1. + Eating and feeding

2. Successful feeding goes hand in hand with developmental progress. Here are some aspects of that mutual relationship…

3. + Feeding supports physical development and good health… Well nourished children grow well Well nourished children experience less illness

4. + 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

5. + Feeding supports speech development… Eating involves movement patterns similar to those used in speech Good feeding programs develop the muscles needed for speech acquisition

6. + 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

7. + 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

8. + 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

9. + 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

10. + Watch for these common “red flags”… Stagnated growth Frequent bouts with pneumonia due to aspiration Feedings which exceed 45 minutes in duration

11. + 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

12. + Infants and children with delayed feeding skills or abnormal oral motor patterns… inadequate use of utensils difficulty in chewing textured foods swallowing difficulties

13. + 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

14. + 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

15. + A Multidisciplinary Feeding Team may include… Family Behavioral Psychologist Dental Hygienist Nurse Nutritionist Occupational Therapist Parent Advocate Physical Therapist Social Worker Speech Therapist

16. + Feeding Activities

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

18. + Eating “When the child is learning to take foods or liquids independently”

19. + Food textures Liquid- then, nectar, syrup, honey Pureed- thin, pureed, thick Soft mechanical- thin, medium, thick Solids- soft chewy, chewy, hard Combination

20. + Food textures

21. + Food consistency

22. + Developmental Process of Eating Sucking Vertical jaw movements (munching) Tongue Movements Eat independently using a spoon

23. + 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

24. + 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

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

27. + Swallowing Voluntary stage Pharyngeal Stage Esophageal stage

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

29. + 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

30. + Typical feeding and swallowing development Rooting response Automatic phasic bite-release pattern Gag response Bottle drinking Spoon feeding Cup drinking Solid food intake

31. + Atypical oral movements Cheek/lip retraction Exaggerated jaw closure Exaggerated tongue protrusion Jaw thrusting Lip pursing Tongue retraction Tongue thrusting Tonic biting

32. + Tongue Thrusting

33. + Jaw thrusting with head and neck extension

34. + 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

35. + Factors affecting eating and drinking Developmental readiness Oral-motor competency Sensory awareness and discrimination Medical stability Positive practice Environmental factors Motor control and position

36. + Conditions and Feeding Problems

37. +

38. + Equipment for Feeding and Eating Spoons Gripping utensils Sandwich holders Bowls and plates Snack cap Non-skid surfaces

39. + Spoons and Gripping Utensils

40. + Sandwich Holders Neater Eater: http://www.youtube.com/watch?v=3QA9gajBd Mk http://www.youtube.com/watch?v=3QA9gajBd Mk Windsford Feeder: http://www.youtube.com/watch?v=KZRFj1UZl- c http://www.youtube.com/watch?v=KZRFj1UZl- c

41. + Bowls and Plates

42. + Cups

43. + Non Skid Surfaces

44. + Positioning a child in a high chair

45. + Assistive Strategies for Feeding Lip movement Lip closure Jaw support Activating cheek muscles Jaw control Developing tongue lateralization

46. + Oral control from the side

47. + Oral control from front

48. + 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

49. + 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

50. + 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

51. + Strategies for Activating Cheek Muscles for Chewing Facial molding Inner cheek massage Infa-dent finger massage

52. + Strategies for developing tongue lateralization for chewing Feeding position Sensory input to the tongue Food placement Practice chewing

53. + Cup drinking with graded lip movements

54. + Spoon feeding with oral control

55. + Presentation of solid food

56. 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?

57. + For children

58. + For adults

60. + Sample IEP Objectives

61. + IHP Information

62. + Tube Feeding

66. + Reasons for a G-Tube Medication Relieving distention by removing fluids and gas Relieving nausea and vomiting Removing gastric samples for testing

67. + Tube Feeding Methods Bolus Syringe barrel- quick Intermittent Gravity Drip Slow drip from bag

68. + 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

69. + Mechanical Pump: G-tube feeding tube

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

71. + Potential Issues & Emergencies Aspiration Tube Displacement Nausea, Vomiting, Cramping Diarrhea Site Infection Leakage of Stomach Contents Clogged Tube