Mealtime Skills

Chapter 12

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

The Big Question

• What is best for the child?• What skills are necessary for improvement?

Collaboration with the Family

• Communication is key– Input from all team members• Speech-language pathologist• Physical therapist• Occupational therapist• Nutritionist or dietician• Physician• Parents

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.

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.

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.

Respiratory Concerns

• Optimal positioning– Opens airways, enhances breathing, decreases

aspiration– Speeds up digestion which lessens chance of

reflux.

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.

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.

Oral Motor Skills

• Structural Abnormalities– Cleft Lip– Cleft Palate– Missing Teeth– Surgical Correction may be needed

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.

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.

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

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!!!!)

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

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.

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.

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.

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?

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.

Overall

• Communication• Have a plan• Collect Data