SPECIAL NUTRITIONAL CARE PROBLEMS
Individuals with special needs may have difficulty achieving an adequate nutrients intake because they may be unable to feed themselves; or they may be limited in their ability or be unable to suck, bite, chew, or swallow fluids and/or foods. Severe arthritis may affect the joints of the fingers, the elbow and the shoulder to such an extent that the adult individual cannot feet himself; or affect the jaw so that he/she may even have difficulty biting and chewing. Some after a cerebral vascular accident (stroke) may be unable to swallow semisolids such as “soupy” mashed potatoes or soft ice cream.
Infants and children with neuromuscular defects such as cerebral palsy may present numerous problems that require carefully planned and consistently implemented feeding training programs in order to achieve their potential for self-feeding. Until a cleft palate with or without a cleft lip is repaired surgically an infant with this congenital anomally has special feeding problems.
It is necessary to assess the individual’s needs when determining the method of feeding and/or feeding training to be used to assist him/her in achieving their potential. There are two major aspects of this assessment:
1. the individual’s nutritional needs- to assess nutritional needs, age, height, weight, activity level and any disease requiring diet modification must be identified.
2. his/her physical capacity- physical capacity must be evaluated to set reasonable goals for self-feeding or feeding training program. In certain situations special attention must be given to the consistency of food required to overcome the difficulty.
-inability to suck, close lips
-inability to bite, chew, swallow
poor hand-mouth coordination
-poor trunk and upper extremities control
These are the developmental tasks the normal infant and young child goes through in achieving the ability to feed himself, and the skills the normal individual uses throughout life. Although it is not necessary that all skills at each level be completely mastered before progressing to the next one, some evidence of skill or readiness is necessary at all levels if self-feeding is to be achieved. The neurologically handicapped infant may present problems in progressing to one or more levels in sequence, while the recently handicapped adult may lose his ability to perform at one or more levels.
Motor Performance Problems
The normal feeding position for humans is upright and requires the ability to sit up and control the balance of the head. Proper position of the handicapped individual should be based on the assessment of his ability to hold himself upright. Aspiration of fluids or food into the bronchi can be hazardous to the individual who cannot maintain head balance.
Individuals with limited ability to support the trunk may be helped to sit at the table by stabilizing the trunk with a binder or strap secured at the pelvis. The individual is also more stable if his feet are firmly positioned flat on the floor or on a footstool. If the individual is in a wheelchair, the footrest is used. This method permits the individual to concentrate on his food rather than worrying about falling off his chair. It also eliminates constricting the chest or “hanging” which happens frequently when a binder is placed under the arms.
If the individual is seated in an armchair, pillows at each side and a headrest may be used for stabilization. A lapboard, or an over-bed table adjusted to the appropriate height, is useful to the individual in a wheelchair or armchair. When a lapboard is used, it is advisable to have it equipped with a raised edge so that the patient with poor motor skills is not frustrated by having dishes and other equipment slide off the board onto the floor. For the small child, a highchair is often appropriate because of the protection it offers on all four sides. For the larger child it is helpful to use a cutout table with a strap placed across the back of the chair to hold him close to the table.
Adaptive equipment may be used in the beginning of any feeding training program. However, the objective is to move from adaptive equipment to independent skill as soon as possible if the situation permits. For the quadraplegic adult or the neurologically handicapped child, adaptive equipment may be a part of his life if he is to achieve and maintain some degree of self-feeding skills. There are many adaptive devices on the market today to help those who need them.