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Evaluating feeding concerns.

Parents of children with special needs often have difficulty finding the appropriate professional(s) to deal with their concerns about how and what to feed their child. Different professionals can contribute to the understanding of the various aspects of feeding. Only rarely can parents find a multidisciplinary team who understands all aspects of feeding problems and can work with the family to solve the problems.

Parents often find that no one professional can answer all of their questions about feeding. A feeding team, where a variety of professionals work collaboratively with parents to solve feeding problems, is not available in all settings. Parents will want to find professionals who are used to working with children with special needs similar to those of their child's. Start by asking professionals you now know, including the nearest Parent Information and Training Center, if they can recommend individuals with special expertise. Places to look include children's hospitals, children's rehabilitation centers and university-affiliated programs for the developmentally disabled.

Team Members

An assessment of a child's feeding problems may require the special skills of a number of different professionals with different perspectives. When a multi-disciplinary feeding clinic is not available, parents may want to consider creating one from some of the following kinds of specialists.

Physicians deal with many issues related to feeding. The physician who knows your child best is the place to start in the evaluation. Most other professionals will want to be sure that your child is free of medical problems which might cause feeding difficulties or make them worse. The physician will prescribe treatment of the medical problem if one is identified. One such treatment might be feeding by tube rather than by mouth.

Nurses can also evaluate your child's general health via a physical exam with measurement of your child's height and weight. The nurse may want to watch you feed your child so that suggestions about how you interact with your child during meals can be given. Nurses can also help you coordinate the various recommendations you receive from others and provide follow-along. School nurses or other nurses in the community can feed your child or supervise others who feed your child while away from home, particularly if a tube feeding is indicated.

Clinical dietitians or nutritionists evaluate a child's growth and the amount and quality of food eaten. They use weight, height and other measures, including the amount of fat and muscle in the body. Dietitians and nutritionists can provide specific information about the types and amounts of food and liquid your child needs to grow properly. These recommendations should be in terms of your child's special health needs and ability to chew and swallow. Before you go for an appointment, they may ask you to keep a record of what your child eats for three to four days. Be sure to be specific about the amounts your child actually swallows.

Dentists and dental hygienists look at your child's teeth to see if dental health is a factor in your child's eating. They will evaluate the shape of your child's mouth to determine if it makes feeding more difficult. Dentists and dental hygienists give recommendations about how to keep your child's mouth healthy so eating is easier.

Occupational therapists evaluate how your child uses the tongue, teeth and lips and the quality of the swallow. This is important especially if your child is choking. They observe how your child reacts to food textures and different temperatures. Occupational therapists also look at how your child is progressing toward self-feeding and will give you recommendations on how to help your child be more independent in feeding.

Speech and language therapists also look at how your child uses the lips, tongue and teeth. They can suggest changes that will improve both your child's eating and talking.

Physical therapists look at your child's balance and posture as they relate to feeding. They may recommend specific kinds of seating that will make feeding your child easier or help with self-feeding.

Psychologists look at how problem behaviors and a child's environment work together to affect feeding. They may watch your child eat and interview you. Psychologists can suggest ways you can encourage your child to eat better with fewer behaviors which interfere.

Most feeding problems take a while to develop. It is likely that they will take a while to go away. Once parents develop a network of professionals to help, it is worthwhile to keep in touch with them so that you will have an ongoing source of support and information.

The photos used in this article were taken during an evaluation at the Nisonger Center, Ohio State University, Columbus, Ohio. Our appreciation to the Nisonger Center, as well as MotEs Photographic Center, Inc., for providing these photos.

Ellen Hall King, Ph.D., R.N., is Chief of Nursing at the Nisonger Center and Adjunct Assistant Professor in the College of Nursing at Ohio State University in Columbus, Ohio.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:King, Ellen H.
Publication:The Exceptional Parent
Date:Jun 1, 1993
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