Mealtime Skills

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Mealtime Skills
2
Framework

• Mealtime is probably the most important
  activity/skill
• Critical to health and happiness
• Several hours are spent on it daily
• Taking food by mouth is a predictor of increased
  life expectancy for people with severe
  disabilities
• Can be the most pleasant time between individual
  and caregiver

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However. . . .

• It can also be stressful and unpleasant
• Little opportunity for positive social
  interaction
• Caregiver works on the child
• Caregiver may find the activity unpleasant
• Seemingly long activity
• Choking or gagging
• Atypical movement
• Muscle tone
• Primitive reflexes
• Structural abnormalities of the mouth
• Dysfunctional eating patterns
• Behavior problems

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Modification Strategies

• Modifications in positioning
• Food selection
• Adaptive equipment
• Environmental factors
• Child-specific training

Info by www.circleofinclusion.org/english/pim/fiv
e/mealtime.html
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Safety Issues

• The difficulties experienced with eating may be
  due to poor posture or poor head control and/or
  limited movement of the lips, jaw or tongue.
• Dysphasia (difficulty swallowing) may be a
  symptom of other problems such as some kind of
  damage to the nervous system, a stroke, spinal
  cord injury or cerebral palsy. It can also be the
  side effect from some medication.
• Aspiration can occur when fluids or food
  particles go into the lungs, or during reflux.

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Safety Checklist for Teams(from
http//www.ddssafety.net/families/safe_mealtime.ht
m)

• The correct texture of food and liquids
• some examples are pureed, minced, ground,
  chopped, and modified regular
• liquids may be thickened until they are
  acceptable to the therapist
• The correct adaptive equipment
• This means that if a coated spoon is required, a
  metal, uncoated spoon is not acceptable.
• There are adapted plates, cups and silverware
  that can add to the person's independence while
  helping get the food to the right place with
  minimal spillage.

• The correct positioning
• specialized chair that will adjust for proper
  alignment during meals
• specialized foot rests and bolsters
• repositioning throughout the meal
• describe the method used to present food
• head alignment must be done as the therapist has
  described
• every person who may assist another with a meal
  needs to know the exact details of the Plan so it
  should be kept nearby
• A pleasant and relaxing environment is very
  important
• Mealtime still needs to be a social experience.
  It is a time to be together, share and enjoy.

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Behavior Issues

• Parent/caregiver interactions
• Environmental Factors
• Physiologic Factors

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Intervention Tech

• Reinforcement ( see Bailey, et al.)
• Shaping approximations of the behavior should
  be reinforced when the student cannot perform the
  exact skill.
• Graduated guidance.
• Chaining
• Discrete response into complex behaviors
• Prompting (review)

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Special Dental Concerns

• More occurrences of cavities, periodontal
  disease, and poor occlusion
• Damage to teeth during seizures or constant
  grinding
• Medications can effect tooth health
• Mobility can effect dental hygiene
• Pureed foods are particularly cavity causing
• Behavior can effect dental visits
• Dental concerns will influence communication and
  mealtime skills
• High-quality dental care is key (including input
  from teachers, parents, and other caregivers)

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Using a Team Approach to Facilitate Inclusion and
Mealtime Activities

• Involve therapy staff who have special training
  in oral motor function, feeding skills and
  adaptive equipment such as occupational
  therapists and/or speech language pathologists.
• Encourage parent input on how they feed their
  child at home and any suggestion they might have
  for the classroom.
• Consult with a nutritionist on a child's weight
  gain, fluid intake, food preferences, snack and
  mealtime food recommendations, etc.

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Using a Team Approach to Facilitate Inclusion and
Mealtime Activities (cont.)

• Use snack time as an opportunity for practicing
  skills such as social interaction, communication,
  fine motor skills, self care routines, postural
  control, and pre-academic skills.
• Allow the child to be as independent as possible
  by using partial participation, task analysis,
  graduated guidance or finger foods at times.
• Make sure to normalize the process of eating so
  that the child eats in the same place as the
  other children, is on the same level at the same
  table, and uses the least amount of adaptive
  devices.

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Using a Team Approach to Facilitate Inclusion and
Mealtime Activities (cont.)

• Use the child's augmentative communication system
  (if applicable) at the table to communicate
  wants, choices and social comments.
• Be aware of any food allergies or foods to be
  avoided due to specific physical disabilities.
• Use creative solutions to problems such as if the
  child needs a longer lunchtime to eat, let a
  friend stay with the child for social
  interactions or if a child is hungry before
  lunchtime, permit a snack sometime in the
  morning or if there is too much stimulation in
  the lunchroom, have the child sit at the end of
  the table in the quietest part of the room with a
  friend