There are 7 student discussion boards. I will post the scenario for each topic with the student discussion. Please respond to each one.
Feeding and Scenario #2
Killian is a 3-year-old girl with Down syndrome. Killian has decreased facial and oral
muscle tone. She is referred to as a “picky eater” who only eats round noodles in sauce,
chips, cookies, and pudding. All foods must be served at room temperature. Killian’s
mother packs her lunch for her every day with these same four foods, When offered
other foods, Killian refuses to eat and often throws her food. Killian packs large amounts
of food into her mouth if allowed and sucks her food rather than chews it. Killian feeds
herself by spoon and puts the food straight into her mouth. She gets upset when her face
is washed with a wet washcloth after she eats and she refuses to brush her own teeth.
First: The ablity level that I think Killian displays according to the Eating and Drinking Ability Classification System may possibly be Level 3 Independent: Eats and drinks with some limitations to safety; there maybe limitations to efficacy. This would be due to the fact that Killian independently feeds herself by spoon and puts it straight into her mouth, however if not monitored she will fill her mouth with large amounts of food (stuffing). Which is not safe and could lead to chocking. Also, it is reported that she has a limited selection of food she will eat and requires a specific temperature for it to be at. These food aversions, although not reported, may or may not be related to texture, however in thinking about the foods she will eat a bit more, this limited diet will dissolve or soften quickly with saliva and minimal chewing. In addition, Killian will not try different foods which is often common for children diagnosed with DS (Demchak, Nutrition & Eating/Feeding issues). The case file also indicates that children diagnosed with DS, experience a weak suck response during infancy, which could lead to greater problems with establishing the ability to munch. This is supported in the scenario that she sucks on the food rather than chewing (possibly the result of decreased oral and facial muscle tone).
Second, one variable that should be considered for Killian would be in relation to oral-motor competency during feeding . The scenario mentioned that Killian will suck on her food, rather than chewing it and requires her food to be at room temperature. Chapter 9 of our text (pg 263) describes solid food that is soft chewy that are soft and breaks apart with little pressure. It seems that from the readings, Killian may have not yet developed the ablity to use the munching pattern and is still using the sucking or sucking pattern much like that of a 5 to 6 month old. This could be related to the decreased oral muscle tone, which may also affect her ability to use her tongue efficiently to move food around her mouth. This decrease in oral muscle tone might also effect her ablity to endurance ability and she may tire quickly while eating food that requires a significant amount of chewing and swallowing.
I’m curious as to all of your ideas and thoughts are in regards to this scenario, as I struggled with deciding which level Killian would best fit into. This also seems like a familiar situation that I’ve worked through in the past with high school aged students with Down Syndrome. We just followed the direction of the OT, PT, & SLP to ensure that the students safely ate and tried new foods.
Discussion #2 Hi all,
Well, I hate to say it but it appears Killian is just so typical when it comes to children with Down Syndrome. Though I should not have favorites, I do love to teach these students the most. They are usually just so loving and have this innate ability about them to be more attuned to one’s feelings. This can also mean they can have their very decisive opinions and interests about many things as we may be seeing him n her food choices. We do often see this with their feeding. I would say that Killian is at level 3 because she is independently choosing some foods though they are not a big variety. I believe for a 3 year old she is pretty typical for the choices she is choosing though she is displaying that sensitivity to temperatures of the food, not tolerating hot or cold- just room temperature. Though I feel her food choices are adequate it does concern me that she sucks instead of chew but that could have to do with structural abnormalities of their tongue could be interfering with her acquisition of her chewing skills according to a study of feeding and swallowing difficulties in children with Down Syndrome (MA Anil et all, 2019).
Maria and Peter, you took the variables that are very obvious so I will discuss the next obvious issue and that would be hand coordination of using the spoon. Eating involves so many multifaceted skills using developmental sequences of oral motor and fine motor skills. Sweet little Killian is obviously having developmental delays as would be expected in a child with Down Syndrome. Her hand coordination is still lacking causing her to shove the spoon too far into her mouth. With some suggestions from the OT, I have no doubt that she would suggest some games and activities that would facilitate Killian’s self feeding skills.
Discussion #3 I think Killian’s ability level from the Eating and Drinking Ability Classification System is a Level 3. I believe this is the appropriate level because she has decreased facial and oral muscle tones and she prefers to suck her food instead of chewing it. This seems to me that her chewing ability may be weaker than her sucking ability. She does have the capability of bringing food into her mouth and ingesting it, but needs monitoring to make sure she doesn’t get large amounts of food in her mouth that she could potentially choke on.
A variable that is relevant to this scenario is how Killian reacts to the temperature of the food shows that she has oral sensitivity. The text points out that temperature, texture, certain tastes and smells (pg 25 of the pdf) can help the child be aware of and react to their food. It was interesting to see that certain flavors, sour and spicy, caused more reaction and activity of the lip and tongue when having these flavors.
Feeding and Eating Scenario #1
Jody is a 3-year-old girl with a diagnosis of failure to thrive. Jody typically eats a good variety of foods and can grab them independently to feed herself. However, she consumes only a small amount of food during each meal and becomes fatigued very quickly. Within an hour she requests more food. Jody’s oral-motor skills are good with the exception of her tendency to munch with her mouth open. She often loses food from the mouth and typically makes grunting sounds while chewing and swallowing. Her swallow is generally followed by a large intake of air as if she is out of breath.
Discussion #1Good Evening,
1. Jodi is very obviously a level 2 eater. She eats a variey of foods which is good and does so independently. However, she tires easily and eats often. However, she does munch with her mouth open which causes her to lose food. The scenerio states that she can grab food but not if she could use utensils to eat it. She may need an adult to help her eat foods that require utensils. I would also keep an eye on her breathing seeing as she takes large breaths after swallowing and could possibly asperate.
2. The first thing I thought of was her nutrition however, other discussed this. Jodi was diagnosed with failure to thrive, which has other reprocussions such as cognitive issues. These cognitive issues are most likely negatively affecting her oral motor competency, which is why she eats with her mouth open and loses food and does not eat much. This could cause other issues along side her failure to thrive. With the low food intake the nutrition intake is low, so she may need supplements that she is able to more easily eat. I would think a protien chake through a straw would be a solution. Her lips would have to be around the straw to suck and then she is less likely to lose any.
Discussion #2 Hi all,
Susie would definitely fall into the following level: Level 4:Eats and drinks with significant limitations to safety on the Eating and Drinking Ability Classification System. The scenario stated that she relies on an anterior/posterior pattern of movement of tongue in an attempt to control food and liquids with her mouth with no tongue lateralization. Her poor lip closure and poor cheek movement and jaw control all causing her to not be able to feed herself independently.
Because you two took the most obvious variables involving Susie, I decided to look into tongue lateralization problems a bit more. When I conducted an advanced search on tongue lateralization problems, I found a recent study in the Journal of Developmental and Physical Disabilities by Whitney Adams, Keith Williams and Jonathan Ivy, “Teaching Tongue Lateralization as a Component of Chewing Instruction.” (2020) The study evaluated the efficacy of a treatment package which included tongue lateralization as part of chewing instruction. Though I feel Susie is quite severe, I wonder if games or direct instruction with her tongue lateralization skills could be successfully taught. This study involved only three children who consumed only pureed food and had no history of chewing. Using the outcome measures, tongue lateralization and chewing instruction they created, they were able to improve all three of the children and at the end of the treatment, all three were able to transition to table food and continued to eat table food in follow up visits. In Susie’s case and her age, it just might be one way to try to improve her independence while eating. What do you guy’s think? Could Susie benefit from this direct tongue lateralization and chewing instruction?
Feeding and Eating Scenario 3
Susie is a 12-year-old girl with cerebral palsy and a severe tongue thrust. Susie must rely on an anterior/posterior pattern of movement of tongue in an attempt to control food and liquid within her mouth (i.e., no tongue lateralization). In addition, she has poor lip closure, poor cheek movement, and poor jaw control. Susie is typically fed while she is seated in her travel chair; however, her feet are not resting on a surface, her hips are forward, her shoulders are elevated, her hands are clenched in fists, and her head and neck are hyperextended. She eats foods that dissolve easily with saliva, and much of her food and liquid is lost as a result of the tongue thrust. She gags easily on new foods and food that must be chewed. Susie must be fed by others.
- Since Suzie “eats foods that dissolve easily with saliva, and much of her food and liquid is lost as a result of the tongue thrust”, she must “rely on an anterior/posterior pattern of movement of tongue in an attempt to control food and liquid within her mouth” and “gags easily on new foods and food that must be chewed”, this seems to put her in Level 4, since it encompasses “challenged by food that requires chewing”, “it is challenging to control the movement of food and fluid in the mouth” and “significant food and fluid loss from the mouth” (Chailey Heritage Clinical Services, 2013). It also specifies that Suzie “must be fed by others.” would suggest she is at a “Totally Dependent” level for level of assistance required.
- I know some of you discussed her oral-motor competency, in regard to her tongue thrust. I was going to discuss this in particular for the concern of hydration. Since Suzie has difficulty controlling the liquid within her mouth and “much of her food and liquid are lost as a result of the tongue thrust”. “Adequate fluids are essential each day to prevent dehydration” since “insufficient water affects multiple systems” (Demchak, 2021). Having a nurse to monitor hydration, as well O.T. to assist with Suzie drinking water would be beneficial for the team and Suzie.
On the scenario presented, Susie would be on the Eating and Drinking Classification at Level 4 where she needs significant assistance in eating and drinking, but doesn’t need tube feeding.
A thing to consider for her is that she has poor lip closure which makes it difficult for her to keep food in her mouth so she can swallow it. I wonder if during feeding time if the food she was given was in small amounts and then put in the middle of the mouth in the center of the tongue so she close her mouth around it as suggested in the Chapter 9 text (pdf pages 30 and 31) on step 3.