ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

M y T op T en R esources for W orking with C hildren with F eeding D ifficulties in the C ommunity S etting Kylie Harris For the past two and a half years I have worked as the senior speech pathologist in the paediatric therapy stream at Logan Hospital. My caseload includes general speech and language delays in children under school age and the paediatric feeding caseload. Our feeding caseload includes the special care nursery, maternity and children’s wards and an outpatient caseload. Most children we see for outpatient feeding are referred to us because they are having difficulties transitioning through lumpy solids or because they have difficulty with chewy foods such as red meat. The list of resources I have put together contains those that we use with the outpatient caseload.

1 List of mealtime rules to establish a positive mealtime environment So many feeding difficulties can be improved by putting in place mealtime rules that set up a positive mealtime environment for families. Examples include: n Having 5 set meals each day – children who graze on food all day are never hungry enough at meal time to try new foods. n Everyone sits at the table or in a highchair for meals – children tend to eat less when they are distracted by the TV or toys while eating. n Everyone eats together – children need to be included in normal mealtime activities (talking about their day, etc.) and they are more likely to eat foods that they see their parents and siblings eating. n Everyone eats the same foods – this stops parents feeling they need to prepare different foods for each child in the family. Some studies suggest that child­ ren need to have a food presented to them more than 15 times before they are likely to try the food. Ensuring they are offered the same foods as the rest of the family means they are constantly exposed to a range of foods. n Everyone over 18 months feeds themselves – children over 18 months should be having all of their food served as finger foods or pieces small enough to stab with a fork. Children at this age should be able to use a spoon independently (although maybe a little messily). n Children are never in trouble for not eating but they should not be given any other foods if they do not eat what is offered. 2 Stages of finger foods by Sarah Starr, Speech Pathology Services This is great to give to parents to help them understand that some finger foods are easier to eat than others. The handout grades finger foods as: n very soft/easy to chew – e.g., well cooked vegetables. n soft, requiring some chewing – e.g., pasta. n more difficult to chew – e.g., red meat, muesli bars. 3 Triple P (Positive Parenting Program) training So much of community-based feeding work involves aspects of behaviour management. Being trained in

Triple P allows the clinician to give accurate and consistent advice on how to manage undesirable behaviours. People who are trained also have access to Triple P Tip Sheets like “Toddlers: independent eating” and “Preschoolers: mealtime problems”. See the website www.triplep.net or phone 07 3236 1212 for more information. 4 Highchair

A highchair is essential for observing infants and toddlers eating/being fed in an environ­ ment that is similar to home. It is often during an observation time that the clinician gains valuable information regarding the interaction between carer and child and the skills of the carer and child.

S p eech P athology A ustralia

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