Health Topics

Feeding problems in the cardiac population may be related to poor endurance, decreased interest to feed, poor suck, swallow and breathe coordination, and muscle weakness.

A syndrome, chromosomal defect or association with congenital heart disease can also have a direct effect on an infant or child's feeding abilities.

Signs and Symptoms

• Poor interest in feeding
• Rapid fatigue during feeding
• Increased work of breath during or after feeding
• Tachypnea
• Poor coordination of suck, swallow and breathe synchrony
• Wet or noisy breathing during or after feeding
• Hyper or hypo sensitive response to oral stimulation
• Increased irritability during feeding
• Coughing, choking or gagging with feeding

A bedside oral-motor evaluation can be performed by an Occupational Therapist. Areas evaluated include:

• Quality and coordination of oral-motor movements (includes the tongue, lips, jaw and cheeks)
• Response and tolerance to oral stimulation (perioral and intraoral)
• Oral - facial tone
• Quality of respiration and the impact of feeding on respiration
• Oral structures
• Level of arousal
• Positioning
• Muscle tone and postural control

An occupational therapist may also recommend a Video Swallow Study (VSS) or Fiber Optic Endoscopic Evaluation (FEES) be performed if the patient displays signs of compromised airway protection. These evaluations can identify anatomical and physiological aspects of swallow dysfunction. A developmental evaluation may also be used to evaluate the following skills:

• Activities of daily living
• Fine motor skills
• Perceptual skills
• Wheelchair and adaptive equipment needs
• Cognitive skills
• Sensory integration
• Positioning
• Level of arousal/sensory responsiveness
• Range of motion/muscle flexibility
• Muscle strength
• Endurance

Following a bedside evaluation, an occupational therapist will develop a treatment plan to be implemented during the patient's hospitalization. Treatment for feeding related problems may include:

• Identifying proper nipple or feeding equipment
• Pacing strategies
• Activities and strategies to optimize behavioral state for feeding and play activities
• Positioning
• Use of external feeding supports
• Perioral and intraoral stimulation techniques
• Implementation of a feeding schedule to optimize interest to feed
• Parent education
• Bedside feeding programs

Treatment for problems related to muscle weakness, positioning, and motor skills may include:

• Splinting
• Range of motion programs
• Age-appropriate play and strengthening programs
• Parent education
• Bedside positioning programs
• Motor activities to promote increases in muscle strength and postural control

At the time of discharge, an occupational therapist will make recommendations for outpatient or home-based occupational therapy as necessary to continue to promote advances in feeding and development.