sphs 543 january 29, 2010
DESCRIPTION
SPHS 543 January 29, 2010. Failure to Thrive (FTT) Poor weight gain/growth failure Below 3 rd – 5 th percentile No gain for three consecutive months Often causes overlap Illness, disorder, feeding difficulty, parent/child interaction May impact cognitive development. - PowerPoint PPT PresentationTRANSCRIPT
SPHS 543JANUARY 29, 2010
Failure to Thrive (FTT)… Poor weight gain/growth failure… Below 3rd – 5th percentile… No gain for three consecutive months
Often causes overlap… Illness, disorder, feeding difficulty, parent/child
interaction
May impact cognitive development
GASTROESOPHAGEAL REFLUX The return of gastric contents, either food
alone or mixed with stomach acid, into the esophagus.
Reflux is normal!
BARRIERS TO REFLUX
LES – contains gastric contents; pressure differentials
Growth – longer esophagus, more upright, solid foods
Saliva… Acid neutralization… Clears refluxed materials… Polypeptide hormone
Respiratory protective systems… Cough/airway clearance (6 mos +)
GER Delayed gastric emptying
… Strictures… Esophageal spasm leads to odynophagia
Respiratory impact… Increased WOB… Lack of energy = slower digestion… Asthma subgroup
Pressure sensitive… constipation
GER OR GERD? Weight loss or inadequate weight gain (FTT) Persistent irritability Food refusal/selectivity Posture -arching Coughing/choking Pain Apnea Sleep disturbance Recurrent pneumonia
CAUSES OF GERD Food allergies/intolerance
Immature digestive system
Structural
Immature neurological system… Low tone
TREATMENT Non-medical
… Thickening
… Positioning
Feeding frequency
TREATMENT Medication
… Improves gastric motility Metoclopramide Erythromycin
… Lowers gastric acid production Ranitidine hydrochloride
… Proton pump inhibitor Omeprazole, lansoprazole
TREATMENT Surgical
… Fundoplication… Percutaneous endoscopic gastrostomy (PEG)… Jejunostomy feedings
TREATMENT Child/Family
… Food as power
NORMAL DEVELOPMENT AND FEEDING SKILLS
Everything is connected
Gradual disassociation of movements
Tactile senses give way to visual and auditory
Drive toward independence
STABILITY Stability
… Need a stable base from which to develop … movement (mobility) and functional skills
Central to distal
External (positional) stability… Supporting one body part against another… Against an external source… Achieve muscle balance on both sides of a joint
STABILITY Internal (postural) stability
… No reliance on external aid or support… Balance of contraction between agonist and
antagonist muscles
Movement through space
STABILITY Achieves external stability by lying supine
Initial success with a controlled reach
STABILITY Balance of co-contraction of shoulder
… begins to develop internal control
Positional stability of elbow on floor
Weight shifts
MOBILITY Mobility develops from a proximal base of
stability
Affects refined development of distal oral-motor skills… Dependent on neck/shoulder girdle stability… Dependent on trunk/pelvic stability
PROXIMAL AND DISTAL Relative terms
… Head/neck distal to body… Jaw is proximal to distal lips, cheeks, tongue
SEPARATION OF MOVEMENT From gross motor to fine motor
GROSS-TO-FINE PROGRESSION Present in all skill areas Gradually develop isolation of a skill
REFINED ORAL SKILLS
STRAIGHT PLANES OF MOVEMENT TO ROTATION
Straight planes first… Random, undirected… Alternate pulls from extensor or flexor muscles
Then lateral/diagonal planes and rotary skills… Gain stability by balancing extensor/flexor
systems… Graded function… Lateral righting reactions
Tendency toward active movement of extensor muscles of neck and back
Gradual control of counterbalancing flexor muscles… Stability in head control
… Rolling and weight shifting… Diagonal and rotary movements
ORAL-MOTOR SKILLS Parallel feeding and speech development
Develop from straight planes to lateral then rotary… Jaw opens and closes for munching
… Lateral movement as food moves side to side
… Circular rotational movement to grind food
MIDLINE DEVELOPMENT Four midlines in the body
… Vertical… Horizontal… Two diagonals
Develop our sense of midlines through weight shifts over proximal joints
Experience plays a major role
MIDLINE AWARENESS OF MOUTH
“Home base” resting place for the tongue… Newborn – tongue fills oral cavity… Grooved tongue = vertical midline… Tongue tip elevation = horizontal midline… Lateral movement = diagonal/rotational
midline… ‘Center of mouth’ = defined sense of
horizontal, vertical, diagonal oral midlines
REVERSION TO EARLIER PATTERNS
As children acquire a new skill, some of the previously learned control and stability may be lost temporarily
Often seen in the development of oral-motor skills… Softer foods – munching with some tongue
lateralization
… Move to harder foods, may revert to forward-backward tongue pattern before using more controlled tongue lateralization
REVERT TO EARLIER PATTERNS
… May revert to suckle-swallow with introduction of spoon before using lips
… May cough/choke with cup when previously handled bottle well
ECONOMY/EFFICIENCY OF MOVEMENT
When two or more possibilities exist, the choice will be the one requiring the least effort
Rhythmicity and smoothness… Body rhythms… Timing… Coordination