The development of normal feeding and swallowing.
ABSTRACT The development of feeding skills is an extremely complex process influenced by multiple anatomic, neurophysiologic, environmental, social, and cultural factors. Most children negotiate the necessary developmental sequence without significant difficulties. An understanding of the development of normal feeding abilities aids the pediatrician in monitoring this remarkable process in his or her normal patients. This understanding also helps equip the pediatrician who is challenged by a child with complex feeding problems. The following statements summarize the major elements of feeding development. 1. Structural integrity is essential to the development of normal feeding and swallowing skills. Infant anatomy differs from adult anatomy. Anatomic changes associated with growth affect feeding function. 2. Normal infant feeding is reflexive, under brainstem control, and does not require suprabulbar input. As feeding development progresses, basic brainstem-mediated responses come under voluntary control through the process of encephalization. 3. The mature swallow consists of a voluntary oral-preparatory phase, a voluntary oral phase, and involuntary pharyngeal and esophageal phases. The infant swallow does not have a voluntary oral-preparatory and oral phase but is otherwise similar. 4. The neurophysiologic control of feeding and swallowing is complex and involves sensory afferent nerve fibers, motor efferent fibers, paired brainstem swallowing centers, and suprabulbar neural input. Close integration of sensory and motor functions is essential to the development of normal feeding skills. 5. Feeding development, although dependent on structural integrity and neurologic maturation, is a learned progression of behaviors. This learning is heavily influenced by oral sensation, fine and gross motor development, and experiential opportunities. 6. The basic physiologic complexity of feeding is compounded by individual temperament, interpersonal relationships, environmental influences, and culture. 7. The main goal of feeding is the acquisition of sufficient nutrients for optimal growth and development. Malnutrition may result directly from feeding problems and may also help perpetuate them. 8. Protection of the airway during swallow is a reflexive, multileveled function consisting of the apposition of the epiglottis and aryepiglottic folds and the adduction of both false and true vocal folds.
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ABSTRACT: This cluster-randomized interventional trial at peri-urban settings of Karachi was conducted to evaluate the impact of maternal educational messages regarding appropriate complementary feeding (CF) on the nutritional status of their infants after 30 weeks of educational interventions delivered by trained community health workers. Mothers in the intervention group received three education modules about breastfeeding (BF) and appropriate CF at a baseline visit and two subsequent visits 10 weeks apart. The control group received advice about BF according to national guidelines. Infants’ growth [weight, length, and mid-upper arm-circumference (MUAC), stunting, wasting, and underweight] were measured at four time points. At the end of the study, infants in the intervention group had a higher mean weight of 350 g (p=0.001); length of 0.66 cm (p=0.001), and MUAC of 0.46 cm (p=0.002) compared to the controls; proportionate reduction of stunting and underweight were 10% (84% vs 74%; ORadj 8.36 (5.6-12.42) and 5% (25% vs 20%; ORadj 0.75 (0.4-1.79) in the intervention compared to the control group. For relatively food-secure populations, educational interventions about appropriate CF to mothers had a direct positive impact on linear growth of their infants.Journal of Health Population and Nutrition 12/2014; 32(4):623-33. · 1.12 Impact Factor
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ABSTRACT: To investigate the characteristic features of transient neonatal feeding intolerance (TNFI) during the hospitalization for birth in the maternity ward. A prospective follow-up study. Maternity ward and neonatal intensive care unit (NICU) in an academic medical center. Term (≥ 37-weeks gestation) infants admitted to the neonatal intensive care unit with recurrent vomiting and refusal to feed between January and December 2011. These infants were prospectively followed-up at 1, 2, 4, 6 months of age in the outpatient clinic. During the study period 1280 infants were evaluated in the maternity ward. Forty-eight (3.75%) neonates with repeated vomiting and refusal to feed were hospitalized from the maternity unit to the NICU Level I on the first postnatal day for further investigation. All infants started vomiting in the first day (median 5.75 hours; interquartile range: 1-24) and recovered by the 48(th) postnatal hour (median 27.5 hours; interquartile range: 14-48 hours). Laboratory and imaging studies showed no abnormalities. After discharge, 6-month follow-up of these infants showed no vomiting or feeding intolerance during well-child visits. Infants with TNFI can be managed with close observation and supportive measures if they have no other indications of underlying disease. We believe that expectant management and supportive measures under skilled nursing care will prevent unnecessary diagnostic evaluation, mother/infant separation, and prolonged hospital stay.Journal of Obstetric Gynecologic & Neonatal Nursing 03/2014; 43(2):200-4. · 1.03 Impact Factor
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ABSTRACT: Mastication efficiency is defined as the efficiency of crushing food between the teeth and manipulating the resulting particles to form a swallowable food bolus. It is dependent on the orofacial anatomical features of the subject, the coordination of these anatomical features and the consistency of the food used during testing. Different measures have been used to indirectly quantify mastication efficiency as a function of children's age such as observations, food bolus characterisation, muscle activity measurement and jaw movement tracking. In the present review, we aim to describe the changes in the oral physiology (e.g. bone and muscle structure, teeth and soft tissues) of children and how these changes are associated with mastication abilities. We also review previous work on the effect of food consistency on children's mastication abilities and on their level of texture acceptance. The lack of reference foods and differences in testing methodologies across different studies do not allow us to draw conclusions about (1) the age at which mastication efficiency reaches maturity and (2) the effect of food consistency on the establishment of mature mastication efficiency. The effect of food consistency on the development of children's mastication efficiency has not been tested widely. However, both human and animal studies have reported the effect of food consistency on orofacial development, suggesting that a diet with harder textures enhances bone and muscle growth, which could indirectly lead to better mastication efficiency. Finally, it was also reported that (1) children are more likely to accept textures that they are able to manipulate and (2) early exposure to a range of textures facilitates the acceptance of foods of various textures later on. Recommending products well adapted to children's mastication during weaning could facilitate their acceptance of new textures and support the development of healthy eating habits.The British journal of nutrition 09/2013; · 3.45 Impact Factor