Feeding – Assessing Difficulties And Intervening

This article relays pertinent information about feeding difficulties, how to assess for signs and symptoms and how to rightfully intervene.

There is often a great deal of anxiety related to assessing why certain individual will not eat. It can be difficult to identify whether the problem is physical or psychological. It is important to explore the personís feelings about not eating. A subjective assessment should include the personís own description of hunger and appetite.

Assessment– Psychological Factors

Emotional problems may be related to the personís feelings about not eating. In the hospital setting, where patients have a lack of control over their environment, eating may be one area where they feel they can exercise some decision making power. Furthermore, they may be angry at their diagnosis and may displace their anger onto eating behavior. Additionally, the depression or despair related to a situational event can take the appetite away.

Assessment– Level Of Consciousness

Assessing the level of consciousness will alert us to those at risk for aspiration. Individuals who were obtunded are obviously in danger of aspiration. A personís cognitive abilities must be assessed, because this will affect their ability to understand and complete the task of feeding independently. Demented, disoriented, or confused individuals, although alert are at risk for feeding problems because of a lack of understanding of the importance of eating and the propensity for being distracted during the task.

Assessment– Physical Factors

Assessing the personís physical ability to feed and identifying those with impairments is imperative for planning a successful intervention. The pace of eating varies among individuals; however, individuals who routinely take longer than 60 minutes to complete a meal may be partially dependent feeders and require assistance. In some, the ability to bring food into the mouth may be inconsistent. They often start out feeding themselves without problems but quickly tire. Poor coordination can result in food landing on a personís bed, meal tray, or floor but never reaching the mouth. Those who are not able to see the tray may leave various foods untouched. Those who cannot handle utensils will eat those foods on the tray that can be easily picked up with the fingers and leave behind foods that require utensils. If chewing is a problem and proper menu selection has not yet occurred, they will favor liquids and soft foods.

Signs of abnormal swallowing include:

  • Packing of food in the cheeks
  • Drooling
  • Throat clearing during a meal
  • Frequent coughing during a meal
  • Fluid leaking from the nose after swallowing demands

Interventions– Assessing Readiness

The following four steps should be taken prior to feeding to assess readiness:

  • Assess the level of consciousness; he or she must be alert
  • Assess the gag reflex by tickling the back of the throat
  • Have him produce an audible cough
  • Have the him produce a voluntary swallow

Interventions– General Reminders

Feeding should take place in a calm, adequately supervised environment. Individuals should be positioned in a normal eating position with the feeder clearly visible. Food should be placed on the unaffected side of the mouth. If the tongue is damaged or impaired, assistive devices such as adaptive feeding syringes will move food toward the pharynx, where the swallowing reflex takes over. Once the food bolus makes it into the pharynx, the person should tilt the chin down, to decrease the risk of aspiration. Massaging the throat on the affected side helps stimulate the tactile areas that initiate the swallowing reflex. Individuals who have difficulty in coordinating chewing, breathing and swallowing should be instructed to hold the head forward and to hold their breath before swallowing.

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