+

Eating and feeding

Successful feeding goes hand in hand with

developmental progress.

Here are some aspects of that mutual relationship…

+Feeding supports physical development and good health…

Well nourished children grow well

Well nourished children experience less illness

+Feeding supports social development…

It provides an important opportunity for babies and their parents or caregivers to bond to each other

Meal time may be the only time of day when the family is together

+Feeding supports speech development…

Eating involves movement patterns similar to those used in speech

Good feeding programs develop the muscles needed for speech acquisition

+ Successful feeding helps infants and children develop a sense of autonomy...

Being able to feed

or refuse food helps

the child develop

a sense of control

over her

environment

+Eating/Feeding process

1. Food enters mouth

2. Moved to teeth by tongue

3. Jaw up and down and rotary

4. Teeth close around food

5. Food finely ground

6. Formed into bolus (saliva food mix)

7. Swallowed

+Developmental Feeding skills

Newborns: primitive reflexes (reflexive sucking, rooting)

6-9 months: repress sucking reflex to munch (vertical jaw movements)

9-24 months: use tongue and rotary chewing to process and grind food

24-36 months: independently use spoon

+ 80% of children with developmental disabilities have difficulty with

feeding- unlikely to outgrow them

Primitive reflexes

Oral defensiveness

Impaired hunger, satiation clues

Poor oral structures

Delayed motor skills

+Watch for these common “red flags”…

Stagnated growth

Frequent bouts with pneumonia due to aspiration

Feedings which exceed 45 minutes in duration

+ Medical diagnoses in which feeding difficulties are commonly seen include…

Autism

Cerebral palsy

Cystic Fibrosis

Failure to Thrive

Gastro-esophageal reflux

• Genetic disorders• Metabolic disorders• Prematurity• Short bowel

syndrome

+ Infants and children with delayed feeding skills or abnormal oral motor patterns…

inadequate use of utensils

difficulty in chewing textured foods

swallowing difficulties

+Infants or children with feeding tubes…

those transitioning from tube feeding to oral feeding

those who will continue to need tube feeds in order to meet nutrient needs, but would benefit from the social aspects of being able to consume some

food orally would experience oral feeding as an enhancement to speech therapy

+ Infants or children with problematic feeding behaviors, including…

significant distractibility during mealtimes

unclear hunger and appetite signals

disruptive feeding behaviors such as throwing food, gorging or rumination

+A Multidisciplinary Feeding Team may include…

Family

Behavioral Psychologist

Dental Hygienist

Nurse

Nutritionist

Occupational Therapist

Parent Advocate

Physical Therapist

Social Worker

Speech Therapist

+

Feeding Activities

+Feeding

“When another person gives the child food or liquids, concentrating on the sucking, chewing, and swallowing process”

+Eating

“When the child is learning to take foods or liquids independently”

+Food textures

Liquid- then, nectar, syrup, honey

Pureed- thin, pureed, thick

Soft mechanical- thin, medium, thick

Solids- soft chewy, chewy, hard

Combination

+Food textures

+Food consistency

+Developmental Process of Eating

Sucking

Vertical jaw movements (munching)

Tongue Movements

Eat independently using a spoon

+Typical oral-motor function in feeding

Automatic phasic bite release pattern

Chewing

Controlled, sustained bite

Gag response

Jaw stabilization

Munching

Rooting response

Rotary jaw movements

Sucking

Suckling

Tongue lateralization

+Chewing

Food enters the mouth which stimulates

Jaw dropping and rebounding

Teeth close around food

Chewing to fine consistency, mixes with saliva, “bolus”

At bolus stage, ready to be swallowed

+Normal Swallow

Normal swallow: http://www.youtube.com/watch?v=1YfO11Pry6Y&feature=related

+Swallowing

Voluntary stage

Pharyngeal Stage

Esophageal stage

+Abnormal Swallow

Abnormal swallow: http://www.youtube.com/watch?v=d_tmhBhec70&feature=related

+Typical oral-motor function in feeding Automatic phasic bite release pattern

Chewing

Controlled, sustained bite

Gag response

Jaw stabilization

Munching

Rooting response

Rotary jaw movements

Sucking

Suckling

Tongue lateralization

+Typical feeding and swallowing development Rooting response

Automatic phasic bite-release pattern

Gag response

Bottle drinking

Spoon feeding

Cup drinking

Solid food intake

+Atypical oral movements

Cheek/lip retraction

Exaggerated jaw closure

Exaggerated tongue protrusion

Jaw thrusting

Lip pursing

Tongue retraction

Tongue thrusting

Tonic biting

+Tongue Thrusting

+Jaw thrusting with head and neck extension

+Warning Signs of Feeding Problem

Excessive drooling

Excessive time needed to complete a meal

Frequent coughing when eating

Difficulty moving the food in the mouth prior to swallowing

Children with imperfect articulation

Tears while eating

+Factors affecting eating and drinking

Developmental readiness

Oral-motor competency

Sensory awareness and discrimination

Medical stability

Positive practice

Environmental factors

Motor control and position

+Conditions and Feeding Problems

+

+Equipment for Feeding and Eating

Spoons

Gripping utensils

Sandwich holders

Bowls and plates

Snack cap

Non-skid surfaces

+Spoons and Gripping Utensils

+Sandwich Holders

Neater Eater: http://www.youtube.com/watch?v=3QA9gajBdMk

Windsford Feeder: http://www.youtube.com/watch?v=KZRFj1UZl-c

+Bowls and Plates

+Cups

+Non Skid Surfaces

+Positioning a child in a high chair

+Assistive Strategies for Feeding

Lip movement

Lip closure

Jaw support

Activating cheek muscles

Jaw control

Developing tongue lateralization

+Oral control from the side

+Oral control from front

+Strategies for Lip Closure

Feeder pauses with spoon resting on lower lip

Use sideways presentation of the spoon to facilitate active upper lip movement

If no upper lip movement, tip spoon up to touch upper lip while still resting spoon on lower lip

+Strategies for jaw closure

Feeder is in front of child with middle finger placed on upper jaw behind the chin to assist with upward jaw movement and reduce tongue protrusion

Jaw support is provided in front of the child with the thumb under the jaw just behind the chin to assist with upward jaw movement

+Strategies for jaw closure while chewing

Chin cupping is provided by the feeder by cupping the chin with the thumb resting on the chin and the index and third finger supporting under the chin

+Strategies for Activating Cheek Muscles for Chewing

Facial molding

Inner cheek massage

Infa-dent finger massage

+Strategies for developing tongue lateralization for chewing

Feeding position

Sensory input to the tongue

Food placement

Practice chewing

+Cup drinking with graded lip movements

+Spoon feeding with oral control

+Presentation of solid food

Nutrition History

What is the home life/meal pattern?

How much is consumed?

Food allergies or intolerances?

Who is present at mealtimes?

Is the child interested in eating?

Any problems with chewing or swallowing? Gagging or choking?

Are there any foods or textures that the child has difficulty with?

Does the child eat non-foods ?

Any weight change perceived?

What religious or cultural backgrounds are present?

+For children

+For adults

+Sample IEP Objectives

+IHP Information

+

Tube Feeding

+Reasons for a G-Tube

Medication

Relieving distention by removing fluids and gas

Relieving nausea and vomiting

Removing gastric samples for testing

+Tube Feeding Methods

Bolus Syringe barrel- quick

Intermittent Gravity Drip Slow drip from bag

+Basic steps

1. Consider environment

2. Wash hands

3. Gather equipment

4. Positioning

5. Involve student

6. Inserting tube

7. Fill syringe

8. Unclamp

9. Monitor student

10. Monitor syringe

11. Water flush

12. Remove tube

13. Remain elevated (30 min)

14. Document procedure

+Mechanical Pump:

G-tube feeding tube

+Bolus: http://www.youtube.com/watch?v=MlfctHJLQ88

+Potential Issues & Emergencies

Aspiration

Tube Displacement

Nausea, Vomiting, Cramping

Diarrhea

Site Infection

Leakage of Stomach Contents

Clogged Tube