fantastic feeders, ndsc convention 2012

Fantastic Feeders

Jennifer Bekins & Krystin Turner

The Jane and Richard Thomas Center

for Down Syndrome

Introduction to feeding

• Medical status:

– Heart-lung connection

– Gastro-intestinal issues common in DS

Pre-feeding Skills

• Medical status

• Suck: swallow: breathe coordination

• Non-nutritive sucking (sucking without eating)

• Other factors

Setting your child in a position for

success

• What is the best way to feed a baby with DS?

• Considerations

• Options

– Cradle hold

– Semi-reclined

– Upright

– Side-lying

Age vs. Developmental Readiness* for

Feeding

• Turns away or uses vocal protests to indicate

meal-time is over

• Appears interested in what you are eating

• Starting to bring objects to mouth

• Sitting with support

* See visual on developmental stages and oral

feeding

Feeding Readiness:

Transition to Purees

• Skills to look for:

• Head control

• Ways to support

during feeding:

• Recline in space

high chair

• Towel rolls

Bumbo for Infant Feeding? No!

• Do not place on elevated surface

• Must have head control

• Do not use for early feeding for children with

Down syndrome

Spoons!

What to look for in a

spoon:

• Shallow bowl

• Straight handle

• Specialty needed?

– Probably not

How to present the

spoon:

• Straight in

• To side

Spoon Feeding: Front Placement

Used with permission from

http://yomammamamma.blogspot.com/

Spoon Feeding: Side Placement

Used with permission from

http://yomammamamma.blogspot.com/

Spoon Feeding

Video Disabled by Author

for Web Use

Spoon Feeding Techniques

Video Disabled by Author

for Web Use

Understanding the Food Continuum

Influence of Taste and Texture on Oral

Motor Skills

• Taste

• Texture

• Sensory Awareness

Establishing a Mealtime Routine

Transition: Finger Foods

Readiness for Finger Foods

• Sitting with support

• Can pick up items and release with control

(e.g. blocks into bucket)

Readiness for Utensils

• Grasp and release

• Reaching for objects

and bringing to

mouth

• Grading of

movements

Sippys and Cups and Straws, Oh my!

Types of Sippy Cups

Types of Open or Rim Cups

Types of Straw Cups

Readiness for Cup

• Supported sitting

• Grasp and release

• Grading movement

• Lip closure on spoon

• Follow command “Give to me”

Introduction to Open Cup

Video Disabled by Author

for Web Use

Narrow rim cups for open cup practice

Drinking from Recessed Cup

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for Web Use

Straw Drinking

Video Disabled by Author

for Web Use

Transition from Tube to Mouth

• Has oral skills that support oral intake and

swallow safety

• Tolerates tube feeding

Oral Stimulation for Tube Transition

• Importance or mouthing/sucking

• Providing developmentally appropriate items:

– Pacifier, adult finger, teething toy, bottle nipple,

– Spoons, sippy cups, plates, bowls, wet

washcloths, teething toys, the child’s own fingers

Sensory Stimulation

• Smell

• Taste & Touch

• Sucking/Mouthing

• Drinking

• Eating

Oral Aversion Treatment

• Oral stimulation or touching the lips, gums,

teeth, and tongue of your child's mouth

• Giving your child items to place in the mouth

that are not food (non-nutritive)

• Positive reinforcement

• Structured meal times and repetition of a

routine during mealtimes

• Desensitization techniques

Questions?

Contact Information

Jennifer Bekins, MS, CCC-SLP

Jennifer.bekins@cchmc.org

Krystin Turner, MS, OTR/L

Krystin.turner@cchmc.org