Brian - 12 Months - Picky Eater (Occupation-Based Problems (Brian is…
Brian - 12 Months - Picky Eater
Fair Strength (Difficulty maintaining B UE in quadruped)
Asymmetrical sitting position (WB through L pelvis and thoracic curvature to R; posterior pelvic tilt with rounded shoulders)
Torticollis with limited rotation to L
Radial digital and raking grasps only
No demonstration of bimanual coordination
limited imitation skills
During his two week stay in the NICU he remained on a heart monitor with caffeine for one wee, then without caffeine for one week.
MRI and CT indicated normal results at 6 months of age
Spent two weeks in NICU due to difficulty breathing
Underwent cranial vault surgery to repair prematurely fused cranial suture at 12 months of age
Born at 34 via emergency C-section due to fetal heart arrhythmia
No interest in self-feeding (finger or utensils)
Does not accept food other than purée
Only accepts bottle containing formula and puréed foods
Eats large variety of purées
Refuses to use any type of cup
Only accepts food from caregiver
Brian will drink independently from a straw in 12 weeks to promote independent self-feeding.
Brian will drink from a straw with moderate assistance to prepare for independent drinking.
Brian's mother is concerned about his weight as he is no longer maintaining, but losing weight.
Brain's mother expressed that she would like Brian to be independent with self-feeding.
Brian's caregiver is a single mother who must return to work soon, and she is concerned how Brian will eat when left at the daycare.
Brian's mother also expressed she would like like him to start using a sippy-cup instead of a bottle.
Grading of Intervention
Grade Up: Have Brian drink out of a straw that is positioned secured vertically in a cup. (Morris & Klein, 2000)
Grade Down : Fill straw with liquid and position horizontally from Brian's mouth. Once Brain puts lips around the straw let a little of the liquid out. (Morris & Klein, 2000)
Frame of Reference
Ecology of Human Performance
There are 5 intervention strategies (Cole & Tufano, 2008)
4.) Prevent Occurrence or Evolution
5.) Create Circumstances That Promote
3.) Modify Contextual Features
2.) Alter Context or Task
1.) Establish or Restore
Collaboration among the person, family, and practitioner is key. (Cole & Tufano, 2008)
Set of 4 constructs: person, context, task, and performance (Cole & Tufano, 2008)
Sensory Integration & Processing
Client's know the amount of sensory stimulation they can tolerate (Cole & Tufano, 2008)
When introducing sensory stimuli the therapist need to take cues from the clients.
Hypersensitivity to sensory stimuli has been treated with success using SI. (Cole & Tufano, 2008)
Breaking feeding down in small components in order to promote small successes, in order to build up to sefl-feeding with utensil. (Feeding) (Morris & Klein, 2000)
Create interesting spoon handles that will encourage Brian to have interest in them
Adding frozen yogurt to the ends will reward Brain with a sweet taste if he brings it to his mouth.
Increasing Sensory Awareness
Will desensitize Brian's oral sensory system and allow him to try foods of different textures. (Chewing) (Morris & Klein, 2000)
Bland foods that make sounds (consistency of cheetos)
Will allow Brian to drink independently, while improving his swallowing posture, and decreasing B UE fatigue. (Swallowing) (Morris & Klein, 2000)
Brian is currently only accepts food from his caregiver (mother) but his mother is returning to work soon and Brain must be able to accept food from other caregivers or learn to self-feed.
Brian is not getting enough caloric intake from the purée foods that he is eating due to his selectively of food consistencies.
Brian is unable to bring utensils to mouth due to B UE weakness. (feeding)
Brian refuses to drink from any type of cup which hinders his ability to self-feed.
Brian's oral sensory system is heightened which limits his foods resources to formula and purées. (chewing)
Brian presents with difficulties when given any substance less than the consistency of formula due to torticollis. (swallowing)
Morris, S. E., & Klein M. D., (2000).
Pre-feeding skills: A comprehensive resources for mealtime development
(2nd ed. )Tucson, AZ: Therapy Skill Builder.
Cole, M. B, & Tufano, R. (2008). Chapter 9: Ecology of human performance. In Applied Theories in Occupational Therapy: A Practical Approach (pp. 117-126). Thorofare, NJ:Slack.
Cole, M. B, & Tufano, R. (2008). Chapter 18: Sensory integration and processing. In Applied Theories in Occupational Therapy: A Practical Approach (pp. 229-242). Thorofare, NJ:Slack.
Test of Sensory Functions in Infants (4-18 months) (Cole & Tufano, 2008)
Used to identify sensory processing disorders among children
Brain is showing food selectivity, so determining if there is a sensory processing disorder is a must.
Quick assessment that allows Brian's mom to fill out a questionnaire concerning areas of which Brian may be having difficulties.
This assessment is important to incorporate due to Brian's mom being part of his intervention team.