Tuesday, May 3, 2016

Toward More Refined Self-Feeding Skills

One of my middle-school students really enjoys her friends--telling jokes, hanging out in the hallways, sharing "insider" info about TV and movie stars.  She's known these friends since late elementary school and feels very comfortable around them.

However, there is one time of the day when she doesn't feel so comfortable and that's lunch time.  Because of difficulties with allover motor coordination, including oral motor, her table area, clothes and face end up covered with stuck-on food and numerous spills.  Her friends have started sometimes eating without her because they are pretty grossed out by the food coming out of her mouth at unexpected times and the spills that end up on their clothes, even on their food.  It may not be a reflection of "true" friendship, but it's reality among pre-teens to strive to hang out with others who draw attention to the group because of their "cool" factor and not because they look different.

As for me, I think about how her difficulties with managing food affect her now and in the future.  She will probably participate in vocational settings while still in high school and then work for pay after high school is completed.  Will her co-workers sit with her in the employee lunchroom or will they avoid her?  Will she miss out on conversations around the water cooler because co-workers avoid looking at her crumb-strewn face?  Sound harsh?  Of course.

Yesterday during her lunch the student, "Zoey," her instructional assistant and I found a quiet kitchen at her school and opened up her lunch box.  My intro to her was that, just for today, we were going to experiment with having her enjoy all her food without losing any.  We were going to keep the table area clean so that we didn't have to spend time sweeping the floor afterwards.  She was going to have a clean face at the end of the meal so she wouldn't have to spend time going to the washroom to towel off her face.

I taped a 3' wide swatch of bulletin board paper to the table, using a dark color so any crumbs could be easily seen.  We focused on eating the nutritious foods first--her chicken sandwich and fruit.  To save time, I cut her chicken into 1" square pieces and asked her to use a fork instead of her fingers.  She said she wasn't crazy about eating the bread so we left it.
I asked her to chew one piece of meat at a time.  After swallowing it I asked her to drink a sip or two of water and then asked if her mouth felt empty.  If it didn't feel empty I asked her to drink more water.  Same for her orange mini sections.  Even though they were juicy I still asked her to drink water after swallowing the food.  She only had time for two bites of potato chips--one at a time-- followed by water.

At the end of lunch I asked her if her mouth felt clean/empty--yes.  She had no crumbs on her mouth or anywhere on her face.  There was no food on the floor and a minimal amount on the "placemat."

Food packages removed--water spills and few crumbs evident.  Floor clean.
She didn't need to wipe her face or get a broom and dustpan to sweep the floor.  She just packed up her leftovers and went on to her next class.

This session answered my questions: could she manage food within her mouth without losing it, simply by slowing down her quantity and pace of food intake--yes.  Does sipping water aid in keeping the food from being trapped within her mouth--yes.  Does she demonstrate any coughing or choking during the meal--no.

I estimate that Zoey can become independent in managing food within her mouth, following these guidelines for reduced food intake per bite and using water to clear her mouth, if she practices for about 1-2 school years and also practices daily at home.  She has spent 14 years practicing what she currently does during mealtimes and snacks; it will take a lot of practice to change her accustomed habits.  Her IEP meeting is this week--I will ask her team if they think better oral management is important.  Zoey and her family will be at the meeting.

Do you remember that I told Zoey that we were doing the experiment "just for today?"  That's true.  It may end up being a one-time thing.  She has to feel it's important and so does her family.  If she wants to work toward more refined self-feeding habits it will require a lot of effort and time from her and on the part of school staff and her family.

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