1. WELCOME!  Assessment and Treatment of Pediatric Dysphagia  SPHSC 543 B  Website: http://faculty.washington.edu/jul2/  Syllabus

25. PREVALENCE  Feeding disorders …25% in all children …80% in children with special healthcare needs and developmental delays …(Manikam & Perman, 2000)  Swallowing disorders …Unknown in pediatric population

27. ADULT VS INFANT  Small mandible  Tongue  Sucking pads till 4-6 months  Directionality of movement  Preferential nose breathers  Close proximity of tongue, soft palate and pharynx  Position of larynx  Preserved until 3-4 mos when anatomical changes start to take place

29. ANATOMICAL CHANGES  Mandibular growth  Sucking pads absorbed  Oral cavity elongates  Lip valving  Neurological maturation  TMJ grading  New directionality  Teeth  Laryngeal descent

30. NEURAL CONTROL

31. EMBRYONIC PERIOD: WEEKS 1-8  3 rd week  By 4 th week  By 7 th week

32. FETAL PERIOD: WEEK 9-BIRTH  Weeks 12-14  Weeks 15-18  Week 24  Weeks 26-29  Weeks 30-34  Weeks 35-38

33. EMBRYOLOGIC ABNORMALITIES  CNS damage  Congenital malformations – both genetic (chromosomal abnormalities) and environmental factors with some a combination of both acting together  Upper airway anomalies/anatomic defects

34. PROBLEMS  Cerebral palsy  Moebus  Treacher Collins, Pierre Robin, palatal clefting  Beckwith-Wiedemann syndrome, Down syndrome, ankyloglossia  Tracheo-esophageal fistula, diaphragmatic hernia, hypertrophic pyloric stenosis  Tetrology of Fallot, transposition of the great arteries, atrial septal defect, ventricular septal defect

35. REFLEXES RELATED TO SWALLOWING  Programmed responses to specific sensory input  Developed early in utero  Allow infant to seek out and obtain nutrition safely  Interplay generally more important than presence/absence  2 categories of oral reflexes: …Assist in the acquisition of food …Protect the airway

36. ADAPTIVE  Rooting  Sucking  Suck-swallow response

37. PROTECTIVE  Gag  Cough  Tongue protrusion

38. OTHER REFLEXES  Phasic bite  Transverse tongue response

39. SUCKLING AND SUCKING  Nutrition  Calming  Exploration  Physiologic flexion

40. SUCKING  Positive pressure/compression  Negative pressure/suction  Pressures may be used differently between breast and bottle.

41. MECHANICS OF SUCKING  Tongue  Jaw  Lips  Cheeks  Palate

44. SUCKING PRESSURE  Variable  Dependent on state  Fluid flow  Nipple characteristics

45. PROBLEMS  Anatomic defects  System dysfunction  Tone/muscular control  Oral pain

46. BREASTFEEDING  “Ideal” food  Suck/swallow sequence similar to other nipple feedings

47. HUMAN BREAST

48. BREASTFEEDING  Nipple elongates  Jaw and tongue elevation  Areola compressed  Milk expressed  Jaw lowered  Lactiferous ducts refill

49. BREASTFEEDING  Letdown reflex  Suck/swallow sequence …Bursts and pauses  Jaw and lips  Volume