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91 views15 pages

csd625-f13 Canvas Mod5

Uploaded by

api-242414162
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Pediatric Dysphagia CSD 625

Management of Swallowing & Feeding Problems

When trying to figure out and manage problem behaviors at a meal REMEMBER:

Children explain themselves via their behavior. This is how they communicate. ALL behavior serves a purpose.
We just need to be persistent, observant, and smart enough to figure out what the communicative intent and function are.

It does not matter if we get the child to eat; What matters most is what happens at home. Parents/caregivers job is to get the calories in; Our job is to teach the child about food & teach them the skills needed to be successful during meals.

General Treatment Strategies


Effective treatment is not about managing the childs problem, but rather collaborating with parents in order to increase the likelihood that the childs unique preferences, strengths, and challenges and medical history are taken into account.

Mealtimes Matter Group- Facilitators Guidelines Gillian Fowler, OTR; Emily Morgan, SLP; Denise Stapleton, Rd. (2004). www.health.wa.gov.au

General Treatment Strategies


Use Key Phrases
Our goal is to use language to assist the child to eat as well as to manage any maladaptive behaviors without using
Negative communication (demands, commands, questions)

How they help?


Encourages and gives permission to the child to advance onto the next step of eating (You CAN vs. can you?)

Clarifies the rules; tell what to do vs what not to do


Helps child understand the exact action being encouraged/taught/reinforced Focuses/refocuses child when distracted or overwhelmed Educates the child about the food and/or their bodys experience of the food

General Treatment Strategies


*to be used at typical family meals vs. therapy meal

A. Social Modeling teaches the social experience of eating.


Family meals Model good feeding behaviors The child is NOT the focus of the meal Discuss the sensory properties of the food (because the food is the focus) Over-exaggerate the correct motor movements Imitate the childs eating Make the food fun Do not punish the child Child should be involved in all aspects (scooping for example) Child needs to stay at the table

General Treatment Strategies


*to be used at typical family meals vs. therapy meal B. Structure Meal/Snack Times
Use the same place/designate a place (table surface) Create a routine to meals and snacks
Warning Transition activity

Sit at the table


Serve family style Eat Clean up (blow/throw food into rubbish, wash hands/table)

Follow the same time schedule (myth 7)

General Treatment Strategies


*to be used at typical family meals vs. therapy meal

B. Structure Meal/Snack Times (contd)


Present foods in manageable bites Only 3 foods at any time (1 protein, 1 starch, 1 fruit/veg) Rule of thumb= 1 Tbsp per year of age

One preferred food at every meal


Several foods on the table for exposure Allow spitting into chosen containers only Limit meals/snacks to 15-30 minutes

General Treatment Strategies


*to be used at typical family meals vs. therapy meals C. Reinforcement
Verbal praise in appropriate amounts Create parent reinforcement value Reinforce siblings eating Reinforce child for ANY adaptive food behavior Playing with the food is reinforcing in and of itself, touching the food desensitizes the child Can very carefully use preferred food as reinforcers Use disappearing object reinforcers if an object reinforcer is only option

General Treatment Strategies


*to be used at typical family meals vs. therapy meals D. Accessing the Cognitive
Utilizing what ever cognitive functioning the child has to help them understand the food and their bodies Sensorimotor: visual, smell, tactile comparisons; physical demonstration of manipulation changes; verbally label the foods Pre-Logical: all of the above; comparisons to known objects and known foods (play with a purpose); begin simple teaching about the body Concrete Operations: all of the above; active discussions of the function of the various sensory systems and how the brain and body influence each other; teach how to change sensory input to improve tolerance

Compliance
begins with

Education

Compliance begins w/Education


Educate families and professionals about treatment approaches and their respective pros and cons; Typical child takes them about 2 years to learn to eat; Be conscious of the fact that many have the expectation that a child with feeding delays should have learning occur in less than two years; If the family doesnt comply w/recommendations we need to look at ourselves and change how we educate parents.

Treatment Strategies in the Clinic


Selecting foods for in clinic:
Nutrition: 1 protein, 1 starch, 1 fruit/vegetable + drink Textures: 1 hard munchable; 1 meltable hard solid; 1 puree Sensory: each food links to the food before and after by the sensory properties (color, shape, size, taste, texture, temperature, consistency) Foods need to be matched to the oral-motor skills and goals for the child in therapy Foods need to be matched to the sensory tolerance of the child

Treatment Strategies in Clinic


When first beginning therapy, goal is to work on increasing the range of foods the child will tolerate at the lower steps of hierarchy Once food starts getting in the mouth, then focus shifts to skill development

Fin.

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