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Feeding Coggle: Jason, 2.5-year-old (References (Case studies for feeding…

- - - - Jason was discharged on oxygen with NG to to supplement bottle feeding
      - Jason had a double ureterostomy
  - - - Only palmar and raking grasp
      - Scoots in supine or rolls for mobility
    - - Only assists with UB dressing by using arms through sleeves: does not assist with LB dressing or attempt more independence
      - Resistant to tooth brush
      - Will hold sippy cup (thin liquid), does not attempt to feed self with finger or utensils
      - Will accept purees (oatmeal, mashed potatoes, e.g.), breads, cheese slices, and soft solids like french fries, hot dogs, and bananas
- - - - This FOR is also client centered! During intervention, the Occupational Therapist is to observed to receive cues from the patient/client. As a therapist, it is important to understand how much sensation the client is able to tolerate and how far the therapist can push the individual out of their comfort zone. The role of the OT is to find available and socially acceptable activities that will involve the intensity the client needs to normalize sensory processing and create the appropriate adaptive responses (Cole & Tufano, 2008)
  - - - Intervention strategies are geared toward increasing occupational performance and how the environment effects the clients overall skill development and well-being. Keeping Jason in his home will make him comfortable to begin interventions. This is also realistic for beginning interventions. Once Jason becomes skilled, adapting the environment all create a new challenge (Cole & Tufano, 2008).
- - - - Sensory Desensitization Strategies: allows Jason to develop skills while adapting to the new texture, forms of feeding, and chewing; one step at a time (Pearl, 2018).
        
        Strategies to use are:
        
        Modeling!
        
        Positive reinforcement; attention or praise
        
        Consequence; ignoring behavior or redirection
        
        Present 10 foods per session
        
        Food can be presented at home with a focus on modeling and describing sensory properties
        
        The use of play
        
        Make a goal to stay calm as each small step taken toward long term goal is taken
        
        Therapeutic sessions are to build on each other
        
        Therapist should understand child cueing and take a step back if he becomes too stressed, to establish clamness and trust moving forward.
        
        Child should: 1) tolerate/look, 2) interact, 3) smell, 4) touch, 5) taste, 6) eat
        
        (Pearl, 2018)
      - Operant Conditioning Strategies: is a skill used to help the child get over their fear. Using this method will hypothetically push Jason to refine those sensory exploration skills, which will lead to overall progression in feeding over time (Pearl, 2018).
        
        Focus is to change meal time behavior by expanding the variety of foods accepted, increase the ingested volume, and target a specific behavior or skill
        
        Prompt and reward
        
        Understand the external drives of the child
        
        Provide instructions for the child
        
        Immediately give reinforcement: "good bite, nice eating"
        
        Goal is to reduce the amount of refusal behaviors & improve self feeding
        
        Use verbal and visual prompts
        
        Consequence is ignoring behavior, visual time out, verbal instruction or redirection, and hand-over-had redirected behavior
        
        End the session on a preferred food
        
        Therapist needed to monitor bites taken, volume eaten, refusal behaviors, reactions to sensations, and self-feeding
        
        Strategies to use are:
        
        (Pearl, 2018)
  - - - Dip in puree
      - Small pieces of dissolvable solid foods in side them
      - Progressively thicken puree over time for development
      - What they look like!
    - - Proper seating
      - Routine
      - Clear instructions from parent and therapist; they should be similar because it will condition the child and implement routine
      - Visual aids
- - - - The OT will mix textures like cheese and bread together to start adapting Jason's palate but to expose him to a different variety of foods. This is to start exposing him to new likings and increase his palate.
  - - - Jason will perform different reaching activities to promote abdominal strengthening to increase his stability. This can be used with food and toys.
  - - - The OT will use the chewy tube to increase Jason's fine motor skills by dipping it in his food and placing it on the high chair table. This can increase Jason's ability to make a pincer grasp for further utensil use.
  - - - To increase Jason's participation, the OT, as well as parents, can use visuals to keep Jason engaged in eating but to also track what foods he like versus what he disliked and how much of those foods he ate.