Tuesday, December 13, 2011

Special Needs Kids: Feeding Difficulties

Things to Remember During the Holiday Season from Mealtimes Partners Newsletter
As the holiday season rapidly approaches, Mealtime Partners, Inc. decided to provide a recap of some of the issues relating to safe eating and drinking, that have been presented in previous Newsletters. During this busy period of the year mealtimes can often be hurried and the issue of safety can sometimes be overlooked in the process of getting other things done as quickly as possible. We hope that these reminders will help keep everyone safe and happy for the holidays.

The Benefits of Independent Eating  The greatest benefit of eating and drinking independently is that it reduces the chance of choking and/or aspiration. There are approximately 40,000 deaths in the U.S. each year due to aspiration pneumonia with a cumulative cost of treatment that is estimated to be more than $3 billion (Calhoun, Wax & Eibling3, DeLegge4). DeLegge’s study identified the best predictors for the development of aspiration pneumonia as: dependency on others for eating; dependency for oral care; neurological status; and positioning while eating. Fundamentally, people who require feeding are more vulnerable to aspiration than people who self-feed. (Aspiration occurs when food, liquid or regurgitated gastric materials are inhaled into the pulmonary system. Pneumonia can result from aspirated materials causing infection in the lungs and can have very serious health consequences.) (Read the entire article... Part 1 and Part 2)
Good Seating and Positioning  The correct seating and positioning of the body during eating is very important because it improves both the safety and the enjoyment of the meal and facilitates better digestion. A good position for eating requires the trunk to be very stable. To enable the trunk to be stable, the feet must have a firm footing so that they can bear weight as the person eating, moves throughout the meal. Additionally, the thighs and buttocks should bear weight. When the feet, thighs and buttocks bear weight, the body becomes more stable and the shoulders, arms, and head are able to maintain a more constant, steady position. This will promote better control of not just the head and neck, but all of the muscles in the jaw, tongue and mouth. The overall result is that the person will eat more safely and gain better control over eating.
Promoting a Chin-Tuck  Even though there is no precise anatomical definition of “chin-tuck”, in general, a chin tuck is a head position that places the chin slightly downward towards the individual’s chest. Regardless of the exact execution of the chin tuck, it is a position that can improve the probability of taking a bite of food, chewing it, and swallowing it safely. When the head is slightly forward and down, the windpipe is in a protective position; food or liquid is less likely to enter the airway than if the head is upright. When food enters the airway, the result is choking; if the individual does not have an adequate gag reflex or cough, the result is aspiration.
The Importance of Hydration   The majority of our body weight is comprised of water (approximately 70%). The water is contained in our cells, our blood vessels, and the space between cells. We constantly lose water from our body. It is lost when we breathe, perspire, urinate or have a bowel movement. However, most of the time, we replace the water that is routinely lost as we lose it, through drinking. Yet, it is estimated that up to 75% of Americans do not drink enough water.
Dehydration occurs when we do not take in adequate liquid to replace what is lost from our bodies. However, thirst is not the first symptom experienced by an individual who is becoming dehydrated. The signs and symptoms of mild dehydration are: headache, dry mouth, fatigue, cramps, weakness, dry flushed skin, and lightheadedness. However, for those people who live in a constant state of mild dehydration, they are unaware of it because the symptoms of dehydration have become “normal” for them.
If dehydration becomes moderate, the symptoms worsen and will include: dark yellow urine, eyes that do not tear, lack of sweating, nausea, vomiting, sleepiness, changes in mental status, increasing weakness, and, skin that does not “return to normal” rapidly when pressed. Ongoing dehydration will cause people to be weak, fatigued, apathetic, and depressed. Dehydration, if not addressed, can become life threatening.
For most individuals, dehydration is 100% preventable and yet many people with disabilities suffer from some level of dehydration almost constantly. The daily routine for many people who are dependent upon another person to provide them with fluids and nutrition, commonly associates drinking with food. That is, drinks are only provided at mealtimes. This practice leads to an inadequate amount of liquid being consumed by the individual. Also, it is a difficult challenge for a care provider to remember, and/or to have the time, to offer a drink to someone at regular intervals. The result is that when liquid is offered, the person providing the drink encourages the consumption of large quantities of liquid, in a hurry. The consumer is then obliged to repeatedly swallow, without a break to breathe or reorganize their mouth. The more swallows taken without a break, the greater the risk of choking or aspiration.
Choking Prevention   On February 22, 2010 the American Academy of Pediatrics (AAP) released a Policy Statement on choking prevention for young children. Because choking is a leading cause of injury and death among children, especially those 3 and younger, AAP has issued recommendations for government agencies, manufacturers, parents, teachers, childcare workers and healthcare professionals to help prevent choking in children.
AAP identifies certain toys and foods as high-risk items for choking. Foods that pose the greatest choking risks are round or oval (for the most-part) and can restrict air-flow if they are sucked into the wind pipe. Additionally, foods that do not dissolve easily or rapidly are a high risk. Examples of high risk foods are: whole grapes, hot dogs, peanuts, round hard candy, meat, carrots, apples, chewing gum, and chunks of peanut butter. How foods that pose a risk of choking are prepared for eating can greatly reduce the risk. Grapes, hot dogs, carrots, and other round shaped foods should never be cut into approximately-spherical portions of food, instead they should always be cut into small random shapes that will not completely obstruct the flow of air through the windpipe should they be aspirated.
It should also be noted that the recommendations provided by AAP about food preparation are of great value to individuals of all ages who have oral motor difficulties and/or are unable to feed themselves. When someone is unable to self-feed they usually do not prepare bites of food for themselves, and thus, do not cut up food to the size and shape that they might desire. 
od, place the utensil on the plate or bowl and remove your hand.
Seasons greetings from Mealtime Partners, Inc! We hope that you enjoy all of the special meals and snacks that are available throughout the holiday.
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