Feeding Team Contract Services

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Mission Statement

The feeding team at MESD is specialized in feeding and swallowing specific in school age and pediatrics. The team travels to various school sites to collaborate with staff to serve students with dysphagia and other feeding needs. This team is responsible for referring at risk students and ensuring students safety in the least restrictive environment, promoting an environment of inclusion, and helping children progress with their feeding and swallowing. The team focuses on supporting teachers, assistants, and other staff to maximize the child’s well-being during school hours related to feeding. The feeding recommendations take into account behavior, sensory, function, motoric, and environmental factors. Some school recommendations may look different from home due to many factors that affect feeding at school. 

What is dysphagia?

Swallowing difficulty at any phase from the mouth to the stomach that can be related to by a multitude of symptoms or a medical diagnosis (delay or disorder in developmental skills).

What is aspiration?

The swallowing difficulties (dysphagia) can lead to silent or overt symptoms of intake; including food, saliva, or other entering into the lungs causing serious health problems.

Referral Indicators

School staff, parents, and administrators need to be aware of the “red flags” that require a referral to the feeding team. There are a variety of medical and behavioral factors that are most often visible to the professional. Some include the following:

• Frequent coughing, choking, gagging, wet gurgly voice, tearing up during or after eating.
• Fast pace of intake requiring support during meals.
• Primary food intake is via a G-tube, but small tastes of food is also taking place.
• History of dehydration, or noticeably thin, frail body.
• Significant fatigue when eating.
• Food refusals.
• Vomiting or gagging during meal times.
• Eating takes a long time.
• Frequent absences due to upper respiratory illnesses.
• Difficulty chewing or swallowing food or liquid.
• Difficulty managing oral secretions.
• Difficulty using tongue to move food bolus from one side of the mouth to the other.
• Voice change after meals.
• History of receiving the Heimlich maneuver.
• Low muscle tone in the face or tongue.
• History of medical swallow studies.

Referral Process

1. Eating concerns / risks are brought to the attention by school staff.
2. Case manager submits a referral to feeding team.
3. Case manager gives parent / guardian notification and obtains permission from family to assess, sign HIPPA form, complete interview intake form, and Request of Information form (found below).
4. Case manager gives completed forms to feeding team, along with IEP if available.
5. Feeding team sets up meeting date and time with case manager to schedule assessment.

Assessment consists of: 

1. Interdisciplinary observation and feeding evaluation for safety, focusing on consistency and textures, behavioral cues, method of presentation/feeding techniques, modification of liquid, and equipment recommendations.
2. Compilation of final report to determine if qualified for Safe Feeding Protocol of Meal Time Procedure.
3. Feeding team will be responsible for continual training/updates to staff members.
4. Reports shared with parent(s), case manager, and team.

*After assessment continual consultation, monitoring, and warranted therapy if required, will be ensured on regular basis to maintain safety. 

Responsibilities of the Team

Occupational Therapist and Speech Pathologist together:

• Coordinating assessment and treatment
• Training on application of swallowing plan for school staff
• Consulting and outside referrals
• Regular follow up to school staff
• Writing swallowing and feeding plans with input of other team members
• Tracking and monitoring of feeding plan

Speech Pathologist

• Knowledge and strategies for oral, pharyngeal, and esophageal phases of dysphagia, compensatory support, structural anatomy and function of swallow, motor based approach, sensory awareness, modified diets, and environmental modifications.

Occupational Therapist

• Knowledge and strategies for positioning, sensory awareness, adaptive equipment, behavioral, and environmental modifications, and greater independence for self feeding.

Nurse

• Knowledge and monitoring of lung sounds, nutritional needs, and tube feeding protocols.
• Identification of allergies and precautions.
• As needed concerns for safety

Teacher / Educational Assistants

• May prepare texture of food
• Informational source of any occurance of changes or concerns to feeding team
• Implements designed feeding plan

Parents

• Provides medical history and information
• Participates in decision making
• Shares knowledge of child's feeding habits, meal time environment, food preferences