A P PE N D IX

6-6 Considerations in Feeding

Older Prelinguistic Children

FOOD CHOICE
1. Sweet, sour, salty, or citrus foods tend to increase saliva; may be avoided for children with excessive drooling.
2. Milk tends to thicken saliva; broth tends to thin it.
3. Thin liquids are hard to manage orally; thicker liquids such as shakes or smoothies are easier to swallow.
4. Combinations of textures, such as soup with noodles, are hard to handle; they should be blended.
5. Slightly cooked vegetables are easier to chew than raw ones.
6. Avoid foods that could block the airway, such as hot dogs, foods with skin, unmashed grapes, and food in chunks.
7. Keep cold foods cold and hot foods hot so that the child can experience temperature differences; be careful not to overstimu-
late child with foods that are very hot or very cold.
8. A balanced diet is a must for any childs health. Vitamin supplements may be necessary and can be added to food.

EQUIPMENT FOR FEEDING

1. Towels and washcloths for cleaning child.
2. Teflon-coated spoon with a shallow bowl to prevent pain if child bites hard.
3. Cup with soft plastic rim; cup should be as big around as childs mouth is when open.
4. Equipment to maintain food temperature if feeding takes a long time.

POSITIONING
1. Hips and knees at 90-degree angles when seated.
2. Feet supported.
3. Shoulders slightly forward and arms supported.
4. Spine straight.
5. Head at midline and slightly forward.
6. Knees slightly apart.

DEVELOPING CUP-DRINKING SKILLS

1. Introduce cup outside of mealtime in playful situations.
2. Let child play with empty cup.
3. Rub a preferred taste on rim of cup and allow child to mouth it.
4. Introduce thickened liquid in cup, resting cup on lower lip in front of teeth; do not tip at more than a 20-degree angle. Be sure
lips are closed before beginning.
5. Let child use upper lip to suck liquid from cup; be careful not to dump liquid in the childs mouth.
6. To increase stability and facilitate mouth closures and upper lip movement, place middle finger under chin and gently push up
while placing index finger or thumb on bottom edge of lower lip and gently pushing up.

DEVELOPING SPOON-FEEDING SKILLS

1. Use adaptive positioning for comfort and stability.
2. Introduce spoon outside mealtime in playful situation, such as pretending to feed doll.
3. Let child play with empty spoon.
4. When child tolerates spoon, dip it in food with a preferred taste.
5. Present spoon to lips or front of mouth. Let child use upper lip movement to remove food from spoon. Do not dump food in
childs mouth.
6. If tongue protrudes or child shows low facial tone, apply pressure down on middle of tongue with the spoon and withdraw it
at a neutral angle, being careful not to scrape the spoon upward.
7. Use support to jaw or chin to increase stability, permit graduated jaw movement, and allow child to use upper lip movement to
close on spoon.
8. When child accepts food from spoon, gradually increase textures presented.

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 CHAPTER 6 Assessment and Intervention in the Prelinguistic Period 229

DEVELOPING CHEWING SKILLS

1. Stimulate a munching pattern by presenting crunchy solid foods between molar surfaces. Look for up-and-down movement of
the jaw.
2. Facilitate lateral tongue and jaw movements by stroking the side of the tongue with a solid food, then place the food between
the molar surfaces.
3. Stimulate chewing during eating by rubbing the childs cheeks, one at a time, in a circular motion.
4. Provide jaw and chin support (as previously described) to reduce tongue protrusion and facilitate graduated jaw movement.
5. As child develops more control, place food closer to front of mouth.

CAUTIONS
1. The possibility of choking is always present. Practice feeding techniques, use care in choosing foods that will be easy for child to
manage orally, and know first aid procedures in case choking occurs.
2. Seizures may occur during eating. If they do, stop feeding and wait until seizure is under control. Check to see whether any
food is in mouth during and after seizure.
3. Look for abnormal feeding behaviors, such as those identified by Jaffe (1989) and listed in the following:
a. Tongue thrust: abnormal protrusion of tongue.
b. Tongue retraction: strong pulling back of tongue to pharyngeal space.
c. Jaw thrust: abnormally forceful downward extension of mandible.
d. Lip retraction: drawing the lips back so that they make a tight line over the mouth.
e. Lip pursing: a tight protrusion of the lips.
f. Tonic bite reflex: an abnormally strong closure of the teeth or gums when stimulated.
g. Jaw clenching: an abnormally tight closure of the mouth.
If these occur, specialized physiological feeding assessments may be necessary.

Adapted from Hall, S., Circello, N. Reed, P., & Hylton, J. (1987). Considerations for feeding children who have a neuromuscular disorder. Portland, OR: CARC Publications; McGowan, J.,
& Kerwin, M. (1993). Oral motor and feeding problems. In K. Bleile (Ed.), The care of children with long-term tracheostomies (pp. 157-19d). San Diego, CA: Singular Publishing Group.