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 Signs and Symptoms
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