Mealtime Partners, Inc.


Specializing in Assistive Dining and Drinking Equipment

August 2010 Independent Eating and Drinking Newsletter

Independent Eating...   is a Wonderful Thing 

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Back to School

It’s that time again. Children are heading back to school and so it is time for us, those who work with children with disabilities, to once more make sure that we are providing the very best services to them. If you work with children who are unable to eat independently in a school setting, now is the time to plan for setting functional Individualized Education Program (IEP) goals and for developing the training pathway that will be used to reach those goals.

According to Dianne Koontz Lowman1 “No single activity is as critical to the health, education, and happiness of children with disabilities as feeding”. However, the wonderful opportunities for learning and socialization at mealtime are often overlooked because at school, just like at home, mealtimes are busy times with much to be done in a limited amount of time. This article is intended to draw attention to some of the possibilities that are available and give some direction as to how they can be pursued.

Once a child has been identified as unable to eat and/or drink independently, school staff must plan for providing food and drinks to the student. Who will take care of these needs and whether there are special medical requirements associated with eating and drinking, must be addressed. (Cultural and religious issues should also be considered.) Once the daily routine for eating and drinking is established, it is time for the therapy team to step in and look at developing strategies for improving the functional abilities of the student.

Eating and drinking require an interdisciplinary team approach that includes the family. It is not simply the domain of the occupational therapist or the speech therapist. To provide support for students who need to develop independent eating and drinking skills, a physical therapist should evaluate (with the collaboration of other team members) their seating and positioning to facilitate an optimal position for undertaking the tasks of eating and drinking. Additionally, a speech pathologist should evaluate issues relating to safe chewing and swallowing. Again, positioning is critical to safe chewing and swallowing. The student’s occupational therapist should look at the mechanics of the student getting food and liquid from a table to their mouth. The school district’s assistive technology team should also be consulted if special eating or drinking equipment needs to be considered. Even though all of these professionals must be involved in the development of goals for the student, the classroom teacher is the person who will orchestrate the plan’s implementation and who must be supported in all aspects of integrating an eating/drinking program for a student.

Classroom aides provide much of the day-to-day assistances for students. Without the help of aides teachers would not be able to provide for the diverse needs of a classroom full of students. However, training for an aide to provide services for eating and drinking should not be understated. Many classroom aides are Mom’s who have raised children or are raising children. It is often thought that because an aide has raised a child from a baby to an independent child who can take care of their own activities of daily living, that they are equipped with the skill set necessary to feed and provide hydration to children who are unable to undertake the tasks independently. This is a massive misconception.

Lowman1 states that most teachers and classroom aides learn how to feed students “on the job”. Training to deal with complex feeding needs is received through demonstration or in-service. Stevenson and Allaire2 maintain that “a knowledge of normal feeding development, and the various factors affecting it, is essential to an understanding of feeding disorders in children with neurodevelopmental disabilities” but understanding normal feeding development is not enough, on its own, to qualify someone to meet the specialized needs of these students. Classroom aides must understand that when they provide food or liquid to a student, they are responsible for the safety of that student and that the risk of choking or aspiration is always present. This risk can be reduced by having aides follow the practices for eating and drinking developed by the clinical team who support the student. The therapy team must provide the teacher and classroom aides with instructions to safely provide food and a drink to each student who needs support. This is not a situation where the same practices are appropriate for all students. Diagnosis, physical abilities, and intellectual level, impact the type of support that is necessary.

One of the great difficulties of executing any program to promoting independent eating is finding the time within a busy school day. Breakfast and lunch in most schools takes less than half an hour. For many children with disabilities this is an inadequate length of time for them to practice the steps necessary to gaining mealtime independence. Instead, they are fed, and the meal is typically provided rapidly to adhere to the school’s daily schedule. Most aides are at their busiest during meals therefore they really don’t have spare time to support teaching strategies. With this knowledge in mind, clinicians should develop strategies for teaching independent eating and drinking that can be incorporated into the rest of the school day.

Acquiring independent eating and drinking skills provides a rich teaching environment. Depending upon the functional level of the student, the student can gain competency in many areas including (but not limited to) cause and effect, counting, self-regulation, etc. Food and hunger are motivators for a student to make an effort.

For students who, for either physical and/or intellectual reasons, are unable to improve their independence for eating or drinking, assistive technology (AT) should be introduced. Mastery of these skills is often easily acquired with the use of AT. Mealtime Partners, Inc. provides a full range of AT for eating and drinking. To learn more about these products, click here to visit our website: Mealtime Partners Website.

Did You Know? ...  Did you know that for children with disabilities it is a good idea to use the same type of spoon at all meals. (The exception to this rule is when attempts are being made to desensitize the child’s mouth.) Also, if the child is learning to self-feed, it is wise to have several of the same spoons available at mealtimes so that if one gets dropped, another spoon is immediately available. Don’t make an issue of a spoon being dropped, don’t stop and wash it, simply replace it.

Learning to eat independently can be messy. For a quick clean-up after a meal, use the Mealtime Partners Cover-Up. Not only does it keep clothes clean and dry, because it is waterproof, it can be wiped clean with a damp cloth (in the same way a table top can be cleaned), and does not need to be washed after each use.



For more information on Cover-ups, click here.
Picture of Cover-Up


How We Eat

How well do we understand the likes and preference of those who we are close to? Do you know whether your children like their vegetables and meat mixed together or kept separate? Does your husband/wife eat a fork full of meat and corn at the same time or first eat the meat and then have a separate bite of corn? Or, does he/she eat all of his meat and then eat the corn? Frequently, we think we know what people like at mealtimes and yet often we are incorrect. The following story is an example of this: a man could no longer feed himself, because of illness. His wife of many years dutifully assumed the role of his caregiver, or mealtime partner, at that time. She carefully prepared each forkful, putting a small portion of several items on his utensil. After a few months of being fed by his wife, he was able to feed himself once again using an assistive dining system. He then ate all of each food that was served, separately, finishing one food before eating the next. His wife, concerned that he was having difficulty, asked if she could help. He told her that he was fine and that this was how he actually liked to eat his food. She was astonished and somewhat saddened at learning this because she had been feeding him the way she liked to eat. (When asked why he hadn’t said anything the husband answered that he was so grateful for her care that he would never complain about how she did anything.)

It is important for clinicians and caregivers to understand that the people they feed may have needs and preferences in how they receive food different from the person providing the food. This can be illustrated by giving each person in a group a small packet of M&Ms. Have them open the packet and hold all of the M&Ms in their hand. Now have them eat them with no further instructions. When they are finished, ask how many ate the M&Ms one at a time, how many ate 3 or 4 at a time, and how many put all of them in their mouth at once. Check to make sure that everyone falls within one of the groups. (If they don’t, make sure you include them as a separate group.) Now ask why they chose to eat the M&Ms in the way that they did. What you will find is that the reasons will depend upon how each individual’s mouth and taste buds react to the sensation of chocolate. Some people can savor the flavor with just a small amount of chocolate; others must have a large volume of chocolate in their mouth to provide a satisfactory response to the flavor.

How the taste buds respond to the taste of food or liquid greatly impacts the ability to control it when it is placed in the mouth. If the taste is mild, and/or the taste buds are less sensitive, it is more difficult to track the food or liquid in the mouth and manipulate it appropriately to form a bolus and swallow it. Stronger flavors help the person eating or drinking to be aware of what they have in their mouth. They, therefore, are better able to manipulate the food more efficiently.

When you feed someone, remember, you aren’t feeding yourself. Try to find out how the person likes to have their food provided!

 

Child using the Mealtime Partner

The Mealtime Partner Dining System empowers children to become independent in activities of daily living. It is an excellent teaching tool and can provide motivation to learn.

For more information, please click here to visit our website.

 

 

August 2010 Newsletter References:

1. Lowman, D., & Murphy, S., The Educators Guide to Feeding Children with Disabilities. Paul H. Brookes Publishing Co. 1999.

2.
Feeding the Disabled Child, Edited by Sullivan, P., and Rosenbloom, L., Mac Keith Press, 1996. (Each chapter authored by different contributors.)


 

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