Feeding Evaluation: o Review of parent concerns/reason for referral o Oral Reflexes (root, suck, swallow, phasic bite, transverse tongue, gag) o Infant Cranial Nerve Evaluation o Non-nutritive suck (pacifier skills) o Nutritive suck (feeding skills) o Lip seal, bottle flow rate o Swallowing skills for liquids (cervical auscultation of the swallow) Therapist is listening for the opening of the Eustachian tube and upper esophageal sphincter o Positioning o Endurance o Respiration (before, during and after feeding) o Spoon feeding skills o Upper airway screening o Allergy screening o Reflux screening o GI function summary
Formula/Breastmilk by Bottle Recommendations Before Feeding o Stimulate root reflex by stroking pacifier or bottle nipple down the middle of the lower lip prior to placement of the pacifier or bottle nipple o Introduce the pacifier prior to bottle, dip pacifier in breastmilk or formula o Slight downward pressure to the middle of the tongue with pacifier to improve tongue cupping skills o Slight upward pressure to the hard palate. This may stimulate the suck reflex o Lightly traction the pacifier to improve lip seal and cheek strength (2-3 x when offering pacifier, twice daily) o Swaddling/swaddle lower body only o Boppy pillow/pillow supports o Lower lights and less noise while feeding
During Feeding o Recommended bottle/nipple_______________________________________________________ o Swaddled, upright positioning (gravity will have less impact on liquid flow in the mouth to the throat) o Side tilt positioning throughout feeding o Support to head and neck (see photos) o Chin support (rolled burp cloth) o External pacing (you set the pace so the baby can breathe and eat comfortably) o Burp mid-feeding, wait 5-10 minutes after feeding for final burp
After Feeding o Upright 15 to 20 minutes after feeding (chest to chest) o Avoid car seat and swing after feedings
Spoon Feeding o Recommended spoon ______________________________________________________________ o Rest spoon on lower lip o Perfect bite size is important o Allow an extra ‘dry’ swallow o Flavored baby food o Move to smooth, higher flavored food o Texture program (chewy spoon for “chewing practice”) o Move to meltable solids (ex. vanilla wafer, graham cracker, puffs)
Cup Drinking o Avoid cup drinking for now o Recommended cup __________________________________________________________________ o Start with drops of liquid in the soft spout of the cup o Small amount of liquid in cup o Cold liquids in cup o Thickened liquid by cup recommended
Additional Suggestions o Ocean Saline Spray o Cool mist humidifier o Elevated head of crib/bed
Treatment Plan o Feeding product change o Pacing and positioning program o Improve pre-feeding skills o Improve awareness during the swallow (high flavor, cool temperature liquids) o Swallow study (see letter) o Referral to RD to try a more gentle formula for better tolerance o Constipation management program o Discuss reflux medication trial with your doctor o Referral to OT/PT o Referral to ENT and/or GI
Next Appointment: ___________________________________________________________
Parent Guide
Patient Name:_______________________________________________________________________________
Parents Names:______________________________________________________________________________
Feeding Evaluation:
o Review of parent concerns/reason for referral
o Oral Reflexes (root, suck, swallow, phasic bite, transverse tongue, gag)
o Infant Cranial Nerve Evaluation
o Non-nutritive suck (pacifier skills)
o Nutritive suck (feeding skills)
o Lip seal, bottle flow rate
o Swallowing skills for liquids (cervical auscultation of the swallow) Therapist is listening for the opening of the Eustachian tube and upper esophageal sphincter
o Positioning
o Endurance
o Respiration (before, during and after feeding)
o Spoon feeding skills
o Upper airway screening
o Allergy screening
o Reflux screening
o GI function summary
Formula/Breastmilk by Bottle
Recommendations
Before Feeding
o Stimulate root reflex by stroking pacifier or bottle nipple down the middle of the lower lip prior to placement of the pacifier or bottle nipple
o Introduce the pacifier prior to bottle, dip pacifier in breastmilk or formula
o Slight downward pressure to the middle of the tongue with pacifier to improve tongue cupping skills
o Slight upward pressure to the hard palate. This may stimulate the suck reflex
o Lightly traction the pacifier to improve lip seal and cheek strength (2-3 x when offering pacifier, twice daily)
o Swaddling/swaddle lower body only
o Boppy pillow/pillow supports
o Lower lights and less noise while feeding
During Feeding
o Recommended bottle/nipple_______________________________________________________
o Swaddled, upright positioning (gravity will have less impact on liquid flow in the mouth to the throat)
o Side tilt positioning throughout feeding
o Support to head and neck (see photos)
o Chin support (rolled burp cloth)
o External pacing (you set the pace so the baby can breathe and eat comfortably)
o Burp mid-feeding, wait 5-10 minutes after feeding for final burp
After Feeding
o Upright 15 to 20 minutes after feeding (chest to chest)
o Avoid car seat and swing after feedings
Spoon Feeding
o Recommended spoon ______________________________________________________________
o Rest spoon on lower lip
o Perfect bite size is important
o Allow an extra ‘dry’ swallow
o Flavored baby food
o Move to smooth, higher flavored food
o Texture program (chewy spoon for “chewing practice”)
o Move to meltable solids (ex. vanilla wafer, graham cracker, puffs)
Cup Drinking
o Avoid cup drinking for now
o Recommended cup __________________________________________________________________
o Start with drops of liquid in the soft spout of the cup
o Small amount of liquid in cup
o Cold liquids in cup
o Thickened liquid by cup recommended
Additional Suggestions
o Ocean Saline Spray
o Cool mist humidifier
o Elevated head of crib/bed
Treatment Plan
o Feeding product change
o Pacing and positioning program
o Improve pre-feeding skills
o Improve awareness during the swallow (high flavor, cool temperature liquids)
o Swallow study (see letter)
o Referral to RD to try a more gentle formula for better tolerance
o Constipation management program
o Discuss reflux medication trial with your doctor
o Referral to OT/PT
o Referral to ENT and/or GI
Next Appointment: ___________________________________________________________
Therapist Contact Information: ______________________________________________
Notes:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Thank you,
_____________________________________________________
Therapist Signature