Unit I - Sensory Based Feeding

Question 1

reactions of children refusing to eat:

Answer 1

• Spitting
• Coughing
• Gagging
• Turning away from food
• Putting hands over head, turning head
• “Hiding” from food

Question 2

Why do sensory sensitivities develop?

Answer 2

Negative early sensory experiences:
• Orally intubated an on a ventilator for a long time
• Oral feeding tubes
• Constant airway suctioning
• “forced” feeding

Child with neurologic impairments:
• May not be able to participate in oral play
• Poor oral motor skills - poor strength and endurance due to medical problems
• Can cause either oral hyper or hypo sensitivities

Lack of oral experiences:
• Medically fragile child that cannot take food by mouth
• Aspiration leading to no foods by mouth
• Child undergoing multiple medical procedures

Question 3

Role of Occupational Therapist

Answer 3

Assessing and treating oral sensitivities:
 oral-motor, eating/feeding skills, hygiene
 reaction to oral sensory input, food type, and texture
 items that child likes, and those they have difficulty eating
 Food textures
 Utensils
 Overall sensory needs
 Self-feeding skills
 Positioning during mealtime

 FOOD Log - a 3-7 day food diary to review

Question 4

Treatment and Intervention:

Answer 4

• Establish rapport and trust. Stop “desensitization” if the child becomes distressed or begins to refuse food. The child will gradually accept greater sensory input if under his/her control
• Use play activities to help “desensitize” the child and help child begin to accept oral experiences
• Therapist sets the goals, child sets the pace
• Use oral exploration with own hands, toys
• Establish mealtime and oral hygiene routines
• Provide activities to “desensitize” the mouth area and get it prepared to accept new oral experiences. Do this in the context of play activities and allow the child to self-guide and explore as much as possible. After building trust, try to “get into the mouth” or “around the face”. Apply deep pressure to gums – 4 quadrants. Firm pressure to the hard palate
• Try vibration toys, bubbles, blow toys
• Avoid wiping the child’s mouth after each bite
• Offer solids first, liquids last
• Mealtime rituals – make food, set table
• Say NO to the TV, yes to conversation!
• Go out to eat, see other kids eating and having fun! Encourage the parents to take the child to restaurants like Moe’s where other children are eating and having a good time.

Question 5

Food Rules for Mealtime:

Answer 5

1. cEstablish a schedule for mealtime. 3 main meals and 2 scheduled snacks. NO extra snacks should be served – you want the child to be hungry and want to eat a FULL meal – no grazing! AVOID drinking juice all day; the child can drink water if thirsty.
2. Parents should always eat with their child.
3. All meals should be in a high chair or appropriate seating. No eating while roaming the house, bathing or in the car.
4. Limit meals to 30 minutes. Terminate the meal sooner if the child refuses to eat, throws food, plays with food. Don’t use games to feed and don’t use food to play with at meal times. Separate meals from playtime.
5. Deal with eating in a neutral manner; don’t be reactive to child’s behavior. No constantly praise for eating and chewing.
6. Prepare to do child-centered, fun activities before and after meals.

Question 6

Early Infancy – OT Treatment using the Beckman Protocol:

Answer 6

The protocol developed by Deborah Beckman, SLP, uses mechanical muscle response, which are not mediated cognitively, to baseline the response to pressure and movement and control of movement for the lips, cheeks, jaw and tongue. The Beckman Oral Motor Protocol uses assisted stretches and controlled movements to improve muscle strength without causing muscle fatigue. The assisted stretches activate a contraction in the muscle. If patients can follow commands, the clinician may have them contract their muscle against resistance to build strength.

Question 7

Suggestions for dental visits

Answer 7

Environment adaptations

• Scheduling the appointment first in the morning or after lunch may minimize waiting time
• Break up the exam into several visits
• Accommodate the need for routine and consistency by having the same staff, appointment time, and exam room to sustain familiarity

Suggestions for dental visits

• Consider providing calming sensory environments to relax anxious children - Snoezelen method
• Unusual sensory responses may be avoided by reducing extraneous noise, light, odors, and movement
• Ask parents about “sensory preferences” such as soft music or a favorite object would comfort the child.
• Visual supports
• Explain and demonstrate each step, and show - “tell, show, do” how the instruments are used
• Social stories