1

Copyright @20 0 8 by Dianne Koontz Lowman and Suzanne McKeever. Do not reproduce without permiion. Contact
author at !owmand"@#mu.edu or $ee d ing!a d y % &@ y a ho o .co m.
.
%
Developing a Plan for Working with
Young
Children with Feeding
Difculties
Creating Connections: Viewing the Future
Through the Window of Opportunit
!otel "oanoke # Conference
Center
$a %&
'(()
Dianne *oont+ ,ow-an&
.d/D/
Coordinator& "egion 0
2
Copyright @20 0 8 by Dianne Koontz Lowman and Suzanne McKeever. Do not reproduce without permiion. Contact
author at !owmand"@#mu.edu or $ee d ing!a d y % &@ y a ho o .co m.
.
T1T2C 3a-es $adison
4niversit $5C 6(('
!arrison7urg& V2
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low-an d k9:-u/edu
Feeding
is:
;ecessar for growth and survival
2n interactional event
2 sensor event
.-otional
<ehavioral
Cultural
!olistic Feeding O7servation
For-
"espirator Concerns
Phsical Develop-ent1 Positioning
5ensor =ssues
Oral $otor 5kills
Co--unication # 5ociali+ation
<ehavioral Concerns
2ppropriate .>uip-ent # $aterials
;utrition
Colla7oration with the
Fa-il
Positive Dialogue a7out fa-il?s concerns and goals
=nfor-ation a7out Past .@periences Feeding "outineAsB
Pleasura7le
Difficult
Cultural =-plications
"espiratio
n
Coordination 7etween 7reathing # swallowing
Cag reDe@ present
Congestion
Feeding pace
"eDu@1aspiration concerns
=ndicators of
2spiration
Positive histor of pneu-onia14"=
Coughing& gagging
Whee+e1asth-a
"apid 7reathing1 fatigue with -eals
"eDu@1vo-it1 regurgitation
Drooling1 food falling out of -outh
Difficult handling li>uid
$ealti-e 7ehaviors
;or-al
Develop-ent
The new7orn arrives read to eatE
5ta7ilit F $o7ilit
Phsiological Fle@ion
5ucking pads
Pri-itive reDe@es
;or-al
Develop-ent
Oral and facial -usculature initiall -ove together as one unit/
Then& each -uscle groups 7egins to -ove separatel: 3aw& lips&
cheeks& tongue
Direct correlation 7etween gross -otor develop-ent and -aturation
of oral
-otor
skills/
Review of typical gross motor development as it
relates to oral motor development
=n tpical develop-ent& as one area 7egins to develop active
-ove-ent& so-ething -ust happen1develop in another area to
-aintains 7od 7alance/
Newborn
Cross $otor:
' phsiological De@ion
' li-ited "O$& closel packed soft tissue
' head rarel in -iddle& turns head to -aintain open airwa
' weight 7earing on face
' ri7 cage high and wide1asnchronous 7ell 7reathing
' increased sta7ilit1decreased -o7ilit
' total pattern of -ove-ent
Oral $otor:
' total pattern of sucking
' pri-itive reDe@es for survival
' deep pressure to cheeks1lips1:aw
' eat and 7reathe si-ultaneousl
' :aw sta7le on chest
' Gsucking padsH
' tongue Ills )(J of oral cavit
5peech
' reDe@ive sounds with -ove-ent
' -onotonous cr
The newborn is mostly a nose breather who initially shows
random disorganized, undirected, and uncontrolled
movements.
Two Month Old
Cross $otor:
' loss of phsiological De@ionK appears to have low tone
' should elevation helps head control
' 2T;"K helps elongate pecs
' as--etr& uses it for sta7ilit
' total head lag in pull to sit
Oral $otor:
' suckling
' li>uid loss is co--on
' less coordination of 7reathing1sucking
5peech:
' 7egins so-e facial e@pression
' increase duration of phonation
' sound with 7od -ove-ent
' greater diLerentiation of cr with loudness& pitch& duration
The 2 month old loos as if they have lower tone. This is
not a good diagnostic month.
!our Month Old
Cross $otor:
' s--etr
' prone on el7ows
' stuck in positions placed in
' swi--ing
' accidental rolling
' supported sit with trunk support
' plas in sideFling
Oral $otor:
' hand to -outh with o7:ect
' longer suck se>uence 7efore pause
' new oral -o7ilit with head1neck control
' drooling while teething
' introduce spoon feedingK uses suckle
5peech:
' inititation of phonation without as -uch 7od -ove-ent
' guttural sounds17ila7ial soundsK depends on position
' -a 7eing 7a77ling
The mouth is their world and the way they learn about their
world.
This is the point where we really begin to see the a"ects of
developing stability in shoulder girdle allows for oral mobility
in feeding and speech.
#i$ Month Old
Cross $otor:
' e@tended ar- pla1reach
' prone to supine& supine to prone& supping to side w1rotation
' pushes 7ackwards
' ,andau response
' plas in side ling
' hands to feet1feet to -outh
' independent sit for 7rief period
' stand with support17ounces
Oral $otor:
' spoon feeding
' -unching
' accepts -ore solidsK gag& cough& spit out
' e-erging tongue laterali+ation
' good& strong& eLective suck
5peech:
' 7a77le variet of sounds AuniversalB& 7a77ling chains
' intonation change with position changeK needs less 7od -ove-ent
' 7egins sound i-itation
The %
th
month is the most critical month&
' 'ses widest range of movement before mid(range control
)graded* begins to develop
' +omplete e$tension and now will balance e$tension and
,e$ion, lateral, and begin diagonal
' Trun activity brings rib cage down and initiates thoracic
breathing and allows for long chains of babbling
' Trun stability allows for oral mobility
' #tranger an$iety
-ight Month Old
Cross $otor:
' uses -ove-ent to interact with environ-ent Gon the -oveH
' co--ando crawl with rotation& creeping e-erging
' -ostl independent sitter with ar-s free
' sit to all M?s and 7ack
' good pro@i-al sta7ilit& increased graded control
' trunk rotation e-erging
' stand with wide 7ased
Oral $otor:
' lips around spoon
' lip closure with cup& 7ites cup for sta7ilit
' -unching
' eats -ore ta7le foods
' tongue and :aw -ove separatel Atongue clickingB
5peech:
' 7a77ling in shorter chains
' vocali+es in i-itation of fa-iliar sounds
' produces1diLerentiates sounds with sa-e articulator place-ent
A-17& d1tB
.On the move/
Ten Month Old
Cross $otor:
' pull to stand with -ore ,. involve-ent A-a N kneelB
' wide variet of sitting positions Along& side& tailorB
' cruising& walk with ' hands held
' supported stand
' pla in W sit due to increased hip -o7ilit
' 7ear stand1crawl
' cli-7ing e-erging
Oral $otor:
' tongue -ove-ent isolated
' fewer sucks1suckles 7efore pulling awa fro- cup
' upper lip -ore active with spoon
' 7egins closing lips on swallow
' gag1choke on new te@tures A-oves gag 7ackB
' uses wrist to 7reak oL soft solid
5peech:
' closel appro@i-ates adult inDection
' sound separate fro- 7od -ove-ent
' long chains of diLerent CV co-7inations
' % to ' word appro@i-ations
0ariety of positions is ey, as is the ability to transition in
and out of positions.
Twelve Month Old
Cross $otor:
' independent stander
' -a take independent steps
' cruises well with trunk rotation
' up to stand with -ini-al 4. assistance
' cli-7ing
' tall kneeling
' independent standingK uses knees # feet for 7alance
Oral $otor:
' wean for 7ottle
' drink fro- cup with less tongue sta7ilit needed
' reInes :aw -ove-ent
' sustained 7ite on soft solids
' phasic 7ite on hard solids
' chewing with tongue laterali+ation across -idline
5peech
' :argon with e-7edded words
' plas with controlled oral -ove-ent due to sta7le 7ase
' OF0 words
' Co-7ines -an -odes of co--unication
' 5peech -a plateau as child learns to walk
1ndependent mobility sets up ma2or cognitive growth.
3anguage taes o".
Tone
Positioning
27sent1delaed
reDe@es
;egative
e@periences
2tpical Patterns
=ncreased length of feeding ti-eK decreased a-ount of feeding
<onding1attach-ent
Postural
align-ent
Feet # knees
!ips # trunk
!ead
Positioning
Coal is proper positioning1sta7ilit that allows for
i-proved oral -o7ilit/
5 5e en ns sor or = =-plicat -plicati ions: ons: C Consi onsid de er r the the GFour GFour TsH TsH
Overview of the 5ensor 5ste-s "elated to .ating
Children receive infor-ation fro- -an sensor sste-sK all of
these sensor sste-s pla an integral part in the feeding
e@perience:
0isual
The visual presentation of food will provide a sensor e@pectation for
the feeding e@perience of the child/ The color of the food& the
place-ent of the food on the serving dish& and the a-ount of food
oLered to a child can produce positive or negative responses/ The
visual sti-ulation within the roo- as well as the color
of clothing worn 7 the feeder can also result in a response fro- the
child/
4uditory
The sounds within the feeding environ-ent can pla a -a:or role in the
feeding process/ 2uditor input cannot 7e ignored or shut out 7 those
who have difficult Iltering out unwanted sti-uli/ The environ-ent
where a child is fed -ust 7e carefull -onitored for auditor volu-e
and distracti7ilit/ Once a -ore co-forting sound level is achieved&
sound can 7e used to soothe and organi+e the child as well as to
esta7lish appropriate feeding rhth-s/
Olfactory
The sense of s-ell is closel linked to taste/ 5-ells are interpreted in
the 7rain and are part of the li-7ic sste-& which is the sste- that
regulates 7od functions& e-otions and the sense of s-ell/ 5-ell has
a strong e-otional co-ponent and is strongl attached to -e-or
storage/ Therefore& 7oth positive and negative e@periences are
associated with feeding and the sense of s-ell/ Odor fro- food& the
environ-ent& or even the perfu-e of the feeder can have a dra-atic
eLect on a feeding session/
5ustatory
This infor-ation is received 7 wa of the taste 7uds in the -outh/
Taste 7uds are found on speciIc areas of the tongue/ The feed7ack is
interpreted as 7itter&
sweet& salt& sour or a co-7ination of these tastes/ Taste varies with
each
individual/ 5weet tastes are detected on the anterior third of the
tongue/ 5alt tastes are detected on the anterior lateral 7orders/ 5our
tastes are detected on the posterior lateral 7orders& while 7itter tastes
are detected on the posterior portion of the tongue/ Children who are
hper reactive will often respond 7est to -ore 7land foods while those
who are hpo reactive often respond 7etter to
spic foods/ Children who have received tu7e feedings or who have
had tracheosto-ies& will often prefer spic foods that have -ore
sensor input/ 5weet tastes have 7een linked to increased drooling
and are thought to 7e one of the -ost powerful of the tastes/ Taste
sensation changes as we age as taste 7uds are lost/
Tactile
The sense of touch is ver co-ple@ and is received through receptors
on the skin/ The various tpes of touch are light touch& deep touch&
te-perature& and pain/ There are -an touch receptors in the face
and -outh/ This helps to esta7lish awareness of the oral -uscles
while eating/ 5o-e touch sti-uli is arousing and can put a child on
alert& while other sti-uli helps the child to organi+e and cal- hi-self/
6roprioceptive
The perception of :oint or 7od -ove-ent& or position of the
7od that is received through the -uscles& tendons& and soft
tissue is known as
proprioception/ The proprioceptive input provides feed7ack to the
central nervous sste- that tells what the -uscles and li-7s are
doing at an ti-e/
;ecessar ad:ust-ents in posture are then -ade as -ove-ent and
activities are carried out/ Children with proprioception pro7le-s often
appear clu-s and -a
have trou7le sitting in a chair or using eating utensils correctl/
2n Overview of Three Theories of 5ensor
Processing
5elfF"egulation <ehavior "esponse Continuu- AW/ DunnB
Winnie Dunn is an occupational therapist who has studies how diLerent
children react to sensor sti-ulation/ Dr/ Dunn has discovered that
children have diLerent thresholds to sensor sti-ulation/ Threshold
refers to the point at which a child will respond to sensor infor-ation
ADunn& %666B/ For e@a-ple& each child -a have a different threshold
for sound/ 2t what point does the noise 7eco-e too loud for each child
in the roo-P Children with a high threshold tend to 7e hpoF sensitive
or underFresponsive& which -eans it takes -ore sound or noise for the
child to react/ This child -ight need for the -usic to 7e louder to react/
Children with a low threshold tend to 7e hperFsensitive or overl
responsive& which
-eans the react to :ust a little sound or are distracted 7 ever noise/
This child -ight need for the -usic to 7e softer/ Dr/ Dunn sas that
children with difcult
processing sensor infor-ation -ight have one of the following
four tpes of responses to senses fro- the environ-ent:
!igh Threshold
F Poor "egistration
Children with poor registration have difcult reacting to sti-uli
7ecause of a high threshold/ This -eans these children need
-ore sti-uli to
react/ These children -ight not react to a whisper& 7ut rather
need to loud call to co-e/
F 5ensation 5eeking
Children who are sensation seeking will look for -an sensor
e@periences/ The have 7e constantl -oving& or touching or
chewing on everthing 7ecause the need a lot of sti-ulation to
notice& feel or react
to the sti-ulation/
,ow Threshold
F 5ensitivit to 5ti-uli
Children who are sensitive to sti-uli -ight not 7e a7le to 7lock
out sti-uli and -a get overwhel-ed 7 lots of sti-uli or even
7 sti-uli which others -a think is not too -uch/ These
children -a have trou7le in a crowded roo- with lots of people
talking/
F 5ensation 2voiding
Children who are avoiding sensations -ight 7e unwilling to tr
new things or to participate in unpredicta7le situations/
5ensor Defensiveness AP/
Wil7argerB
Pat Wil7arger developed the G7rushing progra-H and Irst coined the
phrase Gsensor diet/H 5he deInes sensor defensiveness as the
over activation of our protective sense ADight& fright& or fight
reactionB/ =-agine ou are walking to our car late and night and
so-eone touched our shoulder/ The 7rain would
send a -essage to our autono-ic nervous sste- preparing the 7od
to protect itself/ / / ou would either run& free+e& or turn around kicking/
!owever& for the
child with severe sensor defensiveness& standing in line and 7eing
touched fro-
7ehind -ight have the sa-e response/
5he e-phasi+es that children with severe sensor defensiveness view
sti-ulation not as unpleasant 7ut as D2;C."O45E This -ight 7e wh
children with sensor defensiveness are not willing to tr anthing new
Aand are actuall afraid of anthing newB/
2rousal $odulation A,/
$illerB
Dr/ ,uc $iller is an occupational therapist and researcher who is
currentl conducting a considera7le 7od of research on sensor
processing orders/ Dr/ $iller has discovered that children with sensor
processing disorders& when faced with novel events& -ight e@hi7it 7oth
phsiological over arousal and slower ha7ituation rates/ !a7ituation
refers to how long it takes our 7od to Gget used toH a new sensation/
For e@a-ple& if ou take a whiL of a new perfu-e& it -ight s-ell
strong/ !owever& after each whiL& the perfu-e appears to s-ell less
strong/ You are ha7ituating to that s-ell/ Children with sensor
processing disorders -ight react ver strongl Aover arousalB to that
s-ell and will take
-uch long to Gget used toH Aor ha7ituate toB the s-ell/ This -ight
e@plain wh sti-ulation the child has 7een e@posed to over and over
again still 7rings a negative& and so-eti-es strong& reaction/
4rousal 3evels Through(Out the 7ay
2rousal level refers to how alert ou feel AWillia-s # 5hellen7erger&
%66QB/ Throughout the da& ou -ust 7e a7le to concentrate and
attend to various tasks which re>uire diLerent levels of alertness/ You
-ust have a diLerent level of alertness to pla soccer than ou do to
listen to soft -usic/ =n addition to diLerent tasks& diLerent ti-es of
the da also affect arousal level/ !ave ou ever turned on the car in
the -orning and 7een startled 7 how loud the radio isP You need the
louder sound late in the da 7ecause it takes -ore to arouse ou
Awhen ou were tiredB than ou do Irst thing in the -orning Awhen
ou are freshB/
5elfFregulation refers to how our nervous sste- -aintains and
changes arousal levels to -atch each task that ou do throughout the
da AWillia-s # 5hellen7erger& %66QB/ For e@a-ple& what do ou do to
pep ourself up or to cal- ourself downP What do ou do to sta
awake in a training workshop after a 7ig lunchP
5ensor $otor Preference Checklist AWillia-s #
5helen7ergerB
What cal-s our engine downP
What GrevsH our engine upP
!ow can ou help children attain and -aintain the appropriate
arousal levelP
27nor-al 5ensor "eactions During Feeding
Pick eating
"efusing food
Cagging
Vo-iting
5tuLing food into -outh
5ucking1holding food
Oral
5ti-ulation
There are a few techni>ues for providing oral1facial sti-ulation that
help ensure greater success at feeding ti-e/ These techni>ues will 7e
discussed 7rieD and should 7e e@perienced 7 the feeder Irst in
order to achieve a greater understanding of the eLects of sensor
sti-ulation/
' 7istal to 6ro$imal R 5ti-ulation should start awa fro- the
face and graduall -ove toward the face/ Touch on the hand or ar- is
ver natural while touch around the face is reserved for those with
who- we know inti-atel/ 5ti-ulation that 7egins with the hands will
often help the child prepare for selfF feeding later/ Progression towards
the -outh will take ti-e and the child should not 7e rushed to accept
the sti-ulation/ Patience will pa oL in the end/
' 7eep, !irm 6ressure R This is the techni>ue 7est tolerated 7
-ost children/ ,ight touch is arousing to our sste-/ Deep& Ir-
pressure works 7est to activate the sensor sste- and allow input
into the :oint and -uscle receptors/
' #ymmetrical 1nput R 5ti-ulation done on the 7od should 7e
done in a s--etrical fashion/ Whatever sti-ulation we provide to
one side of the 7od& we want to provide to the other side of the 7od/
2 deep touch is ver powerful and the resulting reactions are strong
and often last for several -inutes/ 5--etrical input will help insure
that ou are keeping the head and 7od in neutral align-ent and will
allow -uscle groups to work together -ore har-oniousl/
' #mooth, +ontinuous +ontact R You want to -ake the
sti-ulation as pleasura7le as ou can/ < using the pal- of our
hand instead of our
Ingertips& ou will provide a -ore continuous& s-ooth input/ This will
help the sensor sste- to 7eco-e -ore organi+ed and prepared for
feeding/ 2 child with decreased -uscle tone will tpicall 7eneIt -ore
fro- >uick strokes to help increase tone& while the child with increased
-uscle tone will tpicall 7enefit fro- slower strokes that help
decrease -uscle tone/
' 'se of 5loves R Cloves should 7e utili+ed whenever working in
or around a child?s -outh/ <e aware of the tpe of glove ou are using/
5o-e gloves are -ade fro- late@ while other gloves have a no@ious
odor or -a leave a 7ad
taste in the -outh/ Clove to skin contact is often irritating so
wrapping our gloved hand or finger in a washcloth& towel& or cloth
diaper -a 7e helpful/ These -aterials should prefera7l 7e soft
and dr/
' 7istraction R The i-portance of the use of distraction cannot 7e
-ini-i+ed/ $an children are fearful of touch and watching as a hand
or towel slowl approaches their face -ust 7e ver scar/ $ake
sti-ulation pleasant and en:oa7le& as this is an essential part of the
dail feeding progra-/ 5inging& talking soothingl& or plaing ga-es
are wonderful for-s of distraction and was to -ove the focus oL of
the sti-ulation/ The child often gets so caught up in the activit that
the are aware that sensor sti-ulation is 7eing provided/
' +ontrol: When a child feels in control& he or she will
cooperate -ore willingl/ $uch of the child?s da is deter-ined 7
others and the have little input into the decisionF-aking/ <
allowing the child to -ake choices in the sti-ulation process& ou
will -ost likel Ind a -ore cooperative and active participant/
Providing Oral 5ti-ulation
<e sure to use deep& Ir- pressure
2lwas work fro- distal to pro@i-al
2lwas provide s--etrical input
5ti-ulate cheek1lip -uscles
With our pal-& stroke down on cheek fro- the ear to the -outh
With our inde@ finger& stroke down fro- the nose to the upper
lip and up fro- the chin to the lower lip
With our inde@ finger& go around the lips1-outh
To increase tone& use fast strokes
To decrease tone& use slow strokes
Touch
Taste
5uggestions for =ntegrating the M Ts into $ealti-es
Te-perature
Te@ture
<egin as soon as possi7le
F -ost children will show earl sensor pro7le-s
F tr a variet of food groups
F work on transitioning fro- activities earl
F alternate ho-eF-ade food with store 7ought food A-a
feel safer with earlier e@posureB
F positive oral e@periences Akissing& touching& 7lowing 7u77lesB
F variet of cups& tos& clothes& spoons& plates& etc/
Treat the child as a whole
F tea- approach
F tactile and vesti7ular input 7efore -eals
F use oral sti-ulation at the sa-e ti-e as other
pleasura7le sti-ulation
F look at all senses
F reduce stress and help organi+e Arhth-ical -ove-ent& -usicB
=dentif sensor causes
F accept concerns are real and present
F discover what aspects of -eal are 7eing re:ected
F have an varia7les changedP Arate& a-ount& si+e& color& te-pB
=ntroduce change within routine
F -ake -inute changes to accepta7le foods
F change onl one varia7le
F 7egin -aking s-all changes as soon as possi7le
F look closel at transitions
$ealti-e vs/ snack1therap
F -ealti-e social& nutritional& safet& co-fort
F oLer new foods1techni>ues at snack ti-e or during therap
F so-e do 7etter with peers than 7 the-selves and vice versa
%(
Portion si+e and 7ite si+e
F also shapes
5lowl -ake changes
F start with fa-iliar food
F -ake s-all changes
FS add ' eggs to pancake 7atter
FS add pureed carrots& s>uash& applesauce to -eatloaf1casserole
FS peanut 7utter on 7otto- of graha-& then crea-
cheese& then :ell& then spreada7le cheese& etc/
<egin with a fa-iliar and accepted food
F s-all incre-ental changes
F diLerent Davored ice cu7e added to drinkT-elts and slowl
changes
F sparkling water with flavor instead of soda
F increase with health alternatives slowl to add nutritional 7eneIts
!ide s-ell and look of new foods
F prepare food awa fro- child
F food sitting awa fro- childK 7ring it to child
F war-er food has stronger s-ell& -a need to chill food
$ask nutritional additions
F so-eti-es ever spoonful -akes a diLerenceK -ake it count
F re-e-7er vita-in and -ineral supple-ents have strong odor
F tr -i@ing Ovaltine& Pediasure& =nstant <reakfast with
another li>uid and free+e in ice cu7es
Uualit vs/ >uantit initiall
F work on s-all changes and then increase a-ount slowl over
ti-e
Distraction
F providing visual and tactile sti-ulation helps tre-endousl
F i--ediatel take focus awa fro- food
Co--unication # 5ociali+ation
Does child have the -a@i-u- control possi7leP
2re opportunities provided for -aking choicesP AProvide as -an
choices as possi7le/B
%8
Does the child have a wa to sa G=?- hungr& stop& slow down& =
want -ore& =?- Inished& etc//PH
What is the child?s 7ehavior telling usP
"efusal
"e>uest
5ociali+ation
Protest
5ensor
=-ple-entation of Feeding Plan
=nvolved all tea- -e-7ers
Cathered all -edical infor-ation
Considered nutritional needs
Considered all feeding e>uip-ent
Deter-ined -ost appropriate feeding se>uence
%)
"esource
s
The -ducator8s 5uide to !eeding +hildren with 7isabilities 7
,ow-an # $urph
!eeding and Nutrition for the +hild with #pecial Needs&
9andouts for
6arents
7 *lein # Delane
!eeding with 3ove and 5ood #ense 7 .llen 5atter
!eeding :oung +hildren in 5roup #ettings& The #i$ 6rinciples
for
!eeding :oung +hildren in 5roup #ettings 7 <ranen # Fletcher
The 5et 6ermission 4pproach to Mealtimes and Oral Motor
Treatment
7 *lein
9andling the :oung +hild with +erebral 6alsy at 9ome& O
rd
ed/
7 Finnie& <a@& <rowne& and Cardner
;ust Tae a <ite& -asy -"ective 4nswers to !ood 4versions and
-ating
+hallenges 7 .rnsperger # 5tegenF!anson
Motor #ills 4c=uisition in the !irst :ear& 4n 1llustrated 5uide
to
Normal 7evelopment 7 ,ois <l
Normal 7evelopment of !unctional Motor #ills& The !irst :ear
of 3ife
7 2le@ander& <oeh-e& and Cupps
The Out of #ync +hild& Recognizing and +oping with #ensory
1ntegration 7ysfunction 7 Carol *ranowit+
6re(!eeding #ills 7 5u+anne .vans $orris
#ensational >ids& 9ope and 9elp for +hildren with #ensory
6rocessing
7isorder 7 ,uc $iller
20
Holistic Feeding Observation Form
Chi!d* +ame, -ge, Date
.berved, /ime, Setting
.berved, .berver01,
/he 2uetion provided under each heading are uggetion to he!p guide your
obervation.
I. Collaboration with the Family
3 4a a poitive $ami!y dia!ogue been etab!ihed5
3 4a in$ormation been gathered $rom the $ami!y about re!evant pat e6perience
concerning $eeding and medica! e6perience 0e.g. +7C89 $eeding tube9 etc.15
3 :hat i the $eeding routine, at home5 in the choo! or center5
3 7ue identi$ied by the caregiver,
:hat i p!eaurab!e peci$ic to the $eeding interaction5
:hat i di$$icu!t peci$ic to the $eeding interaction5
3 :hat cu!tura! imp!ication are important to conider5
II. Respiratory Issues,
3 7 the gag re$!e6 preent and e$$ective 0not over or under reponive15
3 7 the wa!!ow re$!e6 preent and e$$ective 0not inhibited or de!ayed9 no
para!yi15
3 7 the $eeding pace determined by the chi!d 0not the $eeder15
3 7 wa!!owing re!a6ed and without gagging9 coughing9 or apiration5
3 7$ a repiratory in$ection i preent9 i enough e6tra time a!!owed $or coordination
o$ breathing and wa!!owing5
3 7 the coordination o$ breathing9 wa!!owing9 and ta!"ing di$$icu!t5
2%
III. Physical Development/Positioning
3 7 optima! potura! a!ignment achievab!e5
3 -re $eet and arm upported by a $!at ur$ace 0not dang!ing15
3 7 there ade2uate $!e6ion at the "nee5
3 -re hip reting ymmetrica!!y againt a upportive ur$ace5
3 7 trun" upright and ymmetrica!5
3 7 a neutra! head poition aured $or mot e$$ective wa!!ow and eye contact5
I!. "ensory Development,
3 -re any !imitation o$ the enory moda!itie preent, viua!9 auditory9 tacti!e9
gutatory9 o!$actory9 proprioceptive5
3 :hat type01 o$ touch are mot eai!y to!erated 0arouing v. ca!ming15
3 :hat temperatures are mot eai!y to!erated 0note pre$erence15
3 :hich tastes are mot eai!y to!erated 0!i"e v. di!i"e15
3 :hich te#tures are mot eai!y to!erated, thic" !i2uid9 thin !i2uid9 mooth
o!id9
!umpy o!id9 chewy o!id9 crunchy9 mi6ed te6ture5
3 :hat are appropriate timu!ation techni2ue and too!5
22
!. Oral $otor Development,
3 :hat re$!e6e are preent5
3 -re there any tructura! prob!em5
3 4a overa!! muc!e tone been determined 0norma!9 high9 !ow15
3 4ave tone iue peci$ic to the $ace and mouth been determined5
3 4ave need $or ora! motor treatment been identi$ied5 Some common e6amp!e
inc!ude,
;-:, thrut9 c!enching9 retraction9 intabi!ity
/.+<8=, retraction9 thrut9 !imited movement
L7> and C4==K, !ow tone9 !ip retraction
>-L-/=, naa! re$!u69 c!e$t
./4=?,
3 :hich o$ the $o!!owing $eeding techni2ue that enhance ora! motor "i!! are
appropriate $or thi chi!d5
Lip c!oure9 tongue !atera!ization9 munching9 chewing9 cup drin"ing9 wa!!owing
!I. %ransition From &on'Oral Feedings to Oral Feedings,
3 :hy wa the chi!d origina!!y p!aced on tube $eeding5 4ave thee reaon been
reo!ved5 4a medica! c!earance been given to begin ora! $eeding5
3 :hat i the current tube $eeding chedu!e 0intermittent9 continuou15
3 4a the $eeding team deve!oped a p!an to tranition to ora! $eeding5 Doe the
p!an addre chedu!ing9 current enitivitie9 current ora! motor "i!!9 etc.5
3 4ow ha the $eeding team addreed the ba!ance between 2ua!ity and 2uantity5
3 4a a 4ea!th Service >!an been deve!oped5
!II. Communication( )ehavioral( and "ociali*ation "+ills,
3 Doe the chi!d have the ma6imum contro! poib!e5
3 4ow doe the chi!d indicate hunger, $ood preent5 not preent5
3 4ow doe the chi!d indicate need $or a change o$ pace@paue5
3 4ow doe the chi!d indicate a choice o$ $ood or !i2uid5
3 4ow doe the chi!d indicate readine $or more5
3 4ow doe the chi!d indicate $inihed5
3 4ow doe the chi!d indicate deire $or ocia! c!oene@ditance5
!III. Feeding Process and Implementation Plan
3 4a the $ami!y9 a!! $eeder and needed pecia!it participated in the deve!opment
o$ thi p!an5
3 4a needed medica! in$ormation 0inc!uding phyician order and nutrition
re2uirement1 been received and $actored into thi $eeding p!an5
3 4ave nutritiona! need been addreed5
3 4a needed $eeding e2uipment been identi$ied and obtained5
3 4a the mot e$$ective e2uence been determined5