In this two-part post we will explore the factors affecting pediatric feeding intervention. Part 2 focuses on the evaluation and treatment of feeding disorders that occur in pediatric populations.
An evaluation of pediatric feeding, eating, and swallowing should include talking with the parents or caregivers and referring provider in order to better understand the concerns that lead to the referral. Observe and ask about the larger social and cultural context of feeding for this particular family, as these contexts can have an impact on both the child’s skills and abilities with feeding as well as your intervention plans and strategies.
Gain information about delays the child may be experiencing in any other areas so that you have a full understanding about the child and their deficits. Neuromotor functions should be evaluated to look for abnormal tone or other difficulties that may be impacting feeding. You should also examine the oral structures and oral motor patterns before finally observing the feeding or eating process and parent-child interactions during that time. If necessary, a Videofluoroscopic Swallow Study can be completed in order to assess the internal aspects of feeding.
Food refusal is one way that feeding issues will manifest themselves, particularly if they are caused by underlying allergies or GER. Other feeding issues can be caused by cerebral palsy, hypertonia or hypotonia, congenital oral-facial abnormalities including clef lip or palate, and a small oral cavity.
The intervention strategies for feeding, eating, and swallowing deficits can be grouped into the categories of environmental adaptations, positioning adaptations, sensory based interventions, neuromuscular interventions, adaptive equipment, food and liquid property modifications, behavioral interventions, and self-feeding interventions. Each intervention focuses on different aspects of feeding difficulty. By using one or more of these types of strategies, occupational therapists can address and improve upon the various feeding deficits children experience.
Environmental adaptations include modifications to the physical, social, and temporal environments in order to create the most beneficial setting for the particular child. This could mean eating in a quiet environment with limited distractions and scheduling meals when the child is hungry enough to eat but not overly hungry.
Positioning adaptations typically provide support to the trunk in order to facilitate the feeding, eating, and swallowing processes. For a breast fed child, this may mean using positioning to adjust the rate of milk letdown. For an older child eating solid foods, this may mean adaptive seating options that support an unstable truck.
Sensory based interventions focus on the sensory needs of the child and often include extensive oral stimulation through use of both foods and non-foods. It often involves experimentation with various food textures and use of sensory integration techniques.
Neuromuscular interventions address the oral motor impairments and development of the muscles and sensory organs related to feeding and eating. It involves taking a more focused approach towards addressing deficits identified in the various structures involved in the feeding and swallowing process through strategies such as targeted muscle strengthening.
Adaptive equipment consists of various adaptive utensils, cups, and plates that can facilitate the entire feeding process. Plates with lips and edges or utensils with strap handles can increase efficiency when transferring food from plate to mouth and decrease frustrations surrounding eating.
Food and liquid property modifications include the thickening of liquids and the pureeing of foods in order to meet the needs of the child. These modifications can increase safety for those with swallowing and aspiration issues.
Behavioral interventions include addressing any potential underlying medical causes and managing caregiver stress during feeding. This easily overlooked aspect of feeding—the behavioral component—can also have an impact on other aspects of the feeding and swallowing process.
Self-feeding interventions focus on the process of self-feeding through use of techniques such as adaptive equipment, positioning, and hand-over-hand in order to aid children in feeding themselves. They allow for the completion of the process of self-feeding within a context that guarantees success.
Through effective intervention strategies that address the underlying issues associated with feeding issues, occupational therapists can assist parents and children in improving or resolving many of the issues associated with pediatric feeding concerns. And in many cases, these same skills and techniques can also be applied, in modified forms, to older adult populations to restore function following an neurological condition.
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