Outline Chapter 9
Feeding and Its Disorders
Feeding problems can be experienced by 33%–80% of children with developmental disabilities and can be in the form of:
Difficulty chewing/swallowing (dysphagia)
Food selectivity
Inadequate intake
Total food refusal
Causes of feeding problems:
Anatomical abnormality
Motor/sensory dysfunction
Medical/psychological conditions
Growth abnormality
Learning difficulties
Social interaction difficulties
No sucking skills due to premature birth, hence no lateral tongue movement
Prolonged bottle feeding
Minimal mouth-opening for spoon-feeding
Poor weight gain (3rd percentile)
Gastroesophageal reflux (GER)
Caregiver actions during feeding
Feeding Process
Swallowing has 4 phases:
- Oral preparatory
- Oral transport phase
- Pharyngeal transfer phase
- Esophageal transport phase
Developmental changes in oral motor skills
Suckling: 12–14 weeks gestation, reflexive first 3–4 mos.
Sucking: 5 months, leads to spoon-feeding
Munching and chewing: 9 months–2 years old
Successful feeding depends on the anatomy and child’s medical status
•Respiration and digestion
•Esophagus to stomach:
•Gastroesophageal reflux (GER, GERD, allergies)
•Dumping
•Delayed emptying
•The small bowel: lactase deficiency (70% of world population)
•The colon: diarrhea/constipation
•Other medical conditions (e.g., asthma, kidney disease)
Causes for Feeding Problems
Abnormal muscle tone affecting trunk support
Posture and alignment influenced by medical condition
Head/neck alignment vital to feeding
Prolonged feeding time (+30 min.)
Food pocketing
Coughing, gagging, choking
Aspiration
Food refusal (total/partial)
Food selectivity (autism, cerebral palsy)
Vomit
Poor weight gain
Evaluating a Feeding Problem
Use of a Multidisciplinary approach
Obtain medical, motor and behavioral history
Conduct Exams (physical, neurodevelopmental, oral–pharyngeal)
Obtain feeding history
Observe a Mealtime
Document a 3-day nutritional record
Diagnostic Tools to determine a Feeding problem
Films of airway
Modified barium swallow with video fluoroscopy
Food texture variations
Flexible endoscopic evaluation of swallowing (FEES)
Upper GI series with barium
Gastroesophageal duodenoscopy (endoscopy)
Recommendations:
Minimize negative medical influences
(remediate GI irritation, GER, dysmotility, constipation)
Ensure proper positioning for feeding
(hip/trunk support, head/neck aligned)
Facilitate oral–motor function
(stimulation, chin support, food placement, textures)
Improve mealtime environment
(routine, distractions, supervision, adaptive devices, incentives)
Promote appetite (day/night, bolus/continuous)
Use alternative methods (NG tube, G-J tube, enteral formula, Kangaroo pump)
To feed a child with development disability:
Be creative
Involve a team of health care professionals
Optimize social meal interactions for developmental benefits
Include optimal nutrients and fluids for growth/health