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If getting your developmentally delayed child to eat is a three-times-a-day struggle, you've got lots of company; as many as 80 percent of developmentally delayed kids have difficulty eating. Oral defensiveness, tactile sensitivity, reflux and poor muscle control can all make eating a battle rather than a pleasure -- for you and your kid. Even if your child has a feeding tube, your ultimate goal may be to limit its use. Choosing the right foods, presenting them in the right way and proper positioning at the table are all part of successful feeding.
Choosing a Chair
If you've ever tried to eat lying down or slumped over, you can understand the importance of positioning for meals for your child. Postural alignment, with the trunk and head straight, can improve swallowing and decrease feeding difficulties. For some kids, a specially-made chair with a tray that allows them to sit upright, feet on the floor, might be necessary. If your child is older, a footrest might help him maintain his balance and an upright position while he eats. If he doesn't have the motor control to keep his body and head upright and straight while eating, he's more likely to choke. He might also need to use his hands to keep himself balanced, which means he won't be able to feed himself.
Kids who spent weeks or months in the NICU getting their nutrition through a feeding tube or IV often have oral defensiveness. They never learned to coordinate sucking and swallowing at the proper developmental age, and they often had to deal with people putting tubes in their mouth or nose. Overcoming oral defensiveness takes patience and time. Play games in which you gently touch your child's face with soft objects or teach him to touch his own face. When he can tolerate that, touch or stroke the area around his mouth before a feeding. Bring food to his mouth slowly and gently. Avoid metal silverware, which is both hard and cold; choose rubber or plastic feeding implements instead.
Chewing is far more complicated than you might think. Foods react differently in your child's mouth; some fall apart, others require prolonged chewing. When you put food that requires chewing in the center of his mouth, he needs to move it to the side so he can use his back teeth to chew it, then move it back to the center to swallow it, a two-step process. Placing food to one side of his mouth, called lateral placement, means he only has to move it once, from side to back. Doing this might make it easier for him to chew and swallow.
Chewing difficulties and choking often go together in developmentally delayed kids, because both are often related to problems with muscle tone. Developmentally delayed kids often have reflux, which means food comes back up after a meal, causing coughing or choking. Your child will have less problem with reflux if you keep him upright and properly positioned during his meal and for 45 minutes afterwards. Make sure he swallows one mouthful before putting another in; stuffing and swallowing without chewing, which takes effort, is common in developmentally delayed kids. Sit near your child when he eats and watch for signs of difficulty, such as coughing or throwing his head back when he eats.
Widening His Choices
You might be sick and tired of fixing the same foods, day after day, for your kid, but have resigned yourself to the fact that he won't eat anything else. However, you might be able to broaden his choices a bit by thinking about the foods he eats. Are there any common denominators? Will he only eat foods of a certain color or texture? Some kids with sensory issues do better with foods that have a strong taste rather than bland ones; others can't handle the feel of food moving around in their mouth and don't handle foods that need prolonged chewing well. Experimentation can help you find new foods he'll eat, but never force food; expect changes to come slowly.
Suzanne Robin is a registered nurse with more than 25 years of experience in oncology, labor/delivery, neonatal intensive care, infertility and ophthalmology. She also has extensive experience working in home health with developmentally delayed or medically fragile children. Robin received her RN degree from Western Oklahoma State College. She has coauthored and edited numerous books for the Wiley "Dummies" series.