Practical sessions: Orofacial Myofunctional Disorders (LOGO FASE 3)

Samenvatting Practical sessions: Orofacial Myofunctional Disorders (LOGO FASE 3) (2020-2021)
Logopedie (Thomas More) FASE 3
Leerkracht: A. Labaere & E. Geypen

Preview samenvatting (3 van de 22 pagina's)

OC’s: Orofacial Myofunctional Disorders

OC1: Feeding problems in young children
CASES
1. Bottle feeding: Baby E
Drinks poorly
Cries during bottle feeding
Not gaining enough weight
Chokes during feedings
Tongue tie (released at day 10)

What would you ask the parents?
Pregnancy and birth
• Normal prengnancy
• Cesarian section at 40w  in breech
• Birthweight 4,8kg Postnatal period and feeding
• Breastfeeding: painfull, spilled, let go of the nipple, cried, insufficient weight gain, E had
to work hard and got tired during feedings
• Lactation consultant  tongue tie
• No milk through the nose!  no cleft palate Feeding today
• Bottle feeding BUT breast milk
• Eager to start drinking
• Feeding dairy: 7 feeds (135 ml)
• Weight: 6 kg at 10 weeks (63 cm)  also use weight for height to compare the child with
itself and not with other children

Medical conditions, general development
• Suspected reflux (medication)
• Normal motor development  if this isn’t normal you can’t expect the oral motor skills to
be normal
• Normal communication and interaction
• No medical history, never been sick (no airway problems)  IMPORTANT question Oral exam and observation
• Oral exam: normal
• Reflexes: normal
• Motor skills: muscle tone, pull-to-sit, prone position: normal
• Non-nutritive sucking: normal Feeding
 observation
A lot of noises
Turns away from the bottle
Loud breathing
Crying
Eager to drink
Spills a lot of milk
• Reaction to the bottle: eager, keeps restarting: good
• Initiating feeding: good
• Coordination suck-swallow-breath: not okey
• Spilling: a lot of spilling, too much milk in her mouth
• Sounds: a lot of sounds, crying
• ! stress signals ! : moaning, frowning…
• Type of bottle, milkflow, manner, position…
• Parent-child interaction Treatment
Checklist
• Posture  little more up
• Material  bottle was ok
• Consistency
• Technique (of the child)  you can’t tell the child to breath more
• Manner (= technique of the carer)  PACING
Pacing
-
Tilt the child slightly up so that there is no more milk in the nipple of the bottle so the
child has time to breath
Take the bottle out of the mouth (!some children have trouble with initiating!)
…
• Interaction
• Division of responsibility
• Meal rules 2. Spoon feeding: Baby J
10 months old
Refuses spoon feeding

What would you like to ask the parents?
Pregnancy and birth
• All normal
Postnatal period and feeding:
• Breastfeeding went well
Medical conditions and general development
• No problems Transition to spoon feeding
• Starting t 6 months
• Yelling and hitting
• Refused to eat at daycare
• Refused bottle feeding after banana-incident
• Rapley: not interested
• Occansionally touches food Other relevant information
• Has a pacifier to fall asleep
• Oral exploration: puts a lot of toysin his mouth
• Has no teeth yet  no brushing Feedingtoday:
• Breastfed every three hours
• Also at night
• Refuses everything else Treatment
Checklist
• Posture
• Material
• Consistency  thin puree, good
• Technique (of the child)  no technique seen
• Manner (= technique of the carer)  good
• Interaction
• Division of responsibility
Parent is responsible for what, when and where
Child is responsible for how much and whether
• Meal rules
Basic principles
-
Family meals
Do not force
No pressure  also no positive pressure don’tsshcw your happy when your child
does eat
No punishment
No reward  you get a reward for a chord, for something you don’t want to do
Respect refusal
Autonomy & control
Experimenting & spilling
Neutral
No distraction
Take a step back  never remove something
Modeling
Helping in the kitchen
Do not focus on weight
Calm environment
30 minutes  take the plate away and show the kid that he doesn’t get food anymore
Reduce snacks

Inform parents extensively  listen to their needs, wants and suggestions
• Baby J: stop spoon feeding for at least1 week (alsoin daycare)
• Start again: 1x/day exact same food (thin puree)
• Maybe with breastmilk for the taste
• Respect refusal immediately
• Provide safety and give control
• Family meals After two weeks: 1-2 spoons
New goal: attention to the spoon, opening the mouth At 11 months: eats1 spoon feeding each day (mixed fruit, warm)
Observation: pronounced tongue protrusion, inadequate opening of the mouth, no lip closure
New goal: opening AND closing the mouth  tongue pressure, drinking from a cup 12 months: eats fruit mix in daycare
Technique = good
Refuses vegetables