evaluation of neonatal sucking: normal, disorganized, dysfunctional
TRANSCRIPT
![Page 1: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/1.jpg)
Special Start Training Program
![Page 2: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/2.jpg)
Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional
• Presented by:
• Marjorie Meyer Palmer,M.A.
• Speech Pathologist
• Neonatal and Pediatric Feeding Specialist
![Page 3: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/3.jpg)
Course Objectives:
To identify poor feeders by the sucking pattern they demonstrate
To differentiate a disorganized suck from a dysfunctional suck
![Page 4: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/4.jpg)
Infant Oral Anatomy
tongue filled mouth
pear shaped palate
sucking pads in buccal cheek
uvula approximates epiglottis
tongue tip against palate
![Page 5: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/5.jpg)
Tongue filled mouth
![Page 6: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/6.jpg)
Pear shaped palate
![Page 7: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/7.jpg)
Sucking pads
![Page 8: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/8.jpg)
![Page 9: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/9.jpg)
Tongue approximates palateUvula approximates epiglottis
![Page 10: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/10.jpg)
Infant designed for function
To take oxygen nasally
To take nutrition orally
Observe the normal oral resting posture
![Page 11: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/11.jpg)
![Page 12: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/12.jpg)
Interrupted Function
Infant with BPD, chronic lung disease
Open mouth posture
Labored respiration
Breathing is both nasal and oral
![Page 13: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/13.jpg)
![Page 14: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/14.jpg)
Interrupted Function
Infant with Arnold Chiari malformation
Spina bifida
Open mouth posture
Oro-facial hyptonia
![Page 15: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/15.jpg)
![Page 16: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/16.jpg)
Emergence of Primitive Oral Reflexes
gag reflex
rooting reaction
transverse tongue reflex
phasic bite
non-nutritive suck
nutritive suck
![Page 17: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/17.jpg)
Gag Reflex
![Page 18: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/18.jpg)
Rooting Reaction
![Page 19: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/19.jpg)
![Page 20: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/20.jpg)
![Page 21: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/21.jpg)
![Page 22: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/22.jpg)
Transverse Tongue Reflex
![Page 23: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/23.jpg)
![Page 24: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/24.jpg)
![Page 25: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/25.jpg)
![Page 26: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/26.jpg)
![Page 27: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/27.jpg)
Non-nutritive Suck
Short, rapid excursions of jaw
Rate of 2 sucks/second
Cupped tongue configuration
![Page 28: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/28.jpg)
Non-Nutritive Suck
![Page 29: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/29.jpg)
![Page 30: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/30.jpg)
Nutritive Suck
![Page 31: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/31.jpg)
![Page 32: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/32.jpg)
![Page 33: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/33.jpg)
![Page 34: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/34.jpg)
![Page 35: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/35.jpg)
![Page 36: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/36.jpg)
![Page 37: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/37.jpg)
![Page 38: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/38.jpg)
![Page 39: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/39.jpg)
3-6 months:Transition from Reflexive to Volitional
volitional suck
bilabial closure
tongue tip elevation
quiet jaw
![Page 40: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/40.jpg)
![Page 41: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/41.jpg)
Neonatal Intensive Care
The experience
![Page 42: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/42.jpg)
Neonatal Intensive Care
Environment
Medical Intervention
Oro-facial procedures
Development of oral-motor skills
Impact on oral-sensory system
![Page 43: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/43.jpg)
![Page 44: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/44.jpg)
![Page 45: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/45.jpg)
Impact on oral-motor development
![Page 46: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/46.jpg)
Early Diagnosis of Oral Feeding Disorders
![Page 47: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/47.jpg)
![Page 48: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/48.jpg)
![Page 49: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/49.jpg)
![Page 50: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/50.jpg)
![Page 51: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/51.jpg)
NOMAS® (Neonatal Oral-Motor Assessment Scale)
Developed by Marjorie Meyer Palmer, M.A., 1985
![Page 52: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/52.jpg)
![Page 53: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/53.jpg)
![Page 54: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/54.jpg)
![Page 55: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/55.jpg)
![Page 56: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/56.jpg)
![Page 57: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/57.jpg)
![Page 58: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/58.jpg)
![Page 59: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/59.jpg)
Differential Diagnosis of Neonatal Sucking Patterns*
Normal
Disorganized
Dysfunctional
• *Based upon the NOMAS®, developed by Marjorie Meyer Palmer, M.A.
![Page 60: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/60.jpg)
![Page 61: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/61.jpg)
![Page 62: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/62.jpg)
Disorganized Suck
“refers to a lack of rhythm of the total sucking activity”
Crook, 1979
![Page 63: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/63.jpg)
“BPD prevents the infant from breathing and swallowing efficiently during sucking and swallowing”
Craig, CM et.al., 19”99
![Page 64: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/64.jpg)
![Page 65: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/65.jpg)
![Page 66: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/66.jpg)
![Page 67: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/67.jpg)
![Page 68: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/68.jpg)
![Page 69: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/69.jpg)
![Page 70: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/70.jpg)
![Page 71: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/71.jpg)
![Page 72: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/72.jpg)
![Page 73: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/73.jpg)
![Page 74: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/74.jpg)
![Page 75: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/75.jpg)
![Page 76: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/76.jpg)
Dysphagia-
swallowing disorder with difficulty that may occur in any or all stages of swallow: oral, pharyngeal, esophageal
![Page 77: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/77.jpg)
![Page 78: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/78.jpg)
![Page 79: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/79.jpg)
![Page 80: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/80.jpg)
![Page 81: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/81.jpg)
Dysphagia
double aortic arch
infant at 35 weeks PCA
stridorous sounds with bottle feeding
less stridorous with breast feeding
![Page 82: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/82.jpg)
![Page 83: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/83.jpg)
Dysphagia
Infant with TEF repairchoking with feeds
material collects above the surgical repairesophagus will recover
![Page 84: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/84.jpg)
![Page 85: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/85.jpg)
Dysphagia
infant with VACTERL syndrome
TEF fistula repair
now two months corrected age
has developed compensatory strategies
![Page 86: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/86.jpg)
![Page 87: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/87.jpg)
![Page 88: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/88.jpg)
Sensory Aspects of Neonatal Sucking
![Page 89: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/89.jpg)
![Page 90: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/90.jpg)
![Page 91: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/91.jpg)
![Page 92: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/92.jpg)
![Page 93: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/93.jpg)
![Page 94: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/94.jpg)
Perseveration
Responds to initial stimulus
Once stimulus has been removed activity does not diminish
Activity continues indefinately
Poor intra-oral sensory perception
![Page 95: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/95.jpg)
Developing Sensory Aversion
Infant born at 30 weeks gestation
now 40 weeks PCA
BPD, chronic lung disease
observe subtle head movement
poor care giving skills
![Page 96: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/96.jpg)
![Page 97: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/97.jpg)
Developing Sensory Aversion
premature infant now 9 weeks corrected age
observe head movement, facial expression, eyes
expression component of suck still reflexive
suction component of suck volitional
![Page 98: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/98.jpg)
![Page 99: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/99.jpg)
![Page 100: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/100.jpg)
![Page 101: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/101.jpg)
After a series of pain episodes infants learn to escape heartburn by refusing to eat or by limiting the size of
their meals*
PE Hyman, M.D., Journal of Pediatrics, 1994, 125:S103-9.
Visceral Hyperalgesia
![Page 102: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/102.jpg)
Sensory-based oral feeding aversion
7 month old infant
born with diaphragmatic hernia
gastrostomy tube/Nissen fundoplication
non-oral feeder
![Page 103: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/103.jpg)
![Page 104: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/104.jpg)
![Page 105: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/105.jpg)
![Page 106: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/106.jpg)
For more information:
www.nomasinternational.org
www.marjoriemeyerpalmer.com
![Page 107: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/107.jpg)
![Page 108: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/108.jpg)
![Page 109: Evaluation of Neonatal Sucking: Normal, Disorganized, Dysfunctional](https://reader038.vdocuments.net/reader038/viewer/2022102805/5549c048b4c905e5048b52c0/html5/thumbnails/109.jpg)