Deck 15: Feeding Intervention

Question 1

Robert is a 4-year-old boy with a limited diet. He does not like to try new foods. Which statement best reflects how the therapist should help Robert expand his diet?

A) Only provide Robert with new foods; eventually he will try them
B) Continue to introduce new foods over several mealtime sessions
C) Try to "sneak in" new foods by covering them with the food he likes
D) Allow him to eat the food he likes only after he has tried the new food

Answer 1

B

Question 2

Sara is a 4-year-old girl who has the diagnoses of prematurity, cerebral palsy, global developmental delay, chronic lung disease, and seizure disorder. She presents with low muscle tone in the trunk and increased muscle tone in all four extremities. She is unable to sit without support and uses a wheelchair that places her upright with hips at a 90-degree angle, and her head, neck, and trunk are well supported. Given her motor impairments, Sara primarily uses a suckle pattern with bottle-feeding and takes purées by spoon. She is dependent for self-feeding and is held by her mother for meals. She occasionally takes some higher textures such as soft dissolvables. An occupational therapy evaluation finds Sara functioning at an 18-month level for fine motor and cognition. Oral phase swallowing characteristics include an elevated and retracted tongue, slow bolus formation, and lack of tongue mobility. Sara loves to eat but vomits frequently. Her mother reports coughing and occasional choking during meals. There has been slow weight gain, and weight has now plateaued.

-Which team member would you expect to have the least involvement in oral motor treatment at this time?

A) Nutrition
B) Gastroenterology
C) Behavioral psychology
D) Occupational therapy/speech language pathology

Answer 2

Behavioral psychology

Question 3

What is it called when the infant's tongue moves back and forth and the jaw opens and closes, following the movement of the tongue?

A) Suckling
B) Sucking
C) Chewing
D) Non-nutritive suck

Answer 3

A

Question 4

Byron is an 11-month-old child who is not feeding himself with his hands. He drinks from a bottle but does not actively hold the bottle. Byron gags when a cracker or cookie is introduced. He is able to swallow puréed cereal without coughing. Which statement best reflects the interpretation of these findings?

A) Byron is functioning within normal limits; he shows no delays.
B) Byron is delayed in feeding; typically finger-feeding develops by 8 months.
C) Byron is delayed in his ability to tolerate textured foods but is within normal limits for self-feeding.
D) Byron should be able to hold a spoon and feed himself at this age.

Question 5

During feeding, what is the function of the larynx?

A) It contains the food during drinking and chewing
B) It funnels food into the esophagus
C) It is the valve to the trachea that closes during swallowing
D) It stops air from flowing into bronchi and lungs

Question 6

Which pattern of behaviors reflects oral hypersensitivity?

A) Gags frequently, limited variety of foods, turns away from feeding
B) Coughing when swallowing, eats a large variety of foods, enjoys self-feeding
C) Chews all foods carefully, loves soft foods, avoids mealtimes
D) Mouths objects, history of pica, likes brushing teeth

Question 7

Which intervention activity would be recommended for a child with poor oral sensory awareness?

A) Provide foods with many textures and sweet flavors
B) Provide foods with strong flavors and cold temperatures
C) Provide puréed foods only and warm fluids
D) Provide bland foods at warm temperatures

Question 8

Sara is a 4-year-old girl who has the diagnoses of prematurity, cerebral palsy, global developmental delay, chronic lung disease, and seizure disorder. She presents with low muscle tone in the trunk and increased muscle tone in all four extremities. She is unable to sit without support and uses a wheelchair that places her upright with hips at a 90-degree angle, and her head, neck, and trunk are well supported. Given her motor impairments, Sara primarily uses a suckle pattern with bottle-feeding and takes purées by spoon. She is dependent for self-feeding and is held by her mother for meals. She occasionally takes some higher textures such as soft dissolvables. An occupational therapy evaluation finds Sara functioning at an 18-month level for fine motor and cognition. Oral phase swallowing characteristics include an elevated and retracted tongue, slow bolus formation, and lack of tongue mobility. Sara loves to eat but vomits frequently. Her mother reports coughing and occasional choking during meals. There has been slow weight gain, and weight has now plateaued.

-What is the best way to complete an oral motor/feeding evaluation?

A) Position in her mother's lap because this is her preferred position, and present her with bottle and spoon.
B) Use different positions, first in her mother's lap and then in the manual wheelchair, and present her with bottle and spoon.
C) Position in her mother's lap, and present her with higher-textured foods and a cup because this is more age appropriate.
D) Position in manual wheelchair, and present with only higher-textured foods and cup.

Question 9

Sara is a 4-year-old girl who has the diagnoses of prematurity, cerebral palsy, global developmental delay, chronic lung disease, and seizure disorder. She presents with low muscle tone in the trunk and increased muscle tone in all four extremities. She is unable to sit without support and uses a wheelchair that places her upright with hips at a 90-degree angle, and her head, neck, and trunk are well supported. Given her motor impairments, Sara primarily uses a suckle pattern with bottle-feeding and takes purées by spoon. She is dependent for self-feeding and is held by her mother for meals. She occasionally takes some higher textures such as soft dissolvables. An occupational therapy evaluation finds Sara functioning at an 18-month level for fine motor and cognition. Oral phase swallowing characteristics include an elevated and retracted tongue, slow bolus formation, and lack of tongue mobility. Sara loves to eat but vomits frequently. Her mother reports coughing and occasional choking during meals. There has been slow weight gain, and weight has now plateaued.

-To advance Sara's oral motor skills for improved tongue mobility and temporomandibular joint strength, the clinician would incorporate the following intervention techniques:

A) Use of a chewy tube to increase jaw strength
B) Use of Nuk brush to improve tongue mobility and jaw strength
C) Use of cutout cup to increase lip closure and to decrease suckle pattern
D) Use of all of the above

Question 10

What is the first step in evaluating a child's feeding problems?

A) Observe the parent feeding the child crackers and juice.
B) Interpret the results of a videofluoroscopic study.
C) Ask parents and caregivers questions about feeding, eating, and swallowing.
D) Observe the symmetry, size, and range of motion of the jaw and gums.

Question 11

Sara is a 4-year-old girl who has the diagnoses of prematurity, cerebral palsy, global developmental delay, chronic lung disease, and seizure disorder. She presents with low muscle tone in the trunk and increased muscle tone in all four extremities. She is unable to sit without support and uses a wheelchair that places her upright with hips at a 90-degree angle, and her head, neck, and trunk are well supported. Given her motor impairments, Sara primarily uses a suckle pattern with bottle-feeding and takes purées by spoon. She is dependent for self-feeding and is held by her mother for meals. She occasionally takes some higher textures such as soft dissolvables. An occupational therapy evaluation finds Sara functioning at an 18-month level for fine motor and cognition. Oral phase swallowing characteristics include an elevated and retracted tongue, slow bolus formation, and lack of tongue mobility. Sara loves to eat but vomits frequently. Her mother reports coughing and occasional choking during meals. There has been slow weight gain, and weight has now plateaued.

-Considering her cognitive and fine motor performance level, what would be the next developmental milestone to target in treatment?

A) Straw drinking
B) Cup drinking and finger feeding
C) Self-feeding with utensils
D) Introduction of chopped fine/regular texture

Question 12

Sara is a 4-year-old girl who has the diagnoses of prematurity, cerebral palsy, global developmental delay, chronic lung disease, and seizure disorder. She presents with low muscle tone in the trunk and increased muscle tone in all four extremities. She is unable to sit without support and uses a wheelchair that places her upright with hips at a 90-degree angle, and her head, neck, and trunk are well supported. Given her motor impairments, Sara primarily uses a suckle pattern with bottle-feeding and takes purées by spoon. She is dependent for self-feeding and is held by her mother for meals. She occasionally takes some higher textures such as soft dissolvables. An occupational therapy evaluation finds Sara functioning at an 18-month level for fine motor and cognition. Oral phase swallowing characteristics include an elevated and retracted tongue, slow bolus formation, and lack of tongue mobility. Sara loves to eat but vomits frequently. Her mother reports coughing and occasional choking during meals. There has been slow weight gain, and weight has now plateaued.

-If you are recommending a modified barium swallow study, what specific information would you provide the physician?

A) Vomiting pattern (i.e., volume related, texture related, time of day)
B) History of upper respiratory infections, chronic congestion, and low-grade fevers
C) Episodes of coughing and choking on thin liquids by bottle and lumpy puréed food by spoon
D) All of the above

Question 13

Which sequence represents the correct phases of swallowing?

A) Oral, oral preparatory, pharyngeal, esophageal
B) Oral preparatory, oral, esophageal, pharyngeal
C) Oral, esophageal, oral preparatory, pharyngeal
D) Oral preparatory, oral, pharyngeal, esophageal

Question 14

Which sequence best describes the progression of food texture?

A) Various table foods, puréed, soft foods, raw vegetables, and meat
B) Puréed, various table foods, soft foods, raw vegetables, and meat
C) Soft foods, various table foods, raw vegetables, puréed, and meat
D) Puréed, soft foods, various table foods, raw vegetables, and meat

Question 15

Which consistency of liquid is the most difficult to control within the mouth?

A) Iced drinks from a straw
B) Thick, lumpy liquids from a spoon
C) Thickened liquids from an open cup
D) Thin liquids from an open cup