Mealtime Skills

1. Mealtime Skills Chapter 12

2. Assessment Process Form is on page 565 • Components • Family’s feeding concerns • Respiratory concerns • Positioning needs • Oral Motor Skills • Sensory aspects • Communication and socialization skills • Behavioral issues. • Nutritional and dental concerns

3. The Big Question • What is best for the child? • What skills are necessary for improvement?

4. Collaboration with the Family • Communication is key • Input from all team members • Speech-language pathologist • Physical therapist • Occupational therapist • Nutritionist or dietician • Physician • Parents

5. Respiratory Concerns • Total Airway Obstruction • All caregivers must be trained in procedures • Procedures included in IEP and HSP (health service plan) • Warning signs include difficulty breathing and blue lips. • Suctioning, administer oxygen, or Heimlich maneuver could be administered.

6. Respiratory Concerns • Signs of Aspiration • Aspiration is entry of food or fluids into the lungs. • This happens when there is reflux from the food going down to the stomach and coming back up. • Minor issues results in coughing. • Major issues include irritation, inflammation, aspiration pneumonia, and scarring of the lungs. • Some children show no signs and must be observed closely during meals.

7. Respiratory Concerns • Prevention and Treating of Aspiration • VFSS (videofluoroscope swallow study) • VFSS is a procedure to see if there is a problem with the consistency of food and liquid. • Person should be sitting in upright position with head slightly forward so food does not slide down throat. • Pureed foods and thin foods are not recommended. (Excluding these foods though can cause severe constipation) • Medication can help but not always. • Surgery to tighten esophagus is done when all other options fail.

8. Respiratory Concerns • Optimal positioning • Opens airways, enhances breathing, decreases aspiration • Speeds up digestion which lessens chance of reflux.

9. Oral Motor Skills • Typical Development • Jaw, cheek, lips, and tongue move together as one unit. • Children progress through sucking liquids, to tongue usage with semisolids, to chewing and biting, and drinking.

10. Oral Motor Skills • Atypical Oral-Motor Development • Hypersensitivity and gag reflex occurs. • Inadequate lip closure-food falls out, drooling • Jaw/Cheek/Lip/Tongue retraction-this retraction reduces the mobility to eat. • Tonic Bite-Clamping of the jaw which interferes with spoon feeding. • Tongue Protrusion and/or tongue thrust-This occurs when the tongue rests outside of the mouth. This pushes food and fluids back out of the mouth.

11. Oral Motor Skills • Structural Abnormalities • Cleft Lip • Cleft Palate • Missing Teeth • Surgical Correction may be needed

12. Strategies to Improve Oral-Motor Functioning • Rule out medical reasons • Identify food allergies • Environment-Overstimulation • Proper Positioning • Identify activities to help with muscle tone • Provide oral stimulation • Sensory properties of utensils • Appropriate interactions between child and feeder.

13. Providing Oral Support • Feeder may provide aid to the head positioning with hand or cushion • Feeder place hand under jaw while eating to help with stability. • Feeder moves jaw for student while feeding. • Feeding should not involve controlling upper lip.

14. Sensory Aspects • Techniques to help in feeding • Stroke the cheeks downward • Stroke from nose to upper lip • Stroke from chin to lower lip • Stroke around lip in circular motion

15. Incorporating Touch, Taste, Temperature, and Texture into the Meal. • Changing texture by adding graham crackers to pudding. • Take two foods the child likes and mix them together. • Some prefer hot over cold or cold over hot. • Spoon or cup placement can also play a factor. (millions of possibilities…COLLECT DATA!!!!)

16. Communication and Socialization • Feeder needs to watch and listen. • Make sure enough light is on the child to see. • Establish smooth pace. • Some require verbal prompts. • Given child opportunity to signal when ready for next bite. • Distractions need to be minimized

17. Behavior Problems • FBA • What is the reason for the behavior problem. • Collect the data. • Once we know the reason we can implement new skills and strategies.

18. Nutritional Concerns • Risk Factors • Difficult ingestion and digestion, limited oral motor skills, limited movement, etc. • Signs and Symptoms • Low energy, low resistance to infection, anemia, etc. • Nutrition Screening • Diarrhea, constipation, food allergies, lower weight, stunted growth, etc.

19. Dental Needs • Dental Concerns • Damaged teeth, missing teeth, cavities, gum overgrowth. • OT should play a hand in implementing new strategies for brushing teeth if there are sensory issues. • Seizure medicine can cause gum overgrowth in 50% of the cases.

20. Feeding Plan • Did all team members participate? • Was medical documents received and considered? • What is most effective sequence? • What equipment is needed? • Where were meals to be given?

21. Non-Oral Feeding Methods • Feeding Tubes • See table 12.3, page 596 for more examples. • Transitioning back to oral feeding. • Hypersensitivity in eating is now present • Low motivation • Completely resist eating. • Problems for using the feeding tube still exist.

22. Overall • Communication • Have a plan • Collect Data