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Flynn; 4 year old boy (Occupation-Based Problems (Flynn will not…

- - - - Grade up: Decrease the amount of times that he receives a prize for using an open cup versus a sippy cup or 360 cup. Use random opportunities to reward him for expected behavior.
      - Rationale: Allowing Flynn the opportunity to practice using the open cup with guidance from clinician will increase the amount of confidence he has with using the open cup independently. "Children will have the most success when they have begun to demonstrate an interest in self-feeding and an interest in exploring food more independently (Case-Smith & O'Brien, pp. 402).
      - Grade down: Allow Flynn to choose one of the preferred cups one drinking opportunity a day and still receive a prize at the end of the day.
    - - Promote open cup usage through the use of positive behavioral reinforcement, such as the prize from the toy box
      - Promote independence by allowing Flynn to choose which cup he wants to use
      - Provide support to jaw or to posture control during participation in drinking out of an open cup to promote confidence
      - Engage in play with open cups to create positive association to open cups
  - - - Grade down: Clinician will provide external jaw support by placing index finger under lower mandibular bone and thumb on anterior chin.
      - Rationale: "Foods with a smooth, even, cohesive consistency, such as yogurt and strained fruits or vegetables, are easier to manage when a child has oral sensory and oral motor impairments. Thick, lumpy, or pasty foods such as oatmeal require more oral motor strength and sensory tolerance when compared with smoother and thinner pureed foods" (Case-Smith & O'Brien, pp. 403). Provided Flynn with the opportunity to engage in eating non-preferred, thicker foods will increase his independence and confidence when eating at meal time.
      - Grade up: Flynn will eat one bite of a non-preferred food that is at least one level up from pureed for every two bites of a preferred pureed food.
    - - Introduce non-preferred foods to Flynn and continue to add them to his diet gradually
      - Promote chewing and biting by adding chunks to the pureed foods
      - Promote confidence by providing Flynn with verbal praise and reinforcement for positive behaviors
      - Add hard candies to snack time, such as suckers, to promote sucking and oral motor control for independence in feeding
  - - - Grade up: Include the knife utensil and have Flynn decide if the foods need to include using the knife to eat it.
      - Rationale: "Young children need to select from a limited number of options. Choices are appropriate for all children who have reached a developmental age of 6 to 8 months. At that age, an infant can make a choice visually or by reach when shown a filled cup or spoon" (Sensory Issues, pp. 429).
      - Grade down: Allow Flynn to match the utensil to the food but no longer has to participate in eating the foods
    - - Use utensils of different textures and gradients to add tactile stimulation to eating with utensils
      - Provide positive reinforcement through rewards, such as stickers and prizes
      - Promote independence in choosing which utensils to use for each specific food that is presented
  - - - Grade up: Create a longer obstacle course to increase endurance.
      - Rationale: "Children with postural instability and neuromuscular impairments have difficulty with oral motor control if they do not have adequate positioning support" (Case-Smith & O'Brien, 2015, pp. 400). Flynn engaging in obstacle courses including bouncing, tapping, and rocking of the spine will allow him to develop more motor control and increase muscle stability in his core muscles. This will allow him to sit without support and allow independent use of his upper extremities to use during meal time.
      - Grade down: When Flynn completes each section of the obstacle course, he is rewarded with a sticker, as well as a prize from the toy box upon completion.
    - - Promote gross motor control and strengthening by providing activities that include bouncing, rocking, and tapping through the spine
      - Reinforce positive behaviors with a reinforcement system, stickers or prize from toy box