Early intervention supporting mealtimes

A fundamental part of early intervention is involving and empowering the parents and supporting a positive relationship between them and their children. Mealtime is a time were parents and children engage socially several times a day – exploring different food textures, smells and tastes. 

Adequate nutrition is fundamental for children’s growth, mental and physical development and part of the foundation for optimal requirements of learning.   

Feeding disorders and swallowing deficits, for example dysphagia, might interfere with motor and cognitive skills because the child is trying to learn while being hungry and without the appropriate energy levels. 

Children with disabilities might have abnormal muscle tone and reflexes which further contributes to poor alignment of the head, neck, and trunk. Malalignment of the head, neck and trunk can interfere with the swallowing process and cause aspiration.*

Positioning can be used as an intervention to reduce the risk of aspiration in children with moderate to severe neuromotor disabilities. 

Aspiration is a term used when you accidentally inhale food or liquids into your airways and lungs instead of swallowing through your food pipe and into your stomach. Aspiration can cause health problems such as pneumonia. It is well documented that many children with moderate to severe cerebral palsy or other neuromotor conditions are at high risk for aspiration due to poor coordination of their oral motor skills. Oral motor skills include movements of their muscles in their mouth, jaw, tongue, lips and cheeks and poor coordination of oral motor skills interfere with their ability to chew, suck, swallow, bite and lick. 

Changes in neck alignment can affect the child’s ability to protect their airways during swallowing. To protect the airways, flexion of the neck is an optimal position to minimize aspiration. It has also been noted that safety and efficiency can be enhanced with upright positioning. 

Recommendations for safe and efficient feeding for children with high risk of CP and dysphagia:

• Softer food consistencies to enhance feeding safety and efficiency 
• Slightly reclined or upright seated position to enhance feeding safety and efficiency and avoid very reclined positions (> 30º ) that may exacerbate swallowing deficits 
• Individualized, supported positioning of head, neck, trunk and pelvis with a focus on a stable pelvis, optimal body and head alignment and a flexed neck to minimize the risk of aspiration and enhance feeding safety and efficiency. 

Feeding disorders and swallowing deficits in infants and young children are often very complex problems. They are therefore best evaluated by an interprofessional team.