Feeding Flashcards
What does the SOS feeding approach assess and address
all of the underlying causes of feeding difficulties
What classifies a child as a picky eater
Eats at least 30 foods
Foods lost to burn out usually are eaten again after 2 weeks
tolerates new foods on their plate and can touch or taste them
Easts more than 1 food from most food groups
What classifies a child as a problem eater
Eats less than 20 foods
Burn-out foods are not re-acquired
cries with new foods
Refuses entire food groups pr textures
SOS evaluation process
Gather a food list of what wild eats
Observation of a meal with family
Gather background information
look into oral motor skills
What food group is often lacking in picky/problem eaters
Fruits and vegatables
Things to look for when observing a family meal
DO they eat together
Are they at the table
what language is used revolving food
what is the energy level like
SOS treatment
always start with a good rapport and with preferred food
Establish the just right challenge with certain food items
Focus on parent education and how skills used in therapy can transfer to home
What is the first thing to look at when addressing feeding
Posture
Steps to eating
- Tolerate
- Interact with
- smell
- touch
- taste
- Eating
Systematic Desensitization in Feeding
children are allowed to get used to easy things about food and eating first and then helped with progressing up to harder foods
Food chaining
Starting with a preferred food and moving towards a new food
Want to progress by only changing one thing about the food such as color or texture
Family Style Serving
All foods are brought to the table and everyone gets a little of everything
Includes a few preferred foods
No separate meals for kids
Might use a learning plate if child cannot tolerate it on their own
Responsive Feeding guidelines
Coach parents on how to engage in positive interactions
Watch the children’s cues and listen to what they tell you
If they are done let them be done
Support the development of trust between the caregiver and the child by eliminating pressure
Division of Responsibility for infant
Parent is responsible for what they eat
Infant is responsible for how much and everything else
Division of Responsibility for babies
parent is responsible for what and is becoming responsible for when and where the child is offered food
Child is responsible for how much and whether to eat the foods
Division of responsibility for toddlers through adolescents
the parent is responsible for what when and where
The child is responsible for how much and whether or not to eat
Authoritarian Feeding Style
Forceful, restrictive, structured
Relies on force-feeding and overpowers the child
May occur when there are concerns about intake
Consequences: Avoidant behaviors, overweight, child has difficulty self-regulating
Uninvolved feeding style
unengaged, unstructured, no help during meals, lack of reciprocity
This may include parents distracted by technology or mental health issues
Consequences: Child eats because food is there, child unable to recognize hunger
Indulgent Feeding style
involved, nurturing, unstructured
May use food as reward to comfort
Allows child to choose food for meals, offers multiple alternative foods
Consequences: child has high intake of foods with sugar and salt, overweight, child decided when/what to eat, maybe picky
Authoritative Feeding Style
WHAT WE WANT
involved, nurturing, structured
Engages in conversation
Provides clear expectations around mealtimes
Consequences: child learns to self regulate and self-feed, develops healthy eating habits and learns that meals are fun
pediatric feeding assessment
Medical history
Developmental history
Feeding difficulty
Current Feeding routine
Oral motor and sensory skills
Parent feeding styles
Best practice guidelines for feeding
Want the parent to engage in the strategies and feeding during the session so that they feel successful
Infant Assessment for feeding
Pre- and Postnatal histories
State regulation
Positioning and postural stability
Non-nutritive sucking skills (pacifier)
Nutritive sucking skills
Positioning and Postural Stability
Head position
Muscle tone
Overall alignment, make sure body is all facing in the right direction
Non-nutritive sucking
Should be very rhythmic
Tongue lip and jaw movements
Pacifier shape can be geared towards what the baby needs
Sucking burst- 6-8 sucks then a pause
Might gag if not doing well with the pacifier
Nutritive Sucking Skills
Suck-swallow-breathe coordination- has to do with milk flow, might be difficult for very young infants
Suck-swallow ratio- should be 1-2 sucks then swallow
Lip seal- lips might be curled in
Signs of stress during feeding-
Crying
Finger splaying
Falling asleep
feeding milestones at 6 months
Swallows purees
munching begins
Feeding milestones at 8 months
eats textured purees and mashed table foods
When does finger feeding begin
by 9 months should be able to finger feed most of meal
12 month feeding milestone
eats chopped table foods
bites through soft foods
15 months feeding milestone
chews some meats and raw vegetables
Bites through hard foods
Common feeding challenges
persistant gaging
minimal movement of the tongue from side to side
pocketing/stuffing
swallowing food whole
Refusal to self-feed
Food intolerances
Ways to support the parent at meal times
Identify beliefs and fears around food
Educate them on the skills required and importance of self-feeding
empower parents to advocate at medical appointments
Look at responsive feeding and responsiblity
What is not effective when working on feeding?
Pressure at mealtimes
Child should be in control of what they are eating and what steps they are taking
Optimal positioning for airway during feeding
Head in neutral with chin tuck
Epiglottis folds over entrance to trachea
Larynx rises
Vocal folds close
potential challenges of the jaw during feeding
Unstable
wider opening that needed
Clenched
Stability bite
Reflexive (tonic) bite
Retraction
Asymmetry
Interventions to help jaw
Positioning
Low tone- resist jaw movements to improve stability
High tone- massage
Retraction- position prone or side lying to bring jaw and tongue forward
Bite stability- 2 fingers and thumb
Pierre robin sequence
Small jaw
Glossoptosis
tongue lip adhesion
Potential challenges with the tongue
Retracted
Protruded (low tone or tongue thrust)
Asymmetrical
Limited mobility
Tongue interventions
Position
Stable jaw
Retracted- entice forward and to the sides
Protruded- push down with spoon on center of tongue or on lower lip
Place food on sides to increase movements
Potential lip challenges
Retraction -high tone
poor lip closure from low tone
Asymmetry
limited movement
Lip intervention
Positioning
Stability
Stroking from nasal area downward
Straws
Oral motor toys (whistles, blowing bubbles)
Potential cheek challenges
Low tone- unable to develop pressure to suck, cant push food side to side
High tone- static, cant push food side to side
Cheeks intervention
Positioning
Tap cheek muscles
Shake out muscles
Place food on side teeth
sucking through straw
Potential palate challenges
poor timing or insuffiecnt elevation of soft palate
try changing position or consistency of food
SLP help
