SENSORIMOTOR
 
CHANGING THE PHYSICAL ENVIRONMENT

Each meal that you share with a child can be made easier or more difficult for both of you. Much depends upon the physical positioning of the child, the physical positioning and comfort of the feeder, and the type of feeding equipment that is used. The following ideas or tips can help you make useful changes in the physical environment.

Changes in the Overall Physical Environment

  • Prepare the area in which you will be feeding. Do you have the spoon, cup, bib, or other feeding utensils you will need? Do you have any pillows or other equipment adaptations that you use to help position the child for feeding? Do you have the equipment you want to use for your own physical comfort during feeding? If you have this ahead of time, both you and the child will be more relaxed and the meal won't seem so rushed.

Changes in the Physical Positioning of the Child

  • Control at the top, begins at the bottom! If you want to encourage better head control, look at the way the hips, pelvis, bottom, and legs are positioned. Begin to make changes here, and changes of the arms, shoulders, head, mouth will be easier.
  • When the feet are supported, it is easier for the child to sit with weight on both sides of the bottom. When weight is even on both side of the bottom in sitting, it is easier to sit without falling over to the side.
  • Place a pillow, block of foam, or rolled up towel between the child's thighs and knees if the legs tend to pull closely together. The child's wheelchair may have an abduction wedge that keeps the legs apart. These adaptations make sitting easier
  • Place a pillow or rolled up towel under the child's thighs and knees if there is pushing backward with the bottom and trunk when sitting in a chair. This gives more bending or flexion in the hips and sometimes makes it easier for the child to sit without pushing the body into extension.
  • Encourage the child to keep the arms quietly on the wheelchair tray or table. When the arms are quiet, it is easier to control movements of the head and mouth. If the shoulder girdle pulls forward or down, place a thick foam or towel roll on the table. Lean the child slightly forward so that the roll is under the upper arms and the forearms are resting on the table.
  • Find ways to keep the head from pushing or flopping back. When the head is back, it is harder for the child to see food coming and prepare for the bite. It is harder to use the mouth for eating, and harder to swallow.
  • A small pillow or a rolled up towel can be used to keep the head in a more upright position. You can also use your hand or arm behind the head if this is comfortable for you and doesn't cause the child to push back more.
  • You can place your hand gently under the child's jaw to help with mouth closure. This is only effective if you have started at the bottom and improved the position of the pelvis, shoulders, arms, neck, and head first.
  • Some older children have contractures. These are permanent changes in the muscles and bones that make it impossible (or very difficult) to bend or straighten an arm or leg. Sometimes there is a bending or twisting of the spine that makes normal sitting or lying very difficult. Discuss what you can do about contractures with the physical therapist who works with the child. They may have some ideas that will help you get better positioning at mealtimes.
  • Make these adjustments very slowly and gently. Changes usually feel very different and often feel uncomfortable, even if you know they will help the child lie, sit, or eat better. It is easier for all of us to make changes in our lives if they don't come suddenly.

Changes in the Physical Positioning of the Feeder

  • Remember, when your body is relaxed and comfortable, it will be easier to feed someone else. Look around and locate a chair or stool that you could sit in comfortably when you feed the child. Do you need to be higher? Do you need something under your feet? Do you need to be physically closer to the person you are feeding? Figure out ways of adapting or adjusting the chair (with pillows, boxes, etc.) so that it fits your body. Begin the search for equipment that would help you.
  • If you are feeding more than one child in a school or residential facility, use different positions of your body to feed different children.. You could sit or stand. You could feed from in front, from the side, or from behind the other person. When you feed in different ways, your body will have more energy. You won't become as tired.
  • When you sit at the same eye level as the child you are feeding, it is easier for the child to look at you and enjoy your company. It is also easier for the youngster to communicate without pushing the head into extension. When you are standing, the child may want to look at you, so the head pushes into extension. As you know, when the head is back, it is harder to suck, swallow, and chew.
  • If you are sitting in front of the child's wheelchair, move your chair closer to the wheelchair. Place your feet on the footrest of the wheelchair. This makes it easier to reach the mouth and also gives you a comfortable place to put your feet.

Changes In the Equipment Used for Feeding

  • Use a spoon that fits the size of the child's mouth.
  • Bring the spoon into the mouth at a straight, horizontal level. If you tip the spoon or bring it in from a higher level, the child may need to tip the head back to get the food.
  • Use a cup that allows you to see how much liquid you are tipping or pouring into the child's mouth. This gives you more control and it will be easier for both you and the child.
  • Use a shallow cup with a wide rim or a cup with a circular cut-out on one side. When you tip the cup up, the child can get the liquid without pushing the head back. When tall or narrow cups are used, the child often has to put the head into extension to drink.

Get PDF Suzanne Evans Morris, Ph.D.
Speech-Language Pathologist
New Visions
1124 Roberts Mountain Road
Faber, Virginia 22938
(804)361-2285

This paper is a working draft and multiple copies may not be reproduced
without prior written permission of the author
Suzanne Evans Morris, 1997 All Rights Reserved

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