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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.

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mealtime skills

Mealtime Skills

Chapter 12

assessment process form is on page 565
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
The Big Question
  • What is best for the child?
  • What skills are necessary for improvement?
collaboration with the family
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
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 concerns1
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 concerns2
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 concerns3
Respiratory Concerns
  • Optimal positioning
    • Opens airways, enhances breathing, decreases aspiration
    • Speeds up digestion which lessens chance of reflux.
oral motor skills
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 skills1
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 skills2
Oral Motor Skills
  • Structural Abnormalities
    • Cleft Lip
    • Cleft Palate
    • Missing Teeth
    • Surgical Correction may be needed
strategies to improve oral motor functioning
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
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
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
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
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
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
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 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
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
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
Overall
  • Communication
  • Have a plan
  • Collect Data