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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OPTIMAL NUTRITION - this is essential as the feeding process is high energy output

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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) ]

Oromotor / pharyngeal function Motor control Posture Communication

Fear Behaviour: Fatigue; Endurance State Maintenance Social factors Aversive experiences

Vision Hearing Tactile

Developmental levels Cognitive level Drugs

FEEDING GOR Constipation Neurological Issues Cardiac Issues

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

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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

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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

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

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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

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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

Troubleshooting with bottle feeds Check state of teat:  These teats need to be replaced 

Split x-cut

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Deteriorated teat texture

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Check technique 

Teat part empty taking in air

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Poorly supported Bottle weight on mouth

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Look for bubble movement in the teat

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Check for anterior loss

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Chin support can assist when baby fatigues

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Utilise neonatal reflexes that support feeding eg palmar grasp flexed position

Introducing solids

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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

First solids 

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

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Spoon feeding: 

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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

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

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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

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Tumbleform chair   

ALWAYS fasten straps use at angle set by therapist never leave unattended

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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?  CHECK texture temperature viscosity – as per SLT directions

Any questions, contact the SLTs