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Practicalities of feeding cardiac babies

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

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Practicalities of feeding cardiac babies

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  1. Practicalities of feeding cardiac babies Sucking Feeds and Solids Material prepared by Terry Wackrow August 2010

  2. 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

  3. Feeding impacted by:[Chart adapted from: Factors that may affect feeding the child with neurological impairment (Reilly et al inSouthall, A and Schwartz, A (eds)(2000) Feeding problems in Children: a practical guide.Oxford. Radcliffe Medical Press p154) ] Fatigue; Endurance State Maintenance

  4. 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

  5. Associated problem areas • inco-ordination of swallowing • poor oral feeding skills • increased respiratory effort Which can lead to increased risk factors for aspiration

  6. Ongoing difficulty with suck /swallow / breathe synchrony • can be throughout a feed • can develop during a feed • often related to endurance and fatigue problems

  7. 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

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

  9. If a baby is refusing to feed, look in the baby’s mouth • Check for thrush • Look for signs of teething thrush teething

  10. 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

  11. 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

  12. Troubleshooting with bottle feeds Check state of teat: • These teats need to be replaced • Split x-cut • Deteriorated teat texture

  13. Check technique • Teat part empty taking in air • Poorly supported • Bottle weight on mouth

  14. Look for bubble movement in the teat

  15. Check for anterior loss

  16. Chin support can assist when baby fatigues

  17. Utilise neonatal reflexes that support feeding eg palmar grasp flexed position

  18. Introducing solids

  19. 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

  20. NOTE • Ice-cream and jelly both class as liquids so are NOT suitable if a child has swallow safety issues with liquid

  21. 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

  22. Spoon feeding: • Mouth open anticipating • Spoon presented horizontally • Tongue down • Encourage removal of food by upper lip • Residue on face not scraped off

  23. When a baby is reaching for the spoon – give him one too Mess and self feeding go together and are a vital sensory experience Self feeding

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

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

  26. 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

  27. Tumbleform chair • ALWAYS fasten straps • use at angle set by therapist • never leave unattended • Highchair – use rolled up towels or nappies for side support

  28. 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? • CHECK texture temperature viscosity – as per SLT directions

  29. Any questions, contact the SLTs

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