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Diagnosis and Management of Sensory vs' BehaviorallyBased Feeding Disorders

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Diagnosis and Management of Sensory vs. Behaviorally-Based Feeding Disorders ... Diagnosis with SI as a component. Sensory Issues. Sensory Issues. Where do ... – PowerPoint PPT presentation

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Title: Diagnosis and Management of Sensory vs' BehaviorallyBased Feeding Disorders


1
Diagnosis and Management of Sensory vs.
Behaviorally-Based Feeding Disorders
  • Arden Hill, MS, CCC-SLP
  • Sarah Halloran, MS, CCC-SLP
  • Childrens Speech Feeding Therapy, Inc.

2
Prevalence
  • Feeding disorders occur in (Rudolph Link,
    2002)
  • 25-35 of developmentally normal children
  • 40-70 of children with developmental
    disabilities and/or chronic medical conditions

3
Sensory Issues
  • Where do they come from?
  • Prematurity
  • Chronic illness
  • Multiple medical interventions/medications
  • Underlying neuro issues
  • Diagnosis with SI as a component

4
Sensory Issues
  • Where do they come from?
  • Unpleasant oral-tactile experiences
  • Delayed introduction of oral feeds
  • GI issues

5
Behavioral Issues
  • Where do they come from?
  • Bad habits/desperation
  • Poor limit setting
  • Lack of mealtime structure and routine
  • Passive eating with distractions
  • Inconsistent expectations re eating

6
Sensory Issues with Behavioral Override
  • Behaviors often stem from somewhere else
  • Normal cognition yields behavioral issues
  • Children with underlying sensory issues rarely
    just eventually eat
  • Underlying issues must be addressed
  • Similar rules imposed with eating as with other
    behavioral management

7
Sensory Issues - Presentation
  • Often avoids whole foods or texture groups
  • Difficulty tolerating sensory input
    sight/smell/touch/taste
  • Eats the same regardless of people/place
  • Overstuffs oral cavity/takes tiny bites
  • Stores food for later
  • Gags as a sensory response
  • Excessive drooling

8
Behavioral Issues - Presentation
  • Rarely selective avoidance
  • Eats better for certain people/places
  • Gags to get attention
  • Rarely underlying neuro or medical issue

9
Abnormal Sensory Responses
  • Hyposensitivity
  • Hypersensitivity
  • Assess the childs comfort level with food within
    the sensory domain and begin your treatment at
    that level

10
Hyposensitivity
  • Reduced awareness of non-nutritive and nutritive
    stimuli in the mouth, heightened sensory
    threshold to oral input
  • Poor suck
  • Liquid pooling
  • Liquid loss
  • Gag (protection vs. rejection)
  • Overstuffing/pocketing

11
Hypersensitivity
  • Heightened awareness of non-nutritive and
    nutritive stimuli in the mouth, decreased sensory
    threshold to oral input
  • Heightened gag
  • Refusal of foods
  • Refusal to progress in textures

12
Hunger/Satiety Patterns
  • Children with GI issues,
  • Prematurity
  • Alternative means of nutrition
  • Grazers
  • Medication may aid in stimulating hunger

13
Behavioral Issues
  • Behaviors stem from somewhere
  • Children with clearly defined feeding issues
    rarely just eventually eat
  • Underlying issues must be addressed
  • Similar rules imposed with eating as with other
    behavioral management

14
Critical Information to Consider Prior to
Initiating Treatment
  • Medical History
  • Underlying diagnosis
  • GI issues
  • Surgeries
  • Medications
  • Feeding History
  • Early feeding history
  • Primary means of nutrition
  • Previous treatment

15
Critical Information to Consider Prior to
Initiating Treatment
  • Developmental History
  • Cognitive abilities
  • Communication skills
  • Motor skills (i.e., physical and occupational
    therapy)
  • Nutrition
  • Anthropometrics
  • Dietary restrictions and food allergies
  • Supplements

16
Critical Information to Consider Prior to
Initiating Treatment
  • Psychological and Behavioral Issues
  • Emotions of child and family
  • Anxiety/depression
  • Behaviors at mealtimes and in other settings
  • Structure and limits in the childs environment
  • Family Dynamics
  • Cultural
  • Socioeconomic
  • Environment
  • Parents/Siblings
  • School/Daycare

17
What is sensory integration?
  • Sensory pertains to our senses
  • Hearing, sight, smell, touch, taste, and
    perception of motion/movement and gravity
  • Integration refers to the process of unifying and
    allowing the brain to use the information that
    the senses gather and take into the body

18
Sensory-Based Feeding Problems Non-nutritive
Stimulation Protocol
  • Oral stimulation of the lips, teeth/gums, cheeks,
    tongue, and palate with Nuk brush
  • Develop tooth brushing protocol for therapy and
    home
  • Introduce mild tastes on finger, cloths, and
    brushes as tolerated

19
Sensory-Based Feeding Problems Sensitivity to
Food Experiences
  • Visual
  • Olfactory
  • Tactile
  • Gustatory

20
Sensitivity to Food Experiences Visual
  • Non-mealtime visual experience
  • Object-based, picture-based system
  • Establish comfort level with food proximity
  • Work on tolerating food on the table, on the
    childs plate, etc.

21
Sensitivity to Food Experiences Olfactory
  • Introduce mild smells
  • Establish comfort with proximity to smells
  • Handling directly
  • Presenting on another object
  • Increase intensity of smells
  • Scented therapy tools

22
Sensitivity to Food Experiences Tactile
  • Water play
  • Sensory bean bags
  • Painting with food GET MESSY!!
  • Food activities (i.e., flower pots, boats,
    gingerbread houses)
  • Cooking activities
  • Pizza, muffins, waffles, fruit salad, soup

23
Sensitivity to Food Experiences Gustatory
  • Hierarchical Approach (Toomey, 2000)
  • Kissing
  • Licking
  • Bite and remove
  • Bite, chew and spit
  • Bite, chew, swallow
  • Consider taste, temperature, texture
  • Structure movement through hierarchy with an all
    done bowl

24
Treatment of Poor Hunger/Satiety
  • Guidelines for following normal mealtime schedule
    including 3 meals and 2-3 snacks daily
  • Pair tube feedings in high-chair/booster seat
    with or immediately after the oral feeding
  • Medication may aid in stimulating hunger

25
Management of Behaviorally-Based Feeding Problems
  • Rule-out medical, motor, or sensory involvement
  • Parent education
  • Promote ownership in older child
  • Referral to behavior specialist and/or
    psychologist/psychiatrist

26
Use of Reinforcement as a Part of Feeding Therapy
  • Use reinforcers to develop new skills
  • Age appropriate reinforcers including puppets,
    books, peg boards, card games
  • Natural reinforcers should be used at home
  • Homework sticker charts
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