A scenario is listed for each topic. Please read each scenario and respond to each student discussion board. There are 4 student discussion boards. Respond to each one.

Feeding & 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.

Discussion #1 (Dan) 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.

Discussion #2 (San) Oral tactile defensiveness defiantly makes sense as a struggle for Susie. What types of activities do you think a OT would suggest for her teacher or parent’s do in order to help her adjust to new sensations?

Feeding & Eating Scenario #2

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#1(Tee) Hello Everyone,

• 1) Based on that Jody “eats a good variety of foods”, but “consumes only a small amount of food during each meal and becomes fatigued very quickly” and “she often loses food from the mouth”, this seems to match with Level 2, “eats a range of food textures that are age appropriate”, “may tire if textures challenging and mealtimes will take longer than for peers”, and “loses small amounts of food or fluid especially challenging textures” (Chailey Heritage Clinical Services, 2013). It also specifies that Jody is able to “grab them independently to feed herself” would suggest she is at an “independent” level for level of assistance required.
• 2) I think the fact that Jody’s “swallow is generally followed by a large intake of air as if she is out of breath” should be discussed with the concerns for possible aspiration. “Positioning is an essential prevention strategy” (Demchak, 2021). Since Jody tires so easily, making sure that she “remain in an upright to semi-reclining position after finished with the meal” is important as “when one is in an upright position, gravity helps to prevent reflux…preventing reflux helps to prevent aspiration” (Demchak, 2021)
• Discussion#2 (Dan) I would put Jody at Level 2 of Eating and Drinking Ability classification. She is able to eat independently and a wide variety of foods. However, the concerns with her is that she eats only a small amounts of food at meal times and then asks for more later. And with taking deep breaths after eating, there is the concern with either choking or aspiration to look out for. 2) Another reason I put Jody at Level 2 was it mentioned that while Jody eats, she seems to be primarily a finger food eater in that she grabs her food. The scenario doesn’t mention if she uses utensils or a cup, but the text (pdf pgs 29 to 30) of Chapter 9 about Feeding and Swallowing talks about spoon-feeding. It mentions that when presenting food to eat, use small amounts on the front of the spoon. I wonder if using a spoon with small portions on it would help Jody increase more of her food intake and eat more instead of losing it when she eats with an open mouth.

• Feeding & Eating Scenario #1

• 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.
• Discussion #1I 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.