Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional

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Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional

  1. 1. Special Start Training Program
  2. 2. Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional <ul><li>Presented by: </li></ul><ul><li>Marjorie Meyer Palmer,M.A. </li></ul><ul><li>Speech Pathologist </li></ul><ul><li>Neonatal and Pediatric Feeding Specialist </li></ul>
  3. 3. Course Objectives: <ul><li>To identify poor feeders by the sucking pattern they demonstrate </li></ul><ul><li>To differentiate a disorganized suck from a dysfunctional suck </li></ul>
  4. 4. Infant Oral Anatomy <ul><li>tongue filled mouth </li></ul><ul><li>pear shaped palate </li></ul><ul><li>sucking pads in buccal cheek </li></ul><ul><li>uvula approximates epiglottis </li></ul><ul><li>tongue tip against palate </li></ul>
  5. 5. Tongue filled mouth
  6. 6. Pear shaped palate
  7. 7. Sucking pads
  8. 9. Tongue approximates palate Uvula approximates epiglottis
  9. 10. Infant designed for function <ul><li>To take oxygen nasally </li></ul><ul><li>To take nutrition orally </li></ul><ul><li>Observe the normal oral resting posture </li></ul>
  10. 12. Interrupted Function <ul><li>Infant with BPD, chronic lung disease </li></ul><ul><li>Open mouth posture </li></ul><ul><li>Labored respiration </li></ul><ul><li>Breathing is both nasal and oral </li></ul>
  11. 14. Interrupted Function <ul><li>Infant with Arnold Chiari malformation </li></ul><ul><li>Spina bifida </li></ul><ul><li>Open mouth posture </li></ul><ul><li>Oro-facial hyptonia </li></ul>
  12. 16. Emergence of Primitive Oral Reflexes <ul><li>gag reflex </li></ul><ul><li>rooting reaction </li></ul><ul><li>transverse tongue reflex </li></ul><ul><li>phasic bite </li></ul><ul><li>non-nutritive suck </li></ul><ul><li>nutritive suck </li></ul>
  13. 17. Gag Reflex
  14. 18. Rooting Reaction
  15. 22. Transverse Tongue Reflex
  16. 27. Non-nutritive Suck <ul><li>Short, rapid excursions of jaw </li></ul><ul><li>Rate of 2 sucks/second </li></ul><ul><li>Cupped tongue configuration </li></ul>
  17. 28. Non-Nutritive Suck
  18. 30. Nutritive Suck
  19. 39. 3-6 months: Transition from Reflexive to Volitional <ul><li>volitional suck </li></ul><ul><li>bilabial closure </li></ul><ul><li>tongue tip elevation </li></ul><ul><li>quiet jaw </li></ul>
  20. 41. Neonatal Intensive Care <ul><li>The experience </li></ul>
  21. 42. Neonatal Intensive Care <ul><li>Environment </li></ul><ul><li>Medical Intervention </li></ul><ul><li>Oro-facial procedures </li></ul><ul><li>Development of oral-motor skills </li></ul><ul><li>Impact on oral-sensory system </li></ul>
  22. 45. Impact on oral-motor development
  23. 46. <ul><li>Early Diagnosis of Oral Feeding Disorders </li></ul>
  24. 51. <ul><li>NOMAS® </li></ul><ul><li>(Neonatal Oral-Motor Assessment Scale) </li></ul><ul><li>Developed by Marjorie Meyer Palmer, M.A., 1985 </li></ul>
  25. 59. Differential Diagnosis of Neonatal Sucking Patterns* <ul><li>Normal </li></ul><ul><li>Disorganized </li></ul><ul><li>Dysfunctional </li></ul><ul><li>*Based upon the NOMAS®, developed by Marjorie Meyer Palmer, M.A. </li></ul>
  26. 62. Disorganized Suck <ul><li>“refers to a lack of rhythm of the total sucking activity” </li></ul><ul><li>Crook, 1979 </li></ul>
  27. 63. “ BPD prevents the infant from breathing and swallowing efficiently during sucking and swallowing” <ul><li>Craig, CM et.al., 19”99 </li></ul>
  28. 76. Dysphagia- <ul><li>swallowing disorder with difficulty that may occur in any or all stages of swallow: oral, pharyngeal, esophageal </li></ul>
  29. 81. Dysphagia <ul><li>double aortic arch </li></ul><ul><li>infant at 35 weeks PCA </li></ul><ul><li>stridorous sounds with bottle feeding </li></ul><ul><li>less stridorous with breast feeding </li></ul>
  30. 83. Dysphagia <ul><li>Infant with TEF repair </li></ul><ul><li>choking with feeds </li></ul><ul><li>material collects above the surgical repair </li></ul><ul><li>esophagus will recover </li></ul>
  31. 85. Dysphagia <ul><li>infant with VACTERL syndrome </li></ul><ul><li>TEF fistula repair </li></ul><ul><li>now two months corrected age </li></ul><ul><li>has developed compensatory strategies </li></ul>
  32. 88. Sensory Aspects of Neonatal Sucking
  33. 94. Perseveration <ul><li>Responds to initial stimulus </li></ul><ul><li>Once stimulus has been removed activity does not diminish </li></ul><ul><li>Activity continues indefinately </li></ul><ul><li>Poor intra-oral sensory perception </li></ul>
  34. 95. Developing Sensory Aversion <ul><li>Infant born at 30 weeks gestation </li></ul><ul><li>now 40 weeks PCA </li></ul><ul><li>BPD, chronic lung disease </li></ul><ul><li>observe subtle head movement </li></ul><ul><li>poor care giving skills </li></ul>
  35. 97. Developing Sensory Aversion <ul><li>premature infant now 9 weeks corrected age </li></ul><ul><li>observe head movement, facial expression, eyes </li></ul><ul><li>expression component of suck still reflexive </li></ul><ul><li>suction component of suck volitional </li></ul>
  36. 101. <ul><li>After a series of pain episodes infants learn to escape heartburn by refusing to eat or by limiting the size of their meals* </li></ul><ul><li>PE Hyman, M.D., Journal of Pediatrics, 1994, 125:S103-9. </li></ul>Visceral Hyperalgesia
  37. 102. Sensory-based oral feeding aversion <ul><li>7 month old infant </li></ul><ul><li>born with diaphragmatic hernia </li></ul><ul><li>gastrostomy tube/Nissen fundoplication </li></ul><ul><li>non-oral feeder </li></ul>
  38. 106. For more information: <ul><li>www.nomasinternational.org </li></ul><ul><li>www.marjoriemeyerpalmer.com </li></ul>

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