Nutrition Interventions for Children with Special Health Care Needs

Chapter 8 - Oral-Motor Feeding Problems
• the child’s ability to achieve and maintain an appropriate behavior and state of
alertness for feeding
• the stability of the child’s physiologic functions to support feeding (e.g., stability
of heart rate or respiratory rate)
• coordination of feeding, swallowing, and breathing
• swallowing function using videoflouroscopic swallowing study (VFSS), if indicated
(2)
Difficulties in parent-child interaction may also be associated with oral-motor feeding
problems. It is often difficult to differentiate between physical, behavioral, and
interactional problems. Thus, it is necessary to consider all three when evaluating a
child for oralmotor feeding problems (3).
In addition, related medical problems such as gastroesophageal reflux (GER) may
influence the child’s feeding ability. If the child associates eating with the pain that
often accompanies GER, the child may be resistant to feeding and food intake may
decline dramatically. If GER is suspected, further evaluation by the child’s primary
physician or a gastroenterologist is indicated.
Since most feeding problems have multiple underlying factors that contribute to
the overall nutritional and feeding deficits, a team approach is the most effective
method to thoroughly assess and intervene with the oral-motor feeding problems. In
addition to the occupational, speech, or physical therapist, this team should include
a registered dietitian (RD), a pediatrician, or other primary health care provider and
the caregivers. The team may often also include a nurse or social worker to address
the psychosocial issues that frequently occur concurrently with the feeding problem
(see Chapter 9).
Appropriate interventions can significantly improve the child’s basic feeding skill
as well as improve the ease of feeding for the caregiver. Mealtimes can become
more satisfying for the child and family promoting better growth and nutrition.
Intervention may include:
• proper positioning during feeding
• specific therapeutic activities to improve basic oral motor skills
• specific food types or textures to support the child’s level of oral motor control
and swallowing function while ensuring adequate nutrient intake
• adapted feeding utensils
• specialized feeding techniques (4)
If the child is still unable to consume an adequate intake and/or it is unsafe for
the child to eat, partial or full nutrition may need to be given via a nasogastric or
gastrostomy tube.
94 Nutrition Interventions for Children With Special Health Care Needs