Health Topics

Feeding problems in the cardiac population may be related to poor endurance and muscle tone, decreased interest in feeding, 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

• Lack of interest in feeding
• Rapid fatigue during feeding
• Rapid or irregular breathing 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 and lip closure
• 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.

Additionally, an occupational therapist may recommend a developmental evaluation examining the following areas:

• Activities of daily living
• Fine motor skills
• Visual motor and perceptual skills
• Wheelchair and adaptive equipment needs
• Cognitive skills
• Sensory processing
• Postural control and positioning
• Level of arousal and sensory responsiveness
• Range of motion and 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
• Programs to improve range of motion, strength and postural control
• Programs to improve fine motor, visual motor and coordination skills
• Programs to promote age-appropriate play and sensory processing skills
• Programs to increase independence in activities of daily living
• Parent education
• Bedside positioning programs

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 developmental skills.