Feeding evaluation and disorders

Question 1

Feeding

Answer 1

the process of “setting up”, arranging, and bringing food or fluid from the plate or cup to the mouth, Sometimes referred to as “self-feeding”

Question 2

Eating-

Answer 2

the “ability to keep and manipulate food/fluid in the mouth and swallow it: eating and swallowing are often used interchangeably.

Question 3

Swallowing

Answer 3

“a complicated process in which food, liquid, medication, and saliva pass through the mouth, pharynx, and the esophagus into the stomach”

Question 4

feeding disorder

Answer 4

diagnosis in which an infant or child is not able to achieve adequate nutrition.

can be due to:

• poor oral motor skills
• oral sensorimotor impairments,
• maladaptive behaviors during eating.

Question 5

Failure to thrive

Answer 5

a medical diagnosis in which the infant child is not meeting his or her nutritional needs (infants that have it) not enough adequate nutrition in the beginning.

Question 6

Symptoms of feeding disorders

Answer 6

• poor weight gain
• irritability- can be painful
• Constipation
• refusal to eat foods offered
• excessive crying
• stressful mealtimes
• need for special strategies at mealtimes
• pocketing of food in the mouth.

GERD- causes them not to want to eat: gagging, retching, and vomiting

Question 7

feeding disorder criteria

Answer 7

• Lack of adequate eating with significant weight loss or failure to gain weight, lasting one month or longer
• Behavior is not attributable to a gastrointestinal or other medical condition
• Behavior is not better explained by lack of available food or another mental disorder
• Onset is before age 6

Question 8

Child feeding disorder

Answer 8

• medical- If caloric needs are not met, the child is at risk for stunts in physical and mental development.
• May require a gastrostomy tube or nasogastrostomy tube (more temporary) be placed to increase caloric intake.
• may not be able to actively participate in childhood occupations.

Question 9

impact of feeding disorder

Answer 9

• increase stress of looming medical intervention
• family dynamic changes
• possible decrease in time spent with other children
• Feelings of guilt/pressure from others for not being able to meet their child’s basic needs.

Question 10

Oral tactile sensory processing evaluation

Answer 10

Ask questions about food preferences and food refusals

• tastes (sweet, salty, spicy, bland, flavors
• texture (mushy, hard, mixed, lumpy)
• Temperature (hot, cold)

Ask about the child’s general response to being touched or having food or other objects touch face, lips, mouth, and tongue.

Question 11

Tactile sensory evaluation

Answer 11

• Observe general response to touch from therapist or environment
• First check allergies before introducing new textures.
• Observe reactions to different textured foods.
• Observe reaction to deep pressure and vibration activities.

Question 12

Intervention strategies

Answer 12

feeding intervention strategies can be classified as:

• sensory-based
• oral motor
• behavioral

Question 13

Oral motor treatment strategies

Answer 13

-Utilize concepts from biomechanical and NDT frames of reference.

Lips

• ROM and strength
• Beckman stretches/Rona Alexander facial wrapping
• clearing spoon with lips- help build lip strength

Cheeks

• ROM and strength
• Beckman stretches/Rona Alexander facial wrapping

Question 14

Oral motor treatment strategies

Answer 14

Tongue
-Lateralization/Elevation

Jaw

• Strength
• Beckman chewing protocol
• Overland Chewing hierarchy
• jaw support

Question 15

sensory based feeding intervention

Answer 15

Create individualized treatment plan based on child’s/family’s areas of need
Collaborate with caregiver, teacher and school staff to form a Sensory diet, or daily schedule of sensory activities to incorporate at home and at school
Educate family, teachers and school staff on calming sensory techniques: possibly brushing or joint compression or application of weighted vest if appropriate

Expose the child to new sensory experiences in a Non-threatening, play-based manner .
Allow child to have some Choice in activity selection, and then therapist adds a sensory component

Question 16

sensory based intervention strategies

Answer 16

Pretend Play for Self-Feeding
Have child feed a doll or stuffed animal
Then have the child feed him or herself
Also practice scooping food or non-food objects (marbles, pegs) from one container to the next using a spoon

Write letters/shapes in food/non-food textures
Car race through a texture track
Make play-doh snakes/pizzas
Make thera-putty bracelets/ rings
Finger paints
Make cookie dough
Dig for hidden treasures in a bucket of dried beans/rice/ or noodles

Question 17

Hypo-sensitive (under responsive) child

Answer 17

Target activities that will increase oral awareness
Nuk brush, vibration, chewy tubes
Use foods that will give the child input
Hot/cold
Salty/bold
Spicy
Crunchy

ALERT system- how does your system run? This wakes my system up or calms my system down. (in regards to your mouth)

Progression for the non-oral eater
Dry spoon
Wet spoon
Spoon with water
Spoon with flavored water
Spoon with thickened water
Puree

Question 18

Hyper-sensitive (over responsive) child

Answer 18

Target activities that will decrease the child’s sensitivity.
Nuk brush, vibrations, chewy tubes

Question 19

liquids

Answer 19

Liquids
Use cups with lids/straws
Slowly add new flavor to liquids child will accept
Ice cubes
Gradually add flavors to current liquids

Question 20

Sensory versus Behavioral Modification Approach to Feeding

Answer 20

Client-centered
Select appropriate frame of reference (FoR) based on needs
If decreased intrinsic motivation to eat, a behavioral modification FoR may be appropriate

Each therapist must approach the child individualistically and observe the child over several sessions before determining what approach to use.
The therapist needs to have a good understanding of the principles of both approaches before selecting a particular approach for feeding intervention.
For children that have decreased intrinsic motivation to eat orally, a behavioral modification approach may be beneficial because it utilizes extrinsic motivation.

Question 21

Behavioral modification

Answer 21

• Behavioral modification-Psychological approach that attempts to change or alter an individual’s reactions to stimuli through reinforcement of adaptive behavior or extinction of a maladaptive behavior through punishment
• Positive reinforcement- Addition of something positive to increases the likelihood that a behavior will occur in the future
• Negative reinforcement- Taking away something to increase the likelihood that a behavior will occur in the future
• Punishment- Addition or removal of something to decrease the likelihood that a behavior will occur in the future
• Compliance training-System of reinforcement where verbal, gestural, and physical cues are given and positive reinforcement is given when child complies
• Planned/active ignoral- Positive reinforcement is consistently withheld for non-dangerous, non-destructive problem behaviors.

Question 22

behavior modification principles

Answer 22

Goals-

• increase positive responses
• Prevents negative responses from impeding participation and progress
• Generalize feeding techniques in therapy to home/school

Functional analysis of feeding
-Evaluate antecedents and consequences

*consistency is crucial.

Question 23

Behavioral modification approach protocol

Answer 23

• Let child play with toy for 1-2 minutes initially
• Remove toy and present bite of food. In a neutral voice and facial expression say, “Take your bite. When you take your bite, you may play with ________ (toy or watch your video)”
• If the child takes a bite then you give the child the toy immediately and in happy, intonated voice praise the child with specific comments. “Good taking your bite or Good cleaning the spoon.”
• Continue letting the child play with the toy until Child refuses to take a bite

If the child does not take a bite then leave the spoon only a few inches away from the mouth and continue to say, “When you take your bite you may play with your toy”
If the child continues to refuse, you may change the toy you present, but keep the spoon in front of the child and do not offer the child the toy unless the child takes the bite.
If a stand-off develops, the therapist may turn around and utilize planned ignoring tactics for 2-3 minutes and then turn around and attempt to offer bite again.

Set a time limit for the meal (20-30 minutes)
If the child continues to refuse taking the bite for the duration of the session, then end the session by saying, “The meal is over. Because you didn’t take your bites, you do not get to play with your toys. Maybe next meal when you take your bites, you’ll get to play.”

Question 24

Behavioral modification approach general strategies

Answer 24

Keep a neutral voice and facial expression when offering bites
Actively ignore negative behavioral reactions
Begin with a 1 to 1 ratio of bites to opportunities to play
Increase ratio reinforcement system when child is consistently taking bites
Begin building volume, then increase variety