Eating and drinking
Up to 70% of children with physical disability have problems with eating and drinking. This page provides information about such difficulties and how Novita Children's Services staff provide mealtime assistance to children, their families and carers.
On this page
Why are mealtimes so important for children with physical disability?
- Eating and drinking difficulties may mean that a child’s calorie and nutritional intake is poor - this may result in the child suffering from malnutrition, which effects their growth and development
- Some difficulties can result in food or drink entering the lungs instead of the stomach leading to an infection which, in turn, can lead to pneumonia, (this is known as aspiration)
- Feeding difficulties can lead to choking which may be life-threatening
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Why do children with physical disability have problems with mealtimes?
Difficulties with eating and drinking can be caused by:
- Neurological problems, for example, cerebral palsy
- Congenital syndromes
- Disorders of the stomach and intestine, for example, gastro-oesophageal reflux
- The child’s behaviour
- The level of disability of the child
- Problems with development, growth and/or the anatomy of the mouth and neck
- Difficulties with the child being able to feed themselves
- Difficulties using the muscles needed for eating and swallowing
- The way the child is positioned
- Any tendency for the child to have food enter the wind-pipe and/or lungs instead of the stomach
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The importance of reflexes for eating and drinking
Babies are born with reflexes that help them to feed. These are called primitive oral reflexes, for example:
- the rooting reflex – a baby turns its mouth towards a nipple or teat
- the suck-swallow reflex – this helps the baby to suck from the nipple or teat and swallow the milk smoothly
Although present at birth, these reflexes usually disappear gradually as the baby grows and develops other feeding skills. However in some cases this does not occur leading to a variety of difficulties:
- the lips draw back or purse together
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- the jaws bite, clench together, draw back, push or thrust forward
- the tongue is stuck out, pushes forward or draws back
- the soft palate is over-sensitive or under-sensitive
- gagging
- the responses to touch , taste and temperature are too strong or not strong enough.
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Who can help with mealtime issues?
Novita usually has a number of different people working together in a team to work on mealtime difficulties. The team may include the following people:
View a video clip in which Jenny, a speech pathologist and a parent of a child with cerebral palsy talk about how speech pathologists help children with eating and drinking issues (link commences streaming of 3Mb MOV file of 53 seconds duration)
Ideas and methods
Use the links below to go to information on the following topics:
Disclaimer: General information only - you should consult with the relevant professional before using it with a particular child. See disclaimer details.
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Positioning
- Many children with disabilities have their own special seating, for example, in their wheelchairs. However, they often need additional head and body support to keep them steady during mealtimes. Trays and tables are often helpful.
- Correct upright positioning with enough support for eating and drinking is one of the most important things that influences safe swallowing. Good positioning helps:
There's a lot to consider when positioning a child for mealtimes. Because there are so many issues, you should approach the speech pathologist, occupational therapist or physiotherapist for the child to discuss them. They may look at aspects, such as:
- how the child's feet are positioned
- the position of the arms
- whether the child's body is upright.
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Food and drink textures
For children with eating problems, a diet with particular food textures may be recommended because they are:
- safe - for example, raw carrot or apple may lead to choking if the child cannot chew them up small enough
- easier to control in the mouth
- they don’t increase saliva production too much.
Speak to a speech pathologist to look at how to change food and drink textures to suit the child.
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Thickening agents
The speech pathologist may recommend adding thickener to drinks for some children because:
- thin fluids can be difficult to control in the mouth and may start going down the throat before the child actually swallows
- thicker fluids are easier to control for some children.
If thickeners are to be introduced, advice should be sought from a dietitian to find out which one is most suitable, keeping in mind the child’s age and diet. The child’s equipment may also need to be altered.
Mealtime equipment
Children with disability who are feeding themselves can be helped by provision of the correct equipment. In fact, it may mean the difference between a happy and safe mealtime or a stressful one. Occupational therapists assist in recommending appropriate equipment.
It is important to use the correct:
- Bottle
- Teat
- Spoon
- Cup
- Cutlery
- Bowl
- Other equipment, such as non-slip mats and clothes protectors
See an occupational therapist or speech pathologist to help with finding the best equipment.
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Oral eating and drinking care plans
- Can be written for carers who are helping a child at mealtimes who is registered to receive therapy services from Novita. Care plans are developed for mealtimes at:
- Child care centres
- Preschools
- Schools.
- Are designed to provide carers with the correct ways to manage each child at mealtimes - they may include guidelines about:
Oral Eating and Drinking Care Plans are part of the Personal Care Support Plans which have been developed by the Department of Education and Children's Services (DECS).
For further details, go to their website.
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Sensory stimulation to the face and mouth
Stimulation on the face can be provided before a meal to help prepare the muscles for the ‘work’ of eating and drinking. However each child reacts differently to stimulation and some children can be overstimulated.
Many children with disabilities have difficulty taking in and understanding the information received from their senses (that is, from touch, taste, temperature and texture) when eating and drinking. Their responses may be too strong (the child may be hypersensitive) or not strong enough (the child may be hyposensitive).
Sensory stimulation to the face and mouth (also known as oromotor stimulation) can help the child react more normally to food sensations in and around the mouth. This makes eating and mealtimes more pleasant for the child. It is important to remember that a certain amount of sensitivity is necessary to help people to enjoy eating, control food in their mouths, and to protect their airways.
Disclaimer: General information only - you should consult with the relevant professional before using it with a particular child. See disclaimer details.
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Mouth play
To make sure that a young child begins to experience sensations around the mouth that are enjoyable, speech pathologists encourage the child to bring toys of different shapes, sounds, and textures to the mouth. This provides the child with practice sucking, licking and chewing. Also other important eating skills can be practiced, such as how to control a bite, when to let go, and how to move the tongue and jaw separately from each other. Speak to a speech pathologist for activities that can be used for mouth play.
Helping to control eating and drinking patterns
The following information is adapted from The Feeding Assessment Resources Management Guide-Revised. There are several ways to help children with disabilities eat more easily and safely. These include:
- Being in a steady position
- Changing or altering their position
- Stopping reflex patterns which interfere with feeding
Facilitation (assisting) of the jaw helps with closing of the mouth so that food is not lost from the mouth. This facilitation is done by cupping the child’s jaw from the side or front with your hand.
Facilitation (assisting) of the lip helps the mouth to close and to encourage the lips to seal on the spoon or cup so that food is not lost and so normal lip movement and closing of the lips is encouraged. Children may benefit from having a mealtime routine.
It is important to work out the best methods for helping a child to eat and drink. Contact the speech pathologist if you need help in doing this.
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Communication at mealtimes
Mealtimes are a wonderful time to communicate. It is important to ensure that the child has a way they can communicate with you at mealtimes. Communication may be about any topic at all but may also include meal specific issues such as:
- Food choices
- Control of the meal situation, for example, “slow down”, “I don’t like it” “that’s too much”,
- Directing helpers, for example, “Cut it up”, “Warm the drink”, “Put it in the side of my mouth”
If the child has a communication difficulty, see a speech pathologist about way of developing communication during mealtimes.
Training and education
Novita speech pathologists provide training on the topic of mealtime issues for parents, staff and carers. This may include general information about difficulties experienced by children with disabilities or information about a particular child.
Children with mealtime difficulties are more at risk of choking than other children. It is very important that all carers know what to do if a child chokes. Novita speech pathologists can direct carers to first aid training courses that provide information on choking management.
School and education staff are encouraged to attend information sessions about feeding children. Find out more on the ‘Child Health and Education Support Services (CHESS) website.
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Tube feeding
Some children with mealtime difficulties may not be able to eat and drink safely. They may need different ways of getting their food either for a short or a long period of time. The two different ways that this usually happens is by the child being fitted with a gastrostomy or a naso-gastric tube.
Speech pathologist look at and assist with:
- maintaining and developing the child’s oral skills
- determining if the child can swallow safely
- suggesting ways that the child can continue to receive tastes and stimulation in and around their mouths so that they keep and develop their mouth skills and don’t become too sensitive around their face.
Naso-gastric tube feeding
A naso-gastric tube is a soft, thin tube that is inserted through the nose into the stomach. Nutrition and fluids can be given directly into the stomach through this tube.
Use of a naso-gastric tube is likely to be temporary. The reason is usually to help the child to increase their body weight or to provide nutrition while the child is recovering from illness.
Gastrostomy feeding
A gastrostomy is an opening, or stoma, in the abdominal wall into the stomach. Insertion of the soft tube into the stomach is done under a general anaesthetic by a surgeon. A gastrostomy tube is usually used if the child is likely to have mealtime difficulties for a long time.
Further information on types of tubes, devices and possible complications is available from Novita paediatricians and surgeons.
Sometimes a Nissen’s fundoplication procedure is performed when a child gets a gastrostomy. The fundoplication involves wrapping part of the stomach around the bottom of the oesophagus to create a one-way valve. This is done to prevent oesophageal reflux.
Further information on types of tubes, devices and possible complications is available from Novita paediatricians and surgeons.
Disclaimer: General information only - you should consult with the relevant professional before using it with a particular child. See disclaimer details.
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Frequently asked questions about mealtimes
How can I tell if a child is able to eat and drink by mouth?
You will need to talk to the speech pathologist and doctor to work out if a child is ready to eat and drink. For children to be able to eat and drink by mouth they must be able to swallow safely and must be healthy. This means that they need a well-coordinated swallow to send food and drink from the mouth to the stomach without passing it into the wind-pipe and lungs. Specific tests to look at swallowing (such as videofluoroscopy – x-ray) may be needed to determine whether or not a child is aspirating.
What if a child is not ready to eat and drink by mouth?
If a child is not ready to have food or drink by mouth, it is still important to provide him/her with pleasant touch around the mouth and face and help in learning or remembering how to suck and swallow.
When is a child ready to eat and drink orally?
It is important to talk with a child’s feeding team about when they will be ready for eating and drinking by mouth. Recommendations will be different for each child. Some children may have continued to have certain foods or drinks while tube feeding, others will have only had tastes and still others will have had no food or drink by mouth at all.
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The following books may be obtained through the Novita Toy & Resource Centre. If you are registered with the Centre, you can borrow them by completing the on-line request form.
Books referred to on this page
- Blackman (1990) in Koontz Lowman, D & McKeever Murphy, S (1999). The Educator’s Guide to Feeding Children with Disabilities. Paul H. Brookes Publishing Co., USA
- Koontz Lowman, D & McKeever Murphy, S (1999). The Educator’s Guide to Feeding Children with Disabilities. Paul H. Brookes Publishing Co., USA
- Starr, S (1998). The Feeding Assessment Resources Management Guide-Revised (FARM) & The Manual Supplement. Westmead Hospital, NSW
- Wolf, L S & Glass, R P (1992). Feeding and Swallowing Disorders in Infancy: Assessment and Management. Therapy Skill Builders, USA
Books you can read
- Arvedson, J & Brodsky, L (1993). Paediatric Swallowing and Feeding: Assessment and Management. Singular Publishing Company
- Arvedson, J & Lefton-Greif, M (1999). Paediatric Videofluoroscopic Swallow Studies. Communication Skill Builders
- Food for Thought: For People with Disabilities and Their Carers. (1999) Community Accommodation and Respite Agency
- Dunn Klein, M & Delaney, T (1994). Feeding and Nutrition for the Child with Special Needs: Handouts for Parents. Therapy Skill Builders
- Koontz Lowman, D & McKeever Murphy, S (1999). The Educator’s Guide to Feeding Children with Disabilities. Paul H. Brookes publishing Co.
- Morris, S E & Dunn Klein, M (1987). Pre-Feeding Skills. Therapy Skill Builders
- Pridham, L (Ed.) (1999). A Guide to Services in South Australia for Babies with Feeding Difficulties, for Children with Eating and Drinking Difficulties. Dept. human Services: Health SA
- Starr, S (1994). The Feeding Assessment Resources Management Guide (FARM) & The Manual Supplement. Westmead Hospital, N.S.W.
- Starr, S (1994). So Your Child Doesn’t Want to Eat and/or Has Feeding Difficulties. Westmead Hospital, N.S.W.
- Warner, J (1981). Helping the Handicapped Child with Early Feeding: A Manual for Parents and Professionals. Winslow Press
- Wolf, L S & Glass, R P (1992). Feeding and Swallowing Disorders in Infancy: Assessment and Management. Therapy Skill Builders
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Support groups
Families of Infants Reflux Support Association (FIRSA) Inc.
Postal address: P.O. Box 807 Elizabeth, SA, 5112
Phone: 8522 5392 or 8285 4968
Mobile Ph: 0408 817 170 or 0401 241 562
Home Enteral Nutrition Service (HENS)
Women’s and Children’s Hospital
Phone: 8204 7182, Pager No. 4125
Gastrostomy Information & Support Society (South Australia)
- Purpose: An information and support group for adults and children (who have a gastrostomy), their carers and interested professionals, such as speech pathologists, enteral nurses (HENS), nutritionists and representatives from Abbott’s Australia (distributors of gastrostomy products).
- Group meetings:
- Conducted quarterly, 7.00pm, Tues March 15th, Tues July 19th, Tues Nov 15th at Disability Information Resource Centre (DIRC), 195 Gilles Street, Adelaide
- The main emphasis is to provide information (usually via a guest speaker) and provide an opportunity for sharing
- Past speakers have included a gastroenterologist, surgeon, dentist, person from an advocacy agency, HENS nurse and nutritionist
- Suggestions for future topics/guest speakers welcomed!
- Non-members may attend the meetings but will not receive the newsletter or other mail-outs
- Further information: Visit the Gastrostomy Information and Support Society - Victoria website to find out about the branch of the Society in South Australia.
Disclaimer Detail: The above information on is of a general nature only and does not constitute advice. Novita Children's Services makes no representations, express or implied, as to the accuracy, usefulness, suitability or application of the information to a child's particular circumstances. Use of the information above is at your sole risk, and you should seek professional advice before acting or relying on the information. Novita Children's Services accepts no liability for any damages or loss that may arise from the use of, or any omission from, the information provided.
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