Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

October 2015 Independent Eating and Drinking Newsletter

	October Topics: Feeding Difficulties in Infants and Young Children Your Help is Needed in Developing Choking Response Procedures
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Feeding Difficulties in Infants and Young Children

Many children who have developmental delays or who were born preterm have some type of feeding difficulties. These result from problems with their oral-motor function that either have some deficits or are delayed in developing.

The average baby develops oral-motor skills very rapidly after being born. The baby is born with a suckle reflex and as they use this reflex they become better at sucking. The skill used to draw milk from a breast or bottle includes coordinating breathing and swallowing, and as the baby uses the skill to gain nutrition, they gain control over it and become able to initiate sucking to satisfy their hunger. By around 4 months of age, sucking is no longer a reflex but is an ability that the baby has developed. The repeated practice provides the infant with the opportunity to develop the muscles involved in sucking and swallowing, and the ability to control them at will.

The first muscle pattern that develops in infants involves an in and out tongue movement that moves liquid through a nipple (suckling). The next tongue movement that develops is up and down and moves liquid and puree through the mouth (sucking). Next the tongue begins to move from side to side. At this developmental stage, foods with textures are able to be processed within the mouth. They are moved by the tongue over the molar surface (before teeth have erupted) and back to the center of the mouth (munching). Before good functional chewing can develop, the child must develop the muscles to stabilize the jaw. With a stable jaw the range of motion of the tongue can expand to include sweeping movements within the mouth and the ability to elevate the tip of the tongue. Teeth develop and food can be broken down and formed into a bolus ready to be swallowed. The child has now developed quite advanced oral-motor skills and the more they eat a diverse range of food flavors and textures, the better the muscles of their mouth will become. Constant practice using the muscles of the mouth allows eating skills to further develop. When moving from the sucking stage of oral development to eating textured foods from a utensil, the child moves from a serial swallowing pattern to a single swallow pattern. (A serial swallowing pattern occurs when several swallows occur consecutively to clear the mouth of milk before more milk is drawn into the mouth.)

Children born prematurely or with neurological disorders do not always have the opportunity to intake nutrition by mouth immediately after birth. Under these circumstances, infants are often provided with a pacifier to allow them to experience sucking. However, without the opportunity to experience the full scope of suckling, including sucking, being able to pull milk into their mouth from a nipple, propelling the milk back in their mouth and swallowing it, and the necessary breathing associated with these functions, babies may not develop the skills necessary to successfully suck and swallow before the suck reflex fades. Babies who do not have the opportunity to practice feeding in the first months of life do not necessarily develop strong, normal, oral-motor patterns.

In addition to the lack of practice with feeding and swallowing, other factors can be a deterrent to the development of good oral-motor skills. Eating and swallowing do not exist as separate functions but are part of a whole-body-process that includes breathing, digesting food, urinating and defecating. When any of these functions do not work properly all of the rest will be impacted. For example, if someone has a cold and cannot breathe properly, they find eating and swallowing more difficult and frequently reduce the amount of food that they eat. For a child with respiratory problems, eating and drinking can be daunting. When respiratory difficulties exist, breathing is more difficult and the breathing rate can increase. With a rapid rate of breathing, a child might find the pause in breathing that is necessary for swallowing to take place, difficult to coordinate. Thus, they may reduce (or even cease) eating and drinking while experiencing respiratory problems.

Gastrointestinal issues can be manifested as nausea, the feeling of fullness caused by constipation, discomfort from gastroesophageal reflux or other causes, and can impact a child’s willingness to eat. If the problem continues, the child can become defensive and become resistant to being touched around their mouth and on their face. Additionally, they may fight having a nipple put in their mouth. This behavior can also occur when spoon feeding is attempted.

Additionally, without good structural stability of the body, oral-motor control becomes difficult or impossible. If the head does not rest on the neck (which is aligned with the trunk) it will slump forward and the jaw will drop down causing the mouth to hang open. This alone will make eating difficult, and in this position food is easily lost from the mouth before it can be chewed and swallowed. Even with good positioning, low muscle tone can result in an open mouth and unstable jaw. Without jaw stability the movement of the tongue inside the mouth is prevented from functioning proficiently. In many cases, if the mouth hangs open and the head is forward, containing saliva in the mouth is difficult and leakage occurs.

Frequently, infants who have oral-motor problems who are able to drink from a bottle, continue to use bottle feeding as an almost exclusive source of food for an extended time. Many infants have difficulties eating from a spoon; however the muscles of the mouth need the experience of removing food from a spoon to become stronger. The muscles above the lip (orbicularis oris) must, through exercise, become stretched and strong. This allows the child to use the movement of the upper lip to close their mouth around a Sippy cup or clear food from a spoon. Without all of the muscles of the mouth being exercised constantly, feeding, drinking and speech will be impacted.

Children who are identified as having feeding and/or swallowing difficulties should receive treatment as soon as they are medically stable. The interventions should be provided by a team of therapists from a range of disciplines to address all of the potential issues that may be causing the difficulties. To avoid compensatory behaviors from developing, early and intensive therapies should be considered. To find the necessary support, parents should discuss their problems with both their pediatrician and any therapists who are providing services to their child. Potentially, the child might benefit from the services of a feeding clinic where the staff specializes in complex eating disorders. Mealtime Partners January 2012 Newsletter provided a list of Feeding Clinics throughout the United States at the end of the article. (The list was compiled in 2012 and so may have some information that is not current.)

 

Pass the Peas Please
Peas aren't the easiest things to pick up, but the Mealtime Partner can reliably serve bite after bite of them if that’s what you want. If not, just move on to the next bowl and sample the pasta salad. The Mealtime Partner empowers its user to eat what they want, when they want it. To see a video of the Mealtime Partner Dining System, click here. To discuss how it might meet your specific needs, call us at 800-996-8607 or email us by clicking here. (Be sure to include your telephone number so we can give you a call.)
The Mealtime Partner Dining System is quick and easy to learn and has no complicated programming requirements. Each Dining System comes with a complete training video on DVD so new users and caregivers can learn to use it in just a few minutes. To view a list of the instructional videos that may be selected by title, click here. The Mealtime Partner is by far the best assistive dining equipment ever developed. Before the engineering design team ever started, the design requirements for it were developed by a team of medical experts working with potential users. They examined the shortcomings in prior designs, the needs and desires of users, and the special requirements for providing safe and reliable operation in the various, often harsh, environmental settings where it must function. This resulted in the design of a dining system with quiet operation, that is easy to setup and use, easy to clean, has high durability (will last many years), serves food reliably, and is very safe to use. There are no other devices currently on the market that can even come close to matching its performance. For more information about the Mealtime Partner, click here. The Mealtime Partner meets the Medicare and Medicaid definitions of Durable Medical Equipment (DME). The United States Food and Drug Administration (FDA) considers the Mealtime Partner to be a Class I type medical device. The Mealtime Partners has successfully completed all governmental electrical safety and electro-magnetic compatibility (EMC) compliance testing. For more information about safety testing, click here.

 

Your Help is Needed in Developing Choking Response Procedures

In our May 2015 Newsletter we appealed to readers to submit any information that they, and/or the organizations they work for, have about dealing with choking incidences for people who are in wheelchairs.  Does your organization have policies and procedures for handling choking incidences? Mealtime Partners’ objective is to compile a document that describes the various instruction sets used by people who assist individuals who spend the majority of their day sitting in a wheelchair and would appreciate your help. Please, if you are aware of a document that provides instructions about the actions that should be taken when someone who is sitting in a wheelchair chokes, please send a website link to the document, or send a copy of the document by email to: choking@mealtimepartners.com. (If you would like to be credited with providing the document please provide your name, title, and organization name and give us permission to include your information.)

Once all the information that we can identify has been reviewed and cataloged we will make the document available on our website and provide a link to the material in a future Newsletter. Links to all of the resource material that is in the report will also be available.

Any other information or feedback on this subject would be welcomed. This is an area of concern to many people who are responsible for feeding individuals who sit in their wheelchair while eating. The level of difficulty in handling this situation varies significantly depending upon the level of dependency of the individual.

Did You Know? Did you know that expectant mothers should be vaccinated against whooping cough (pertussis) during the third trimester of each of their pregnancies? The number of occurrences of whooping cough in the United States is increasing and the death rate from whooping cough is greatest among infants. Therefore, it is important to protect new born babies from exposure to infection. If a mother is vaccinated two weeks before delivery, the protective antibodies created in her body will be at their highest when the baby is born and will be passed along to the baby before birth. Many children and adults show no symptoms of whooping cough or think that they just have a cold with a cough and sneezing, when they are infected with whooping cough. The bacteria can be spread through the air when infected people cough or sneeze and it can be inhaled by the infant who, without the protective antibodies passed along from a vaccinated mother, can be easily infected. Infants cannot be vaccinated at birth and are at risk for infection until they are old enough to receive the DTaP shot that will protect them against diphtheria, tetanus and pertussis, at about 2 months of age. The Centers for Disease Control and Prevention (CDC) recommend that everyone who is going to be around a new born baby (friends, grandparents, etc.) be vaccinated against pertussis two weeks before visiting the infant.