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  • What is Feeding Therapy?

    Feeding therapy is a safe space that is client-focused to help develop the skills necessary to have holistic mealtime experiences. Feeding therapy is for any client or child that is demonstrating or expressing difficulties with manipulation of their foods, difficulty with swallowing, difficulty with tolerating different textures or temperatures, and/or difficulty sitting at the table for a meal. The GOAL of feeding therapy is to focus on learning the skills needed to be successful at home, not on the volume of food the child intakes. The therapists will ensure they provide as much support as the child needs, and NOT do anything for the child such as forcing them to eat foods (Satter, 2000). A healthy approach to mealtime for any client/child is very important as it happens multiple times throughout the day. Mealtimes open up opportunities for oral motor development, sensory exploration, social interaction, family connection, and communication (Basco, n.d.; Gronski & Doherty, 2020). In addition, eating is a vital part of a child’s life in order to receive adequate nutrition and calorie intake, as it is necessary for appropriate growth and development (Gettier, 2022). Important Definitions: “Feeding is the process of involving any aspect of eating or drinking, including gathering and preparing the food and liquid for intake, sucking or chewing, and swallowing” (ASHA, n.d.) “Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected” (ASHA, n.d.) References American Speech-Language-Hearing Association (n.d.). Pediatric feeding and swallowing (Practice Portal). Retrieved May, 3rd, 2023, from topics/pediatric-dysphagia/. Basco, K. K. (n.d.). Pediatric feeding disorders - summit professional education. Summit Education. disorders#VIDEO/ONDEMAND.CFEEKB.1 Gettier, M. (2022, June 1). Children with problematic feeding, selective restrictive eating: A pilot program. issues/2022/problematic-feeding-selective-restrictive-eating Gronski, M., & Doherty, M. (2020). Interventions within the scope of occupational therapy practice to improve activities of daily living, rest, and sleep for children ages 0–5 years and their families: A systematic review. American Journal of Occupational Therapy, 74(2), 1–31. Satter, E. (2000). Child of mine: Feeding with love and good sense. Bull Publishing Company.

  • Eating is a Sensory Experience

    Children that have difficulty with sensory perception tend to have difficulty with eating. Mealtimes involve several sensory systems (Klein, 2019)! Sensory systems are involved in looking, smelling, tasting, and hearing food. Eating requires a child to experience and tolerate various temperatures, flavors, colors, and textures in a sensitive area: the mouth! Imagine trying a new foreign food for the first time and being forced to eat it without being able to explore it with all of your senses; it would be overwhelming! If a child has abnormal sensory responses to eating, feeding becomes an overwhelming experience for all those involved in mealtimes. When eating and feeding are impaired due to sensory difficulties, occupational therapy can address the issue. Occupational therapist’s are knowledgeable about the sensory systems and how the sensory systems need to work in the body during mealtimes. Sensory Variables (Klein, 2019), (Morris & Klein, 2000): Vision → We can learn about food by looking at the food from afar or close-up, by watching others eat, how utensils interact with food, the color of food, the texture, and how it is presented Smell → We can learn about food by smelling the food. A smell can be connected to an emotion or memory of past experiences. If there are negative associations with that food that is connected to a memory, it will be much hard to break the barrier. Smelling is how we taste from a distance. Hearing → We can learn about food by hearing others chew or how it sounds to our ears when we chew. Carrots and chips will create a loud crunchy sound, while cheese and apple sauce will hardly make any sound. Touch → We can learn about food by touching how the food feels, it is slimy, bumpy, slippery, wet, dry? Touching gives us a preview of what it may feel like in our mouth. Taste → We can learn about food by how our brain receives and interprets different foods that touch our tongue. Foods can be sweet, salty, sour, spicy, and/or bitter. Internal Awareness → We can learn about food by how we feel. Does the food give us a stomachache, make us go to the bathroom, feel calm, or feel excited? Balance & Equilibrium → We learn about food the best when we feel well-supported and comfortable in the chair we sit in. Proprioception → We learn about the food the best when we can create smooth motor movements with our body, such as chewing, bringing a spoonful of food to our mouth, or preventing a cup from tipping too much. Causes of Sensory Issues (Marcus & Breton, 2022): Limited pacifier or object-to-mouth play Having sensory processing disorder (difficulty receiving environmental stimuli) Food allergies Tips to Help Sensory Issues: Object sucking (pacifier, chewies that are textured) Make small changes, only one at a time Introduce foods through play Make gradual changes to the taste of food Start with simple ingredient foods (no mixed-textured foods) Give the child control Food Chain Teach chewing skills Do not force the child to complete something above their skill set (e.g., chewing a piece of steak) Learn about the food by following simple steps such as tolerating it in the same room, interacting with it, smelling it, touching it, tasting it, eating it References Klein, M. D. (2019, November 8). Anxious eaters, anxious mealtimes: Practical and compassionate strategies for mealtime peace. Archway Publishing. Marcus, S., & Breton, S. (Eds.). (2022). Infant and child feeding and swallowing: Occupational therapy assessment and intervention (2nd ed.) AOTA Press. Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive resource for mealtime development. Pro-ed International Publisher.

  • Developmental Milestones in Feeding

    Reflexes: Gag Reflex: In an infant, the gag reflex is at the tip of the tongue due to the nipple needing to be at the back of our mouth for breastfeeding or bottle feeding. The gag reflex moves back as the infant ages and explores different objects by placing various objects in their mouth. As the gag reflex moves towards the back of the mouth, the reflex is desensitized allowing the child to move on to the next feeding stage. 6-9 Months: gagging occurs less than 25% of the time when lumps contact (mouthing toys, food) with the posterior third of the tongue Adult: Gag reflex is retained, and can be done under volitional control Rooting Reflex (3-4 Months): newborn babies automatically turn their face towards the stimulus and begin to make sucking motions with the mouth when the cheek or lip is touched. The rooting reflex helps to ensure successful breastfeeding. Demonstration of Rooting/Hunger cues: YouTube Shorts Video (Rappaport, 2013) Phasic Bite/Chewing Reflex (4-6 Months): The “clench” reflex. The reflex is initiated when pressure is applied to the baby’s gums. The response is a rhythmic closing/opening of the jaw with no lateral movement of the jaw. This reflex usually diminishes between 9-12 months with a controlled, sustained bite. Tongue Reflexes: Diminishes at 5 months old Transverse tongue reflex: In 28 weeks gestation, the tongue develops to move towards the side of stimulation. By 6-8 months, the reflex begins to diminish as the infant gains control of the reflex. Tongue protrusion: When an object or food touches the tip of the tongue, the reflex signal to push the object/food away from the mouth. This reflex protects from choking on things they do not know how to chew yet. By six months, the reflex diminishes. It is important this diminished before the introduction of spoon-feeding. Suck-Swallow-Breathe (4-7 Months): Sucking involves the coordination of several different muscles to achieve a rhythmic oral motor pattern. You need the suck-swallow-breathe pattern to feed/eat functionally. Visual Demonstration of Reflexes: YouTube Video (HelpMe Feed Foundation, 2020) Physical/Oral Motor Development: **Gross motor skills must develop before oral motor skills*** 32 Weeks Gestation: air sacs in the lungs develop, more surfactant is produced, and changes in blood vessels and lungs prepare to breathe outside of the womb **If a baby is born preterm: breathing can be difficult, leading to the baby to focus more on breathing and not eating = causing feeding difficulties Birth-3.5 Months: Head and trunk support needed for feedings Roots for nipple Sucks Swallows liquids 4-7 Months: Visually recognizes food and the bottle Attempts to secure a tiny object with a few fingers or a whole hand Hand-to-mouth play Adequate trunk control for independent sitting for 3-5 seconds Lateral tongue movements start to emerge 7-9 Months: Infant drinks from a cup held by an adult Can close lips around the spoon and clean it after bites Wants to help with feeding Begins finger-feeding, raking grasp to pick up small food Trunk control and weight shifting 9-12 Months: Begins to experiment with drinking liquids from a sippy cup Straw drinking initiated at 12 months Holds cups and drinks with some spilling Begins to take controlled bites of a soft cookie Begins to move food from one side of the mouth to the other side Independent finger feeding using a pincer grasp to pick up small dissolvable solids Holds a spoon but cannot hold it independently 12-15 Months: Holds the cup with both hands Takes a few sips without help Dips spoon in food Holds spoon, brings to mouth and lick, but it is messy and spills; usually cannot prevent it from turning over before it gets to mouth May bite on the cup to stabilize the jaw Learning to make controlled bites on a hard cookie 16-36 Months: The child becomes the feeder; the parent is no longer the feeder (wean off, do not completely shut off in feeding your child in one-day) Scoops food with a spoon and feeds self Holds cups and drinks with minimal spillage Holds spoon, scoops food, and gets food safely to mouth, chews well Efficient use of straw (if already introduced) Gives up bottle entirely and drinks from a cup (18-24 months) Wants to feed himself/herself Stabs food with a fork Can chew with lips closed **Pacifier should not go beyond 2-3 years in order to have good alignment of the teeth that is needed to chew** 3-4 years: Swallows food in the mouth before taking another bite Serves self at the table Refills a cup with some spilling using a container with a handle or spout Holds cup with one hand while holding straw with another hand to drink 4-5 years: Puts appropriate amount of food in the mouth and can chew with lips closed Can spread soft substances with a plastic/child-safe knife 5-6 years: Can cut foods with a knife under supervision (dull knife or slightly serrated) Can cut with a fork and knife Chewing Patterns: Sucking (Begins as a Newborn): holding the food at the front of the mouth and sucking on it, no jaw movement Munching (4-7 Months): up and down jaw movement Tongue Thrust/Protrusion: pushing the food out with the tongue Diagonal (9-12 Months): jaw jetting to the right or left, side or down, not making a complete circle Emerging Rotary Chew (15-18 Months): starting the beginning of a consistent circular swing but not a full complete circle Circular Rotary Chew (24 Months): The jaw moves in a circular motion to chew food Visual of a Rotary Chew: YouTube Video (G, 2017) Check out this video to help remember the milestones: Infant Feeding Milestones Food Progression Development: Birth - 3 Months: Thin liquids Breast milk or formula Typically complete a 5-7 oz oral feeding in 20-30 minutes. If it is taking longer than 30 minutes or multiple attempts of feeding with breaks are needed, that would indicate concern 4-6 Months: Thin puree Cream of wheat, pudding, apple sauce, blended meats, vegetables, and fruits, stages 1 and 2 of baby food Munching patterns on meltable solids and soft cubes begin to emerge Begin transition from liquids to solids (If recommended) Guide to Starting Solids: YouTube Video (Hubbard, 2022) "Go by what your baby can DO, not by how old he/she is" (Satter, 2000) 5-6 Months: Thick puree or blended Blended meats, vegetables, and fruits (mashed bananas, applesauce, yogurt). Transitioning to thicker smooth foods can be an important step for children with feeding issues 6 Months: Mashed Lumpy Mashed potatoes, soft fruits, mashed hard-cooked eggs, mashed carrots or squash, oatmeal, Stage 3 jarred baby food 7-9 Months (Ground) Crumbled/ground meat, scrambled eggs, cottage cheese, small pieces of toasted bread crumbs, crackers broken into smaller pieces, graham crackers Food can be ground in a food chopper, not a blender, and retains some lumps for chewing foods. 8-10 Months: Soft Chopped Small pieces of food of one type of food: pasta, mac and cheese, soft fruit pieces, cooked carrots, graham crackers 12 Months: Medium Chopped Medium chopped is the same as soft chopped, just bigger but not big enough to choke on Portion sizes are approximately the same size as a clenched fist 15 Months: Mashed foods, chopped table foods, some raw veggies, and meats Increase intake of solid foods, 3 meals a day with 2-3 snacks per day Offers milk in a cup Trying to wean from bottle and encourage cup drinking to elevate nutritional needs to support brain growth, needs nutrition-dense foods 18 Months: Firm foods, table foods Pieces of meat (chicken), hard cookies, bread, tortilla Offer bite-sized pieces, offer fist-sized portions 24 Months: Mixed Toddler meat, soup with pasta and vegetables, sandwich 24-36 Months: Very firm, regular diet Unaltered hot dogs, nuts, seeds, chunks of meat or cheese, whole grapes, popcorn, and raw vegetables. Food can be cut up or left whole. They should be biting and ripping food easily and have a complete rotary chew Signs Your Baby is Ready for Food: Can sit up alone or with support Can hold his/her head up straight with neck Mouths with fingers and toys Opens mouth when he/she sees something coming to mouth Turns head away when he/she does not want it and stay open when he/she does want it Keeps tongue flat and low for spoon feeding Closes lips over spoon Communicates eager and excitement physically or socially when it comes to mealtimes Willing to play with food such a finger painting, mashing, or smearing it Reaches for utensils References Adler, L., & Freeborn, D. (Eds.). (n.d.). Breastfeeding your high-risk baby. Health Encyclopedia - University of Rochester Medical Center. /encyclopedia/content.aspx?contenttypeid=90&contentid=P02386 Basco, K. K. (n.d.). Pediatric feeding disorders - summit professional education. Summit Education. disorders#VIDEO/ONDEMAND.CFEEKB.1 Developmental milestones. SOS Approach to Feeding. (n.d.). Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet. Hachette Books. G. (2017, December 19). Mastication chewing animation[Video]. Youtube. HelpMe Feed Foundation. (2013, September 3). Breastfeeding tips: Newborn feeding reflexes[Video]. Youtube. Hubbard, J. (2022, July 6). Baby’s first food - The complete guide to starting solids[Video]. Youtube. Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive resource for mealtime development. Pro-ed International Publisher. Rappaport, K. (2013, September 3). Early feeding cues rooting[Video]. Youtube. Satter, E. (2000). Child of mine: Feeding with love and good sense. Bull Publishing Company. Sensory Solutions. (2017, May 7). Oral motor for chewing and swallowing. Sensory Solutions. Toomey, K. A., Ross, E. S., Kortsha, B. C., Beckerman, L., Fitzpatrick, K., & Lagerborg, D. (2017, November). When Children Won’t Eat: Picky Eaters vs. Problem Feeders. Assessment and Treatment Using The SOS Approach to Feeding. Typical development of feeding skills - San Diego occupational therapy. San Diego Occupational Therapy. (n.d.). /uploads/2012/01/TypicalDevelFeeding.pdf

  • The Culture of Eating

    Much of our eating corresponds to our biological and social needs as it provides an opportunity to share values and beliefs of the family and culture (Bonsall, 2014). Beliefs and values include nutrition, cultural traditions, how foods are presented, kinds of foods we ate, and how we eat the food (Morris & Klein, 2000). Some families like to sit at the table to have a meal, as it symbolizes the unity of the family or friendship. While other families are too busy to have structured dinner times, forgoing connection and unity. Depending on the culture, food portions can be large, children may be fed separately, feeding independence might be highly encouraged, women may be the main person to feed the children, messy play is possibly not accepted, or special food might only be offered to older children. Some cultures have different values as to how they treat the child, some having the child being dependent on their family member for feedings, giving the child overdependence which leads to how the child develops eating and feeding skills. Culture and values with meals can be a great influencer on how a child develops their eating habits. As each family has unique beliefs and values, the family’s budget may impact how a child eats. A family budget might only include processed and microwavable foods, or it might include fresh produce and homemade cooked meals. The budget can impact how a family eats and creates traditions. The budget can also determine if the family has time to eat together at the dinner table every night, eat separately due to parents needing to work, or impact the intake of essential ingredients. As you can see, eating and feeding may look different depending on who is being treated in feeding therapy. As professionals, it is important to consider the patient’s culture and background. Here are some examples of things to consider when working with different cultures: Latinx Culture: Big family gatherings are surrounded by food Cooking and eating are a way for families to bond Creating food takes a team The females tend to do all the cooking Portion sizes do not exist; you eat what you are presented As children, heavier children are perceived as healthier African Culture: Learn recipes and traditions from grandma Sharing meals at home, cookouts, reunions and church provides a sense of comfort and builds community strength Passing down old and new recipes from one generation to another strengthens the family bond Jewish Culture: Being kosher is an important way of showing obedience to God (Kosher includes: any animal that has a split in the middle of their hooves, any animal that is ruminant meaning they chew cud a ball of food that is chewed and brought back from the stomach to be chewed again) Any food that is meat is never eaten at the same meal as dairy (from a kosher animal). Typically the foods are eaten 1-6 hours apart. Utensils used for the meat and dairy are separated during the preparation process Holiday foods enhance and elevate festival celebration. Certain foods are reserved for special holidays. Hanukkah is celebrated by eating foods cooked in oil Egyptian Culture: “Food played an essential role in performing religious rites, mummification, coronation and wedding banquets, burial ceremonies, and particularly in preparation for entering eternal life in the afterlife” (Halawa, 2023). Most commonly consumed foods included plant-based foods such as eggplants, pears, lentils, garlic, and wheat. Following a vegetarian diet is common Meat dishes are uncommon due to the availability Food supply is used to sustain a person’s spirit in afterlife Indian Culture: Eating with hands since eating is supposed to be a sensory experience Food is offered to Hindu before it is consumed Thali (large) plates are used to give the ability to try everything that is offered Left hand is always off the plate while eating as it is used for taking of shoes or cleaning Sharing food goes for all parties involved (e.g., everyone brings a dish to the party) Leaving food on your plate is considered disrespectful Middle East: Solids and semi-solid foods are introduced much later than those from Chile Families from Chile eat their largest meal at noon and serve a very light meal in the evening Coffee is used to help people stay awake for evening worships Muslims fast from dawn to dusk, only eating after a prayer at sunset. This meal brings everyone together for a social event. If you empty your plate, your plate will be filled again. A sign that you are full is when a little food is left on your plate. Arab countries avoid using their left hand when eating as it is used for cleaning or work tasks. Korea and North African Countries: Food is medicine Eating is communal Food presentation is important - the more colors and variation, the better! Repeating refilling plate, double-dipping, and eating directly from serving plates is considered rude Eating with mouth open and smacking the lips meals the meal is enjoyable Bowls are not lifted off the table Use both hands when passing food Spoons are placed on the left hand side where chopsticks are placed on the right hand side If children are disrupting or interfering with the ability to sit at the table, this can disrupt the family dynamic and decrease the ability to share thoughts, beliefs, and feelings with each other (Morris & Klein, 2000). References Bonsall, A. (2014). The social context of occupations: Analysis of a father feeding his daughter diagnosed with cerebral palsy. OTJR: Occupation, Participation and Health, 34(4), 193–201. Choi, K. (n.d.). Korean food culture: A brief history. Korean Food Culture: A Brief History | Kelly Loves. Ensign, A. (2021, September 22). Middle Eastern food etiquette to recipes . FamilySearch. Fine Dining Lovers, Editorial Staff. (2021, July 23). Kosher Food: What does it mean?. Fine Dining Lovers. Fink, R. S. M. (2015, April 3). Holiday foods: Foods associated with holiday depend on geography . My Jewish Learning. foods/ Halawa, A. (2023, May 1). Influence of the traditional food culture of Ancient Egypt on the transition of cuisine and food culture of contemporary Egypt. J. Ethn. Food 10, 11 Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive resource for mealtime development. Pro-ed International Publisher. Oregon State University. (n.d.). African Heritage. Food Hero. /magazines/african-heritage Oregon State University. (n.d.). Latinx. Food Hero. Saunders, J. F., Bravo, E. I., & Kassan, A. (2023). 'Anorexia doesn’t exist when you’re Latina’: Family, culture, and gendered expectations in eating disorder recovery. Journal of Latinx Psychology. Sulaindianrestaurant-User. (n.d.). Indian food traditions - A journey to the roots. Sula Indian Restaurant. to-the-roots/

  • Children's Books Related to Food

    Reading books can provide a safe space for children that have difficulties with food and mealtime; it does not require the child to touch or try actual food. Here is a list of recommended books to read to your child to teach them about food and table manners. Pete the Cat: Three Bite Rule by Kimberly & James Dean In this book, a character shares the importance of trying something new three times! The new something can include a food your child has never explored before. This book sets a great example that everyone is involved in the learning process, no matter what age, and that it is important to be a good role model for others learning. Just Try One Bite by Adam Mansbach & Camila Alves McConaughey In this book, the roles are reversed! The children in the family teach the parents how to be good food explorers and why eating certain foods is important. Daniel Tries a New Food by Becky Friedman In this book, food exploration is encouraged! The characters make a banana dessert dish and use language to explain what the food looks like and how it feels throughout the baking process. The book role models an example of the characters initially saying, "I don't like the food," even though they have not tried it and end up liking it after it is tried! Table Talk: A Book About Table Manners by Julia Cook In this book, the table character explains what good table manners look like. Good table manners, such as cleaning your hands, respecting others, and removing all distractions that do not include food.

  • Caregiver's Role in Feeding

    Caregivers of a child, whether it’s a parent, nanny, teacher, or babysitter plays an important role in a child’s eating. The caregivers oversee how the child eats across different environments, what they eat, and how they react to mealtimes. Caregivers are an important consideration when it comes to developing a treatment plan for any child that is being seen for feeding therapy. Since caregivers play a huge role in eating and feeding, it can also provide a positive or negative impact on the child. The impact can depend on the child, whether they will be willing to explore or expand their food repertoire. Tips to ensure a positive feeding experience: The caregiver chooses what, when, and where they are feeding Caregiver does not force the child to eat any foods they present Caregiver creates a consistent mealtime and snack schedule Caregiver demonstrates good behavior Ensure the child is not snacking throughout the day preventing hunger when mealtime comes The child chooses how much, and whether they are eating or not Child determines how to eat Child determines how much they will eat Child will watch their caregivers eat Child will watch how their caregivers behave at the table Provide offers not demands An offer is when you provide the ability for the child to accept or reject any foods presented An offer provides the child with a sense of control A demand is when the child is forced to do something they may not be ready for A demand creates PRESSURE! Children are usually really good with listening to their bodies. Children will know when they are hungry, when they are full and it is important to allow children to listen to these internal cues (Healthwise Staff, 2021). The internal cues are signals of what the body needs! The division of responsibility allows the child to listen to their internal cues fully without the interference of their caregiver(s). References Healthwise Staff. (2021, September 20). Feeding your child using division of responsibility. MyHealth Alberta. /conditions.aspx?hwid=ug2200 Klein, M. D. (2019, November 8). Anxious eaters, anxious mealtimes: Practical and compassionate strategies for mealtime peace. Archway Publishing. Satter, E. (2015). Ellyn Satter’s division of responsibility in feeding. Ellyn Satter Institute. %E2%80%99S-DIVISION-OF-RESPONSIBILITY-IN-FEEDING.pdf

  • Sibling Impact in Eating

    When a family has a child that is a resistive eater, picky eater, or problem eater, mealtimes tend to be a stressful and chaotic time for everyone that is involved. The goal is to make the mealtime environment and experience positive and fun! Siblings can be utilized to demonstrate how to eat, how to behave at the table, and can teach their brother or sister how to be like them. Patrozelle and Moll (2020) stated that 70% of children who ate with their siblings increased their vegetable intake. In addition, older siblings tend to have a responsibility in role modeling and imitating feeding practices for their young siblings in all aspects of their life, and this includes eating (Ayre et al., 2023). Siblings can dilute the worry for their siblings that are hesitant to try new foods. Potential Sibling Roles: Eating food like they normally do Demonstrating try-it strategies for child’s non-preferred food (e.g., bite and spit, lick it, kiss it, smell it, touch it) Demonstrate positive mealtime behaviors (e.g., sitting at the table until everyone is done, using a napkin to clean face) Following dinner table rules that are set by the family Demonstrating messy play (e.g., touching spaghetti with hands, placing toys in yogurt, playing with fruit in water) No Sibling? No problem! Present videos of other children or animals eating the food Set routines and structure as parents Demonstrate try-it strategies as parents Pretend play with foods Involve child in food preparation or grocery shopping Read books about food An important tip for parents who encourage their siblings to be role models: Celebrate the sibling’s accomplishments Create time for the sibling without the picky, problem, or resistive eater Allow the sibling still to explore their interest and values as a person Have meals with the sibling only *This ensures the sibling feels as important as the picky, problem, or resistive eater. References Ayre, S. K., White, M. J., Harris, H. A., & Byrne, R. A. (2023). “I’m having jelly because you’ve been bad!”: A grounded theory study of mealtimes with siblings in Australian families. Maternal & Child Nutrition, 19(2), 1–19. Klein, M. D. (2019, November 8). Anxious eaters, anxious mealtimes: Practical and compassionate strategies for mealtime peace. Archway Publishing. Petrozelle, D., & Moll C. M. (2020). Sibling-supported feeding intervention: Sibling participation leads to growth in food repertoire and generalization of positive habits to home. OT Practice, 25(2), 10–13.

  • Eating with Cerebral Palsy

    Cerebral palsy is a non-progressive neurodevelopmental condition that causes the person to feel sensation, perception, cognition, communication, and behavioral differences (Speyer et al., 2019). Children with cerebral palsy are also known to have difficulty with swallowing and feeding. Mlinda et al. (2018) has identified that 80% of caregiver’s have reported their child with cerebral palsy to have difficulty with feeding. Difficulties include poor tongue function, bolus transportation, sitting balance, head control, mouth control, eye-hand coordination, delayed swallow initiation, drooling, and/or lip closure. These difficulties present lower self-esteem, poor mealtime experiences, dehydration, malnutrition, and/or aspiration pneumonia. When it comes to feeding therapy, it is important to address all these aspects as early as possible, as it also can cause stress for the caregivers and child. Intervention Ideas: Hand-Arm Bimanual Intensive Therapy (HABIT): the use of two hands during a task (e.g., cutting with a fork and knife, drinking from a cup) Constraint-Induced Movement Therapy (CIMT): increase usage of one hand/arm to enhance performance Sensory processing interventions Encouraging proper positioning Providing jaw stability support during feedings Adapt form of communication (e.g., a father used two click sounds with mouth as “yes I want food” for child and child was able to pick up on the clicks and respond with making two clicks with mouth when she wanted food) References Bonsall, A. (2014). The social context of occupations: Analysis of a father feeding his daughter diagnosed with cerebral palsy. OTJR: Occupation, Participation and Health, 34(4), 193–201. Cahill, S. (2022, March 24). Interventions for children with cerebral palsy. interventions-children-cp Mlinda, S. J., Leyna, G. H., & Massawe, A. (2018). The effect of a practical nutrition education programme on feeding skills of caregivers of children with cerebral palsy at Muhimbili National Hospital, in Tanzania. Child: Care, Health & Development, 44(3), 452–461. Speyer, R., Cordier, R., Kim, J., Cocks, N., Michou, E., & Wilkes, G. S. (2019). Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: A systematic review and meta-analyses. Developmental Medicine & Child Neurology, 61(11), 1249–1258.

  • Eating with Down Syndrome

    A child with Down syndrome is born with an extra copy of a chromosome changing the body’s ability to grow and develop (CDC, 2023). The changes in how the body develops creates physical and mental challenges. Challenges can include but are not limited to: hearing loss, obstructive sleep apnea, social interaction with peers, ear infections, eye diseases, heart defects, or eating difficulties. In addition, children with Down syndrome are associated with low muscle tone, reduced oral space, thin lips, almond-shaped eyes, small hands/feet, and shortness in stature (Lewis & Kritzinger, 2004). Down syndrome is a lifelong condition, therefore several services are helpful for the person to achieve their full potential. When a new parent or caregiver starts to learn more about their child diagnosed with Down syndrome, feeding and eating difficulties tend to be present (Lewis & Kritzinger, 2004). “80% of children with Down syndrome have difficulties related to food or feeding” (Shaw, 2003). Eating difficulties can include decreased strength, weak sucking, weak swallowing, poor lip closure, strong tongue protrusion, and difficulty with nose breathing during eating. What feeding therapy may look like: Encouraging proper positioning in seat Emotional regulation Oral motor skill development Structuring mealtime Try-it strategies for new foods Caregiver education to improve feeding at home Sensory processing exploration Addressing attention span Using first, then approach Develop meal preparation skills References Centers for Disease Control and Prevention. (2023, May 9). Facts about down syndrome. Centers for Disease Control and Prevention. /downsyndrome.html Lewis, E., & Kritzinger, A. (2004). Parental experiences of feeding problems in their infants with Down Syndrome. Down Syndrome Research and Practice, 9(2), 45–52. Shaw, R. J., Garcia, M., Thorn, M., Farley, C. A., & Flanagan, G. (2003). Treatment of feeding disorders in children with Down Syndrome. Clinical Child Psychology and Psychiatry, 8(1), 105–117.

  • Treating Eating Disorders

    Eating disorders are behavioral and mental health conditions that interfere with eating behaviors related to thoughts, beliefs, emotions, and values (Knight, 2021). There are several types of eating disorders that disturb a person’s day-to-day life. Anorexia nervosa is when food intake is restricted with the goal of losing weight and the fear of gaining weight. Bulimia nervosa is when excessive food intake is binged then vomited to ensure the person’s weight is maintained. Binge eating disorder is overeating when not hungry due to emotions, depression, guilt, or diminished self-esteem. Any of the following eating disorders are harmful to the person’s cognitive, physical, medical, and psychological health. Occupational therapists can play a huge role when it comes to treating patients that are experiencing eating disorders. Occupational therapy consists of helping clients engage in daily activities that they want to do and have to do (Mack et al., 2023). The goal is to learn about the patient, what their hobbies are, their motivations, their values, and responsibilities that do not solely focus on their disordered eating. You can imagine the patient’s doctors, caregivers, and peers are already “judging” or creating an excessive worry for them. Once the occupational therapist learns about the patient, the occupational therapist can provide different ideas and therapeutic interventions to help decrease their disorderly eating. In addition, a patient with an eating disorder may also not know they have an eating disorder in the first place. Occupational therapists can educate what a meal looks like, how to cook a meal, how to bake a meal, mealtime behaviors, and try-it strategies with new foods. What Occupational Therapy can look like: Food preparation Trip to the grocery store Restaurant outing Gardening Finding their motivation (e.g., creating art, reading, listening to music) to help support eating Provide support in must-have tasks (e.g., oral hygiene, completing homework, finances) Teaching appropriate eating behaviors Determine a balance between must-have tasks and desired activities Emotional regulation Boost self-esteem Positive coping skills Identify roles wanted Develop problem-solving skills It is important to consider that patients with eating disorders are as complex as the person’s cognitive, physical, medical, and psychological health, as all areas are impacted (Mark et al., 2023). Therefore, a multidisciplinary approach is important to address each aspect of the person. Potential professions that can be involved but not limited to are: Occupational therapist Family Therapist Social worker Nurse Exercise Therapist Counselors Physician Psychologist References Knight, C. (2021, March 16). What is an eating disorder?. News Medical Life Sciences. Mack, R. A., Stanton, C. E., & Carney, M. R. (2023). The importance of including occupational therapists as part of the multidisciplinary team in the management of eating disorders: a narrative review incorporating lived experience. Journal of Eating Disorders, 11(1), 1–8. Mack, R. (2019, April 26). Treating Eating Disorders: An Inside Look at Occupation-Based Interventions. issues/2019/eating-disorders

  • Self-Feeding for Older Adults

    “80% of older adults have at least one chronic condition” (Neves et al., 2020). Increasing in age is associated with acquiring chronic health conditions such as: dementia, paralysis, or dysphagia (swallowing difficulty). These chronic conditions may impact the person's higher functioning skills as it relates to cognition, memory, orientation, language, and judgment, all of which are needed to be successful in day-to-day activities (Rehman et al., 2023; Boczko & Feightner, 2007). Aging can diminish the ability to complete daily tasks with ease. As one age, daily tasks such as toileting, eating, hygiene, and dressing become more difficult. The difficulty comes from the impairments of physical, cognitive, and sensory function (Boczko & Feightner, 2007). In addition, aging comes with alterations to the taste and smell sensations that affect an individual's appetite, diet, and oral intake (Christmas & Rogus-Pulia, 2019). These significant changes in one’s life can alter typical eating habits and routines. When routines or habits are forgotten, it can lead the person to undereat, overeat, or not be aware of their nutritional intake. Eating is closely related to our culture, environment, role, education level, and economic status (Neves et al., 2020). Since self-feeding becomes increasingly difficult as a person ages, it is important that there is support from their family or peers (e.g., caregivers, therapists, physicians, nursing staff). Sagari et al. (2023) found that self-feeding ability is determined by the support the person has. As feeding occurs multiple times a day with food preparation and consideration of the person’s diet, this responsibility can become a burden for the person taking care of their spouse, patient, or peer. In order to decrease the need for others to feed their aging patient, spouse, or peer, it is important that education is enforced to continually work the cognition, memory, language, and orientation of the brain. Occupational therapists can help patients address these barriers and increase their ability to complete daily activities. What Occupational Therapy can address (but not limited to): Hand dominance Range of motion strength Coordination Sitting balance Safety awareness Oral sensory skills Motor planning Problem solving Memory Posture Provide feeding modifications Meal preparation Utensil use Caregiver education Tips for Increase Successful Eating For the Aging Population: Provide reminders throughout the day and slowly backing off on the reminders Re-teach mealtime behaviors until learned Re-teach eating habits until learned Create compensatory strategies Create feeding modifications Remove distractions (e.g., television, music) Use bright color utensils/plate for individuals with decreased vision or depth perception Use window shades or screens to reduce glare Encourage oral hygiene (e.g., provide reminders to brush teeth) Ensure proper positioning in chair for increase safety and ease when eating (e.g., feet flat on the floor, elbows at 90 degrees) Create a food diary to track food intake Examples of Assistive Feeding Devices: Wonder-flo Cup Helps drink in a semi-reclined position Liquid only flows when the user is sucking Nosey Cup Useful for users with a reduced neck extension No tilting of head necessary Removed piece of cup to allow room for nose or glasses Sure-Grip Utensils Utensils that have a bulky handle For users with a weak grasp Utensils are comfortable for the hand Sure-Grip Bendable Utensils Useful for users with a decreased wrist range of motion Utensils are comfortable for the hand Utensils minimal wrist/hand motion Weighted Utensils Useful for users with limited hand control Useful for users that have Parkinson’s disease with tremors Utensil has a bulky handle for comfort Coated Utensils Provides protection for the teeth and lips Useful for users that have mouth sensitivities (e.g., cold, hard surfaces) Useful for users that have a strong bite refle Plate with Inside Rim Useful for users that have tremors or involuntary hand movements Prevents the food from sliding off the plate Partitioned Scoop Dish 3 sectioned plate Useful for users with a visual impairment Useful for users with involuntary coordination References Boczko F, & Feightner K. (2007). Dysphagia in the older adult: the roles of speech-language pathologists and occupational therapists. Topics in Geriatric Rehabilitation, 23(3), 220–227. Christmas, C., & Rogus, P. N. (2019). Swallowing Disorders in the Older Population. Journal of the American Geriatrics Society, 67(12), 2643–2649. Neves, F. J., Tomita, L. Y., Liu, A. S. L. W., Andreoni, S., & Ramos, L. R. (2020). Educational interventions on nutrition among older adults: A systematic review and meta-analysis of randomized clinical trials. Maturitas, 136, 13–21. /j.maturitas.2020.03.003 Rehman, S., Likupe, G., McFarland, A., & Watson, R. (2023). Evaluating a brief intervention for mealtime difficulty on older adults with dementia. Nursing Open, 10(1), 182–194. Sagari, A., Tabira, T., Maruta, M., Tanaka, K., Iso, N., Okabe, T., Han, G., & Kawagoe, M. (2023). Risk factors for nursing home admission among older adults: Analysis of basic movements and activities of daily living. PLoS ONE, 17(1), 1–10. /journal.pone.0279312

  • Modified Barium Swallow Study

    The Modified Barium Swallow Study (MBSS) is where a speech-language pathologist, radiology doctor, or x-ray technologist determines a patient’s swallow. A swallow is hard to determine directly; therefore, if a child is presenting wet talking noise, poor control of oral secretions, coughing, choking, changes in breathing when eating or drinking, or has frequent respiratory infections, an MBSS is suggested to determine underlying factors. Determining if the patient has an effective swallow or not is important when it comes to successful eating. An abnormal swallow leads to a risk of aspirating foods into the lungs, weight loss, uncontrolled reflux, difficulty with harder to chew foods, or choking. During the MBSS, the speech-language pathologist will create a series of thin and thick liquids using Barium to visualize the swallowing process with a fluoroscopy (a moving x-ray screening). The fluoroscopy allows the therapist to determine how the patient swallows by viewing the head and neck area. The actual fluoroscopy should not take longer than 15 minutes. What is being observed (but not limited to): Bolus formation Bolus control Oral transit time Type of chewing Epiglottic movement Aspiration Structural abnormalities References Bousquet, J., & Shonbrun, S. (2015, November 7). Pediatric modified barium swallow studies [PowerPoint slides]. Tampa Bay Medical Speech Pathology. swallow-studies.pdf Evans, K. K. (n.d.). Five facts about modified barium swallow studies. University of Mississippi Medical Center. /SOM%20Departments/Otolaryngology/About-Us/News/Articles /Five%20Facts%20about%20Modified%20Barium%20Swallow%20Studies.html Fluoroscopy procedure. JHM. (2019, August 14). procedure Modified barium swallow (cookie swallow): Children’s Pittsburgh. Children’s Hospital of Pittsburgh. (n.d.). /modified-barium-swallow Modified barium swallow. UM Baltimore Washington Medical Center. (n.d.). pathology/modified-barium-swallow

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