Self-Assessment Questions

This section provides a review. Mark each statement on the Answer Sheet according to the factual materials contained in this issue and the opinions of the authors.

Article One (pp. 77–86)

1. A synergy is

   • part of the microbiome

   • a close relationship between mother and child during feeding

   • a functional grouping of muscles and tissues for performing action

   • a biomarker for risk of prematurity

2. An illustration of an emergent property is

   • bacteria

   • formula (milk supplement)

   • obesity

   • nonnutritive sucking

3. When assessing whether a premature infant is appropriate for oral feeding, which of the following factors should be considered?

   • Level of alertness

   • Level of respiratory support

   • Gestational age

   • Physiologic stability

   • All of the above

4. Which of the following is not a characteristic of infant feeding behavior as viewed through a dynamical systems approach?

   • Attractor dynamics

   • Exploratory behavior

   • Emergence

   • Gut microbiome

5. The “primitive” components of infant behavior, traditionally called reflexes, are governed by

   • cohesion

   • age

   • attractors

   • robustness

   • none of the above

   Article Two (pp. 87–95)

6. In neonates, central pattern generators

   • have no role in swallowing function

   • are collections of neurons in the brainstem that ultimately coordinate the interactions between breathing and swallowing

   • cannot function without cortical input

   • only control sucking behavior

   • consist of only sensory neurons

7. The coordination of breathing and swallowing is necessary because

   • preterm infants cannot swallow

   • infants are obligate nasal breathers

   • the two vital functions must share common anatomy

   • apnea can impair swallowing function

   • breathing overrides swallowing

8. The most mature infant breathing and swallowing pattern is

   • swallow-exhale-inhale

   • inhale-swallow-exhale

   • exhale-swallow-exhale

   • inhale-swallow-inhale

   • swallow-inhale-exhale

9. The postswallow respiratory phase is believed to be important because

   • the positive pressure of exhalation can potentially clear the airway of any remaining material

   • inhalation can help to push the fluid into the esophagus

   • inhalation can protect from aspiration

   • apnea can stop aspiration from occurring

   • exhalation can open the airway

10. Esophageal motility

    • is unrelated to the respiratory cycle

    • has no role in swallowing function

    • is the same as gastroesophageal reflux

    • can be affected by the respiratory cycle because there is an inverse relationship between the pressures in the lungs and those in the esophagus

    • has never been studied in infants

    Article Three (pp. 96–105)

11. Neonatal intensive care unit (NICU) infants most at risk of feeding problems include infants

    • classified as late preterm

    • who require mechanical ventilation

    • born < 28 weeks' gestation and with a birth weight < 1,000 grams

    • transported from one hospital to another

    • exposed to drugs during intrauterine life

12. In a NICU feeding culture focused on volume intake, staff typically do not

    • unswaddle the infant

    • consider a nipple flow rate manageable by the infant

    • view faster feeding as “good”

    • feed a drowsy infant

13. For infants in the NICU, aspiration is

    • rarely observed

    • always prevented by using a sidelying position during feeding

    • typically, silent

    • unlikely to cause changes in the lungs

14. For preterm infants, signs of stress during oral feeding

    • may include color changes, increased work of breathing

    • are no longer observed at term age

    • cannot be avoided

    • can be reduced by shorter feeding time

15. Research on co-regulated feeding has shown

    • reduced days to full oral feeding

    • improved intake and growth

    • greater maternal confidence

    • decreased heart rate fluctuation

    • all of the above

    Article Four (pp. 106–115)

16. Flow rate has been shown to

    • be faster at the breast

    • be the best predictor of intake

    • affect swallowing integrity

    • support optimal ventilation

    • both C and D

17. Providing rest during feeding

    • can lead to fatigue

    • can improve stamina

    • typically involves 5-minute rest periods

    • is unlikely to support intake

    • interferes with the infant's active participation

18. Co-regulated pacing

    • is offered every three to five sucks

    • requires leaving the nipple in the infant's mouth

    • supports safety, endurance, and physiologic stability

    • should be used only at the beginning of the feeding

    • is no longer needed by term age

19. Prodding

    • promotes infant learning

    • is an essential intervention for success

    • allows the infant to be an active participant in the feeding

    • should be used when the infant is not rooting

    • may jeopardize adequate respirations and swallowing safety

20. The parent–infant relationship is best supported during feeding by

    • professional caregivers finishing a feeding

    • having parents feed the first bottle feeding in private

    • focusing on emptying the bottle

    • offering anticipatory guidance while parents learn along

    • ensuring the feeding is completed quickly

    Article Five (pp. 116–125)

21. What percentage of children with severe developmental disabilities has some form of feeding problem?

    • 10%

    • 50%

    • 65%

    • 80 to 90%

    • 30%

22. Who are potential members of the pediatric feeding team?

    • Speech-language pathologist

    • Occupational therapist

    • Gastroenterologist

    • Psychologist

    • All of the above

23. In the area of pediatric feeding assessment, there are

    • no commercially available assessments

    • many well-standardized and readily available assessment tools

    • many checklists and criterionbased assessments, but few wellstandardized instruments

    • a clear gold standard assessment used by most feeding therapists

    • several computer-based assessments available

24. Which intervention approach is most commonly used with children who have severe motor and muscle tone disorders?

    • Behavioral approaches

    • Neurodevelopmental or sensory/motor approaches

    • Surgeries for structural abnormalities

    • Intraoral appliances

    • Complex swallowing maneuvers

25. There is an urgent need in field of pediatric feeding for

    • standardized classification of types of feeding disorders

    • standardized assessment protocols

    • empirical research on the effectiveness of feeding intervention programming

    • guidelines to delineate which interventions match best with which type of pediatric feeding disorder

    • all of the above

    Article Six (pp. 126–134)

26. Legislation relevant to the provision of dysphagia management in the schools includes

    • Rehabilitation Act of 1973

    • Americans with Disabilities Act

    • Individuals with Disabilities Education Improvement Act

    • Every Student Succeeds Act (formerly No Child Left Behind)

    • all of the above

27. Which of the following reasons provide justification for the provision of dysphagia services in the schools?

    • Students must be safe while eating in school.

    • Students must be adequately nourished and hydrated so that they can attend to and fully access the school curriculum.

    • Students must be healthy.

    • Students must develop skills for eating efficiently during meals and snack times so that they can complete these activities with their peers safely and in a timely manner.

    • All of the above are true.

28. The percent of school-based speechlanguage pathologists who are treating children with dysphagia is likely to be

    • less than 5%

    • between 5 and 10%

    • between 14 and 35%

    • between 35 and 45%

    • more than 45%

29. Which of the following is a good way for speech-language pathologists to increase communication across team members?

    • Keep a “working file” in a locked file cabinet.

    • Share personal passwords, so other professionals can access your records.

    • Tell all involved team members why your goals are the most important.

    • Talk to each other for shared cases (e.g., discuss instrumental findings).

    • Wait until other professionals ask for a report before you send it.

30. A possible innovative approach to increase training opportunities in the area of pediatric dysphagia may include

    • technologies such as telepractice for training

    • increasing mentoring opportunities

    • more face-to-face trainings

    • reducing conference fees

    • more graduate courses in pediatric dysphagia

    Article Seven (pp. 135–146)

31. Advantages associated with the videofluoroscopic swallow study include that

    • it requires contrast medium

    • it can be completed with minimal patient cooperation

    • it provides a dynamic view of the structures of swallowing and contact aspiration

    • radiation exposure is low or inconsequential

    • the examination should be repeated every 3 months

32. Radiation exposure associated with videofluoroscopic swallow studies is influenced by all the following except

    • duration of the examination

    • pulse rate

    • experience of the personnel performing the examination

    • diminished sensitivity of children to ionizing radiation

    • specific diagnostic conditions and the associated swallowing impairments

33. The generally agreed upon optimal fluoroscopic pulse rate in children is

    • 12.5 frames per second to limit radiation exposure

    • 15 frames per second to limit radiation exposure

    • 30 frames per second to detect supraglottic penetration during bottle-feeding

    • the lowest rate that enables image quality needed to capture necessary information

    • D and C

34. The most important advantage of fiberoptic endoscopic evaluation of swallowing with infants is

    • visualization of suck, swallow, and breathe sequencing

    • assessment of upper esophageal swallow function

    • determination of suck-to-swallow ratios for efficiency of sucking

    • direct observation of structure and function of hypopharynx and larynx

    • use of blue dye to identify laryngeal penetration and aspiration

35. A recent expansion of use of fiberoptic endoscopic evaluation of swallowing in specialized populations involves the following group(s)

    • infants feeding by bottle/nipple

    • infants feeding directly from the breast

    • transition feeders with puree by spoon

    • transition feeders with solid finger foods

    • children who receive nothing by mouth

    Article Eight (pp. 147–158)

36. Early identification of neonates at risk for poor neurobehavioral functioning

    • is available through a number of commercially available tools

    • has become a part of routine screening in the neonatal intensive care unit

    • takes advantage of neuroplasticity mechanisms

    • is not necessary for prevention and/or treatment during infancy

37. Research correlating early sucking and later neurodevelopmental outcomes is limited by the fact that

    • methods used may alter sensory feedback during feeding

    • appraisal of sucking performance is based largely on subjective data

    • only a snapshot of sucking performance is analyzed

    • all of the above

38. To provide clear evidence of the association between early sucking and later neurodevelopment, we must

    • complete a randomized clinical control trial

    • correlate brain imaging with early patterns of sucking during bottlefeeding

    • identify an observational tool of early sucking with high interrater reliability

    • screen all preterm infants at discharge

39. Dynamical systems theory

    • emphasizes the importance of variability in any human movement

    • describes sucking in the context of three phases

    • fails to account for the coordination of sucking, swallowing, and breathing for safe, efficient sucking

    • fails to take into account the gestational age of infants

40. The variables of interest reported here

    • focus on movement variability of the nipple during sucking

    • are calculated taking the standard deviation of the mean and dividing by the mean

    • emphasize the motor learning and coordination aspects of neonatal sucking

    • are calculated across each sucking burst

    • all of the above