Eating and Feeding techniques

Oral Motor Competency

Oral motor competency involves coordination of lip, jaw, tongue, and swallowing movements. Difficulties arise from abnormal reflexes or motor delays. Reflexes like biting or rooting can disrupt feeding, requiring specific strategies like avoiding touching sensitive areas.

Positive Practice

Developing mature feeding skills requires repeated, intentional practice of movements until they become automatic. Students must perform these refined skills consistently for successful eating. The more practice they get, the quicker they learn.

Environmental Factors

A calm, distraction-free setting supports better eating. Minimize noise and smells; avoid feeding near bathrooms or trash. Use bright utensils or high-contrast placements to aid visual attention. Ensure the student is well-positioned and stable.

Positioning and Motor Control

Proper positioning is crucial for feeding success. It affects comfort, motor control, and swallowing safety. Each student requires individualized support based on posture, tone, and alertness. Stability and visual access must also be considered before implementing feeding interventions.

Spasticity

Students with cerebral palsy may have muscle spasticity, causing head extension and unsafe swallowing. Tilting the head forward (5–15 degrees) helps prevent aspiration. Shoulder alignment is key; rolled towels or adapted wheelchairs may correct posture. Proper positioning supports better swallowing.

Severe Extensor Thrusting

This condition involves extreme body extension—arched back, tight arms, and retracted shoulders—often worsening feeding challenges. Students may experience unsafe swallowing and tongue or lip retraction.

Hypotonic (Low) Muscle Tone

Low muscle tone affects head and trunk control, causing poor posture and food pooling. Support with headrests or tray height adjustments helps maintain alignment and reduce aspiration risk during feeding

Athetoid Movements

Involuntary movements in athetoid cerebral palsy interfere with feeding. Stabilizing head and limbs using straps, dowels, or weighted tools improves control. Supporting head midline enhances safe and independent eating.

Primitive Reflexes

Persistent infant reflexes (ATNR, STNR) affect posture and feeding. Head turning triggers asymmetrical movements; chin tucking causes leg and arm shifts. Positioning and head support’s help minimize reflex activation.

Oral Tactile Defensiveness and Lack of Tactile Response

Some students overreact to oral input, rejecting food; others underreact and can’t feel food in their mouths. Desensitization or sensory programs help improve oral awareness and feeding comfort.

Food Consistency for Tongue Thrust

Thickened or altered food textures reduce exaggerated tongue movements. Smoother textures and slower flow support mature swallowing, jaw movement, and safer, more controlled feeding for students with tongue thrust.

Jaw Support for Tongue Thrust

Jaw support helps stabilize tongue position and reduce thrusting. Applying gentle pressure under the chin supports alignment. Not suitable if thrusting relates to breathing difficulties or respiratory issues.

Tongue Pressure for Tongue Thrust

Pressing down on the tongue with a spoon for 2–3 seconds helps reduce thrust. Placing food on the front third of the tongue assists with control and safe removal.

Vibratory Input for Tongue Thrust

Vibration on the tongue can reduce thrust. With infants, a finger is used; with students, a spoon delivers gentle, rhythmic stimulation. Helps improve tongue awareness and reduce unwanted movement.

Tonic Bite and Unstained Bite Reflexes

Tonic bite causes tightly clenched jaws triggered by stimulation. Unsustained bite involves hesitation when biting. Both hinder functional biting. Strategies include environmental adjustments, tactile support, and feeding techniques to build control.

Preparing the Feeding Environment for Tonic Bite

Proper seating and a calm, low-stimulation environment help prevent tonic bite. Poor posture and overstimulation increase tension and oral defensiveness, making the reflex more likely. Positioning is key to regulation.

Tactile Input for Tonic Bite

Firm, predictable tactile input to face and mouth can reduce hypersensitivity. Avoid light or tickling touches. Calm preparation helps build tolerance. Therapists can guide caregivers on safe, appropriate tactile strategies.

Feeding the Student with Tonic Bite

Reduce bite reflex frequency by creating a predictable feeding rhythm. Present cups or spoons to the lips, not teeth. Use soft-coated tools, jaw support, and cheek delivery if needed.

Releasing Tonic Bite on a Utensil

If a utensil is clenched, don’t pull. Use calm, firm pressure and check head alignment. Facial massage or jaw pressure may release tension. Gentle manipulation can open the bite safely.

Allergies

Food allergies can cause intestinal, respiratory, or skin reactions—sometimes delayed. Elimination diets help identify triggers. Students may react to new foods or previously safe ones, requiring close monitoring and planning.

Management Issues for Feeding and Eating

Individualized Health Plans (IHPs) and IEPs outline feeding needs, dietary restrictions, and assistive strategies. Tracking prompts and progress ensures safe, consistent support—especially for students with allergies, motor issues, or emergencies.