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What do feeding skills form the basis for in infants?
- development of speech system
- gross and reflexive movements become refined and coordinated movements for seech and swallowing
- strength, coordination
What two reflexes help newborns feed?
sucking and rooting
What is rooting?
orienting toward the direction of tactile contact with the mouth region
What is sucking?
eliciting piston-like tongue protrusion and retraction in preparation for receiving food from the mother's breast
How does the oral cavity in an infant compare to an adult?
How do the larynx and hyoid in an infant compare to an adult?
they are elevated
How does the velum in an infant compare to an adult?
it is relatively larger
How do teeth in an infant compare to an adult?
In what two ways is an infant's anatomy adapted for nursing?
- infants can breathe and swallow at the same time
- hyoid and larynx move down, this is no longer possible
What is the importance of mature swallow?
- in the mature swallow, tongue pushes against palate
- this force is needed for development of dental arches and hard palate (lack of pressure can result in high vaulted palate and medially collapsed maxillary dental arch)
How may muscles are involved in chewing and swallowing?
over 55 pairs
What is a bolus?
ball of food or liquid
What are the 4 stages of mastication and deglutition?
- oral preparatory
What is the purpose of the oral preparatory stage?
- to prepare food for swallowing
- *it is voluntary, but can do it automatically
What happens in the oral preparatory stage?
lips close, facial tone, rotary jaw motion, rotary lateral tongue motion, soft palate depressed (open) to enable breathing through the nose
What happens in the oral stage?
tongue motion propels bolus posteriorly (tongue drops down and pulls posteriorly), mastication stops and bolus is squeezed back toward the faucial pillars (by tongue elevating toward hard palate), at faucial pillars, oral phase ends
When does the pharyngeal phase begin?
when bolus passes anterior faucial pillars
What happens in the pharyngeal phase?
soft palate closes to separate oral and nasal cavities, respiration ceases- vocal folds close to protect airway, larynx elevates, cricopharyngeus muscle relaxes (muscle of superior esophagus- relaxing this muscle gives bolus a place to go), contraction of pharyngeal constrictors to propel bolus down the pharynx
What happens in the esophageal phase?
the esophageal peristaltic motion carries the bolus through the esophagus, esophageal sphincter opens into stomach
When does the esophageal phase begin?
when the bolus reaches the esophagus
What happens when an individual has deficits in the oral preparatory stage?
- if muscles of velum are weak:
- velum may not be fully depressed
- tongue may not be elevated in back
- food can slip into pharynx before the swallowing reflex (pharyngeal stage) has occurred
- dangerous because other protective mechanisms are not in place then (vocal folds close, etc)...aspiration pneumonia is the most severe outcome
What happens when an individual has deficits in the oral stage?
- weakened movements cause increased posterior transit time of bolus (it takes longer)
- food may remain on tongue or hard palate following transit
- may have difficulty initiating the swallow reflex because of decreased posterior movements
What happens when an individual has deficits in the pharyngeal stage?
- slow velar elevation can result in nasal regurgitation
- reduced constrictor action can result in slowed pharyngeal transit time and person may prematurely initiate respiration
- residue left in valleculae of pharynx
- thyroid and hyoid don't elevate- decreased airway protection and food can get into lungs
What senses are involved in chewing and swallowing?
- taste (gustation)
- smell (olfaction)
- touch (tactile sense)
- temperature (thermal sense)
- pain (nociception)
- muscle stretch and tension
Where are the taste buds found?
in papillae on surface of tongue
What are the 5 main types of taste receptors and on what regions of the tongue are they located?
- sweet- tongue tip
- salt- sides
- sour- sides
- bitter- posterior
- umami ("meaty")- tip
What does the IX glossopharyngeal cranial nerve innervate?
the posterior 1/3 of the tongue, which accounts for a bitter taste
What does the VII facial cranial nerve innervate?
- anterior 2/3 of tongue, palate
- mainly sweet/sour taste
What does the X vagus cranial nerve innervate?
Where does taste data from cranial nerves end up?
insula (regulation of the body's homeostasis) in cortex
Where does smell data end up?
What is smell data routed through?
- amygdala (emotion and motivation)
- hypothalamus (phsyiological response)
- hippocampus (memory)
How do touch and temperature play a role in mastication an deglutition?
- tongue has receptors for movement, pressure
- thermal receptors: each responds best to either warm, hot, cool, or cold; rapid change is easier to detect than gradual change
How does pain play a role in mastication and deglutition?
- nociception- response to noxious stimuli
- can respond to mechanical trauma or extreme temperature
- usually respond to destruction of tissue rather than specific qualities of stimuli
- detect stretch
- found in mandibular elevators, genioglossus, and palatoglossus
How does saliva help with mastication and deglutition?
saliva lubricates and protects the mouth, and also mixes with food to create the right consistency for swallowing
What are the 3 main glands in salivation response?
- sublingual- anterior floor of mouth
- submandibular- posterior area of inner mandible
- parotid- behind ramus, upright portion of mandible
What does the sublingual gland do?
secretes mucus (high viscosity)
What does the submandibular gland do?
secretes mucus and serous saliva (low viscosity)
What does the parotid gland do?
secretes serous saliva
What triggers the chewing reflex?
deep pressure on palate
What triggers the rooting reflex?
What triggers the sucking reflex?
contact with inner margin of lips
What triggers the pharyngeal (gag) reflex?
triggered by tactile stimulation of faucial pillars, posterior tongue, or posterior pharyngeal wall
What triggers the vomit reflex?
- tastes and smells
- gastrointestinal distress
- vestibular dysfunction
- distressing images or thoughts
What triggers the cough reflex?
noxious stimulation of pharynx, larynx, or bronchial passageway