Eating and Feeding Techniques - Summary

 

Eating and Feeding Techniques - Summary

Oral Motor Competency

Feeding requires precise coordination of lips, jaw, tongue, and swallowing. Problems may appear as difficulty achieving normal movements, persistence of primitive reflexes, or abnormal patterns. Reflexes such as rooting, biting, and suck–swallow usually integrate in infancy but can persist and interfere with mature eating skills. Abnormal responses like tongue thrust, tonic bite, tactile defensiveness, and hypersensitive gag also disrupt feeding.

  How Swallowing Works Animation Video - Stages of Swallowing Process - Swalllow Anatomy & Physiology

AniMed

https://youtu.be/eLvfzyZNnVw?si=44vABMnfJnwaw_E9

Strategies include careful use of coated spoons, avoiding gum or teeth contact, and therapeutic programs from occupational or speech therapists to reduce reflexes and promote voluntary control. Individualized approaches are essential for safety and independence. Positive Practice

Developing mature eating skills depends on practice. New movements must be repeated until they become part of regular eating routines.

oral motor and oral sensory activities for developing speech and feeding skills

  SENSES CENTER

https://youtu.be/_bPYjuEyfUk?si=qXfpwJq1PFXJxmsr

The rate of progress is influenced by the amount of practice, the consistency of training, and the level of assistance provided. Students may need guided repetition in calm, structured sessions to master skills like chewing, swallowing, or independent drinking.

It is important to balance support with opportunities for self-initiated action. Over time, consistent positive practice strengthens coordination, reduces reliance on reflexes, and builds independence in feeding. Patience, persistence, and structured reinforcement are key to success.

 Pre-Feeding Oral Motor Exercises with SLP Angeliki Xygka

https://youtu.be/ESB7OTDLbEM?si=60_5HX1T-HdcjMLP

Environmental Factors

The environment strongly shapes feeding outcomes. Students need quiet, low-distraction spaces to focus on eating. Unpleasant smells or chaotic settings can create stress. Simple strategies like using bright utensils, contrasting placemats, or colored strips on cups help draw attention to food.

Calm, unhurried mealtimes reduce resistance and support safety. Students should be well-positioned, free from interruptions such as wheelchair bumps.

The amount of food should be appropriate, avoiding overstuffing that leads to gagging. Food should never be forced; instead, students should be encouraged to communicate preferences.

 A pleasant, predictable environment makes eating safer, more enjoyable, and more effective.

 

Positioning and Motor Control

Correct body alignment is the foundation for safe eating. Positioning requires attention to trunk support, pelvic tilt, shoulder placement, and head posture. A slightly forward pelvic tilt supports spinal curves, enabling chin tuck and easier swallowing. Improper positioning—like hyperextended neck or rounded shoulders—interferes with chewing, swallowing, and utensil use. Rolls, wedges, and adaptive seating can improve posture. Head alignment with chin slightly downward allows better tongue and lip control.

Each student’s optimal position depends on tone, respiration, and alertness. By addressing posture first, many feeding problems can be reduced or eliminated, creating safer, more successful mealtime experiences.

  Assistive Devices for Eating

https://youtu.be/H03dsAsv7xk?si=2Wyp1aF-Wrnb8X8B

 

Tone and Movement Disorders

Different tone patterns complicate feeding. In spasticity, excessive extension of head and neck increases aspiration risk, requiring forward chin flexion and headrests. Severe extensor thrusting, seen in spastic quadriplegia, involves total body extension that disrupts feeding; wedges, supports, and headrests inhibit this. Hypotonic students lack trunk/head control, leading to food pooling; reclined seating and head support help. Athetoid cerebral palsy causes continuous, involuntary movements; straps, wrist weights, weighted utensils, or headrests improve stability. Each condition requires individualized adaptation to promote safe swallowing, reduce fatigue, and support functional independence during meals.

Primitive Reflexes

Some students retain infant reflexes that interfere with eating. In asymmetrical tonic neck reflex (ATNR), turning the head straightens one arm, disrupting stability. Presenting food at midline and using head supports reduces this. In symmetrical tonic neck reflex (STNR), flexing or extending the head alters arm/leg posture, making sitting unstable and feeding difficult. Head collars, trays, or supports that keep the head midline with slight flexion help inhibit these reflexes. Proper seating, symmetrical arm support, and midline positioning encourage control and reduce disruptions. By limiting reflex activation, students can focus on chewing, swallowing, and utensil use more effectively.

 How to build exceptional seating outcomes for complex postures: Part 1 Clinical Evaluation

https://youtu.be/atKYxunqPX0?si=mnTgeKQddN3xXr-O

 

Feeding Problems and Emergencies

Challenges include oral tactile defensiveness, tongue thrust, tonic or unsustained biting, and hypersensitive gag. Students who overreact to touch may reject feeding, while others with low response cannot sense food properly.

Tongue thrust pushes food out; strategies include positioning, texture changes, jaw support, and vibratory input. Tonic bite requires calm positioning, coated spoons, and jaw-release techniques. Unsustained biting needs practice with objects and jaw support. Hypersensitive gagging is reduced with gradual tactile input, thickened foods, and food transitions. Emergencies like choking or aspiration require immediate intervention—chin tuck, Heimlich maneuver, and close supervision to ensure safety during meals.

 

  Animation showing Swallowing and Digestion of Food

https://youtu.be/jAP5Biyf7Nc?si=6zdkLHXHC4Xf5pxC

 

Aspiration

Aspiration occurs when food, liquid, or secretions enter the lungs, risking aspiration pneumonia. Symptoms within hours include coughing, fever, cyanosis, and rapid breathing. Severe aspiration can cause apnea or shock, requiring emergency response. Prevention is critical: avoid overfeeding, prevent “bird feeding” (neck hyperextension), and keep students upright during and after meals. Those with persistent aspiration risk may need medical tests or tube feeding. Caregivers should monitor posture, pacing, and swallowing closely, always watching for signs of aspiration. Preventive strategies, medical input, and safe feeding environments reduce risk, making aspiration management central to feeding safety.

  Why do Things Go Down the Wrong Way When Swallowing Sometimes (Aspiration)?

https://youtu.be/bGntDrp6XYk?si=XjYLy8oTXGXI_Z_2

 

Allergies

Food allergies can cause intestinal distress (diarrhea, nausea), respiratory problems (breathing issues), or skin reactions (rashes).

 Reactions may appear within minutes to 48 hours. Identification is vital: elimination diets help find triggers but must be short-term and dietitian-supervised to ensure nutrition.

 Allergens should be clearly documented in the student’s health plan, and all staff must know which foods to avoid. Monitoring symptoms carefully and eliminating unsafe foods prevents harmful reactions. Because allergies vary and may develop suddenly, vigilance and collaboration with healthcare professionals are necessary. Safe food planning supports student health and reduces risks during feeding.

 

  Managing Food Allergies in the School Setting

https://youtu.be/zvM8EaQpckw?si=W8VDU1mnrLnYCxL1

 

Management and Nutrition

 

Feeding strategies should be written into Individualized Health Plans (IHPs) and Individualized Education Programs (IEPs). IHPs outline allergies, restrictions, and emergencies; IEPs define feeding goals, adaptive equipment, and strategies. Nutrition and hydration are essential but complicated by tone differences, stamina, or food preferences. Students with spasticity often need extra calories due to higher energy use, while those with low tone may need caloric limits. Hydration monitoring (e.g., skin recoil test) helps detect dehydration. Medications may affect appetite, vitamin absorption, or hydration, requiring dietary adjustments. Team collaboration ensures nutritional needs are met while supporting health, safety, and independence.