BRIAN: 1-YEAR-OLD PICKY EATER (Performance Skills (Radial digital and…
BRIAN: 1-YEAR-OLD PICKY EATER
Born prematurely at 34 weeks
Spent 2 weeks in NICU with heart monitor
Due to fetal heart arrhythmia
Normal MRI and CT scans
Cranial vault surgery to repair premature craniosynostosis
Models / Frame of Reference
Interventions revolve around environments that support growth and stimulation of age-appropriate behaviors and skills
Considers physical, psychological, and social aspects of Brian.
Assess Brian's ability to reach appropriate developmental tasks for the age group and stage he is in. Compares skills to other "normal" developing children.
Assess environmental factors that may contribute to postural challenges
Focuses on occupation of feeding during mealtime
Considers Brian and possible sensory issues
Enhances role functioning by developing Brian's current skills and modifying the environemnt
ADLs (functional mobility): moving from one position/place to another, includes transportation of objects (AOTA, 2014)
Limited functional mobility due to asymmetric sitting posture during mealtime
Address seating posture by positioning Brian into a ring-sitting position during mealtime. Apply joint approximation to his R pelvis/hip to adjust WB on L pelvis and R thoracic curvature.
Grade down: if ring-sitting position is too overwhelming for Brian, it can be replaced cube chairs with supporting cushions to allow for truncal support and proper positioning.
Grade up: assist Brian to sit on large stability ball to activate core support and balance to facilitate corrective pelvic and truncal positioning
Address restrictions from torticollis while in ring-sitting position. Facilitate usage of his R UE to cross midline while reaching and turning towards food object that are placed on his L side. Complete by facilitation of Brian transporting the food to his mouth.
Social Participation (family): successful interaction with family members and other individuals (AOTA, 2014)
Only accepts food from caregiver
Organize interactive play time with important figures (other than caregiver) before mealtime to enhance Brian's familiarity and trusting relationships with others
Grade up: Have Brian interact with other important figures in new environments to show generalized learning throughout other settings.
Grade down: Carry out this intervention in a familiar environment or room that Brain usually has meals in. Have the caregiver(s) that Brian feels comfortable with stay in the room. The caregiver can take turns with the other important figures in providing Brian his meal to establish that relationship.
Incorporate caregiver education into becoming aware of Brain's changes in his body tone/movement patterns, his facial expressions, eye gaze, mouth movement, and the verbal messages he sends. This will allow the caregiver to form a better understanding of what Brain wants and needs
ADLs (self-feeding): bringing food or fluid from the plate or cup to the mouth (AOTA, 2014)
Does not finger feed or use utensils/cups
Explore and experiment with various types of feeding utensils to accommodate for Brain's grasp pattern. This may include finding a utensil with a larger grip that is lightweight.
Grade down: Brian may receive physical assist in holding his utensil and bringing it to his mouth. The therapist/caregiver can reinforce his grip by placing their hand over his and guiding it to his mouth to faciliate an effective grasp pattern and motion.
Grade up: The backward-chaining technique can be incorporated by having the therapist/caregiver complete all the steps of feeding, but leaving the last step for Brian to complete. Ex: the caregiver can put the food on the spoon, direct it into Brian's mouth, and then leave the spoon in Brian's mouth to facilitate his participation in pulling out the spoon with his hands
Parent education should be implemented since Brian may lack the opportunity to self-feed. The caregivers should provide assistance to enable Brain to physically participate in mealtime, however, they should not use excessive effort. The parents must understand that this may require time and patients to develop.
ADLs (eating): keeping food/fluid in the mouth and swallowing it (AOTA, 2014)
Brain will only eat pureed foods
Utilize oral motor tools to increase oral sensory stimulation in preparation for eating various food textures and consistencies
Grade down: manually assist Brian in oral motor stimulation with a toothette.
Grade up: utilize vibrating oral motor tools to increase stimulation input, and allow Brian to facilitate this himself if he is comfortable
Slowly transition the pureed diet to a mechanically altered diet, then to an advanced diet with soft solids, and eventually reaching regular age-appropriate food textures/consistencies.
Short Term Goal: Within 3 wks, Brian will consume at least 50% of his mechanically-altered meal with maxA, after utilizing an oral motor tool for oral stimulation, for at least 2x/day during mealtime, for 5 consecutive days per parent report.
Long-Term Goal: Within 9 wks, Brain will consume at least 75% of his advanced-prepared meal with soft solids with maxA, after utilizing an oral motor tool for oral stimulation, for at least 3x/day during mealtime, for 10 consecutive days per parent report.
Age appropriate: birth - 7yrs,11mos (Houghton Mifflin Harcourt, 2016)
Aligns with developmental milestones and specifically addresses the adaptive domain of self-feeding (Houghton Mifflin Harcourt, 2016). Addresses the areas that Brian is developmentally delayed in.
Contributes to eye-hand coordination, vestibular stimulation, and muscle tone distribution (Integrated Learning Strategies, 2016).
Onset 0-2mos, integrates 4-6mos
If persists, may impair hand function at midline, impair visual regard to objects held, contribute to poor sitting posture, and/or affect fine motor skills (Integrated Learning Strategies, 2016).
Explains Brian's poor sitting posture during mealtime and his under-developed grasp patterns that prevent him from self-feeding.
Onset 4-6mos, integrates 8-12mos
Contributes to bilateral patterns of body movement and maintain quadruped position against gravity (Integrated Learning Strategies, 2016).
If persists, may interfere with strength and balance development, contribute to poor posture, and/or affect fine motor skills (Integrated Learning Strategies, 2016).
Explains why Brian has difficulty maintaining B UE WB while in the quadruped position
Assess sensory patterns/processing and information that may explain his preference for pureed foods. (Texas Statewide Leadership for Autism Training, 2015).
Age appropriate: birth - 14yrs,11mos (Texas Statewide Leadership for Autism Training, 2015)
Explains that Brian is sensory avoidant to particular textures of food in his mouth
Difficulty maintaining B UE WB in quadruped position - fair strength
Asymmetrical sitting posture
Posterior pelvic tilt
WB through L pelvis and thoracic curvature to R
Torticollis with limited rotation to the L
Assessed with testing the ATNR and STNR reflexes
Radial digital and raking grasp only
No demonstration of bimanual coordination
Limited imitation skills
Possible signs of developmental delays
Assessed with the BDI-2 and SP2-Toddler Assessments
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S19-S23.
Houghton Mifflin Harcourt. (2016). Battelle developmental inventory, second edition normative update. Retrieved19 February 2018, from
Texas Statewide Leadership for Autism Training (TSLAT). 2015. The sensory profile 2. Retrieved 19 February 2018, from
Integrated Learning Strategies. (2016). Primitive reflexes. Retrieved 19 February 2018, from
Brian is a 1yo male who has recently undergone a successful cranial vault surgery. He is an only child and spends most of his days at a daycare while his parents are at work.
Parents report that their main concern pertains to mealtimes since he will only eat pureed food and spits out any dry solid food that is placed in his mouth.
They also show concern of his physical and motor development, such as the limited amount of rotation that he has in his neck and the curvature in his spine when he sits. Parents also report that Brian is not efficient with self-feeding during mealtime since his radial-distal grasp is not effective with their utensils and he just runs his fingers through the pureed meal. Due to his frustration, his parents insist that they, and his daycare providers, should continue to feed Brian for him.