Practicalities of feeding cardiac babies
Sucking Feeds and Solids Material prepared by Terry Wackrow August 2010
An effective feeding plan considers:
SAFETY - the feeding plan should support and maintain the child’s health
OPTIMAL NUTRITION - this is essential as the feeding process is high energy output
FARSIGHTED - the implications of current treatment on future feeding and oral functions must be considered
Feeding impacted by:[Chart adapted from: Factors that may affect feeding the child with neurological impairment (Reilly et al in Southall, A and Schwartz, A (eds)(2000) Feeding problems in Children: a practical guide. Oxford. Radcliffe Medical Press p154) ]
FearBehaviour:
Social factorsAversive experiences
FearBehaviour:
Social factorsAversive experiences
Vision HearingTactile
Vision HearingTactile
GORConstipation
Neurological IssuesCardiac Issues
GORConstipation
Neurological IssuesCardiac Issues
Developmental levelsCognitive level
Drugs
Developmental levelsCognitive level
Drugs
Oromotor /pharyngeal function
Motor controlPosture
Communication
Oromotor /pharyngeal function
Motor controlPosture
Communication
FEEDINGFEEDING
Fatigue; EnduranceState Maintenance
Cardiac specific feeding issues
Infants and children with cardiac difficulties frequently have feeding difficulties that result in failure to thrive
Poor endurance, fatigue and high nutritional needs are key limiting factors
Associated problem areas inco-ordination of swallowing poor oral feeding skills increased respiratory effort
Which can lead to increased risk factors for aspiration
Ongoing difficulty with suck /swallow / breathe synchrony can be throughout a feed can develop during a feed often related to endurance and fatigue problems
Persistent stress signs during sucking feeds have a huge impact on feeding skills increased sweating colour change changes in state increased respiratory effort persistent feed related
desaturations coughing and /or choking increased heart rate during
feeds
If a baby is refusing to feed, look in the baby’s mouth Check for thrush Look for signs of teething
thrush teething
Breast Feeding
Breast Feeding is the GOLD STANDARD Breast feeding support is from the Lactation
Consultant If there are oro-motor difficulties or queries
regarding swallow safety, the SLT becomes involved
Bottle Feeding
Bottle feeding, like all feeding, is a learned process
There are always two parties involved: it is a feeding DYAD
Communication within that dyad is essential Feed to early cues A baby gets stressed with feeds for a reason All feeds should be enjoyable for both parties
Check state of teat: These teats need to be
replaced Split x-cut
Deteriorated teat texture
Troubleshooting with bottle feeds
Textures and viscosity relating to swallow safety is SLT responsibility
Calorie intake, volumes, dietary restrictions are dietician responsibility
Cultural considerations around food and drink should be known and implemented by all involved with the child
NOTE
Ice-cream and jelly both class as liquids so are NOT suitable if a child has swallow safety issues with liquid
Some cardiac babies start solids before 6 mths
The dietician must agree
If initial NG insertion not just for nutrition support, SLT should review swallow before solids started
If a baby is tube fed, it is fine to introduce solids if cueing appropriately
First solids
Spoon feeding: Mouth open
anticipating Spoon presented
horizontally Tongue down Encourage
removal of food by upper lip
Residue on face not scraped off
Self feeding
When a baby is reaching for the spoon – give him one too
Mess and self feeding go together and are a vital sensory experience
Seating for solids: spoon and fingers
A child needs to be stable and well supported for meals
Avoid feeding seated on caregiver’s lap: the feeder cannot see the child’s face if it has difficulty
Seating supported in a highchair, a tumbleform chair or car seat are safer choices
Tumbleform chair ALWAYS fasten
straps use at angle set by
therapist never leave
unattended
Highchair – use rolled up towels or nappies for side support
Safety first for every meal or drink
FOCUS on the task in hand LOOK AT POSITIONING
how is the head positioned?is the trunk supported?is the baby swaddled?
CHECKtexturetemperatureviscosity – as per SLT directions