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Andy's Mealtime Plan (Occupation Based Problem List (Eating,…
Andy's Mealtime Plan
Occupation Based Problem List
Eating
Swallowing
Requirement of entertainment while eating
Requires specific eating utensils
Models/Frames of Reference :
Find Andy's motivation and routine during mealtime, and his motivation for what his favorite foods are to create a food chain based off of his favorite foods.
MOHO will examine Andy's volition, habituation, environment, and performance capacity.
His eating environment is very important with both the physical environment, as well as the social environment through his mother being stressed out
Approaches to Intervention
Create/Promote
: creating a mealtime routine and coloring food diary will promote better eating habits and encourage food-trials. Eating can be encouraged by expanding food options or expanding utensils (ie: fun utensils, truck/car scoopers, fun plates)
Establish/Restore
: Andy's mother can establish her own behavioral boundaries by not giving in to Andy by giving him his favorite foods after hours of refusal.
Types of OT Interventions/Activity
Adaptive positioning to improve patterns for hand to mouth movements. Specific activity for Andy will include providing a chair with various supports to improve posture during feeding and swallowing.
Food therapy to introduce Andy to new textures and foods, and orient him to a mealtime routine
Introduce Andy to new eating environments that do not include entertainment stimulus
During mealtimes, occupational therapists may try a variety of spoons, such as those with a small diameter or smooth handle, to improve a child’s success and tolerance.
How would you adapt and grade the intervention/Activities
Increase the ratio of preferred items to non-preferred items
Using a supportive chair with seatbelt and straps to promote good eating alignment
Use a fun food board to increase motivation for mealtime, and promote trying new foods to be able to eat desired food
Grading up
Increasing the amount of food that needs to be consumed before reinforcement is given
Introducing a new food item that the child has to interact with in order to receive preferred item
Removing arm supports to encourage independent trunk control and postural support
Goals
STG: Andy will independently select and eat one food per meal in three out of five opportunities within two weeks with no prompting from a caregiver.
LTG: Andy will independently select and eat two foods per meal in five out of five opportunities within four weeks with no prompting from a caregiver.
Baseline: Andy is showing developmentally appropriate moves toward independence by resisting caregivers' attempts to control his eating. This has led to Andy refusing food, or demanding very specific, ever-changing environmental factors and an array of foods for every meal.
MOHO
MOHO would holistically look at Andy through a top-down approach
. His roles as a child impacted his habits to have his mother start making mealtime a production, because she was so intentional on him eating
Caregiver education: Educate Andy's mother in methods to diffuse the situation at mealtimes. Encourage her to let go of the "battle" of who controls eating. Educate Andy's mother about the importance of not force feeding or forcing Andy to eat, and letting him be in control what and how much he eats. Introduce the Ellyn Satter method of "Division of Responsibility" where the parent decides what and when food will be served, and the child decides what and how much to eat of the foods on offer. Encourage her to refrain from forcing or commenting on Andy's eating, and reassure her that when he is allowed to express his independence in eating, he will eat to his hunger.
Paige Browning, Lauren Moore, Grace Yerkes, Brittney DeFranco, Heather Fierros, Tara Odams, Markia Bryant, Tiera Grissom, Kaylee Hefty, Alexa Hanley, Morgan LaBarbera