Management strategies for daily mealtime feeding include positioning, modification of the sensory properties of the food, oral motor facilitation techniques, and equipment adaptations. For individuals with increased energy needs, the nutrient density of their meals may need to be maximized. Table 6 lists
Table 6 Calorie boosters
Instant breakfast Powdered, evaporated milk Whole milk cheeses Peanut butter Wheat germ
Yogurt, pudding, custards Milkshakes, eggnog Supplements such as Polycose, Promod, Microlipid, Pediasure, and Ensure
Arms free and forward I for function
Margarine, butter, oils, gravy Sugar, honey, syrup Cream cheese Sour cream Concentrate juices Breading or cracker meal Fruit canned in heavy syrup commonly used calorie boosters. It is important to acknowledge the inability to change the underlying feeding problem while providing a method of circumventing the problem to allow adequate nutrition and growth. For example, facilitative techniques to minimize excessive jaw movement may entail the feeder providing physical jaw control/support; a change in the food consistency, texture, temperature, or taste to improve the ability to propel a bolus through the oropharynx; the careful selection of adaptive feeding equipment to assist with self-feeding and/or increased intake; and an appropriate seating system. Proper positioning also allows the feeder use of both hands.
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