Please enable JavaScript.
Coggle requires JavaScript to display documents.
Brian 1 yo Male: picky eater (Approaches to Intervention (Modify the…
Brian 1 yo Male: picky eater
Profile
born 6 weeks early due to fetal heart arrythmia
spent 2 weeks in NICU because of difficulty breathing
was on a heart monitor and caffeine
at 12 months, he had cranial vault surgery to repair a cranial suture that had fused prematurely
has 2 yo older brother
enjoys playing with animal toys and figures; the elephant being his favorite
mom is the primary caretaker and wants to return back to work but feels reluctant because Brian refuses to eat if she is not the one feeding him
Client Factors
Torticollis with limited rotation to L
Fair Strength: difficulty maintaining B UE weight bearing in quadruped
Asymmetrical sitting posture: weight bearing through L pelvis and thoracic curvature to R, posterior pelvic tilt with rounded shoulders
Performance Skills
radial digital grasps
raking grasps
no demonstration of bimanual coordination
limited imitation skills
Occupations
will only accept a bottle that contain formula and pureed foods from the caregiver
does not use fingers for feeding
does not attempt to use utensils for feeding
will refuse foods if not pureed
will each variety of foods if pureed
will not use a cup of any kind
pureed foods are store bought, not made in home
engages in play with caretaker and sibling but has a negative behavior change when new peers or person are introduced
Model/FOR
PEOP
accepting food from other's besides his caregiver; learning to trust
creating positive environment
addressing the use of utensils and cup
accepting and trusting others to engage in play with him
Sensory Integration
addressing his picky eating of only pureed foods
addressing use of utensils and cup
encourage finger feeding
Biomedical and Rehabilitation
addressing the limited ROM from Torticollis
addressing posture during sitting, especially while eating and feeding
addressing different types of graps
addressing the use of two hands when playing with toys, and eventually with self feeding
Goals
LTG: In 12 weeks, Brian participate in feeding with a caretaker besides his mother for a full meal, 2/3 times per opportunities per day, per caregiver report.
STG: In 6 weeks, Brian will eat half of his meal, prepared by caregiver with 1/2 tbsp of rice cereal mixed in with puree, 2/3 opportunities per day, per parent report
Approaches to Intervention
Modify the environment to promote a pleasant and welcoming space for meal time
Prevent social isolation during play and eating; encourage interactions with multiple people, especially unfamiliar people
Collaborate with caretaker to create a routine for eating and feeding to create comfort for Brian
Educate caretaker how to integrate different textures of foods into Brian's diet
Establish the correct sitting posture for Brian to recorrect his thoracic curvature, posterior pelvic tilt, and rounded shoulders
Educate caretaker how to modify activities that encourage stretching and rotation to L, to help decrease the signs and symptoms of Torticollis
Establish new relationships with people, besides his brother and caretaker
Modify the textures of his food
Establish use of two hands during play and manipulation
Types of Interventions/Activities
Education
Teaches care taker how to thicken and or add texture to his pureed food to integrate texture into diet
use of cereal into food
use of a blender at home to vary the desired texture
Educate caretaker to create an a positive and encouraging environment during meal time
should not be done in isolation
learn to refrain from becoming upset so Brian does not react to caretaker
Educates the caretake on positions that Brian should be in to gain strength and stretch his neck
Activities
exploring the use of utensils and empty cup; using different grasps to manipulate and handle feeding tools
Manipulating different types of toys during play to help develop graps
Engages in choice of food, not texture
placing engaging objects to left side ob Brian while changing diaper to engage in neck rotation to the L
Preparatory Methods
Building of Trust
using gentle touch
permission from child
being consistent in with words and actions before, during, and after meal time
setting out utensils and unfilled cup in front of Brian to explore
Provides massage to the sternocleidomastoid muscle
Before eating and feeding, use of a vibrating toy or tooth brush to create sensory stimulation in Brian's mouth to decrease oral sensory defensiveness
Assistive Technology and Environment Modifications
placing a tray in front of Brian
supports for drinking out of a cup; able to rest elbows on try to gain more control of cup
adding lateral supports to highchair to recorrect posture of thoracic curvature to the R
Occupations
Plays with peers and adults in multiple settings, particularly starting in the home and then in other and/or public places
engages in exploratory self feeding with different textured pureed foods
leaving the spoon in Brian's mouth after feeding him, to have him pull the spoon out of his mouth himself
during drinking, caretaker will encourage Brian to hold bottle along with caretaker while drinking, then caretaker will remove hands to have Brian engage in holding the cup to allow himself to drink
Grading of activities
Up:
adding more cereal to puree
blending his food for less time
mashing his food instead of blending it
taking Brain to play with 3 children and their caretakers in a different environment
having a different person feed Brian during mealtime with caretaker present
adding more environmental stimulation during meal time
increasing the rate of the vibration on the toothbrush or tool
Down:
decreasing the amount of cereal put into puree
create wider, easier manipulable self-feeding utensils
having Brian's peers and their caretakers come to the house to engage in play
have caretaker only participate in mealtime
no external environmental stimulation during mealtime
decreasing the rate of the vibration on the toothbrush or tool