Feeding (Oral)

Table of Contents

There are a range of issues that may affect the need to assist in feeding learners. A child may experience abnormalities with their muscle tone, which affects their ability to feed themselves. Children may have dental problems, or other medical conditions that may affect their willingness or ability to eat. A learner may be hypersensitive to touch or temperature which prevents unassisted feeding from occurring. The instructional steps assist the registered nurse working under the auspices of the school or program in professional judgement and accountability of delegation. Additional steps may be required depending on the learner’s health needs.

Training on feeding a learner should include the following information about the environment, position, equipment (if applicable), quantity, feeding techniques, precautions, training plans, safety plan and process for communicating with the child’s family and staff. This training would include any individualized steps in addition to the basic fundamentals.

Tips: The paraprofessional may be responsible to ensure a prescribed diet is followed. An example would be a prescribed texture or consistency of food, prevention of ingestion of life threatening allergens, or to help maintain glucose levels within a prescribed range. If the feeding doesn’t go as planned, notify the school nurse or follow the emergency plan (if applicable).

Steps

  1. Be familiar with the child’s routine.
    1. Wash your hands and have or help the student wash their hands
    2. Allow for easier transitions by informing the student through verbal or pictures that snack or mealtime is next on the schedule
  2. Provide comfortable space
    1. Provide the student with a comfortable space for eating, allowing them to eat in the same place as other children
    2. Make sure there are no other strong smells competing with the food smells
    3. If possible, reduce the movement that goes on around the child
    4. Give the child enough space to move appropriately while eating
  3. Let child set pace with enough time to eat
    1. Let the child be in charge of the pace of the feeding and plan enough time for the child to eat
  4. Let the child practice feeding
    1. If appropriate allow the child to practice feeding themselves
  5. Provide sips of liquid in-between solids
    1. Liquids help clear the palette of existing food.
  6. Let the child make choose the food that they will eat
    1. Let the child make verbal or nonverbal choices
    2. “Are you asking for milk?” “Do you want meat or fruit?”
  7. Interact with the child
    1. Sit facing the child at eye level
    2. Interact with the child & give them a chance to answer
    3. Tell the child the name of the food
    4. Ask the child how the food tastes & how the texture feels
    5. Be aware of your own facial expressions. You may inadvertently convey feelings on such things as the appearance of pureed food or the child’s drooling and spitting
  8. Wash your hands and have or help the student wash their hands
  9. Prepare or cut up food (if necessary)
  10. See if the child picks up the utensil by themselves
    1. Hand over hand technique:
      1. make sure the child’s thumb is separated from the fingers and wrapped around the utensil from underneath to create a secure grip
      2. using the same hand that is used by the child, place your hand gently over theirs and bring the food ( half a spoonful) slowly up in a straight horizontal line to their mouth
      3. wait until the child swallows before offering a new bite
    2. spoon feeding without child involvement technique:
      1. fill the spoon halfway to ensure the entire bite is consumed and doesn’t spill off the chin
      2. never use a spoon that is bigger than the mouth you are feeding, especially the children
      3. move the spoon in a straight horizontal line to the child’s mouth
      4. put the spoon into the mouth deep enough to gently push the tongue to encourage the child to accept the food and swallow
      5. make sure the child swallows with their mouth closed
      6. wait until they swallow before offering another bite.
  11. Place dishes and remaining food away in accordance with school policy
  12. Wash your hands and have the student wash their hands
  13. Follow any additional steps unique to the student’s delegated care as instructed by the school nurse.
  14. Document the date, time, the procedure, the child’s intake and student’s response, your initials and signature.