1. Dr Sheelu SrinivasConsultant ENT Surgeon & Department CoordinatorFortis Hospital B.G. Rd

2. Nothing would be more tiresome than eating anddrinking if God had not made them a pleasure aswell as a necessity.~Voltaire 3. Feeding & swallowing Feeding includes the act of preparing food andgetting it to the child either orally or throughalternative means. Swallowing includes the manipulation of food in themouth and directing its passage from the oral cavitydown to the stomach. 4. Age (months) Development/posture Feeding/oral sensorimotorSource: Adapted from Arvedson and Brodsky10 (pp. 6267).Neck and trunk with balanced flexor Nipple feeding, breast, or bottleand extensor tone Hand on bottle during feeding (24Visual fixation and tracking months)Birth to 46Learning to control body against gravity Maintains semiflexed posture duringSitting with support near 6 months feedingRolling over Promotion of infantparent interactionBrings hands to mouthSitting independently for short time Feeding more upright positionSelf-oral stimulation (mouthing handsSpoon feeding for thin, smooth pureeand toys)Suckle pattern initially Suckle suckExtended reach with pincer grasp Both hands to hold bottle69 (transition feeding)Visual interest in small objects Finger feeding introducedObject permanenceVertical munching of easily dissolvableStranger anxiety solidsCrawling on belly, creeping on all fours Preference for parents to feedPulling to stand Cup drinkingCruising along furniture Eats lumpy, mashed foodFirst steps by 12 months912 Finger feeding for easily dissolvableAssisting with spoon; some become solidsindependent Chewing includes rotary jaw actionRefining pincer graspRefining all gross and fine motor skills Self-feeding: grasps spoon with wholeWalking independentlyhand1218 Climbing stairsHolding cup with 2 handsRunningDrinking with 45 consecutive swallowsGrasping and releasing with precisionHolding and tipping bottleImproving equilibrium with refinementof upper extremity coordination. Swallowing with lip closureIncreasing attention and persistence in Self-feeding predominates>1824play activities Chewing broad range of foodParallel or imitative play Updown tongue movements preciseIndependence from parentsUsing tools Circulatory jaw rotations Chewing with lips closedRefining skills One-handed cup holding and open cupJumping in place2436drinking with no spillingPedaling tricycle Using fingers to fill spoonUsing scissors 5. Three phases of swallowing oral preparatory phaseOral phase 1 s liq20 s solid oral propulsive phase aspiration is most likely to occurPharyngeal phase1s involuntary and totally reflexive lower esophageal sphincterEsophageal phase 8-20 s gastroesophageal reflux. 6. Airway & swallowing 7. Factors leading to feeding & swallowing disordersArvedson and Brodsky, (2002), ASHA (2002), Kurjan, Newman (2000) and Swigert (1998) central nervous systemabnormalities or injuries (e.g., neural tube defects; genetic Premature birth/LBWAnatomic defects like clefts syndromes; cerebral palsy; pre-, peri- or post-nataltrauma, such as stroke ortraumatic brain injury oral and upper digestive tractand/or food texturehypersensitivity (e.g., someIntellectual disability Dysphoniachildren with autism; secondary to use of nasogastric tube in some children 8. Inter relationships among development of feeding &swallowing & other developmental domain Ability to Delay in selfMotor skillshold things feed Communication Ability toAttitudedevelopmentexpress needtowards food DelayedNeed to beMedical feeding fed with food condition patterns textures 9. Impact Aspiration-lung infections Dehydration Malnutrition 10. Early assessment & interventionFeeding and swallowing skills changedramatically during the first three years of life.Developmental gains in feeding and swallowing aredue to the combined influences of anatomicgrowth, neuromotor maturation and learning(ASHA, 2004). 11. Why aversion/hypersensitive later? lacks the opportunity to build associations betweenpositive sensations in the mouth and the reduction ofhunger, or the social interaction Tube feedings cause GER-associate feeds withdiscomfort & pain Negative and invasive stimulation to the face andmouth -suctioning, intubation, tube insertion Mouth becomes unfamiliar with touch, taste, texture,and other stimuli that had pleasurable associations &become physically hypersensitive to touch and taste 12. Behavioral expression fall in 3categories resistance to accepting food orally; lack of energy and endurance to do the work ofeating; oral-motor -disabilities resulting in an inability toproduce the necessary motor skills for ingestion. Determine if the problem has a strictly physiologicorigin or whether it may be exacerbated by the feedinginteraction between child and feeder. 13. Role of ENT Surgeon Feeding issues 20 % swallowing / dysphagia 14. Diagnosis FEES ST/DIAGNOSTIC NASOENDOSCOPY VFS 15. Functional Endoscopic Evaluationof Swallowing 16. Cricopharyngeal dysfunctionpooling 17. Video fluoroscopy 18. Aspiration 19. Fluoroscopy picture 20. Establishing a feeding & swallowingTeam Individualized SLP,OT Therapy to enhance strength, range of motion &coordination of the lips ,tongue, cheek & jaw muscles Decrease oral aversion due to sensory problems Decrease behavioral resistance to feeding Decrease risk of aspiration Others: food texture, feeding equipment &compensatory strategies 21. Components of the Plan. environment positioning during feeding equipment for food preparation and feeding diet content (including food and liquids), quantity andtexture feeding techniques precautions, including emergency procedures training plans for personnel implementing the plan, monitoring safety, progress and effectiveness of the plan process for communicating with families 22. strategies Oral awareness Mouthing Special utensils school-based PT has knowledge and training toprovide input to the school team that includes: positioning (tonal issues, head/trunk control); seating options (e.g., wheelchair, adapted chair); and assistance with assistive technology needs. Dietitian or Nutritionist. 23. Tube Feeding 24. Surgical intervention 25. Tongue tie release 26. Drooling Surgery 27. Thank you ! www.entbangalore.in http://sheelusrinivas-entpractice.blogspot.in/