Supporting the Development of Eating Skills for Children with Multiple Disabilities
Learning to eat and drink can be a challenge for many children who have multiple disabilities including a visual impairment. The way your child responds to food can be affected by factors such as his medical conditions, physical abilities, or resistance to trying new foods because of the texture or taste.
Members of your child’s educational team will often have important information and suggestions for how you can work together on specific goals that will help your child to develop his skills in this area. It is important to consult with your child’s medical team for specific information about what beverages and foods your child should or should not try. In addition, occupational therapists and speech and language therapists often have training in helping children with multiple disabilities learn to eat and drink.
A child needs to learn many skills in order to eat and drink independently. Expecting your child to learn all of them at once is probably not realistic. Instead, target one or two specific skills for him to learn to perform more independently, such as bringing the spoon to his mouth or sipping a drink from a glass or a “sippy” cup with a lid and a spout.
And rather than trying to teach the skill all at once, think of having him partially participate in many of the aspects of mealtime. Partial participation means that you do some steps in the process and he does some steps. For example, you might put the food on his spoon, but then he has the responsibility of bringing the spoon to his mouth. Over time, you can gradually increase his level of participation in his mealtime skills.
Consider these additional suggestions to help your child develop eating skills and independence at mealtime:
- Allow your child to self-feed with his fingers first, before introducing utensils.
- Start with food or drinks that your child really likes to increase his motivation.
- Make sure your child feels secure physically. Work with his occupational therapist or physical therapist to explore the best seating options for him. They will have ideas about how to position or stabilize the child in his chair so that he is not worried about falling or having to concentrate on sitting skills.
- Work from behind your child when assisting him or showing him how to do something so that your hands and his are moving together in the same direction.
- Use the hand-under-hand or hand-over-hand method when guiding your child during mealtime.
- Place a mirror in front of you and your child so that you can more easily see his mouth.
- Include your child in family mealtimes, even if he is not eating a full meal at that time, to let him be part of the social interaction that occurs.
Educational team members may be able to recommend equipment that can help your child develop his eating and drinking skills with less assistance. Such equipment might include
- utensils with built-up handles that are easier for your child to grip;
- plates or bowls with raised sides so that food is less likely to spill;
- cups or bottles that have a special opening that is easier to drink through; and
- nonslip placemats or trays on which to place plates, cups, and utensils so that they are less likely to move.
Your child’s teacher of students with visual impairments may also have suggestions for you and other team members to help your child gain skills in learning to eat without assistance. Use of color, contrast, touch cues, texture, positioning, and sound may increase your child’s independence at mealtime.
Some children, especially those with cortical visual impairment, are attracted to certain colors, such as red or yellow. Incorporating your child’s preferred color into mealtime routines may increase his awareness of food and other items at mealtime and stimulate his interest in participating.
If your child has low vision, it will be helpful to provide contrast between the color of the food and the plate or bowl. For example, it is much easier to see mashed potatoes when they are placed on a dark-colored plate rather than on a white plate. One creative mom dyed all the white foods different colors to help her son see them. He had purple mashed potatoes, and all his friends loved to come and eat with him.
Also, look at the objects on the table or your child’s tray at mealtime from his eye level. Is he facing a busy wall so that it is hard for him to see his cup against the flowers on the wallpaper? If so, consider moving his place at the dining room table or covering the wallpaper with a sheet of a solid color.
Your child may be resistant to mealtimes because they are scary or unpredictable to him if he can’t see what you are trying to help him eat or drink. The use of mealtime routines and touch cues will help him anticipate what is going to happen next. For example, when you go to feed him a bite of food, touch his cheek with your finger to help him understand that a bite is coming. Guide his hand to his cup and help him bring it to his mouth rather than suddenly touching the cup to his lips without warning.
The use of texture may help your child during mealtime. If he is learning to get his own beverage out of the refrigerator, for example, you might put a rubber band around the handle of the juice he prefers. Then he can use his sense of touch to pick out this container from a similar one that contains the ice tea.
Consider where to position things for him to help him maximize his mealtime independence. For example, if he sees best out of his left eye, present food you want him to see on his left side. If he is attracted to movement, move his cup with your hand in order to catch his interest and encourage him to reach for it.
Some children respond to different sounds and find them motivating. If this is the case with your child, you might try tapping the item you want him to look at or reach for in order to get his attention. Other children find sound distracting. If your child is easily overstimulated, consider reducing the sound when he is eating. You might want to turn off background noise such as a television or limit conversation at the table.