Nutrition Interventions for Children with Special Health Care Needs

Chapter 8
Section 2 - Problem-Based Nutrition Interventions
Oral-Motor Feeding problems
Robin P. Glass, MS, OTR/L and Lynn Wolf, MOT, OTR/L
Children with neurodevelopmental disorders or developmental delays frequently
have oral-motor and swallowing problems. These feeding difficulties influence the
child’s ability to consume a nutritious intake in a variety of ways. The child may
have inefficient or abnormal oral-motor patterns, making ingestion slow or labored.
Oral-motor difficulties may limit the types of foods the child can eat. In addition,
swallowing dysfunction may severely restrict the type of food textures that are
safe for the child to eat. Most frequently, swallowing dysfunction affects the child’s
ability to drink liquids. This may not only compromise the child’s overall nutrition but
also his hydration status (1). Some factors associated with oral-motor and feeding
problems include:
• abnormalities in muscle tone and delays in motor development
• oral-facial defects that interfere with feeding (such as cleft palate)
• delayed oral motor development or abnormal oral motor patterns (e.g., a tonic
bite reflex)
• hypersensitive responses to touch and/or temperature in and around the mouth
• dental problems such as severe dental cavities or acquired malalignment of the
jaws and teeth
• inability to properly coordinate feeding, swallowing, and breathing due to chronic
medical conditions or central nervous system damage
• related medical conditions such as gastroesophageal reflux that may affect
willingness to eat
• prolonged length of feeding sessions which tax both the child and the caregiver
If feeding difficulties such as these are observed, a thorough feeding evaluation is
indicated. A pediatric occupational, speech, or physical therapist skilled in feeding
disorders can perform this type of evaluation.
Complete evaluation of oralmotor and swallowing deficits in children with
neurodevelopment disorders involves assessment of a wide range of factors beyond
assessment of the level of oral-motor control. These include assessment of:
• basic postural control and level of motor development as it relates to feeding
• tactile sensitivity in the oral area and throughout the body
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