Managing Feeding Problems

The common therapists' expression "If you want the lips, you have to first get the hips." is very true and shows the importance of muscle tone and posture on feeding. The muscle strength and control is necessary to maintain postural alignment of the trunk which affects the breathing process. This then influences the position of the shoulders and head, which affects the alignment of the oral and pharyngeal structures of swallowing. The abdominal muscles play role in transporting the food through the digestive tract. The correct alignment of pelvis, trunk, and shoulder are the supporting base for the swallowing and oral motor structures. The lack of muscle tone interferes with maintaining the neutral head position, the stability of the trunk and the rib cage, and the efficiency of breathing which are important for movement of the bolus and the safety and effectiveness of feeding. The medical problems, sensory input, level of fine motor skills, self help skills, and cognitive abilities shape child's attitude to mealtime and accepting variety of foods.

Steps in managing feeding problems:

• Minimizing medical issues, such as respiratory illness, constipation, gastrointestinal disorders, cleft lip and cleft palate, salivary gland infections.

• Providing proper positioning for feeding - sitting posture with hips, knees, and feet at 90 degrees and weight evenly spread; stability of the pelvis which enhances head/trunk alignment and facilitates the chin tuck.

• Facilitating oral–motor function by altering the texture and consistency of the food; chewing and sucking stimulation; providing jaw stability, stretching facial muscles.

• Improving mealtime environment by establishing a routine and minimizing distractions, use of adaptive devices and serving utensils, use of reinforcers and effective interaction