I had a friend send me a video of her 10 month old eating puree by spoon. The baby presents with a tongue thrust with some anterior bolus spillage. The baby is currently being treated by PT due to Torticollis, and her PT suggested an SLP feeding evaluation. I treat adult dysphagia, so this is not my area of specialty. Should this Mom seek an eval now at 10 months or wait a few months to see if the tongue thrust diminishes naturally?
Answer: An evaluation will be beneficial now, and would be concerned that without intervention, this atypical oral-motor pattern is unlikely to resolve. It is not uncommon for infants with torticollis to develop associated maladaptive oral-motor patterns and/or to have GER/EER issues that may contribute to adaptive behaviors that unfortunately become maladaptive. We don’t know anything else about this infant (possible medical co-morbidities, potentially pertinent birth or developmental history, prior/early feeding history) which would be informative. Unclear whether he accepts only purees and has this been a pattern from the beginning, how effective his oral-moor skills are with the bottle (which would provide good data to examine), whether the apparent tongue thrust is a refusal behavior (related to GER/EER) or truly a lack of oral-motor skill (perhaps use of tongue extension instead of expected thinning and cupping?) Lots of possibilities that could be explored in an evaluation. This is not typical at this age and is likely to block further development of oral-motor skills and texture progression, and reinforce maladaptive neuro-motor mapping without focused diagnostic therapy.
Keep us posted. Mom is lucky to have you in her corner!
Wanted to share this fascinating article just published about the neonatal microbiome. Abstract below. Article attached. Some take a ways: Important that we advocate for and facilitate KMC ( kangaroo mother care) and use of expressed breastmilk when possible. And advocate for our involvement early on for those fragile infants for whom weaning respiratory support will be a prominent initiative, and safe and successful feeding remain the most complex task required for discharge to home.
Hope this informs your practice like it did mine.
Nursing care of the neonate in the neonatal intensive care unit (NICU) is complex, due in large part to various physiological challenges. A newer and less well-known physiological consideration is the neonatal microbiome, the community of microorganisms, both helpful and harmful, that inhabit the human body. The neonatal microbiome is inﬂuenced by the maternal microbiome, mode of infant birth, and various aspects of NICU care such as feeding choice and use of antibiotics. The composition and diversity of the microbiome is thought to inﬂuence key health outcomes including development of necrotizing enterocolitis, late-onset sepsis, altered physical growth, and poor neurodevelopment. Nurses in the NICU play a key role in managing care that can positively inﬂuence the microbiome to promote more optimal health outcomes in this vulnerable population of newborns.
Rodriguez, J. et al (2017). The Neonatal Microbiome: Implications for Neonatal Intensive Care Unit Nurses. MCN: The American Journal of Maternal/Child Nursing, 42(6), 332-337.
Wrapped up a busy teaching year at Johns Hopkins in Baltimore where they
have an amazing inpatient team that services infants and children from
NICU to burns to psych. Pediatric therapists from around the US joined me
and my colleague, Theresa for a dynamic 5 days of problem-solving,
learning and networking. Now a break for the holidays and focus on
finalizing my 2018 teaching schedule, which will include Atlanta and
Austin, and likely the NJ/NY area, Chicago area, and California. Will be
teaching a one day Advanced Pediatric Dysphagia Seminar in Atlanta along
with the Cue-Based Feeding seminar I co-teach with Suzanne Thoyre, RN/PhD,
which includes training on the EFS. The Pediatric Swallowing and Feeding, NICU
Swallowing and Feeding, and the Pediatric Videoswallow seminars will be
offered at all other sites.
Stay tuned for updates. I hope our paths cross in 2018!