Feeding

  • Temporal factors: time of day

  • Things to consider

    • Family cultural background: need to know so you know how that family completes occupation

    • Child’s age and development skills:

    • Environment: Sensory, and current environment vs home

    • Socioeconomic: What they eat, what food is accessible, what can you recommend

    • Caregivers: dictate most of this process and create food and environment for the child

Oral motor milestone

Newborn

  • rooting reflex

  • suck, swallow, breathe pattern- babies are able to do this automatically (usually)

  • suckling


  • Physiological function-pos out of the womb (fetal pos)

1-3 months

  • improvement of suck, swallow, breathe pattern, less reflexive, more intentional

  • Physical flexion decreasing

4-6 months

  • true suck pattern emerges

  • Chewing patterns develop

    • munching-up & down movement

    • lateral & diagonal jaw movement emerging

    • lateral tongue movement emerging

  • can hold their own bottle

  • Usually start solids

  • sitting to drink from a cup (sippy/straw)

    • 6 months (2 oz of water a day)

7-9 months

  • tongue lateralization

  • diagonal rotary movements

  • circular rotary pattern developing

  • drinking from an open cup (small silicone cup)

  • finger feeding-self feeding (fine motor, sensory, occupation)

12 months

  • independent utensil use (MESSY)

  • Rotary chewing

  • tongue protrusion

  • eats most table foods

  • eating on fam schedule


Evaluation

  • parent/caregiver interview

  • medical hx

    • allergies

    • sensory

    • tonuge tie

  • observation

    • Who:

      • Caregiver

      • therapist

      • child

    • What:

      • postural stability

      • oral motor skills

      • UE skills for self-feeding

      • Sensory


Anatomical structure feeding issues

  • Jaw

    • Jaw thrust

      • tone

    • Tonic bite reflex

      • reflexive bite reflex

  • tongue

    • thrust-high tone

      • tongue shoots out, hard to move around

    • retraction

    • Protrusion

      • tongue hanging out

    • Tongue ties

      • under tongue line under tongue

  • lips

    • retraction-high tone

    • drooling-low tone

    • lip ties

      • line in lip

    • cleft lips or cleft palate

      • anomalies, gaps in the mouth


Self feeding

  • head control

  • trunk control

  • control of reach, grasp, and release

  • hand-eye coordination


SENSORY + mealtimes

  • smell

    • do you want near food

  • sight

    • what does food look like

  • touch/texture

    • slimey, wet, bumpy, smooth

  • taste

    • does it taste good to them

  • sound

    • environment, cafeteria, at home


Causes of oral hypersensitivity

  • Neg early experience

    • hospital stays, force feeding, reflux

  • lack of oral experience

    • ng tube, OG tube, G-tube feedings

  • Neurological impairments


Intervention

  • Pos

  • Jaw control techniques

  • Oral desensitization & stimulation