&ng is thought to be an easy process that the majority of people like to do. So why is it so challenging for some parents to feed their children ? Why are there some children that can’t/won’t eat food by mouth? We are laying the foundation for feeding…… First 4-­‐6 weeks of life feeding is an instinct After that time it is learned Acquisi&on of Feeding Skills 0-­‐6 months 6-­‐12 months 12-­‐24 months Suck Swallow Breathe Sequence
Im pa ct of Suck ing on Swa llowing
1. Su ckin g l iqu id tri gg e rs swa ll ow in g.
2 . S uck in g ra te , s ize a nd spe ed of bo lu s
affe ct fre qu en cy an d tim in g o f sw al lo w.
Impa ct of S wa llowing on B re at hing
1 .As a p rote cti ve me ch an ism ,
re sp ira ti on i s su pp ress ed d u rin g
Sw al lo wi ng .
2 .Th e se freq ue nt re spi rato ry sup pr essi on s du rin g N S
L ea d to d ecr ea sed RR a nd de pth o f r esp ira tion .
Impa ct of B re athing on Suc king
1 . S en sitiv ity to de cre ase d a rteri al o xyg en satu ratio n h ypo the size d to
trig ge r cha ng e from co n ti nu ou s to in termi tte nt su cki ng .
2 . Ab no rma l re spi rato ry fun ctio n res ul ts i n ab no rma l su cki ng p atter ns to
mi ni mize resp ir atory c omp ro mise .
3 . Su cki ng rhyth m may i nfl ue nce th e re spi ra to ry ra te an d pa ttern .
Wolf , L. & R. Gl ass . Feeding and S wallowing Dis orders i n Inf ancy : As s es s ment and M anagem ent . Tuc son, A Z: Therapy Sk ill Buil ders 1992.
Sucking Spoon Feeding Chewing Things That Can Make Feeding Challenging………… CleI Palate Low Tone
Cardiac and Respiratory Issues Feeding Tubes Red Flag with Feeding (Infants) —  Increased oral loss —  Increased noise with suck —  Poor latch to the nipple —  Increased feeding time >30 min —  Stress signs (splaying of fingers, wide eyes, pulling away, tachycardia) —  Increased respiratory infections Red Flags with Feeding (Older Children) —  Increased meal times >20-­‐30 —  Meal times are a struggle/not enjoyable —  Your child needs distractions during meal times —  Limited food variety <10 starches, <10 proteins, <10 fruits/veggies —  Increased respiratory infections So What Can You Do????? —  Contact your Pediatrician —  Get a referral to a Pediatric Feeding Team or Feeding Therapist