Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

March 2014 Independent Eating and Drinking Newsletter

Independent Eating...   is a Wonderful Thing

March Topics:

  • A Review of Significant Aspects of Eating and Drinking

  • The Psychological Effects of Being Fed

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A Review of Significant Aspects of Eating And Drinking

Over the years Mealtime Partners Newsletters have provided a wide range of information about eating and drinking for individuals who are unable to eat and/or drink in the traditional manner due to many different disabilities. Because the purpose of the Newsletters is to disseminate helpful information about all aspects of eating and drinking, the Newsletter topics revolve around a core set of issues that are all interwoven and relate to successful and enjoyable eating and drinking experiences.

This month some of these issues will be reviewed to reiterate how important many aspects of the eating and drinking experience are to safe and pleasurable mealtimes, and how intertwined they are. (References to previous Newsletter articles will be provided throughout the article to enable the reader to access more detailed information about the subjects that are addressed.)

There are two groups of people who require assistance with eating and drinking: one group was born with a disabling condition that has limited their ability to eat and drink independently; the second group was able to eat and drink without assistance prior to the disability impacting their independence. Experience with independent eating and drinking makes these two groups very different from one another.

The first group has always been provided food and drinks by another person, and has always depended upon someone else to feed them. Congenital disabilities (present at birth) limit an infant’s ability to develop the necessary skills to become an independent eater that normally evolves as a child grows. This includes moving from being fed to eating through the various stages of childhood development including developing a grasp, sitting up, bringing hand to mouth, etc. (August 2009 Newsletter, “Independent Eating for Children”.) It is quite common to find that an individual is still being fed in a similar manner to that used when they were an infant, when they are an adolescent, or even, an adult. This style of feeding is continued as it is familiar to the care recipient and care provider, and is, in many circumstances, cleaner, and quicker, than the individual evolving into a more mature method of eating. Thus the person goes on being fed rather than developing the understanding of eating and the associated freedoms of choosing both the food they want to eat and the pace at which they want to eat. From the caregiver's prospective, facilitating independent eating for someone who must be provided every bite of food can be frustrating and is definitely more time consuming than just quickly feeding someone. (June 2010 Newsletter, “Eating Versus Being Fed”, and, November 2012, “The Importance of Mealtime Independence”.)

For someone who has acquired a disability, to be fed in the manner just described would be difficult to tolerate because they typically have strong feelings about what they want to eat and how the food should be presented to them. It is common to hear complaints about meals when they are fed by a nurse or professional caregiver. However, we have observed that spouses usually are very “in tune” with their partner and able to provide food in a way that is comfortable.

Above all, for both groups, eating and drinking should be performed as safely as possible. Common behaviors that can make eating and drinking less safe are: first, related to the speed at which food and liquid are provided to an individual, and, secondly, the position that the person is in when they receive the food or drink. Additionally, distractions, like people moving around a lot and making excessive noise, can be detrimental to safe eating and drinking because the person receiving the food may turn their head to see what the hubbub is about and not be in a good position to safely receive food or liquid.

Choking or aspiration can result when someone is given bite after bite of food too quickly. To eat safely each bite of food should be chewed and swallowed before the next bite is offered. Many people, who are fed, open their mouth and take another bite of food simply because the next bite of food is offered, even if they are not ready for it. Therefore the person feeding someone should wait to offer another bite until the previous bite has clearly been swallowed. (March 2010 Newsletter, “Choking Prevention”.)

The position in which someone is seated at mealtimes, and/or when they take a drink, is significant to how safely they are able to swallow. Able bodied individuals adjust the position that they are in when they undertake specific tasks. This includes when they eat or drink. Their body innately knows how it should be positioned to accommodate the task at hand. Unfortunately, for many individuals who are fed, adopting an appropriate position is not possible and thus they must be helped to obtain (and maintain) the correct posture for meals, etc. One of the major oversights regarding positioning for safe eating is that if someone sits in a wheelchair to eat, the position that they are in for driving the wheelchair, or being transported, is assumed to be the correct position for all tasks, including eating. However, this is not true in the majority of cases. The typical posture for driving a wheelchair is erect with the head positioned to provide the best view of what is in front of the occupant. This often requires the shoulders to rest on the back of the chair and the head to be tilted slightly backward. For eating the shoulders should be slightly forward and aligned over the buttocks. Also, the head should be tilted downward slightly to produce a chin tuck. More detailed information about seating and positioning can be found in: the June 2009 Newsletter, “Promoting a Chin Tuck for Safer Eating”; the July 2009 Newsletter; “Positioning for Eating”; the March 2010 Newsletter, “Good Buttocks Positioning Promotes Safe Eating”; the June 2011 Newsletter, “Positioning for Eating Revisited”; and the September 2012 Newsletter, “The Importance of Seating and Positioning for Eating”.

Once the correct seating and positioning is achieved and a meal is progressing at a leisurely pace, fatigue should be considered. Eating can be very demanding for some people and requires them to exert a lot of effort to manage their gross and fine motor control. When someone begins to tire, their coordination and control is reduced and the mechanics of their swallow can become less organized. If this happens it is wise to end the meal. If inadequate calories were consumed, the meal can be continued, or a snack served after a rest (February 2010 Newsletter, “Avoiding Mealtime Fatigue”). Regardless of who is feeding another person, it should be remembered that the risk of aspiration, and the ensuing possibility of aspiration pneumonia, have been clinically shown to increase whenever someone is fed rather than feeding themselves, no matter how experienced the feeding partner may be. For that reason (as well as many others), Mealtime Partners is dedicated to providing equipment to facilitate independent eating and drinking for individuals who are unable to use their hands and arms to pick up food, a utensil or a drink. More information about these products can be found at the Mealtime Partners Website.

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The Hospital Bed Drinking System
Meeting hydration needs for hospital patients who are unable to use their hands or arms to drink.

The Hospital Bed Hydration System from Mealtime Partners is suitable for patients who have difficulty picking up or holding a cup while lying in bed in the hospital. Adequate hydration is essential for the best medical outcomes for all patients. But, when a patient is unable to take a drink independently, it becomes the responsibility of hospital staff to ensure that adequate water is consumed. However, this increases the workload for staff and it requires the patient to request assistance whenever they are thirsty.
Hospital Bed Hydration System
The Mealtime Partners Hospital Bed Hydration System

Making liquid constantly available allows the user to drink whenever they want. This lowers the risk of dehydration and improves the quality of life for those who have one of these systems. Click on the following link for more information about the Hospital Bed Hydration System. For more information about all of the Mealtime Partners drinking systems and information about choosing the most appropriate drinking system, click here.


The Psychological Effects of Being Fed 

The first article in this Newsletter discussed some of the practical necessities for safe eating and drinking which are extremely important. However, the psychological impact of being a dependent eater should not be overlooked. The psychological impact upon individuals differs significantly depending upon whether the individual has a congenital cause for their disability, or whether they have an acquired disability (as discussed in the previous article).

For children who are dependent upon family and school staff to meet their nutrition and hydration needs, the concern should be about the child becoming passive in their expectations of ever being able to do anything for themselves. This is sometimes described as learned helplessness. The original research about learned helplessness was conducted with dogs that were subjected to adverse stimuli that they were unable to escape. Over time, the dogs did not try to avoid the stimuli, they simply became passive. Even though this research was tied to animal psychology and behavior, it has, over time, been applied to many situations involving people. When people feel that they have no control over their situation, they may also behave in a helpless manner. It is important that children do not develop this view of themselves and they should be helped both with teaching and assistive technology to participate in, or execute, as many activities for themselves as possible. Because of the amount of time spent on eating and drinking every day, independence with these skills is especially important for children. If they can take care of such a time consuming activity of daily living without requiring very much help, they will gain significant autonomy.  

For those who become disabled, the psychological impact of their disability is extremely significant. Moving from being able to do everything independently to needing help with all aspects of their life can be devastating. The feeling of “helplessness” can be extrapolated into a feeling of “uselessness”. This self-concept can lead to depression and according to Shimizu, et. al., can result in feelings of shame, feelings of discomfort, loss of appetite, decreased self-esteem, and panic or fear. Therefore, every effort should be made to facilitate independence in all aspects of life, wherever possible.

For most people mealtimes are an important part of the day. They not only provide us with nourishment but they are a time for social interactions, relaxation and time to rejuvenate. For those who are limited in what they can do independently, meals are a break in the tedium of the day. Therefore, mealtimes should be made as enjoyable as possible, regardless of your ability level. (October 2011 Newsletter, “The Significance of Mealtimes”.).

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Did You Know?  Did you know that a new study recently reported in the Journal of Pediatrics evaluated sound machines used to sooth babies? These machines are popular with parents as they provide background noise in the nursery. Fourteen different machines were tested in the study. The noise production from them was measured at varying distances to evaluate how loud they were when placed in different parts of a nursery.

As a reference, the set noise level limits recommended for hospital nurseries and neonatal intensive care units is 50 decibels for sound exposure periods of one hour. The recommended workplace limit is 85 decibels over eight hours for adults. (The implication is that for longer periods of exposure, the sound level limits would need to be reduced.)

Three of the machines tested in the study had outputs greater than 85 decibels. If they were played for eight hours researchers wrote, “Infant’s would be exposed to sound pressure levels that exceed occupational noise limits”. This level of noise could potentially damage infant’s hearing and hinder their auditory development. The study recommendation is that if the machines are used, that they are placed as far away from the baby as possible and played at a very low level. Experts differ in their opinions as to how long the machines should be played at one time.

What should be taken away from the study findings is that noise machines should never be placed in the crib near the infant or on the crib rails. If they are to be used, they should be placed as far away from the baby, in the nursery, as possible. Additionally, they should be played as softly as possible. Finally, the lowest tone should be selected from the tones that are available as, not only are they less likely to be damaging to an infant’s hearing, but also most closely replicate the sounds heard in the womb.

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