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Q. What are some good sources for information about helping children transition from tube feeding to oral feeding?
A. The New Visions site is an excellent beginning, with several Information Papers on this topic that are available as PDF documents which can be downloaded into your computer. This gives you away to print out professionally formatted articles for your personal library or to share with a colleague.

Q. What is the best way to help a child transition from bottle to cup?
A. It really depends on the age of the child, his or her intake of other food, and developmental readiness. For example, parents whose child's nutritional needs are being met with solid food have an easier time withholding the bottle and offering the cup, at least during the day at first. The child who still needs to suck, for self-regulation (emotional needs) or to improve lip musculature (motor needs), can benefit from learning to use a straw. The 6-Stage Grow Nurser and Feeding System helps this transition with series of lids: wide-neck silicone nipple, snap-on dual handles, soft sipper spout, flip-up travel spout, straw lid with straw, and a screw on cup rim.

Q. Should parents let the child play with feeding utensils (spoon, cup, straws) to help them normalize sensory input, explore new shapes, and practice hand-to-mouth patterns, in preparation for self-feeding?
A. Parents often give their babies spoons to play with during dependent feeding, to prevent them from grabbing the parent's spoon. However, as their baby begins to develop self-feeding skills, the parent withdraws within a relatively short time. It is usually not socially age-appropriate for children with developmental delays to use feeding utensils as toys. A better alternative to give the child would be a variety of oral-motor toys such as horns (blowing), harmonicas (vibration), tubing necklaces (chewing), etc. Many of those toys are available from PDP Products and New Visions.

Q. How can we help a child who wants to self-feed with a spoon but still has active reflexes such as the grasp reflex and/or avoiding responses?
A. Although the grasp reflex prevents a child from opening the hand to independently pick up a utensil, it actually assists a child in maintaining grasp once the utensil is placed in the child's hand. The avoiding response, however, may be responsible for unintended release. A universal cuff is a simple and useful solution. It can easily be made from Velcro straps.

Q. Why do some children who have advanced to self-feeding with utensils, refuse foods that have mixed consistencies, e.g. soup with vegetables or cereal with milk?
A. This problem has two components: sensory and motor. If sensory processing is inadequate, these children cannot discriminate easily between the solids and liquids, and may not know what they are and where they are in the mouth. If motor control is deficient, they may have trouble dissociating one part of the oral musculature from the other parts, such as jaw, tongue, and lips, to manipulate the food efficiently within the mouth for chewing and preparation for swallowing. We can help them with the transition from smooth to mixed textures by combining foods that are very similar, then less similar, and finally very different.

Q. Why do children have an easier time controlling the cup when it is almost full instead of containing only a little liquid?
A. A full cup requires minimal neck extension, thus a shorter and more comfortable range of movement to be coordinated with finely graded wrist/hand movements and lip/tongue movements during the act of drinking.

Q. What can parents do when their child is frustrated by a new task, such as using a fork, but won't accept help?
A. First we need to analyze the problem, and determine which components need adaptation. Is the child positioned with proximal stability (head, trunk, pelvis) for distal mobility (arm, hand, fingers)? Is the problem with accuracy of shoulder, forearm, and/or wrist movement for correct hand placement? Does the child have an efficient grasp? Is the hand-to-mouth pattern accurate? Can the lips remove food from the utensil? The task itself can be adapted to make success easier, with special utensil handles, a Dycem base for the plate if the child does not hold it with the other hand, and food such as cheese cubes that are easy to stab. Some children will allow a parent to guide the handle of the utensil, rather than use the hand-over-hand method. Also, activities with clay can provide practice.

Q. Why do some children get stuck in that normal negative two-year-old stage, like refusing new foods, for example, and what can we do to help them expand the variety of textures they will accept?
A. The negative stage of eating is a common problem in children with sensory issues and in those whose parents have been very worried about nutritional intake. These children will accept certain familiar foods only, and usually have a very limited repertoire of favorites. The primary problem of sensory defensiveness must be addressed first, before the secondary behavioral problem.

Q. How can we work toward more independence in the older child who still needs external control by the caregiver to use a cup without spilling?
A. The caregiver could alternate jaw control with hand control, so the child can develop skill in one, instead of having to cope with both at the same time.

Q. Why does a child continue to chew with the mouth open despite many reminders?
A. Dissociation of lips from jaw is necessary before a child can chew with mouth closed. Verbal reminders will not help if the motor skill is not achievable. Manual assistance for lip closure during chewing, by the caregiver or the child, may help provide sensory awareness and opportunities for practice.

Adapted from: Erhardt, R.P. (August 23, 1999). Feeding Function Series #1. Independent feeding: Answers to some common questions. ADVANCE for Occupational Therapists, 15(17), 31-32.

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