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 complex needs including blindness or low vision. The way your child responds to food can be affected by factors such as 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 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 complex needs 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 to learn to perform more independently.

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. Over time, you can gradually increase your child’s level of participation during mealtime skills.

Mealtime Support

• Allow your child to self-feed with fingers first before introducing utensils.
• Start with food or drinks that your child likes to increase motivation.
• Make sure your child feels secure physically. Work with an occupational or physical therapist to explore the best seating options. They will have ideas about how to position or stabilize the child in a chair, not to have to worry about falling or having to concentrate on sitting skills.
• Work from behind your child when assisting or showing how to do something
• Use the hand-under-hand method when guiding your child during mealtime.
• Place a mirror in front of you and your child so you can see their mouth more easily.
• Include your child in family mealtimes, even if they are not eating then, to be a part of the social interaction.

Educational team members may be able to recommend equipment that can help your child develop 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.

Color

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 awareness of food and other items at mealtime and stimulate interest in participating.

Contrast

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 at eye level. Is your child facing a busy wall so that it is hard to see a cup against the flowers on the wallpaper? If so, consider moving your child’s place at the dining room table or covering the wallpaper with a sheet of a solid color.

Touch Cues

Your child may resist mealtimes because they are scary or unpredictable if you can’t see what you are trying to help them eat or drink. Using mealtime routines and touch cues will help your child anticipate what will 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.

Texture

The use of texture may help your child during mealtime. If your child is learning to get their own drink out of the refrigerator, for example, you might put a rubber band around the handle of the juice they prefer. Then your child can use their sense of touch to pick out this container from a similar one that contains the iced tea.

Positioning

Consider where to position things to help maximize mealtime independence. For example, if your child sees best out of their left eye, present food you want them to see on the left side. If your child is attracted to movement, move their cup with your hand in order to catch their interest and encourage reaching.

Sound

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 them to look at or reach for in order to get their 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.

Adapted from article American Printing House
Photo: Cerebral Palsy Guidance