1. FEED THE BABY! - PEDIATRIC FEEDING DISORDERS IN Infants
Sally Asquith, MS, CCC-SLP
Amanda Morse, MS, CCC-SLP
Carolina Speech & Language Center, Inc.

2. Gratitude
Deepest gratitude to the many families who have endowed me with the joy and privilege of working with their children over the years.
© Sally Asquith 2018

3. Jan Lougeay, UT-Dallas, my clinical supervisor.
Gratitude also to:
Jan Lougeay, UT-Dallas, my clinical supervisor.
Angela Pittman, my CFY supervisor who promised that the kids would survive my treatment.
Catherine Shaker, who shares her insights with us so eloquently and graciously.
© Sally Asquith 2018

4. DISCLOSURES: SALLY ASQUITH
I have the following financial relationship in services described in this presentation:
100% Ownership of Carolina Speech & Language Center, Inc., and Eat*Talk*Play, LLC, private practices specializing in pediatric speech- language-feeding.
I have the following relevant non-financial disclosures: VP of Governmental Affairs for SCSHA
© Sally Asquith 2018

5. DISCLOSURES: Amanda morse
I have no financial relationship in services described in this presentation.
I have no relevant non-financial disclosures.
© Sally Asquith 2018

6. PLEASE: NO PHOTOS/VIDEO OF OUR PTS!
Agenda
PLEASE: NO PHOTOS/VIDEO OF OUR PTS!
Vocab
Overview of Pediatric Feeding Disorders (PFD)
Key concepts
Practical exercise
Sequence of normal feeding skills
Smoking guns and red flags
Treatment and tools
Group discussion
© Sally Asquith 2018

7. vOCAB AA = adjusted age CA = chronological age
CLD = chronic lung disease
DD = developmentally delayed
FTT = failure to thrive
PCA = post conceptual age
PFD = Pediatric Feeding Disorders
Physiologic stability
Stable respiration + cardiac function
No cyanosis – no apnea = drop in oxygen
Baby “paces” self
Pauses sucking in order to breathe
Independently re-establishes breathing
© Sally Asquith 2018

8. vOCAB PMA = post menstrual age PO = per oral/by mouth
s/sx = signs/symptoms
TD = typically developing
VC = vocal cord
WOB = work of breathing
Retractions: suprasternal, supraclavicular, pharyngeal, nasal
Nasal flaring and blanching
Chin tugging
Use of accessory muscles to breathe
Rib cage rocks (from C. Shaker, “NICU Swallowing and Feeding: In the Nursery and After Discharge”, presented June 2017, Chicago, IL)
© Sally Asquith 2018

9. Overview: PFD
Ped dysphagia is a relatively new field, and changing rapidly
Feeding Matters’ definition of PFD
Feeding Flock assessments coming!
20% of TD kids and 80% of DD kids have PFD
Technology and the NICU
Breathing outranks eating
“First do no harm”
Banchaun, B., Chaithirayanon, S., & Eiamudomkan, M. (2013) ©Sally Asquith 2018

10. Overview: DEFINITION Biometrics: Intake quality for infants FTT
Flat growth curve
Evidence of malnutrition, dehydration
Inadequate wet diapers
Newborns: 5 to 6 (or more)
Then 4 to 5 (or more) by six months
Intake quality for infants
Stress signals
Difficulty transitioning to spoon/purees
© Sally Asquith 2018

11. FEEDING IS DYNAMIC Cookbooks belong in the kitchen 
Eating and drinking are shifting experiences from moment to moment:
DYNAMIC, NOT PRESCRIPTIVE
Feeding tx should shift likewise
One session consists of many touchpoints
E.g. the beginning and end of a meal, or bottle, are not the same!
© Sally Asquith 2018

12. INFANT STRESS SIGNALS Can be subtle; LOOK & LISTEN The “worried look”
Noisy feeds
Gulping, slurping, velar sounds
Coughing, choking
Fluid loss from mouth or nose
Eyes fluttering or blinking
Fingers splaying
Cyanosis
Compression only
© Sally Asquith 2018

13. INFLUENCES ON TD INFANT FEEDING
Breast milk vs. “industrialized milk”
Bottle/nipple product
Nipple confusion
Positioning
Tongue and/or lip tie
© Sally Asquith 2018

14. D.G. videos In utero vascular separation Twin birth at 26 weeks
5 months 3 weeks AA
8 months 2 weeks PCA
Dr. Brown level 2, 1, preemie, ultra-preemie
© Sally Asquith 2018

15. KEY CONCEPT #1: safety & nourishment
ABILITY TO BREATHE AND ADAPT SAFELY
ADEQUATE NOURISHMENT FOR CA
© Sally Asquith 2018

16. VIDEO Examples Of poor adaptation
Reagan
Sterling
Blake
© Sally Asquith 2018

17. KEY CONCEPT #2: don’t muck it up
Principle of Ethics I
Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner.
Rules of Ethics
Individuals shall provide all clinical services and scientific activities competently.
Individuals shall use every resource, including referral and/or interprofessional collaboration when appropriate, to ensure that quality service is provided.
Individuals who hold the Certificate of Clinical Competence shall evaluate the effectiveness of services provided, technology employed, and products dispensed, and they shall provide services or dispense products only when benefit can reasonably be expected.
Individuals may make a reasonable statement of prognosis, but they shall not guarantee— directly or by implication—the results of any treatment or procedure.
Individuals who hold the Certificate of Clinical Competence shall use independent and evidence-based clinical judgment, keeping paramount the best interests of those being served.
ASHA (2016)

18. KEY CONCEPT #3: AMERICA’S WEALTH
Alice Waters; Jamie Oliver; Michael Pollan
© Sally Asquith 2018

19. PRACTICAL EXERCISE

20. Developmental sequence OF NORMAL FEEDING
Handout #1: Typical Development of Feeding Skills (0 – 3)
Handout #2: Developmental Stages in Infant and Toddler Feeding
© Sally Asquith 2018

21. Prenatal: # of weeks pma
10 to 14: pharyngeal swallowing, movement of tongue
11 to 13: development of taste buds
15: non-nutritive sucking and swallowing
18 to 24: suckling
22 to 24: consistent swallowing
26 to 29: lungs can breathe air
28: tongue cupping
32: nutritive sucking
35 to 40: well-defined sucks Delaney, A., & Arvedson, J. (2008)
Near-term: swallows 500 – 1000ml of amniotic fluid/day
Ross, M.G., & Nyland, M.J.M. (1998)
© Sally Asquith 2018

22. newborn to 1 month Handout #1, p 1 Handout #2, p 6 Highlights =
2 to 4oz per feed in suckle pattern 6+ x/day
Sequences 2 or more sucks before pausing to swallow
Inelegant – coughing, choking, aspiration

23. 2 to 4 months Handout #1, p 1 Handout #2, p 6 Highlights =
4 to ~7oz per feed w good coordination of suck-swallow-breathe
By 4m, sucking becomes intentional
Loss of reflexive tongue thrust ↑ ability to accept spoon

24. 6 months Handout #1, p 1 and 2 Handout #2, p 6 Highlights =
9 to 10oz per feed 4-6x/day
Primitive phasic bite-release pattern
No controlled, sustained bite
May revert to sucking
May use intermittent up/down movements

25. 7 to 8 months Handout #1, p 2 Handout #2, p 6 Highlights =
Takes thicker purees; lumps not safe
Recognizes spoon and breast/bottle
Long SSB sequences
Tongue lateralizes

26. 9 to 12 months Handout #1, p 2 Handout #2, p 6 Highlights =
Cup-drinking is difficult
Graded bite on soft cookie
Vertical jaw movements in chewing
Begins diagonal rotary movements
(I) finger feeding

27. 12 to 14 months Handout #1, p 3 Handout #2, p 6 Highlights =
Takes liquids and modified (ground, mashed, coarsely chopped) table foods
Controlled bite on soft cookie
Transfers food to chewing surfaces
Lips are active but not always neat
Karter Grace 14m videos
© Sally Asquith 2018

28. Suckling & eating Suckling Eating
Starts in utero and is Starts ~4 months, is mature by term mature by 3 years
Oral phase is reflexive Oral phase is volitional
Tongue movement is Tongue movement is unidirectional multi-directional
Brainstem mediated Large cortical input to brainstem activity
Presented by A. Chogle, MD, at CHOC, 1/20/18
© Sally Asquith 2018

29. smell & taste Taste buds first develop at 7 weeks of gestation.
Mature taste buds by 12 weeks gestation.
Flavors from the mother’s diet during pregnancy are transmitted to amniotic fluid.
Acceptance and enjoyment of those flavors is enhanced during weaning.
J.A. Mennella, Pediatrics, 2001, presented by A. Chogle, MD, at CHOC, 1/20/18
© Sally Asquith 2018

30. derailment What happens when the baby derails…
Chokes and coughs?
Becomes physiologically unstable?
Loses weight?
Develops maladaptive compensations?
Maladaptive compensations become habits
Sammie smacking
NICU grads sucking
Tongue extrusion in Down S to stabilize vessel
© Sally Asquith 2018

31. Smoking guns & red flags
Kay Toomey handouts: Red Flags, 10 Myths
(retrieved 9/11/17)
Wolf, L., & Glass, R. (1992) diagram
© Sally Asquith 2018

32. Remember it’s a dynamic process!
Swallowing “phases”…
Remember it’s a dynamic process!
Wolf, L., & Glass, R. (1992)
© Sally Asquith 2018

33. Wolf & glass model
Wolf, L., & Glass, R. (1992)
© Sally Asquith 2018

34. DISRUPTORS TO THE MODEL
#1 = altered cardiac system due to poor valving, hypoplastic chambers, CLD/BPD, syndromes… not just preemies, also sick late term or term babies
© Sally Asquith 2018

35. CARDIOPULMONARY FX and work of breathing
Congenital heart defects in 1% of the TD pop
Looks disorganized: signs of adaptive behavior b/c baby cannot breathe
Excessive breathing effort  decompensation
Quality of respiration:
Matching aerobic demands to the task
Asking babies to drink + breathe is a “treadmill test”
© Sally Asquith 2018

36. Physiologic control
Responses to the WOB may include significant changes in physiologic parameters (from C. Shaker, “NICU Swallowing and Feeding: In the Nursery and After Discharge”, presented June 2017, Chicago, IL)
Increased respiratory drive can inhibit oral feeding (Timms et al., 1993)
Sucking can inhibit breathing
Need to breathe can inhibit suck
Pre-terms with CLD may purposefully use a weak sucking pressure to reduce respiratory work and maintain breathing (Mizuno et al., 2007)
© Sally Asquith 2018

37. respiration Breathing regulation and WOB; study of 161 preterm infants
Severity of respiratory complications lengthened the time to achieve full oral feedings (Craig et al., 1999)
Non-nutritive sucking (NNS):
NNS stim did not result in earlier wean from NGT (Bragelian et al.,. 2007)
NNS is NOT predictive of nutritive sucking (Lau, 2001)
Readiness to initiate nippling: complicated by medical status
Highest risk factors =
Co-morbidities
Birth weight
Gestational (not PMA/PCA) age
Ventilator
(from C. Shaker, “NICU Swallowing and Feeding: In the Nursery and After Discharge”, presented June 2017, Chicago, IL)
© Sally Asquith 2018

38. CHALLENGES THE CARDIOPULMONARY SYSTEM COMPROMISES BREATHING
history of…
Cardiac anomalies
Atrial septal defect
Patent ductus arteriosus
Stenotic aorta
Hypoplastic chambers
Et cetera, et cetera
CHALLENGES THE CARDIOPULMONARY SYSTEM
COMPROMISES BREATHING
© Sally Asquith 2018

39. 4 MONTHS PRE/POST surgery
© Sally Asquith 2018

40. HISTORY OF… Prematurity – POOR respiration 2* to immature lungs
POOR coordination of breathing & feeding 
Physiologic instability
Neurological immaturity
Tiny space (Wolf & Glass diagram)
Orally invasive experiences
Oral-gastric tubes
Naso-gastric tubes
© Sally Asquith 2018

42. Outcomes of prematurity
Although <1% of preterm infants required supplemental tube feedings at time of D/C from NICU, >50% of NICU grad parents report problematic feeding behaviors at least through 18 to 24 months.
Hawdon, J.M., Beauregard, N., Slattery, J. and Kennedy, G. (2000).
© Sally Asquith 2018

43. Stress signs redux Uncoupling of swallow-breathe Noisy feeds Gulping
Drooling, fluid loss
Fingers splaying
“The worried look”
Blinking
Reddening or blanching around mouth and/or eyes
Gurgling sounds in the pharynx
Double/multiple swallows
Coughing, choking
C.S. Shaker, 1999
© Sally Asquith 2018

44. compensations Strategies when swallowing/breathing compete:
Limited jaw and excursions
Compression-only sucking
Use of a “purposeful” weak sucking pattern
Stopping sucking
Pulling away, pushing away
From C. Shaker, “NICU Swallowing and Feeding: In the Nursery and After Discharge”, presented June 2017, Chicago, IL
© Sally Asquith 2018

45. Over the course of time…
Compensations become the baby’s normal
Maladaptive habits become the baby’s normal
Escape behaviors quickly expand with…
Age
Awareness
Cognition
LANGUAGE
Family response
© Sally Asquith 2018

46. More HISTORY OF… Down Syndrome global hypotonia
+ cardiac defects (ASD, PDA, et al.)
= POOR respiratory effort
Global hypotonia  poor oral-motor dev  failure to advance textures
No crushing skills
© Sally Asquith 2018

47. More HISTORY OF…
Reflux
© Sally Asquith 2018

48. More HISTORY OF… Reliance on g-tube, transition/weaning
*A necessary bridge*
Necrotizing enterocolitis (NEC)
Allergies
Laryngomalacia
Eosinophilic esophagitis (EoE)
Chronic constipation – encopresis
Slow gastric emptying, gastric dumping
© Sally Asquith 2018

49. More history of…
Neuromuscular d/o  global weakness  inability to develop chewing skills
Examples:
Chronic-severe epileptiform seizures, seizure d/o
Mitochondrial disease
Spinal Muscular Atrophy (SMA)
Muscular Dystrophy (MD)
No crushing skills
© Sally Asquith 2018

50. INABILITY/FAILURE TO BREATHE AND ADAPT SAFELY
TO THE LIQUID, BOTTLE, FOOD, SPOON, CUP
INADEQUATE NOURISHMENT FOR CA
© Sally Asquith 2018

51. So…
Which really came first… Sensory Processing Disorder? Motor disorder? Anxiety disorder?
© Sally Asquith 2018

52. What if… Most of the problem is mechanical?
Rooted in airway protection?
Due to compensatory strategies?
© Sally Asquith 2018

53. Analyze a dynamic system
Consider Catherine Shaker/Suzanne Thoyre’s EFS course to assess the baby’s…
Oral feeding readiness
Oral feeding skills
To maintain engagement
To organize oral-motor functioning
To coordinate swallowing
Ability to maintain physiologic stability
Thoyre, S., Shaker, C., & Pridham, K. (2005)
© Sally Asquith 2018

54. early feeding scale (efs)
Thoyre, S., Shaker, C., & Pridham, K. (2005)
© Sally Asquith 2018

55. The family “I cannot feed my baby” = “I cannot nourish my child”
Screaming baby, difficult to feed, vomiting, diarrhea
Sleep deprivation

56. Treatment and tools Breathing outranks eating “First do no harm”
Don’t muck it up
Look for inability/failure to BREATHE and ADAPT SAFELY
Look for inadequate nourishment
© Sally Asquith 2018

57. direct the bolus safely breathe in a stable, replenishing fashion…
If the baby cannot:
direct the bolus safely
breathe in a stable, replenishing fashion…
the treatment or tool is wrong.
Risky. Unsafe. Unethical.
© Sally Asquith 2018

58. Sub-optimal ideas Water-boarding
Disregarding the baby’s stress signals, compensations, maladaptive behaviors
“Tripod support” to mandible
Decreases flow/sucking
Closes the one safe airway left
Syringe feeding
Offering unsafe textures, bolus sizes
© Sally Asquith 2018

59. A shift in practice Co-regulated, cue-based feeding to:
Improve physiologic stability
- decrease WOB
Ensure quality, not quantity
Promote neuroprotection
Promote adaptive vs. maladaptive feeding skills
Improve NICU LOS and PO reliance
We owe: Catherine Shaker, Suzanne Thoyre/ Feeding Flock, Suzanne Evans Morris, Marsha Dunn Klein, Erin Sundseth Roth, Joan Arvedson
© Sally Asquith 2018

60. Infant-guided practice
Catherine Shaker: “Cue-Based Feeding in the NICU: Using the Infant’s Communication as a Guide”
Improves physiologic stability
- heart rate
- breathing
Ensures quality, not quantity
Promotes neuroprotection
NOT infant-driven or volume-driven
Boston Children’s: CICU, NICU, BPD outcomes
Shaker, C.S. (2013)
© Sally Asquith 2018

61. A shift in practice Red flags – again! – in infants/toddlers:
The “worried look”
Urgent breaths
Coughing/choking
Splayed fingers
Gulping
Loss of fluid
Blinking
Nasal flaring/blanching
Suprasternal retractions
Shaker, C.S. (2013)
© Sally Asquith 2018

62. Catherine Shaker Suzanne Thoyre
2009: Supporting Better Feeding Outcomes in the NICU: Critical Perspectives on Co-Regulated Feeding in the NICU
2010: Improving Feeding Outcomes in the NICU: Moving from a Volume-Driven to an Infant-Driven Approach
2012: Feed Me Only When I’m Cueing: Moving Away from a Volume Driven Culture in the NICU
Suzanne Thoyre
Implementing Co-Regulated Feeding with Mothers of PreTerm Infants
Shaker, C. (2009, 2010, 201); Thoyre, S. et al. (2016)
© Sally Asquith 2018

63. Slow the flow Allows the baby to breathe
“islands of stability”
Allows the baby to control and direct the bolus
Promotes physiologic stability
Decrease WOB
Promotes neuroprotection
Decreases maladaptive behaviors
IN RESPONSE to the infant’s cues, in the moment, not a predetermined plan
© Sally Asquith 2018

64. POSITIONING + pacing + flow
Early Feeding Skills (EFS) assessment
D.G. again
26-weeker, CA = 8m 2w, AA = 5m 3w
Dr. Brown levels 2, 1, preemie, ultra-preemie
Thoyre, S., et al. (2005)
© Sally Asquith 2018

65. breastfeeding Allows the baby to breathe
Allows the baby to control and direct the bolus
Promotes physiologic stability
Promotes neuroprotection
Automatic elevated semi-elevated side-lying
© Sally Asquith 2018

66. Coryllos’ 4-type description
Tongue tie
Coryllos’ 4-type description
Type 1 = classical (anterior) lingual frenulum; attachment of frenulum to the tongue tip, usually in front of the alveolar ridge in the lower lip sulcus
Type 2: 2-4 mm behind the tongue tip and attaches on or just behind the alveolar ridge
Type 3: Posterior lingual frenulum; tongue-tie is attachment to the mid-tongue
Type IV: essentially against the base of the tongue; thick, shiny and very inelastic
Coryllos et al. (2004)
© Sally Asquith 2018

67. Tongue tie
“…Properly performed scientific research has identified true tongue-tie in only 5% of babies and posterior ties in only 30% of that 5%.”
(Todd et al., 2015)
Take-aways from Cincinnati Children’s Hospital Dysphagia Conference 10/16:
Everyone has a lingual frenulum. Just because it’s there doesn’t mean it impedes function
Abnormal lingual frenula can affect breastfeeding
*Lack of consensus on dx and tx*
Whole picture m/b evaluated re breastfeeding
© Sally Asquith 2018

68. SPECIFIC TOOLS
Any tool should promote safe, adaptive, normal, oral-motor development.
Contraindicated:
Fast-flow nipples
Cups that encourage biting
Cups that encourage suckle pattern
Spoons with deep or wide bowls
Foods that are too hard, too large
© Sally Asquith 2018

69. manufacturing Standards for bottles, nipples, cups, baby food 
SAFE ADAPTATION IS UP TO US
Slow the flow
Co-regulate the feeding
Pace externally
Provide external support to rib cage
Add thickeners….…???
Rice cereal slows gastric emptying
No strong research +/-
Control volume of purees, finger foods, liquids
© Sally Asquith 2018

70. Bottles/nipples Britt Pados et al. article, UNC-CH
Milk Flow Rates From Bottle Nipples Used for Feeding Infants Who Are Hospitalized. American Journal of Speech-Language Pathology, November 2015
© Sally Asquith 2018

71. Bottles/nipples USDA study on decline of vitamins C, A, and E
Francis, J., et al. (2008)
© Sally Asquith 2018

72. PACIFIERS Those that promote a central groove
“Orthodontic” nipples discourage central groove
© Sally Asquith 2018

73. Positioning: bottles External support: promote cardiopulmonary fx
Semi-elevated side-lying
Swaddling
Midline flexion
Upper arms to rib cage
Hands to face
Straight cephalocaudal relationship
© Sally Asquith 2018

76. Therapy strategies: bottles
Find the best flow rate
Pace – remove the bottle X # of sucks
Post on cheek, not lip/corner of mouth
Keep fluid as level as possible
Even ultra-preemie drips
Last ounce is the hardest
Semi-elevated sidelying
Rib cage support
Look for:
stress signals, physiologic instability
© Sally Asquith 2018

77. “baby-led weaning” site
“According to the most recent research most babies reach for food at around six months, which is also the time that mothers are being encouraged to wean [In UK, this means add complementary foods] … in accordance with the WHO guidelines.”
“The distinct advantage of weaning at around 6 months is that by then, our children are developmentally capable of feeding themselves proper food, in other words – no more mush!”
Unsafe supposition that the baby’s gag reflex is thoroughly protective
Cited: Davis, C.M. (1939)
© Sally Asquith 2018

78. Cup transition Magical skill development at 12 months
Is the cup really a bottle?
With a hard spout?
Spillable or non-spillable?
Analyze the baby’s skills! Maybe transition, maybe not…
© Sally Asquith 2018

79. Lidded cups
InfaTrainer, $11.95; slow-medium-fast flow; snap and twist lid; 3oz, 5”h, BPA-free

80. Lidded cups
Recessed Lid Cup, TalkTools, $19 on Amazon; two twist-on lids, BPA-free

81. Lidded cups
OXO Tot Cup, $55 on Amazon; twist-on lid, BPA-free

82. Open cups: control flow
Toy cups for small vol/2oz
Fast- or slow-moving fluids
Tupperware
Tea set cups
Dixie cups: small volume
2oz or 5oz

83. Therapy strategies: cups
Find the best flow rate
Avoid cups that promote sucking!
Determine need for external support
Weighted if possible
Handles if possible
Look for:
stress signals, physiologic instability
© Sally Asquith 2018

84. Spoons: control volume
Flattish bowl, heft/weight… length of handle
Maroon spoon – small
EZ spoon: Debra Beckman
DuoSpoon: Marsha Dunn Klein
Commercial: Gerber
© Sally Asquith 2018

85. “Purees” Manufacturing standards…  Overall viscosity:
Watery, nectar, honey, thick, MIXED
Smoothness vs lumps & bumps
Whole pieces of “formed solids” in puree
Squeeze pouches
© Sally Asquith 2018

86. “Finger foods” Manufacturing standards…  Begin with the safest:
graham crackers, Keebler crackers
NOT Puffs, Wagon Wheels
Consider intersection of food + saliva
© Sally Asquith 2018

87. Positioning: chairs Cephalocaudal relationship Feeling of security
External support to rib cage
Level of eating surface to elbows/shoulders
© Sally Asquith 2018

88. Abiie chair, $195 Keekaroo chair, $190

89. Therapy strategies Promote safe adaptation Err on the side of caution
Pace with the child
Create trust and faith
Move forward in little steps
Promote safe adaptation
© Sally Asquith 2018

90. Therapy strategies: methods
Beckman Oral Motor, Debra Beckman
TalkTools®, Sara Rosenfield Johnson
NMES (neuromotor electrical stimulation): elicits muscle contractions using electric impulses
SOS (sequential oral sensory approach), Kay Toomey
SOFFI (supporting oral feeding in fragile infants), Erin Sundseth Ross
NOMAS (neonatal oral-motor assessment scale), Marjorie Meyer Palmer
© Sally Asquith 2018

91. What can we do on monday? KEY CONCEPT #1: Safety and nutrition
KEY CONCEPT #2: Don’t muck it up
KEY CONCEPT #3: America’s wealth/
availability of every food imaginable
© Sally Asquith 2018

92. Free resources Put Feeding Matters on your favorites bar
Krisi Brackett’s Pediatric Feeding News
Sheri Fraker/Laura Walbert’s blog
Key web sites:
Catherine Shaker
Feeding Matters
Diane Bahr’s Ages and Stages
Feeding Flock, UNC-CH
© Sally Asquith 2018

93. More free resources Read daily posts on SIG 13 Ask advice
Ask the parents
Find a mentor
Visit clinics
Read one peer-reviewed article per month
Get to know the WIC nutritionist
© Sally Asquith 2018

94. Pretty cheap resources
Join SIG 13 – only $35 per year
Form a “Dysphagia Dinner” group; meet up for dinner with other local SLPs
Read “Food Chaining” by Sheri Fraker and Laura Walbert
Read “Feeding and Nutrition for the Child with Special Needs” by Marsha Dunn Klein and Tracy Delaney
Read “Feeding and Swallowing Disorders in Infancy” by Lynn Wolf and Robin Glass
© Sally Asquith 2018

95. Worth the $
Courses:
Catherine Shaker
Sheri Fraker and Laura Walbert
Krisi Brackett
Mary Massery, DPT
Feeding Matters 6th conf, Phoenix, Jan 2019
Read Pre-Feeding Skills, 2nd ed, by Suzanne Evans-Morris
© Sally Asquith 2018

96. DISCUSSION

97. references
ASHA. (2016). Code of Ethics. Retrieved 9/11/17.
Banchaun, B., Chaithirayanon, S., & Eiamudomkan, M., (2013). Feeding Problems in Healthy Young Children: Prevalence, Related Factors and Feeding Practices. Pediatric Reports, 5(2). Doi: /pr.2013.e10
Bragelian, R. (2007). Stimulation of Sucking and Swallowing to Promote Oral Feeding in Premature Infants. Acta Pediatrica, 96: 1430 – 1432.
Coryllos, E.V., Genna, C.W., & Salloum, A.C. (2004). Congenital tongue‐tie and its impact on breastfeeding. American Academy of Pediatrics Section on Breastfeeding, 1–6
Craig, C.M., Lee, D.N., Freer, Y.N., & Laing, I.A. (1999). Modulations in Breathing Patterns During Intermittent Feeding in Term Infants and Preterm Infants with Bronchopulmonary Dysplasia. DMCN, 41,
Davis CM. Results of the self-selection of diets by young children. (1939). Canadian Medical Association Journal, 41:257-61
Delaney, A., & Arvedson, J. (2008). Development of Swallowing and Feeding: Prenatal Through First Year of Life. Developmental Disabilities Research Reviews, 14: 105 – Retrieved 9/11/17.
Estrem, H., Pados, B., Thoyre, S., Knafl, K., McCornish, C., & Park, J. (2016) Concept of Pediatric Feeding Problems From the Parents’ Perspective. MCN in Advance.
Fraker, C., Fishbein, M., Cox, S., & Walbert, L. (2007). Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. Marlowe & Company.

98. references
Francis, J., Rogers, K., Brewer, P., Dickton D., & Pardini, R. (2008) Comparative Analysis of Ascorbic Acid in Human Milk and Infant Formula Using Varied Milk Delivery Systems. International Breastfeeding Journal, 11;3:19. doi: / Retrieved 10/2/17.
Hawdon, J.M., Beauregard, N., Slattery, J. and Kennedy, G. (2000). Identification of Neonates at Risk of Developing Feeding Problems in Infancy. DMCN, 42:
Lau, C., & Kusnierczyk, I. (2001). Quantitative Evaluation of Infants’ Non-Nutritive and Nutritive Sucking. Dysphagia, 16(1):
Mennella, J.A, Jagnow, C.P. and Beauchamp, G.K. (2001). Prenatal and Postnatal Flavor Learning by Human Infants. Pediatrics, Jun;107(6):E Retrieved 2/13/18.
Mizuno, K., Nishida, Y., et al., (2007). Infants with Bronchopulmonary Dysplasia Suck with Weak Pressure to Maintain Breathing during Feeding. Pediatrics, 120(4): e1035-e1042.
Pados, B.F., Park, J., Thoyre, S.M., Estrem H., & Nix, W.B. (2015). Milk Flow Rates From Bottle Nipples Used for Feeding Infants Who Are Hospitalized. American Journal of Speech- Language Pathology, 24: doi: /2015_AJSLP Retrieved 9/11/17.
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101. Thank you! Sally Asquith: s.asquith@mycsal.com
Amanda Morse:
Carolina Speech & Language Center, Inc.