How OTs Can Help Patients Thrive with Feeding Therapy

By Megan Murdock Krischke, contributor

Some might not associate the occupational therapist’s role with nutrition, but OTs can assist patients in developing independence in food preparation and self-feeding, as well as adjusting to textures and food temperatures they may have difficulty tolerating.

In fact, occupational therapy can mean the difference between failure to thrive and a healthy, well-fed patient.

Feeding therapy in adults

Sometimes adult patients are having trouble with self-feeding: occupational therapists often the first people on the care team to identify the problem.

Cassie Aspen, MS, OTR/L works at a facility that provides a continuum of care to the elderly--from independent living through skilled nursing. She says that patients often come to her with a diagnosis of malnutrition or failure to thrive, but the real problem is that they are having trouble with self-feeding.

“For many of my patients, stretching and strengthening the wrist and hands is a critical first step. I utilize a variety of strengthening methods including electrical stimulation to improve upper extremity and hand function along with adaptive utensils to increase the individual’s independence. Many people feel ashamed at the thought of having to be fed and therefore have refused to eat and become malnourished.”

“For example,” she continued, “I worked with a woman who had had a successful career and was used to being able to take care of herself. She was diagnosed with failure to thrive. She had plenty of food available to her, but her arthritis was so bad that she couldn’t feed herself. All she needed was a built-up handle and she felt more confident to go down to the dining room and socialize.”

Aspen notes that there is correlation between grip strength and malnutrition, but it often goes unrecognized. “OTs are often the first people on the care team to identify the problem,” she pointed out. “I would encourage other OTs not to just treat patients based on their diagnosis, but to do a thorough assessment on everyone. We can really help people to have a better life by recognizing those things.”

Feeding therapy in children

Aspen also had an opportunity to apply her occupational therapy skills in a pediatric setting. At Oregon Health Science University in Portland, she worked with children on the autism spectrum and with developmental delays.

“Children with autism can be hyper-sensory, causing them to have sensitivities to eating or different textures in their mouths,” she said. “There are tools that help reduce the sensitivity of the nerve endings in their mouth--a toothbrush-looking tool will vibrate and train the muscles around their mouth. With those kids we did a lot of sensory integration as well. We slowly expose them to different textures that might be irritating--like working with shaving cream--and allow them become more desensitized.”

Kimberly Korth, MEd, OTR, OT feeding and swallowing program coordinator at Children's Hospital Colorado, works with an interdisciplinary team so that they can develop a holistic view of any child and determine the needs and the best ways to meet the needs of that child.

In particular, Korth encourages any OT who is seeing a child with feeding and nutritional problems to work closely with a dietician.

“OTs are skilled in how to incorporate foods into a child’s diet, but the dietician helps us to know what to incorporate and what kinds of supplements are necessary,” she said.

“Here at Children’s, we use a very child-centered approach. There is no forced feeding and we work with children at their pace and comfort level,” she explained. “We use a lot of interactive play-based therapy and that helps them be comfortable with the food and down the road to put it in their mouth and possibly eat it.”

For older toddlers on up to teens, participating in food preparation can be powerful way to increase a child’s comfort level with foods

Korth notes that there are a lot of adaptive utensils that can help, as well--including curved spoons for children who have trouble orienting the spoon to their mouth, weighted utensils for those with tremors and a variety of cup systems. “One of my favorite products is a Happy Mat which is like a place mat but has a raised smiley face with two eyes and a big smile where you can place food. With the mat there is less throwing of dishes and more eating,” she said.

She adds that for older toddlers on up to teens, participating in food preparation can be powerful way to increase a child’s comfort level with foods.

“Food prep allows a child to explore a food through touching, chopping (as is age appropriate) and stirring. As their interaction with the food increases so does their comfort level,” stated Korth.

“Feeding is an integral part of a child’s day--they have to eat in order to grow and develop and parents have to feed their kids every day. Feeding can be such a challenging aspect of parenting and parents can be so heartbroken over it,” she reflected. “I love being able to help parents--to help them gain tools, to develop a more successful way to feed their child and to relieve the stress.”

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