Beruflich Dokumente
Kultur Dokumente
Financial disclosure
We have no relevant financial relationships with any commercial interests. Arwen Jackson, MA, CCC-SLP Jacklyn Kammerer, MS, OTR
Learning Objectives
Review typical feeding development Understand atypical patterns common in children with DS Understand and familiarize with various food textures Review medical diagnoses that can impact feeding Discuss therapeutic perspectives to support feeding and mealtimes with a child with DS
BRIEF REMINDER Normal Development to Support Successful Feeding 9-12 months of age
Motor Skills Skilled dissociation with hands one to stabilize and one to play Engaging in independent finger feeding Development of pincer grasp Active release Bringing loaded spoon to mouth Oral Motor Skills Increased disassociation of oral structures Tongue lateralization to move foods side to side Rotary chewing patterns - diagonal jaw movements Controlled bite on soft foods Sensory Progressions Lots of sensory play with foods To explore the taste, texture, temperature, smell, etc. Food Textures Liquids for continued nutrition Purees of varying thickness and texture Meltable solids Soft solids Some mashed and coarsely chopped table foods
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PUREES
These foods offered by spoon, may vary in consistency from smooth, thin, and runny to lumpy, thick, or stiff.
Any table foods that are blenderized Grain Group Hot cereal (rice cereal, oatmeal, cream of wheat, malt-omeal) Vegetable Group Baby foods (sweet potatoes, squash, peas, beans) Mashed potatoes or mashed sweet potatoes Spaghetti sauce (marinara or alfredo) Fruit Group Baby foods (applesauce, peaches, pears) Berry sauces Applesauce Mashed banana Milk Group Yogurt Soft cheese spreads Sorbet and sherbet (considered a thin liquid with respect to swallow function) Soft cheese spreads Milk/Fat Pudding or custard Ice Cream, frozen yogurt (considered a thin liquid with respect to swallow function) Meat Group Refried beans Hummus Peanut butter (not recommended the first year due to potential for allergies) Fats and Sweets Cream cheese and flavored cream cheese Ketchup Barbecue Sauce Gravy Jelly, jam Chocolate sauce, butterscotch, or caramel sauce Mashed avocado
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Author: N. Creskoff OTR Approved by the Patient Family Education Committee January 2011 2010 The Childrens Hospital, Aurora, CO
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MELTABLE SOLIDS
These foods which melt or soften readily with saliva and then break apart easily with gumming, mashing, or some chewing. Grain Group Pirates Booty Puffed Rice/Corn Snacks (Veggie Booty, White Cheddar) Gerber wheels Dehydrated veggie sticks Graham crackers Wafer cookies Grain/Fat Group Butter cookies Butter crackers Crushed cookies, cookie crumbs Fruit Group Fruit Booty Fats and Sweets Cheetos Butter cookies Butter crackers Graham crackers Chocolate Mini marshmallows Cotton candy Ice cream cone Wafer cookies Crushed cookies, cookie crumbs
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Author: N. Creskoff OTR Approved by the Patient Family Education Committee January 2011 2010 The Childrens Hospital, Aurora, CO
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SOLIDS
These foods which require some manipulation and breakdown via chewing prior to safely swallowing. Consider variety from semi-soft to crunchy to chewy, with increasing requirement for thorough chewing. Combined Pizza Sandwiches (grilled cheese) Grain Group Pasta, macaroni and cheese Dry cereal, such as Cheerios Crackers Pretzels Bagels, crusty breads Vegetable Group Raw vegetables such as cucumber, celery, carrots, green beans Salad Fruit Group Fruits (apple slices, strawberries, melon, pineapple) Dried fruit, raisins Milk Group Cubed cheese Meat Group Deli meat Chicken, chicken nuggets Hamburger Steak Various other meats, including sausage and bacon Beef jerkey Fish sticks Hard boiled eggs Fats and Sweets Cookies Chips Licorice Carmel or taffy Olives
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MIXED TEXTURES
These foods which contain more than one food texture, and require the most mature oral motor skills to manage. Vegetable and Meat Groups Casseroles Soups with vegetables, pasta, rice, meat Selected Stage 3 Baby foods Fruit and Milk Groups Yogurt with fruit pieces
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Food lab
Exploring food textures What does your mouth do to manage different food textures?
THINK ABOUT YOUR
lips tongue jaw/teeth cheeks
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Oral Hypersensitivity
Clinical Signs Difficulty advancing food textures Reduced acceptance of tastes, temperatures and smells Aversive/exaggerated response to touch in and around the mouth Hyperactive gag response Aversion to teeth brushing Lack of age-appropriate oral exploration of hands/toys Treatment Blendarize table foods gradually thicken Avoid mixing food consistencies Meltable or soft mechanical solids are often more easily accepted foods Change only one sensory variable at a time Make gradual changes in taste/texture Work to normalize sensory response with desensitizing activities
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Oral Hyposensitivity
Clinical Signs Slow registration of food in mouth Poor awareness of food on face/lips Overstuffs mouth May result in gagging or choking Pockets food in mouth Swallows food without adequately preparing the bolus to swallow May result in gagging or choking Drooling Preference for strong tastes Treatment Oral alerting activities Variety of textures of foods Variety of food temperatures Increase flavor of foods with spices/sauces Manipulate foods into safe proportions bite sized pieces
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A child with Down syndrome can present with a feeding and/or swallowing difficulty
Feeding/Swallowing Swallowing Chronic poor growth Coughing or choking while eating or immediately after eating Compromised nutritional status History of chronic pulmonary difficulties Food refusal/picky eating which may include diagnosis of Decreased variety and volume of oral aspiration pneumonia intake Chronic oxygen requirement Choking, gagging, coughing and Vocal cord dysfunction vomiting while eating Weight gain is difficult and thought to be Inability to chew/swallow secondary to oral motor or pharyngeal Delayed attainment of self-feeding skills dysfunction Inability to maintain oral skills when tube Difficulty initiating a swallow fed Difficulty transitions from tube to oral feeding Behavioral or learned feeding problems
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Reliance on pureed food textures, jarred baby foods, or home blenderized foods Reliance on caregivers for feeding purees due to less efficient but functional fine motor grasping patterns
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Author: N. Creskoff OTR Approved by the Patient Family Education Committee January 2011 2010 The Childrens Hospital, Aurora, CO
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Support for a child in the highchair so they are able to easily reach baby purees and spoon to grasp, touch, explore, learn!
Highchair designs vary significantly Adding rolled towels may provide lateral (side) support so that baby can easily stay seated in the highchair without falling to either side or leaning on the tray for support Postural support will allow for more controlled oral movements
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