Topic 03: Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
Gestational Age Assessment
An accurate assessment of age is important for 2 reasons
• Age and growth patterns appropriate to that age aid in identifying neonatal risks
• Help in developing management plans
Gestational age can measure by weight for gestational age chart.
Gestational Age Number of weeks that have elapsed since the first day of the last menstrual period to the time of birth. This is usually retrieved from mother’s Antenatal History.
Gestational Age:
• SGA- small for gestational age-weight below 10th percentile •
• AGA-weight between 10 and 90th percentiles
• LGA-weight above 90th percentile
Behavioural Assessment
While babies may not speak their first word for a year, they are born
How to support & dealing with parents in nicuOsama Arafa
We admit babies to the Neonatal Intensive Care Unit (NICU), because they need specialized medical and nursing care.
We recognize that, this can be a very stressful and confusing time for parents and family.
Separation from your new baby is difficult .
Understanding the needs of your baby will help you get through this difficult time.
Weaning is the process of gradually introducing an infant human or another mammal to what will be its adult diet while withdrawing the supply of its mother's milk. The process takes place only in mammals, as only mammals produce milk.
Play in Children or Play Therapy (Importance of Play, Functions of Play, Age-Related Play, Categories of Play, Types of Play, Selection, Safety and Guidelines)..
Childhood is a period where the needs vary according to age.
For a pediatric nurse when dealing with children they should be aware of the needs of a healthy child.
PREVENTION OF ACCIDENTS AMONG CHILDRENS. SANJAY SIR
It is uploaded to create awareness regarding prevention of accidents in children in various age groups among general public. it also helps nursing & paramedics educator to teach their students.
This slides contain description about breast feeding, anatomy of breast, types of human milk, good position for latching, holding for the baby, advantages of breast feeding, contraindication of breast feeding, barriers and problems associated with breast feeding with their management
Topic 03: Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
Gestational Age Assessment
An accurate assessment of age is important for 2 reasons
• Age and growth patterns appropriate to that age aid in identifying neonatal risks
• Help in developing management plans
Gestational age can measure by weight for gestational age chart.
Gestational Age Number of weeks that have elapsed since the first day of the last menstrual period to the time of birth. This is usually retrieved from mother’s Antenatal History.
Gestational Age:
• SGA- small for gestational age-weight below 10th percentile •
• AGA-weight between 10 and 90th percentiles
• LGA-weight above 90th percentile
Behavioural Assessment
While babies may not speak their first word for a year, they are born
How to support & dealing with parents in nicuOsama Arafa
We admit babies to the Neonatal Intensive Care Unit (NICU), because they need specialized medical and nursing care.
We recognize that, this can be a very stressful and confusing time for parents and family.
Separation from your new baby is difficult .
Understanding the needs of your baby will help you get through this difficult time.
Weaning is the process of gradually introducing an infant human or another mammal to what will be its adult diet while withdrawing the supply of its mother's milk. The process takes place only in mammals, as only mammals produce milk.
Play in Children or Play Therapy (Importance of Play, Functions of Play, Age-Related Play, Categories of Play, Types of Play, Selection, Safety and Guidelines)..
Childhood is a period where the needs vary according to age.
For a pediatric nurse when dealing with children they should be aware of the needs of a healthy child.
PREVENTION OF ACCIDENTS AMONG CHILDRENS. SANJAY SIR
It is uploaded to create awareness regarding prevention of accidents in children in various age groups among general public. it also helps nursing & paramedics educator to teach their students.
This slides contain description about breast feeding, anatomy of breast, types of human milk, good position for latching, holding for the baby, advantages of breast feeding, contraindication of breast feeding, barriers and problems associated with breast feeding with their management
Stages of deglutition and tongue thrustingprincesoni3954
The presentation features the types and stages of deglutition; types, etiology, classification, diagnosis, clinical findings and management of tongue thrusting.
cleft lip and palate are the most common type of congenital anomalies. the worldwide prevalence of cleft lip and cleft palate ranges from 0.8 to 2.7 cases per 1000 live births. cleft lip is called cheiloschisis and cleft plate is called palatoschisis. Cleft lip is a gap or indentation in the lip or split continued up to the nostril due to the failure of fusion of the maxillary and medial nasal process.
Cleft palate is the condition in which the two plates of the skull that forms hard palate are not completely joined due to the failure of fusion of the lateral palatine processes, nasal septum and medial palatine process. EMBRYOLOGYPrimary palate forms during the 4-7th week of gestation when two maxillary processes and two medial nasal processes fuse.
Secondary palate forms in 6-9th weeks of gestation when palatal shelves change from vertical to horizontal position and fuse. Tongue migrates Antero-inferiorly.
Cleft lip occurs when an epithelial bridge fails.
Clefts of primary palate occur anterior to incisive foramen and clefts of secondary palate occur posterior to the incisive foramen.
ETIOLOGY Genetic: Non-syndromic inheritance (risk increases with parents or siblings or both affected); chromosome aberrations, associated with other syndromes like Van der Woude syndrome.
Environmental teratogens: Intrauterine exposure to the anticonvulsant phenytoin, alcohol, retinoic acid, maternal smoking, Rubella virus, thalidomide, aminopterin.
Maternal/intrauterine condition: Maternal diabetes mellitus and amniotic band syndrome.
Advanced paternal age
Unknown
CLASSIFICATION Prof. Balakrishnan (1975) classified cleft lip and palate according to the Indian context and divided them into three groups.
Group 1: Only cleft lip, which may be unilateral (right/ left), bilateral, or midline.
Group 2: Only cleft palate, which may be which also can be unilateral (right/left), bilateral, or submucosa.
Group 3: Includes cleft lip, alveolus, and cleft palate, which can be unilateral, bilateral, or midline. LAHSAL system for the classification of cleft lip and/or palate (2005) modified by Royal College of Surgeons Britain: LAHSAL system is a diagrammatic classification of cleft lip and palate. According to this classification, the mouth is divided into six parts. LAHSAL code indicates a complete cleft with a capital letter and an incomplete cleft with a small letter.
CLINICAL FEATURES Cleft lip: Notched vermilion border and may involve alveolar ridge.
Cleft palate: Nasal distortion, exposed nasal cavities.
Misaligned teeth.
Passage of milk through nasal passages during feeding.
Recurrent ear infection.
Speech difficulties.
Poor weight gain and failure to thrive.
DIAGNOSIS Newborn examination at birth
Palpate with a gloved finger or visual examination flashlight
In-utero ultrasonography
PROBLEMS OR COMPLICATIONS OF A CHILD WITH CLEFT LIP AND CLEFT PALATE Immediate Problems:
Feeding difficulty:
Infant with an unrepaired cleft palate will have ...
here we describe about how to take care of infants during the development of his primary dentiton , his progress till 1 year
basically foundatin of
a permanent teeth
b a sound oral health
for lifetime is laid down
Sensory and Motor Disorders of Neonatal SuckingSpecial Start
Sensory and Motor Disorders of Neonatal Sucking: Non-nutritive and Nutritive. presented by Marjorie Meyer Palmer,M.A. Neonatal/Pediatric Feeding Specialist
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
5. Feeding
process of setting up, arranging and bringing of
food from the plate or cup to the mouth
Eating
Swallowing
6. SSB synchrony
Must be rhythmically synchronized so that infant
can receive adequate nutrition from mother’s
breast or nipple of a bottle
Allows individuals to breathe while
simultaneously and unconsciously sucking in
and swallowing food, drink, and saliva
8. Feeding Problems
Clinical findings may include food
refusal/selectivity, vomiting, swallowing
difficulty, prolonged mealtimes, poor weight gain
and failure to thrive.
11. Newborn
Small oral cavity filled
with fat pads inside the
cheeks and tongue.
Can feed safely in
inclined position
12. Infant
neck elongates and the
configuration of the oral
and throat structure
changes
Oral cavity becomes
larger and more
open, tongue becomes
thinner and more
muscular, and the cheeks
lose much of their fatty
padding
13. < 1 year
Hyoid epiglottis, and larynx descend, creating a
space between these structures and the base of
the tongue.
The hyoid and larynx become more mobile
during swallowing, elevating with each swallow.
14. Functions of Oral
Structures in Feeding
Oral cavity =
Contains the food
during drinking and
chewing and
provides for initial
mastication before
swallowing
21. Oral Preparatory Phase
voluntary control
Oromotor feeding intervention
Oral manipulation results in the formation of a
BOLUS
amount of time varies depending on the texture of
food/liquid
Cranial nerves V, VII, IX, and XII
22.
23. Oral Phase
voluntary control
Begins when the tongue elevates against the
alveolar ridge moving the bolus posteriorly
Ends with the onset of pharyngeal swallow.
1-3 seconds
24.
25. Pharyngeal Phase
involuntary control
Starts with the trigger of the swallow at the anterior
faucial arches
Hyoid and larynx move upward and anteriorly and the
epiglottis retroflexes to protect the opening of the airway
Ends with the opening /relaxation of the cricoesophageal
sphincter
1-3 seconds
26.
27. Final/Esophageal Phase
involuntary control
Starts with the contraction of the
cricopharyngeus muscle and ends with the
relaxation of the lower esophageal sphincter,
allowing the food into the stomach.
8-10 seconds
37. True Sucking
4 months of age
Hallmark: tongue begins to move up and down
6 months: Sipper cup with a spout
12 months: bottle to cup, bites on rim of cup
15-18 months: excellent coordination of SSB
24 months: efficiently drink from cup
40. Drinking
6 mos: interest in drinking from a cup
12 mos: emerging cup drinking skills
Cup with a lid and spout
24 mos
4-6 ounce cup without a lid
Drinks from straw
41.
42. Dysphagia
Difficulty in swallowing
Results when obstacles in normal development
arise and are not overcome
Limiting variations in feeding:
Problems in individual oral structures
Problems in sensory processing
43.
44.
45. Jaw
Most important partner of the feeding team
Poor postural tone and poor central stability of
neck and trunk
Jaw thrust, tonic bite reflex, jaw clenching
46. Jaw Thrust
1 year olds use visual input and knowledge of
size to guide jaw movements
Lack of jaw grading
Strong downward extension of the lower jaw
47. Tonic Bite Reflex
When child doesn’t release the bite easily or
when there is tension associated with the bite
elicited from the biting surfaces of the gums or
teeth
May have resulted from an experience of
discomfort in the mouth from oral
hypersensitivity, constant suctioning or oral
hygiene
48. Tonic Bite Reflex
Results to jaw clenching more constant
closure risk of contractures
LOM of the Jaw
51. Tongue
problems in the muscles that attach the tongue
to other structures of the body and move it in
different directions
Low or high tone
Tongue retraction, tongue thrust
52. Tongue Retraction
Results from abnormal postural tone
Breathing difficulties
Child may compensate by pressing tongue
against hard palate
55. Lips and cheeks
These two work together
Low tone:
Cheeks become inefficient barrier to food moved
against gums and teeth = food easily falls into
cheek cavity
Lips are not able to retain food and saliva in mouth
High tone: retracted position
56. Lip Retraction
lips are drawn back so they form a tight
horizontal line over the mouth
Difficulty in sucking, removing food or
liquid, transferring or retaining food placed in
mouth
57. Lip Pursing
Seen when child attempts to counteract effects
of lip retraction
Puckered lips
64. Cleft Palate
The infant has difficulty building up sufficient
negative pressure within the mouth to obtain an
efficient feeding pattern
Food/liquid/tongue may pass through the
opening
65.
66. Sensory Processing
CNS is unable to control and process and
appropriate amount of sensory information at a
level that is comfortable for the child
Hypersensitivity Hyperresponsivity
Hyposensitivity Hyporesponsivity
Sensory defensiveness and Sensory overload
68. Sensory Processing
Often manifests as behaviors like teeth
grinding, tongue sucking, nail or finger
biting, prolonged bottle feeding, thumb
sucking, and pacifier usage
INPUT TO TMJ
Preferred reactions to stress e.g. bite nails, talks
incessantly, chew gums stability
71. Questions
questions about feeding, eating, and swallowing
Assess mealtime participation
Developmental status and health history
Feeding history = any possible frustration and
the parents’ ability to cope with the child’s
feeding issues
72. Neuromotor Evaluation
generalized muscle tone, neuromuscular
status, and general development level
use of adapted seating systems = helps
determine the optimal position for feeding
Upright position or reclined
73. Evaluation of Oral Structures
& Oromotor Problems
Observation of symmetry, size and ROM of oral
structures
Increased oral tone may cause the tongue to be
retracted, humped, or have tip elevation and
may often be the primary cause of feeding
difficulties
Hypotonia may cause tongue to be flat, lack a
midline groove and extend beyond the lips
74. Eating and Feeding
Performance
Final aspect: observation of the actual
feeding/eating and swallowing process to assess
level of performance and to analyze how
motor, sensory, cognitive and communication
skills contribute to performance
parent-child interaction = clues about factors
that may affect the child’s food intake
Variety of textures
75. Videofluoroscopic
Swallow Study
To confirm or rule out swallowing problems
modified swallow study = identifying aspiration
or risk of aspiration
detecting problems related to head and neck
positioning, bolus characteristics, rate and
sequence of presentation, and food/liquid
inconsistencies.
76. Penetration vs Aspiration
flow of liquid/food
underneath the
epiglottis into the
laryngeal vestibule but
not into the airway.
It does not pass
through the vocal folds.
may be silent
It refers to food
entering the
airway before,
during or after
swallow.
77.
78. Feeding Team
Planning and implementing a feeding program
depends on the treatment setting and needs of
the child
Pediatrician, nutritionist/dietitian, SLP, OT, child
behaviorist, developmental psychologist,
dentist, nurse, social worker, teachers, childcare
providers, parents/caregivers
79. Global Considerations
Feeding problems persist = new problems/skill
impairments to complicate intervention needs
consider medical and nutritional problems that
coexist with the feeding d/o and collaborate with
physician and nutritionist for optimum intervention
plan
OTs have to work closely with families and other
caregiver to ensure carryover within daily routines
80. OTs use a holistic
approach
Child factors
Performance skills
Activity demand, context
Family patterns
81. Safety and Health
child’s nutritional status and prioritize treatment
goals to meet basic nutritional needs
use of gloves during therapy services when
there is potential contact with oral mucous
membranes
understanding that certain foods carry a high
choking risk and require modifications or close
supervision with young children
83. Positioning Adaptations
Positioning of the feet, legs and pelvis trunk
stability
Stability, muscle tone and activity in the trunk
muscles affect the child’s ability to move or stabilize
the head and neck
position and muscle activation of the child’s head
and neck influence jaw movements
Good jaw stability and freedom of movement
influence the child’s lip and tongue control.
84. positioning adaptations provide stability in the
trunk and support the child in midline orientation
with the head and the neck aligned in neutral or
slight flexion during feeding
86. Older infants/Toddlers
Regular high chair -
may provide
adequate trunk
support and may
easily be adapted
with small towel rolls
for additional foot
support or lateral
support
89. Positioning
A chin - tuck position
Slight
contraindicated for
young infants who have
laryngomalacia or
tracheomalacia
90.
91. 5 steps to extinguish oral
habits:
1. Root cause of behavior?
2. Why should the habit be eliminated?
3. Program with alternative means to address jaw
weakness and sensory stimulation
4. Conference with family/caregivers/support
team
92. 5 steps to extinguish oral
habits:
5. Convince child to give up the habit
Introduce a substitute
94. Oral Defensiveness
Increase child’s
tolerance to different
textures, tastes and
temperatures
Wilbarger intraoral
(inside the mouth)
technique
Jaw-tug technique
deep pressure
techniques
95. Hyposensitivity to
taste/texture
Noted to have less efficient patterns of moving
food around in the mouth, including chewing and
swallowing secondary to decreased muscle tone
and generalized weakness
Introducing increased food texture consistency
= choking hazard
At risk nutritionally
96.
97. General Treatment
Strategy
Work for better sitting posture on the lap or in a
chair: trunk and pelvis should be in good
alignment with the shoulder girdle in forward
and abducted position, the cervical spine (neck)
is elongated with capital flexion (chin-tuck).
changes in feeding position should be done
gradually.
99. Jaw Retraction
In prone on feeder’s lap with arms forward across
the feeder’s thigh
Angle the support surface on the feeder’s lap so that
the child’s shoulders are higher than the hips
Gravity may cause the tongue and jaw to drop into a
more forward position
Gently place a hand under the child’s jaw producing
a slight traction forward to further enlarge the
airway.
100.
101. Jaw
Apply carefully graded firm pressure to face,
gums, and teeth while maintaining the jaw in
closed position
low facial tone: Apply patting, tapping, stroking
and other types of tactile and proprioceptive
stimulation of the muscles that open and close
the jaw
102.
103. Tonic Bite Reflex
Assist the child into tonic flexion of neck with
trunk and shoulder support
apply firm pressure on the upper and lower
gums then into the biting surface of the teeth
Use coated spoon to protect child’s teeth from
harm or discomfort
104.
105. Tongue Retraction
1. (prone) stimulate the lips, move into the mouth
and stroke the tongue rhythmically and entice it
to follow your finger as it slides forward in front
of the mouth
2. (chin-tuck) gently tap under the chin on the
muscular area to provide greater tongue
stability and give it more tone for moving
forward
106. Tongue Retraction
(Prone) move into the mouth entering the cheek
pouch from the side then gently work your finger
towards the gums and tongue in which you begin
a downward vibration of the finger in the center
of the tongue to flatten it
on the middle of the tongue, press evenly
downward
107. Tongue Thrust
Reduced by being in a well-supported and
slightly flexed position
facilitate tongue lateralization
encourage the child to make silly faces in the
mirror or to lick lollipops or favorite flavors at the
corners of the mouth or within the cheeks
109. Cheeks
Low tone
place fingers on the side of the child’s nose and
vibrate downward toward the bottom of the
upper lip slowly and evenly providing a long-
lasting relaxation of upper lip tightness
110. Lips Retraction & Pursing
Slow perioral and intraoral cheek stretches can
help promote lip closure
use cotton swabs with drops of liquid placed at
the corner of the lip or in the cheek pocket
111. Lips
teach straw drinking beginning with squeeze
bottle and aquarium tubing
Close the child’s lips as you slowly squeeze
liquid to the edge of the lips
Gradually lessen liquid squeezed into the
straw
113. Cleft Palate
Football hold for
breast-feeding:
infant is held along
the side of the
mother’s body,
facing her rather
than across her lap
114. Cleft Palate
The Habermann nipple: for
infants with cleft palate to
deliver flow without requiring
suction
has a one-way valve that allows
infant to express fluid through
compression alone, without
requiring suction
116. Adaptive Equipment
adaptive spoon, forks, cups and straws
promote independence and improvement in oral
motor control
increase independence in self-feeding
compensate for a motor or sensory impairment
118. spoon with bumps or
ridges in the bottom
of the bowl or a
chilled metal spoon
provide additional
sensory input for a
child w/ decreased
sensory registration
Bites utensil
Rubber
119. Utensils with shorter
handles or large grip
diameters help a
child to self feed more
independently
Learning to use straw:
use a shorter or
smaller straw
relatively short straw
with a large diameter
children who
require thickened
liquids or those with
decreased lip closure
120. cup with a handle
Poor FMS
U shaped cut out cups
help to maintain a
neutral head position
when drinking liquid
Clear cut-out cups
allow to easily see
liquid entering the
child’s mouth when
physical assistance is
provided when
drinking
121. Modifications to Food and
Liquid Properties
Thickened liquids > thin liquids
easier to control with the lips and tongue, move
more slowly within the mouth, and allow child to
organize bolus for effective swallowing
122. Modifications to Food and
Liquid Properties
Examples:
Simply thick
Pureed or baby food fruits and vegetables
Dried infant cereals or mashed potato
Yogurt or pudding may be added to create
blenderized milkshakes
123.
124.
125.
126. Behavioral power struggles
may develop during mealtimes
encourage parents to offer small amounts of a
new food across multiple meal sessions
Thx should try to create new positive
interactions
Offering choices and turn taking may help child
have a sense of control and increase willingness to
participate in feeding
127. Behavioral power struggles
may develop during mealtimes
provide clear expectations
break the activity down into small, achievable
steps
130. Other problems:
neurological immaturity
abnormal muscle tone
lack of proximal stability
weakened state
exaggerated extensor
patterns of movement,
irritable state
insufficient energy to
consume sufficient
quantity of food
dislike of mealtimes
depressed oral reflexes
decreased tongue
mobility
oral hypersensitivity due
to tube feedings
disorganization of SSB
pattern
136. Components of Oromotor
Treatment Program
1. Improving postural control of head, neck and
trunk
capital flexion and activation of lateral and
diagonal control of the abdominal muscles
in supine, sidelying and prone
137. Components of Oromotor
Treatment Program
2. Improving control of pharyngeal airway
in prone to bring tongue forward to clear the
airway
138. Components of Oromotor
Treatment Program
3. Using touch and movement communicatively
find a comfortable holding position on the lap for
tube feedings, for play around the face and mouth,
and for general interaction
139. Components of Oromotor
Treatment Program
4. Normalizing response to
stimulation
5. Identifying and facilitating
swallowing reflex
stimulation of faucial area with
cold temperatures
140. Components of Oromotor
Treatment Program
6. Reducing impact of Gastroesophageal reflux
medical management precedes surgical
management
141. Components of Oromotor
Treatment Program
7. Improving tone and movement in the lips and
cheeks
vocalizing, patting lips to make interesting sounds
and firmly applying facial lotion to cheeks
Stroking firmly with circular motions around lips
encourage greater lip activity and a forward
posturing for suck
142. Components of Oromotor
Treatment Program
8. Improving tone and movement in the tongue
downward bouncing or patting on the tongue with
finger, toy, teether or Nuk brush
done in the context of sound play or with rhythm of
folk music
143. Components of Oromotor
Treatment Program
9. Facilitating a rhythmical suckle swallow
initially stroke the tongue downward and forward by
therapist’s or infant’s finger
as suckling rhythm emerges, water, juice or small
amounts of pureed fruits and vegetables can be
placed on stroking finger
eventually use a plastic medicine dropper, syringe,
modified pacifier or a moistened cotton swab
144. Prematurity and Tube
Feeding
each component of the program is important,
the most basic underlying elements of function
or dysfunction should receive the greatest
emphasis in the program
145. Blindness
need to control rate of eating and size of
spoonfuls in order to feel safe and to prepare
mouth to swallow food and breathe in a
rhythmical coordinated fashion
146. Blindness
Put the child in a familiar position or chair for
eating and develop a routine
Tell the child that the food is approaching or
touch the upper or lower lip in a familiar place so
the child will open the mouth
147. Blindness
Gradually fade the support
keep tastes separate as much as possible
Verbal directions + physical prompts allow
them to experience and kinesthetically
understand movements and sequences that are
efficient and socially acceptable
148. Blindness
Help to establish a personal frame of reference
at the table
Consistency
Teach him to bend the trunk forward so that the
face is directly above the plate to help avoid
major spills
149. Blindness
Teach the child to use
characteristics that can be
sensed using utensils to
identify food
Weight in utensil/cup =
different-sized bites or
different amounts of liquid
151. Minimal Movement
activation of righting and equilibrium reactions
for higher level of Sensorimotor integration and
coordination
developing greater stability in the trunk and
shoulder girdle
152. References:
[1] Case-Smith, J. (2001). Occupational
therapy for children. St. Louis Missouri, USA:
Mosby, Inc.
[2] Solomon, J. (2006). Pediatric skills for
occupational therapy assistants. St. Louis
Missouri, USA: Mosby, Inc.
[3] Wagenfeld, A. (2005). Foundations of
pediatric practice for occupational therapy
assistants. USA: SLACK Inc.