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

Use a syringe with caution: introduce fluid slowly and allow baby time to swallow

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

Check technique Teat part empty

taking in air

Poorly supported Bottle weight on

mouth

Look for bubble movement in the teat

Check for anterior loss

Chin support can assist when baby fatigues

Utilise neonatal reflexes that support feeding eg

palmar grasp

flexed position

Introducing solids

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

Finger foods are developmentally important These need to be appropriate and safe

Texture choices for finger foods are helpful to develop tolerances and preferences

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

Any questions, contact the SLTs