Assisted Eating
Although I am an Occupational Therapist I learned a lot on this topic from the references I am listing below. In learning more about individuals who require assistance with feeding I am increasingly aware that it is not as straightforward a topic as it would seem and I recommend anyone who assists someone with feeding obtain more information on this topic including checking out the references I have included on assisted eating below. An excellent resource is a continuing education article by AOTA,
Self-Feeding With The Adult Population: (search under publications) by Patricia Swiech OTD, OTR/L, Allison Sullivan, OT, DOT, OTR. and Christine Helfrich, PhD, OTR/L, FAOTA. Another great resource is a Bridgepoint active healthcare handbook, Mealtime Assistance Program Handbook (search for Mealtime Assistance Program) edited in 2014 by Danielle Szpiech.
It would not be uncommon for an individual requiring assisted eating to be experiencing a decreased level of self worth. The interpersonal approach of the caregiver, whether a healthcare professional or a family member can go a long way toward mitigating these feelings and making the mealtime experience a positive one. While the best approach will vary among individuals, in general a smiling, warm, engaging approach will be successful.
Before beginning the process of assisted feeding, care should be taken to insure that the person receiving assistance is in a good position for eating. This means an upright seated position or an upright long sitting position if the person is eating in bed. A tip here is to position a pillow under the knees to relax the hamstrings. This will facilitate a more upright position Let gravity be your friend! When a person is positioned upright, food moves with gravity downward where it should go, into the pharynx, into the esophagus and down into the stomach. If the individual receiving assistance has dysphagia (difficulty with swallowing), it is also important to determine if a special diet should be followed. A Doctor should be consulted if difficulty with swallowing is suspected. Signs of eating problems include coughing or choking during meals, frequent throat clearing, wet or gurgly voice, drooling, vomiting, nasal regurgitation, chest congestion, holding lips tight, and food spilling out of the mouth. Of course choking is an immediate emergency.
When presenting food to the individual, the caregiver should be seated at the same level as the person receiving assistance. Either directly in front or a little to the side from that are good. When placing the utensil for the patient to obtain food, position the utensil so that the person has to bring the head down slightly. This is called a “chin tuck”. A “chin tuck” is difficult to accurately describe but it is basically slight head downward movement. This is a good position for eating because the goal of all eating in addition to nutritional intake is to prevent aspiration. Aspiration is passage of food or liquid into the trachea and lungs instead of the esophagus. If this occurs the serious condition of pneumonia can develop. If you have taken a CPR course you know that a head tilt maneuver helps open the trachea up for assisted breathing. The opposite movement then will help close the trachea during eating. This slight downward/inward movement of the chin does not need to be excessive. A speech therapist should be consulted to provide knowledgable guidance on this maneuver as there is some controversy over whether or not a “chin tuck” is a good idea.
Also take care to insure that about a teaspoon of food is presented. Too large a quantity of food will be harder to chew and swallow and may result in aspiration. It is also important to have proper pacing of the meal. A guideline is to allow for two swallows between mouthfuls. Watching for up and down movement of the Adam’s apple can help identify when a patient has swallowed. Communication between the person receiving assistance and the caregiver can help guide this process.
Also, this is a good time to mention involving the person receiving the assistance. In fact, this should have been mentioned earlier! Let them know why the strategies you are using together are important. For example let them know about the risks for aspiration with a reclined posture instead of just cueing them to “sit up straight”.
Finally, we are all at risk for developing heartburn/acid reflux. After finishing a meal, individuals should remain upright for at least an hour after finishing the meal.
Of course during the assisting process even small incremental steps toward independent eating should be reinforced and facilitated. We also have a concise guide to adaptive eating aids on this site. Thanks for visiting and we invite you to contact us at anytime. Post Updated: 4-14-22. We just launched our new Adaptive Aids Shop. We invite you to visit for adaptive utensils and other adaptive eating aids.
References:
Mealtime Assistance Program Handbook: Bridgepoint active health care, Editor: Danielle Szpiech, 2014.
Self-Feeding With The Adult Population: Back to Basics: AOTA Continuing Education Article, Patricia Swiech, Allison Sullivan, Christine Helfrich, August 2020.
Feeding the Disabled: Blog at Mealtime Partners Website: https://feedngthedisabled.com/thebenefits-of-independent-eating-2/