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Early Intervention Speech Therapy

The Feeding Solutions – Part 1 – EVALUATE

Published October 17, 2008 8:19 AM by Stephanie Bruno

As I began writing all the many strategies I have used to address feeding issues with the children I have worked with, I knew that it would be impossible to squeeze it all into one blog post. Therefore, I've decided to break the topic of feeding down into various components that will be discussed over the next several weeks. I am hoping that this will also allow time for readers to send in questions and solutions making this an ongoing discussion that will grow over time.  

Since "The Feeding Challenge" post was published, several important ideas were shared by our readers. One extremely important point that was brought up was EVALUATING the situation and determining the CAUSE of the feeding disorder. This is absolutely crucial. How can you effectively treat any type of disorder, delay, etc. if the cause is unknown? It is much easier to plan the course of therapy when you understand the nature of what is causing the problem.

Another important technique that I always use to evaluate both speech disorders and feeding is OBSERVATION. I spend at least one entire session interviewing the family and observing the child in the home and daycare if they are attending one. I always want to see if both the speech and feeding behaviors and skills are uniform across all environments. Of course, informal observations are ongoing; however using a session to interview the family and watch the child eat (or watch mom feed the child) is vital to understanding the crux of what may be happening. (i.e. if the child eats a variety of foods at daycare but not at home, this lets me know there may be a big behavioral component that is taking over the family dynamics).

For those of you who are struggling to find additional ways to EVALUATE and OBSERVE your "feeding kids", here are some very specific ideas that I have used and may help you think "outside the box":

  • Ask a feeding specialist and/or a nutritionist to consult with you. See if there is one that works in your county. Ask them to evaluate the child and see if they can be added to the case even if only on a consultative level. If they cannot be added to the case, ask if they can give you suggestions to incorporate into your sessions.
  • Videotape the child eating. Tape both your sessions and sessions of the parent(s) feeding the child. Observing the situation can be very insightful for both you and the family.
  • Go to hospital visits and swallow studies with the family. This will help you gain insight about the nature of the disorder and give you the opportunity to consult with the hospital SLPs.
  • Co-treat with other therapists! If the child is being seen privately for feeding, swallowing, etc, go to a session! Contact the therapist! Reinforcing the therapy can make all the difference with the child's success.

Upcoming posts will include additional Feeding Solutions as well as fun Fall and Halloween therapy tips to spice up your sessions!

6 comments

Over the last two weeks I have been focusing on how to "get started" in EI home care. The posts have

June 30, 2009 11:54 AM

Hi Genevieve ~

Thank you for writing in....I remember bring a CF well and it's great that you are using all your resources. To answer your question, please refer to the post we published on this blog on 10/28 ~ The Feeding Solutions Part 2: Treatment Overview. I would focus mainly on the oral motor and possibly sensory piece. Also, since the child is aspirating you definitely need to be careful about how and what you are feeding this little guy. If necessary, you may want to bring in your supervisor for a visit to help you assess the situation and plan a therapeutic course. I have done that in the past - it has always helped me to feel more confident with my plan and it helps you to know what you are doing is safe. Keep us posted and good luck!

stephanie , blog author November 9, 2008 8:52 AM

I work with a 15 mon yo who was low muscle tone and video swallow revealed that he was aspirating while feeding. He eats only baby food and takes pediasure for extra calories. What exercise beside massages would you recommend for his age. He spits out solid foods and only sucks them.

Genevieve, Early intervention - CF-SLP, EBS November 5, 2008 3:02 AM
philadelphia PA

To Nadia ~ Have you had a chance to do some oral motor exercises with the little baby you are working with? It sounds as though he would benefit from massage and tools different from a spoon, such as a nuk, to help him open his mouth. Hope this helps....keep us posted! Other suggestions?

stephanie , blog author October 28, 2008 9:40 PM

i have a premature baby  which he dosen't have the skill how to open his mouth for solid food i mean he is hungry but he dosen't know how to do it  i really find a hard time to give him spoon usually it takes 2 hours to feed him just one jar  because   i squeese it into his mouth please if you have any ideas help me with thanks

nadia el attaria, 617/294/1772 October 22, 2008 7:09 PM
everett MA

I have worked with many children who have feeding difficulties. I have found that many of them have significant sensory integration difficulties. I generally have a sensory profile done which helps me address those areas first. I have had some experience with children adopted from orphanages in other countries that were strictly bottle fed and many of them had trouble transitioning from bottle to solid food. They also had several sensory issues perhaps brought on by the fact that they were seldom held. By addressing their sensory issues first and encouraging oral motor exploration they were able to slowly transition to solids and move along the texture spectrum to a variety of table foods.

Doreen Shea, SLP October 22, 2008 9:18 AM
Topeka KS

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