Special feeding issues

special_feeding_issues

The roles of child and parent can become confused when the child has neurological, developmental, or other medical difficulties that influence feeding. Many times these children are uncomfortable with the feeding process. The mealtime cues can be difficult to read. It may take a while for the parents and physicians to figure out what is causing the problem. Sometimes children with disabilities do not have good internal cues. They may stop eating before they actually have had enough nourishment, or they may eat until they are more than full. Feeding specialists have the opportunity to promote a positive feeding relationship in all therapeutic suggestions.

Sensory considerations

Working on specific feeding skills must be done with sensitivity to the child’s specific sensory concerns. Feeding skills can be worked on only in an environment that supports the child’s sensory needs.

Hyposensitivity: Hyposensitivity to mealtime stimuli can interfere with the development of sucking, swallowing, biting and chewing. Children may have difficulty initiating or sustaining the appropriate movement patterns and control for eating and drinking. They may be unaware of food in the mouth and stuff the mouth to increase the amount of sensory information. Pieces of food may become scattered and remain in the mouth for many hours after the meal is completed.

Hypersensitivity: Sensory overload responses can strongly influence the acquisition of mature feeding skills. The extremes of responses can interfere with controlled sucking, swallowing, biting, and chewing, and even the ability to participate in a mealtime. They influence the quality of eating and drinking responses.

Self-feeding considerations

As infants and young children have positive experiences with foods and increasing opportunities to watch others eat, they begin to show signs of readiness for self-feeding that emerge as a process between infancy and toddlerhood (Gessell & Ilg, 1937). Older infants take more and more responsibility for the pace of the meal and the foods they eat. They demonstrate stronger preferences. Toddlers are psychologically and socially focusing on independence. The “do it myself” attitude often strongly dominates toddlers” mealtimes and gives the parents a strong indication of self-feeding readiness and a demand for independence.

Strategies to cope

• Anticipation (start with a child that is hungry; verbally cue the child about it being time to eat)

• Eagerness and enjoyment (start with preferred food; involve the child in preparation of the food)

• Preferences (start with preferred foods and change from day to day)

• Mouthing (provide opportunities for mouthing toys and sucking on fingers dipped in food)

• Play with the food (using food and toys together; finger paint with pudding, chutney, whipped cream, jelly, curd)

• Reach for the spoon (when the child is reaching for the spoon or cup they are indicating that they are ready to feed themselves)

• Do it myself (child should have own spoon while they are feeding; encourage finger foods)

Communication considerations

Communication during mealtimes requires that both the parent and child use a set of signals that is understood by both. (Facial expressions; body posture; vocal loudness; eye contact; head movements; words and signs). Communication is a series of taking turns and the child needs to know how to initiate their turn and the parent needs to be able to read the turn, respond to the turn and then take their own turn in response to their child’s turn.

Strategies to cope

• Turn taking

• Label the foods, utensils

• Label the child’s feeling about the food and meal time process. ( wow, yuck, yum, mmm, in, out, all done, more) and also add a gesture if needed

• Describe the food (hot, cold, sweet, sticky, crunchy)