Oct 03, 2018
Child Early Intervention Medical CentreOccupational Therapy Department
No more tears at tea time: An occupational therapy approach
to feeding difficultiesPresented by:
Jennifer Logan Occupational Therapist
What is Occupational Therapy?
Occupational Therapy is a goal based approach to assisting people complete the tasks required in their everyday lives.
Occupational Therapists use fun activities to help our clients achieve their goals in their daily lives.
What areas does Occupational Therapy cover at CEIMC & CLEMC?
Fine motor skillsGross motor skillsVisual motor skillsSensory processing skillsSchool readiness skillsSelf care skills
Eating and drinking is a very complex process.
Structural anatomy of the mouth Oral Motor Skills Suck swallow breathe mechanism Sensory processing Behaviour
Insufficient food intakeFood refusalFussiness for type or texture of foodInadequate caloric intake
Skill DeficitsChewing, sucking and swallowing coordinationSelf - feeding
Disruptive BehavioursCryingSpitting out foodPushing away foodKnocking food off plate or tableLeaving seatAggressive behaviours towards othersSelf injurious behaviours(Ahearn, 2001)
Feeding Problems Continued
Incidence of Feeding Problems
Children with diagnoses of developmental disabilities frequently have feeding difficulties.
Studies have estimated up to 30% of children with autism spectrum have difficulties with feeding. (Ahearn, Castine, Nault & Green, 2001; Archer, Resenbaum & Steiner, 1991)
Physiological and Biological Causes
Present and past medical conditions History of surgical procedures particularly any involving nasal -gastric feeding or PEG feeding Allergies and food sensitivities Gastro intestinal reflux Metabolic disorders Constipation Upper respiratory infections Structural or muscular abnormalities Motor planning disorders Sensory processing disorders Dental health issues Prematurity
Environmental Causes Lack access to variety of textures, foods or food temperatures Inappropriate size or shape of feeding utensils Chair and table inappropriate size Emotionally or anxiety charged environments Excessive distractions
Child need many exposures to a new food before accepting it into their dietYoung children often prefer to have a narrow diet
Frequently see food refusal behaviours:- turning head- pushing away food- throwing food- spitting out food
How picky is too picky?
Typically when a child is failing to thrive medical intervention becomes involved
When to seek intervention for the child?
If the child is having insufficient food intake to maintain growth and health
If the child is unable to participate in typical meal time situations in the family home or school environments
If the child is unable to participate in social meal time functions such as a Birthday Party
Multidisciplinary Team-Based Approach
Paediatrician Speech Therapist Occupational Therapist ABA Therapist Case Management Teachers Parents and Carers
Motor PlanningThis is a complex planning task, it is the ability to plan, think and problem solve around motor tasks. Children who have difficulties with motor planning require additional support to learn new tasks as almost all tasks have a motor control aspect, including gross motor, fine motor, oral motor and visual motor skills.
Meal time Impact: Opening containers Completing hand to mouth movement with utensils Lip closure Coordination of jaw to chew foods Control of tongue Saliva management Coordination of suck swallow and breathe patterns
Representation in primary sensory Cortex
Suck Swallow Breathe SynchronyThis is a complex automatic movement pattern typically present at birth to ensure survival.
A normal swallow requires the coordination of cranial nerves and up to 26 muscles.
Inability to control this area can contribute to Gagging or chocking during snacks and meals Poor saliva managementOral health issuesUpper respiratory infections Difficulty regulating autonomic nervous system responses Difficulty with postural development.
Sensory ProcessingThere are 7 common senses that we rely on to interact with our environment effectively.
Sight / Vision Hearing / Auditory Taste/ Gustatory Smell / Olfactory Touch / Tactile Proprioception Vestibular
Sensory ProcessingSensory processing in the mouth can have a significant impact on meal times.
Hyper and hypo sensitivity can impact food choice and food tolerance.
Textures Temperatures Tastes Size of bite Squirreling food in mouth
Taste / Gustatory
Our sense of taste is a survival mechanism to ensure we avoid dangerous foods and helps us identify suitable foods to provide our daily caloric needs.
Meal time impact:Child may show excessive seeking of a particular taste Child may incorrectly sense that a food is noxious resulting in food refusal
TactileWe are all constantly receiving tactile inputs to the touch receptors located in our skin, our hair, our nails by our clothes and accessories that constantly touch us. This allows us to interact with our world, helping us to identify the objects and surfaces we are in contact with. A child can be overly sensitive to touch or can seek out touch excessively.
Meal time impact: Over selectivity in foods. Refusal to eat different brands of the same food Gagging response to undesired textures Swallowing food prior to effectively chewing Mouthing non-food objects Difficulties brushing teeth
ProprioceptionThe proprioceptive system is part of the central nervous system which receives and processes information from muscles, joints and ligaments.
Meal time impact: Child may have difficulty with:Location and movement of food in mouthForce and intensity required to chew foodsAbility to stabilise jaw (at the tempro-mandibular joint)Saliva managementObtaining and controlling food during self feeding
VestibularThe vestibular system is located in the inner ear and is activated by movement or by changing head position. This system is responsible for balance skills and impacts on our overall level of alertness
Impacts on meal times:Child may be always on the goChild may be excessively lethargic
Move n sit cushion is helpful for use in the classroom for children who need to move to keep their attention levels up.
When to recommend intervention? If the child:
Coughs during meal times Gags during meal times Shows extremely strong taste preferences Shows extremely strong textural preferences If the child is unable to eat the typical family diet If the child is unable to meet their nutritional needs on their existing diet
Oral defensiveness must be treated to ensure the success of any other interventions
What can be done in the classroom?
15 minutes prior to snacks and meal times provide access to oral motor input and proprioceptive input.
Sensory Diet Sensory Tool Kit
Provide adequate seated support for children with poor postural support
Sensory DietA sensory diet is recommended for all children to ensure they are meeting their sensory needs on a daily basis. This will help ensure children are not missing out on learning experiences due to avoidance of specific sensory modalities. The sensory diet also helps ensure that the child is able to receive the sensory inputs they are seeking in a safe, effective manner.
A sensory diet should be implemented throughout the day at home, in the clinic, at school and in the community. This will help to ensure the childs sensory needs are met enabling the child to participate more effectively in a variety of learning experiences.
Sensory Diet ExampleProprioception 1/09/10 2/09/10 3/09/10 4/09/10 5/09/10
Carry heavy items (e.g. books)
Holding up the wall
Jumping with a rope
Hanging from a trapeze bar
Roll into a ball and rock
Blow into home made silly putty
Sensory Tool Box
Fiddle toys Oral motor toys
Recommended resourcesRecommended Reading: The Out of Sync Child by Carol Stock Kranowitz The Out of Sync Child has fun by Carol Stock Kranowitz Picky Eating Solutions by Betsy Hicks Deceptively Delicious by Jessica Seinfeld Making a Difference: Behavioral Intervention for Autism.
Maurice, Fozz & Green.Recommended Resource Suppliers: www.skillbuilders.com.au www.therapybookshop.com.au www.therapytoyshop.com.au www.sensorytools.com.au
QuestionsDo you have any questions?
How to contact the Occupational Therapy Department
Jennifer Logan Occupational Therapistjenny@childeimc.comCEIMC: 044 233 667CLEMC: 043 440 737