Practicalities of feeding
cardiac babies
Sucking Feeds and Solids
Material prepared by Terry Wackrow August 2010
An effective feeding plan considers:

SAFETY - the feeding plan should support
and maintain the child’s health

OPTIMAL NUTRITION - this is essential as
the feeding process is high energy output

FARSIGHTED - the implications of current
treatment on future feeding and oral
functions must be considered
Feeding impacted by:
[Chart adapted from: Factors that may affect feeding the child with neurological impairment (Reilly et al in Southall, A and Schwartz, A (eds)(2000) Feeding problems in
Children: a practical guide. Oxford. Radcliffe Medical Press p154) ]
Oromotor /
pharyngeal function
Motor control
Posture
Communication
Fear
Behaviour:
Fatigue; Endurance
State Maintenance
Social factors
Aversive experiences
Vision
Hearing
Tactile
Developmental levels
Cognitive level
Drugs
FEEDING
GOR
Constipation
Neurological Issues
Cardiac Issues
Cardiac specific feeding issues

Infants and children with cardiac difficulties
frequently have feeding difficulties that result in
failure to thrive
 Poor endurance, fatigue and high nutritional
needs are key limiting factors

Associated problem areas



inco-ordination of swallowing
poor oral feeding skills
increased respiratory effort
Which can lead to increased risk factors
for aspiration
 Ongoing difficulty with suck /swallow /
breathe synchrony



can be throughout a feed
can develop during a feed
often related to endurance and fatigue problems

Persistent stress signs
during sucking feeds
have a huge impact on
feeding skills







increased sweating
colour change
changes in state
increased respiratory effort
persistent feed related
desaturations
coughing and /or choking
increased heart rate during
feeds

Use a syringe with caution: introduce fluid
slowly and allow baby time to swallow

If a baby is refusing to feed, look in the baby’s
mouth


Check for thrush
Look for signs of teething
thrush
teething
Breast Feeding

Breast Feeding is the GOLD STANDARD
 Breast feeding support is from the Lactation
Consultant
 If there are oro-motor difficulties or queries
regarding swallow safety, the SLT becomes
involved
Bottle Feeding

Bottle feeding, like all feeding, is a learned
process
 There are always two parties involved: it is a
feeding DYAD
 Communication within that dyad is essential



Feed to early cues
A baby gets stressed with feeds for a reason
All feeds should be enjoyable for both parties
Troubleshooting with bottle feeds
Check state of teat:
 These teats need to be
replaced

Split x-cut

Deteriorated teat
texture

Check technique

Teat part empty
taking in air

Poorly supported
Bottle weight on
mouth


Look for bubble movement in the teat

Check for anterior loss

Chin support can assist when baby fatigues

Utilise neonatal
reflexes that support
feeding eg
palmar grasp
flexed position
Introducing solids

Textures and viscosity relating to swallow
safety is SLT responsibility
 Calorie intake, volumes, dietary restrictions
are dietician responsibility
 Cultural considerations around food and drink
should be known and implemented by all
involved with the child
NOTE

Ice-cream and jelly both class as liquids so
are NOT suitable if a child has swallow safety
issues with liquid
First solids

Some cardiac babies
start solids before 6
mths
 The dietician must
agree
 If initial NG insertion not
just for nutrition support,
SLT should review
swallow before solids
started
 If a baby is tube fed, it is
fine to introduce solids if
cueing appropriately

Spoon feeding:





Mouth open
anticipating
Spoon presented
horizontally
Tongue down
Encourage
removal of food
by upper lip
Residue on face
not scraped off
Self feeding

When a baby is
reaching for the
spoon – give him
one too
 Mess and self
feeding go together
and are a vital
sensory experience

Finger foods are developmentally important
 These need to be appropriate and safe

Texture choices for finger foods are helpful to
develop tolerances and preferences
Seating for solids: spoon and fingers

A child needs to be stable and well
supported for meals
 Avoid feeding seated on caregiver’s
lap: the feeder cannot see the child’s
face if it has difficulty
 Seating supported in a highchair, a
tumbleform chair or car seat are safer
choices

Tumbleform chair



ALWAYS fasten
straps
use at angle set by
therapist
never leave
unattended

Highchair – use rolled
up towels or nappies
for side support
Safety first for every meal or drink

FOCUS on the task in hand
 LOOK AT POSITIONING
how is the head positioned?
is the trunk supported?
is the baby swaddled?
 CHECK
texture
temperature
viscosity –
as per SLT directions
Any questions, contact the SLTs