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Occupational therapists are vital parts of a multi-disciplinary team to help make clients’ eating experiences safe and enjoyable. In this lesson we will discuss how clients’ medical and developmental needs influence how the OT approaches each case.Feeding: A Vital Activity of Daily LivingTo many people, occupational therapy is almost synonymous with activities of daily living, or ADLs. Bathing, dressing, grooming, and other actions we all take every day are the ‘occupations’ of occupational therapy.Eating, of course, belongs in this group, and is primary in most schools of thought, as virtually the only ADL on which life depends. Occupational therapists are uniquely qualified by their training to play a major role in helping people in need learn to eat independently, safely, and happily.Sensory Needs and FeedingOne area in which OTs have particular strength is the area of sensory integration, the way the brain organizes input from the senses so a person can act on them. Sensory issues often impact feeding ability, particularly in children with special needs. OT addresses those needs in a variety of ways, some of which are not directly set during a feeding of mealtime experience.For example, Carolyn, an OT, works with Sasha, a preschooler with mild autism spectrum disorder. Sasha only eats a few foods and gets very upset when pressed to try other things. Carolyn works closely with Libby, her team’s speech pathologist, who focuses more on what happens to the food once it gets into the mouth. Libby has evaluated Sasha’s oral motor skills, how well his tongue and lips and jaw work, and found they are adequate.However, Carolyn assessed his sensory status and found he has some significant problems with processing. So she put together a sensory diet program, teaching Sasha gradually to tolerate and even enjoy new experiences. At first, she did not implement anything during mealtime, to avoid creating any aversive reactions and causing Sasha to have negative feelings about eating. Over time, however, as he became more able to handle novel sensory input, she began encouraging him to try new foods.Developmental Levels and FeedingEating is by definition a developmental skill. As infants grow, they develop the physical and mental ability to participate in feeding and eventually dine independently. Some children with feeding problems are ‘stuck’ at an early developmental level, despite their chronological age. They must be met by the OT where they are.Another of Carolyn’s clients, Latrice, has cerebral palsy. Though she is 14 years old, her oral skills are closer to a baby of 18 months. She bites on a cup to hold it stable when drinking, and chews food by munching with her jaw moving up and down. Carolyn and Libby work together teaching Latrice more advanced oral skills so she can eat more neatly and effectively, enjoying her meal and improving her nutrition.Physical Issues and FeedingJulio is another of Carolyn’s clients. He has a lot of physical challenges, and has a great deal of difficulty holding utensils and eating. Carolyn breaks out her full arsenal of adaptive equipment designed to make up for physical limitations and allow eaters to be as independent as they can be.In Julio’s case, he has trouble with his fine motor control including tremors that sometimes cause him to drop or even throw things he tries to hold. Carolyn brings him a spoon with a weighted handle; the added weight helps to dampen Julio’s uncontrolled movements and lets him manage the utensil much more smoothly. During her last visit with him, Carolyn helped Julio eat some mashed potatoes by himself. His big grin and laugh of delight made her day!The interaction of FactorsThese examples are somewhat simplified. Each client’s case is a delicate interplay of the factors we have discussed and more. The social and environmental aspects of mealtime play a large role in a client’s performance, whether positive or negative. Cultural norms are important as well, as is the individual client’s cognitive level.Occupational therapists are trained to consider all these elements in every task they address with their clients, whether showering, cleaning house, or eating a meal. This puts them in a position to be a critical part of a treatment team for feeding disorders. Carolyn gives and receives input from Libby and the rest of her co-workers every day, working to manage their clients and help them to be the best they can be.Lesson SummaryOccupational therapists’ work targets activities of daily living, or ADLs like bathing and dressing. Feeding is one of the most important ADLs. OTs are trained to take a holistic approach incorporating physical, cognitive, sensory and environmental elements. Sensory integration, the way the brain organizes information, affects how a child perceives food. A sensory diet program works to improve processing while avoiding aversive reactions. A child with physical challenges can benefit from adaptive equipment to enable independence. Developmental delays in feeding skills are addressed starting from where the child is and moving forward at their rate. In all these areas, OTs work closely with their teammates in other disciplines, especially speech pathology.

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