1. Feeding Therapy for an Ex-24 Week Preterm Infant
Alexandra Munroe,1
Lisa LaGorio,1
Sara Shapiro,2
1
Department of Communication Sciences and Disorders, Rush University, Chicago, IL, 2
Chicago Pediatric Therapy and Wellness Center
Background
•Up to 45% of preterm infants have feeding difficulties. These difficulties may
present differently between infants due to the multi-system involvement
necessary to develop age appropriate feeding skills.
•The premature infant’s sensory system is immaturely organized, negatively
affecting the ability to modulate sensory information. This sensory modulation
dysfunction often results in sensory defensiveness and feeding problems.
•Sensory defensiveness and feeding problems may also manifest in the
presence of a tracheostomy due to increased negative oral experiences and
taste loss/change.
•Sensory integration (SI) therapy is a therapeutic technique to address sensory
defensiveness and feeding problems by improving a child’s ability to process
and integrate sensory information. The approach targets the underlying
processing deficits as opposed to specific maladaptive behaviors.
•The goal of SI therapy is to promote sensory modulation ability, decrease
sensory defensiveness, and increase the child’s independence and participation
in daily life. Successful SI therapy results in independent function in a number
of key developmental domains.
•For feeding development, SI therapy aims to decrease oral defensiveness,
increase oral acceptance, and expand the child’s food tolerance inventory.
Purpose
• To report on the effects of SI-based feeding therapy in an ex-24-week
premature infant.
Methods
Participant: Ex 24-week male preemie, with a complicated PMH including
pulmonary hypertension and bronchopulmonary dysplasia; 17 months
corrected age (CA)
•100% G- tube dependent
•Mechanical ventilation and tracheostomy (Bivona® Pediatric TTS™)
dependent; did not tolerate a Passy Muir Speaking Valve
•NPO except for water via bottle; no tolerance of puree or any other texture
Assessments:
•Swallowing:
Clinical Evaluation: Anatomy WFL; emerging dentition; hypersensitivity
Videofluoroscopic Swallowing Study: No signs or symptoms of aspiration
•Overall Development:
Developmental Assessment of Young Children – Second Edition (DAYC -2):
Used to assess for current developmental levels in social emotional skills,
adaptive behavior, communication, physical development, and cognition.
Methods (Cont.)
Intervention: PT and SLP Early Intervention (EI) services were provided in the
home, 2x/week, for 6 months.
Therapy Techniques:
•Integrated gross, fine, and oral motor sensorimotor movements, appropriate to
developmental age including reaching, clapping, puzzles, blowing kisses, food
play, and oral stimulation.
•Oral Stimulation Therapy: Multi-modal tactile, vibro-tactile, and gustatory to
the child’s hands, arms, cheeks, and lips.
•Vibrotactile stimulation included the ARK Z-vibe® (Fig. 1) and the
DuoSpoon (Marsha Klein, Fig.2).
Outcome Measures:
•Number of bites of puree accepted; increase in overall developmental levels.
Results
Puree Bites:
•Increased to 12 bites (4 oz.) of favorite pureed food (applesauce) (Fig.3).
•Tolerates 2 additional different pureed fruits; does not tolerate other meats or
vegetables at this time
Results (Cont.)
Developmental Improvement:
•Gained 5 months of developmental age (Fig. 4).
•Communication showed minimal improvement due to continued presence of
tracheostomy.
Conclusions
•Prematurity may affect the sensory development of premature infants which
in turn can result in feeding problems.
•Sensory development should be considered when planning treatment for
preterm children.
•Sensory integration based feeding therapy helps to decrease oral
defensiveness, increase oral acceptance, and expand a child’s food tolerance
inventory.
•Therapy that includes sensory integration techniques provides a good
foundation for developing age-appropriate feeding skills in ex-preterm infants
with difficulty processing sensory information.
Fig.1. ARK Z-vibe®
ARK Therapeutic Services
http://www.arktherapeutic.com/arks-z-vibe-
vibrating-oral-motor-tool/
Fig.2. DuoSpoon
Marsha Dunn Klein
https://www.beyondplay.com/ITEMS/T263.HTM
Fig.3. Number of bites accepted during a 60 minute session
Fig.4. Child’s DAYC-2 developmental age equivalent scores at 12 and 23 months CA