Defining Characteristics:
Oral phase impairment
- Lack of tongue action to form bolus;
- weak suck resulting in inefficient nippling;
- incomplete lip closure;
- food pushed out of mouth;
- slow bolus formation;
- food falls from mouth;
- premature entry of bolus;
- nasal reflux;
- inability to clear oral cavity;
- long meals with little consumption;
- coughing, choking, or gagging before a swallow;
- abnormality in oral phase of swallow study;
- piecemeal deglutition;
- lack of chewing;
- pooling in lateral sulci;
- sialorrhea or drooling
- Altered head positions;
- inadequate laryngeal elevation;
- food refusal;
- unexplained fevers;
- delayed swallow;
- recurrent pulmonary infections;
- gurgly voice quality;
- nasal reflux;
- choking, coughing, or gagging;
- multiple swallows;
- abnormality in pharyngeal phase by swallowing study
- Heartburn or epigastric pain;
- acidic smelling breath;
- unexplained irritability surrounding mealtime;
- vomitous on pillow;
- repetitive swallowing or ruminating;
- regurgitation of gastric contents or set burps;
- bruxism;
- nighttime coughing or awakening;
- observed evidence of difficulty in swallowing (e.g., stasis of food in oral cavity, coughing, or choking);
- hyperextension of head, arching during or after meals;
- abnormality in esophageal phase by swallow study;
- odynophagia;
- food refusal or volume limiting;
- complaints of "something stuck";
- hematemesis;
- vomiting
Related Factors:
- Congenital deficits;
- upper airway anomalies;
- failure to thrive;
- protein energy malnutrition;
- conditions with significant hypotonia;
- respiratory disorders;
- history of tube feeding;
- behavioral feeding problems;
- self-injurious behavior;
- neuromuscular impairment (e.g., decreased or absent gag reflex, decreased strength or excursion of muscles involved in mastication, perceptual impairment, or facial paralysis);
- mechanical obstruction (e.g., edema, tracheotomy tube, or tumor);
- congenital heart disease;
- cranial nerve involvement;
- neurological problems;
- upper airway anomalies;
- laryngeal abnormalities;
- achalasia;
- gastroesophageal reflux disease;
- acquired anatomic defects;
- cerebral palsy;
- internal or external traumas; tracheal, laryngeal, esophageal defects;
- traumatic head injury;
- developmental delay;
- nasal or nasopharyngeal cavity defects;
- oral cavity or oropharynx abnormalities;
- premature infants
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
- Swallowing Status
- Swallowing Status: Esophageal Phase, Oral Phase, Pharyngeal Phase
- Demonstrates effective swallowing without choking or coughing
- Remains free from aspiration (e.g., lungs clear, temperature within normal range)
Suggested NIC Labels
- Aspiration Precautions
- Swallowing Therapy