Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional
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Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional

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Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional Presentation Transcript

  • Special Start Training Program
  • Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional
    • Presented by:
    • Marjorie Meyer Palmer,M.A.
    • Speech Pathologist
    • Neonatal and Pediatric Feeding Specialist
  • Course Objectives:
    • To identify poor feeders by the sucking pattern they demonstrate
    • To differentiate a disorganized suck from a dysfunctional suck
  • Infant Oral Anatomy
    • tongue filled mouth
    • pear shaped palate
    • sucking pads in buccal cheek
    • uvula approximates epiglottis
    • tongue tip against palate
  • Tongue filled mouth
  • Pear shaped palate
  • Sucking pads
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  • Tongue approximates palate Uvula approximates epiglottis
  • Infant designed for function
    • To take oxygen nasally
    • To take nutrition orally
    • Observe the normal oral resting posture
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  • Interrupted Function
    • Infant with BPD, chronic lung disease
    • Open mouth posture
    • Labored respiration
    • Breathing is both nasal and oral
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  • Interrupted Function
    • Infant with Arnold Chiari malformation
    • Spina bifida
    • Open mouth posture
    • Oro-facial hyptonia
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  • Emergence of Primitive Oral Reflexes
    • gag reflex
    • rooting reaction
    • transverse tongue reflex
    • phasic bite
    • non-nutritive suck
    • nutritive suck
  • Gag Reflex
  • Rooting Reaction
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  • Transverse Tongue Reflex
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  • Non-nutritive Suck
    • Short, rapid excursions of jaw
    • Rate of 2 sucks/second
    • Cupped tongue configuration
  • Non-Nutritive Suck
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  • Nutritive Suck
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  • 3-6 months: Transition from Reflexive to Volitional
    • volitional suck
    • bilabial closure
    • tongue tip elevation
    • quiet jaw
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  • Neonatal Intensive Care
    • The experience
  • Neonatal Intensive Care
    • Environment
    • Medical Intervention
    • Oro-facial procedures
    • Development of oral-motor skills
    • Impact on oral-sensory system
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  • Impact on oral-motor development
    • Early Diagnosis of Oral Feeding Disorders
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    • NOMAS®
    • (Neonatal Oral-Motor Assessment Scale)
    • Developed by Marjorie Meyer Palmer, M.A., 1985
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  • Differential Diagnosis of Neonatal Sucking Patterns*
    • Normal
    • Disorganized
    • Dysfunctional
    • *Based upon the NOMAS®, developed by Marjorie Meyer Palmer, M.A.
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  • Disorganized Suck
    • “refers to a lack of rhythm of the total sucking activity”
    • Crook, 1979
  • “ BPD prevents the infant from breathing and swallowing efficiently during sucking and swallowing”
    • Craig, CM et.al., 19”99
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  • Dysphagia-
    • swallowing disorder with difficulty that may occur in any or all stages of swallow: oral, pharyngeal, esophageal
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  • Dysphagia
    • double aortic arch
    • infant at 35 weeks PCA
    • stridorous sounds with bottle feeding
    • less stridorous with breast feeding
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  • Dysphagia
    • Infant with TEF repair
    • choking with feeds
    • material collects above the surgical repair
    • esophagus will recover
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  • Dysphagia
    • infant with VACTERL syndrome
    • TEF fistula repair
    • now two months corrected age
    • has developed compensatory strategies
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  • Sensory Aspects of Neonatal Sucking
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  • Perseveration
    • Responds to initial stimulus
    • Once stimulus has been removed activity does not diminish
    • Activity continues indefinately
    • Poor intra-oral sensory perception
  • Developing Sensory Aversion
    • Infant born at 30 weeks gestation
    • now 40 weeks PCA
    • BPD, chronic lung disease
    • observe subtle head movement
    • poor care giving skills
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  • Developing Sensory Aversion
    • premature infant now 9 weeks corrected age
    • observe head movement, facial expression, eyes
    • expression component of suck still reflexive
    • suction component of suck volitional
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    • After a series of pain episodes infants learn to escape heartburn by refusing to eat or by limiting the size of their meals*
    • PE Hyman, M.D., Journal of Pediatrics, 1994, 125:S103-9.
    Visceral Hyperalgesia
  • Sensory-based oral feeding aversion
    • 7 month old infant
    • born with diaphragmatic hernia
    • gastrostomy tube/Nissen fundoplication
    • non-oral feeder
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  • For more information:
    • www.nomasinternational.org
    • www.marjoriemeyerpalmer.com
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