Sensory and Motor Disorders of Neonatal Sucking

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Sensory and Motor Disorders of Neonatal Sucking: Non-nutritive and Nutritive. presented by Marjorie Meyer Palmer,M.A. Neonatal/Pediatric Feeding Specialist

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Sensory and Motor Disorders of Neonatal Sucking

  1. 1. Sensory and Motor Disorders of Neonatal Sucking: Non-nutritive and Nutritive presented by Marjorie Meyer Palmer,M.A. Neonatal/Pediatric Feeding Specialist
  2. 2. Course Objectives: <ul><li>To recognize the differences between motor and sensory disorders of neonatal sucking </li></ul><ul><li>To identify four characteristics of a motor based feeding disorder </li></ul><ul><li>To describe three types of sensory feeding problems </li></ul>
  3. 3. Non-nutritive Suck <ul><li>burst/pause pattern </li></ul><ul><li>burst of 5-20 sucks* </li></ul><ul><li>followed by pause of equal duration </li></ul><ul><li>rate of 2/second </li></ul><ul><li>consistent degree of jaw depression </li></ul><ul><li>bursts last about 7 seconds* </li></ul><ul><li>*(Sameroff, AJ, 1973) </li></ul>
  4. 5. Deviant Non-nutritive Suck: Motor Aspects <ul><li>Jaw clenching </li></ul><ul><li>Open mouth; unresponsive </li></ul><ul><li>Lack of fluid movement </li></ul>
  5. 6. Non-nutritive Suck: Sensory Aspects <ul><li>Habituation </li></ul>
  6. 7. Non-nutritive Suck Sensory Aspects <ul><li>Perseveration </li></ul>
  7. 8. What do we know about the nutritive suck? <ul><li>suck develops at 16 weeks in utero </li></ul><ul><li>suck/swallow develops at 32-34 weeks PCA </li></ul><ul><li>suck/swallow/breathe develops at 37 weeks PCA or later (continuous burst pattern) </li></ul><ul><li>optimal feeding occurs when the pharyngeal swallow and respiration are well coordinated </li></ul>
  8. 9. Nutritive Suck
  9. 10. Nutritive Suck: Motor Aspects <ul><li>Rate 1/2 of non-nutritive suck </li></ul><ul><li>Normal immature pattern (3-5 sucks) </li></ul><ul><li>Normal mature pattern(continuous burst) </li></ul><ul><li>Cupped tongue configuration </li></ul><ul><li>Jaw depression greater with swallow </li></ul>
  10. 11. Dysfunctional Suck <ul><li>the interruption of the successful sucking activity by abnormal movements of the tongue and jaw </li></ul><ul><li>(Palmer, 1983) </li></ul>
  11. 12. Deviant Nutritive Suck: Motor Aspects <ul><li>Excessively wide jaw excursions </li></ul><ul><li>Flaccid; flattened tongue configuration </li></ul><ul><li>Jaw clenching </li></ul><ul><li>Tongue retraction </li></ul><ul><li>Inappropriate sucking rate </li></ul>
  12. 13. Dysfunctional Suck: with abnormal movements of tongue and jaw <ul><li>flaccid tongue </li></ul><ul><li>excessively wide jaw excursions </li></ul>
  13. 14. Dysfunctional suck with abnormal movements of tongue and jaw <ul><li>jaw clenching </li></ul><ul><li>tongue retraction </li></ul>
  14. 15. Nutritive Suck: Normal Sensory Aspects <ul><li>the mouth is the “oral sensorium” </li></ul><ul><li>sensory differentiation among five stimuli </li></ul><ul><li>acknowledgement of change in facial expression </li></ul><ul><li>adaptation immediate and apparent </li></ul>
  15. 16.
  16. 17. Nutritive Suck: Sensory Disorders <ul><li>Poor adaptability </li></ul><ul><li>Habituation </li></ul><ul><li>Perseveration </li></ul><ul><li>Visceral hyperalgesia </li></ul><ul><li>Oral feeding aversion </li></ul>
  17. 18. Infant with neonatal encephalopathy of unknown etiology <ul><li>presents with poor adaptability </li></ul>
  18. 19. Infant with intra-uterine drug exposure <ul><li>presents with habituation and poor adaptability </li></ul>
  19. 20. Perseveration <ul><li>sucking begins with initial stimulus </li></ul><ul><li>there are no pauses </li></ul><ul><li>behavior continues without stopping </li></ul>
  20. 21. Sensory-Based Oral Feeding Aversion <ul><li>developing in a 40-week old infant </li></ul><ul><li>chronic lung disease/BPD </li></ul><ul><li>normal oral-motor characteristics of suck </li></ul><ul><li>labored respiration = stress </li></ul>
  21. 22. Sensory and Motor Problems during nutritive sucking <ul><li>ex-premie with 23 week gestation </li></ul><ul><li>now 6 weeks corrected age </li></ul><ul><li>four characteristics of motor problems </li></ul><ul><li>also presents with perseveration </li></ul>
  22. 23. Sensory-Based Oral Feeding Aversion <ul><li>developing in 6-week old infant </li></ul><ul><li>multiple signs of stress with feeding </li></ul><ul><li>suck reflex still present </li></ul>
  23. 24. Transitional Stage of Sucking in 9 week old infant <ul><li>from reflexive to volitional </li></ul><ul><li>occurs between 3-5 months </li></ul><ul><li>tongue movement inhibited </li></ul><ul><li>jaw movement last to become volitional </li></ul><ul><li>development of sensory-based oral feeding aversion </li></ul>
  24. 25. Sensory-Based Oral Feeding Aversion secondary to structural abnormalities
  25. 26. Double Aortic Arch
  26. 27. Tracheo-esophageal Fistula Repair
  27. 28. Sensory-Based Oral Feeding Aversion secondary to gastroesophageal reflux
  28. 30.
  29. 35. THE END

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