Problems with Eating

There can be a number of reasons why someone may be having difficulty eating. Possible causes include:

  • structural abnormalities
  • psychological or behavioural conditions
  • motor or sensory impairments
  • or something unrelated to a condition

Due to the diverse nature of such difficulties, you may work with a multi-disciplinary team that might include:

  • a speech and language therapist
  • a physiotherapist
  • an occupational therapist
  • a dietician
  • a doctor
  • a health visitor (in the case of children)
  • district or community nurse (in the case of adults)
  • the person’s carers
  • and, if appropriate, the disabled person themselves.
  • Eating advice and support

Seeking advice and support

The first step is getting an assessment; contact your health professionals, who will form part of the multi-disciplinary team.

Speech and language will have access to a therapist specialising in eating. If you are finding it difficult to get help or are not sure who to talk to, your GP's a good starting point for getting specialist help.

Mealtimes aren't just about eating, but can also be a great opportunity for communication and social interaction. They should be enjoyable occasions and as stress-free as possible.

Growing up and gaining more independence

Many people would prefer to be able to sit at the table and feed themselves, even if it takes longer or is messier than being assisted to eat. Being able to choose what you eat and when to eat it is one of life's pleasures for many people. We can make adaptations for mealtimes, ensuring our pupils can enjoy eating with others.

Most children will learn to feed themselves to some degree eventually. Taking the time and effort to help a person to develop these skills can sometimes also help them in other ways, such as language development, greater awareness of position and movements and hand-eye co-ordination. Our staff manage tables of diners to ensure our pupils are supported in being able to sit with others and engage in the dynamics of eating with others.

Problems with Eating - Further Advice

ARCOS (Association for Rehabilitation of Communication and Oral Skills)
For children and adults who have communication and eating (swallowing) difficulties, their families, carers and others involved. Information, advice, practical help, specialist therapy training and other services not readily available elsewhere.

ASLTIP (The Association of Speech and Language Therapists in Independent Practice)
Information about independent speech and language therapists.

BAPEN (British Association for Parenteral and Enteral Nutrition)
A multi-professional charity whose members include doctors, dieticians, nurses, patients, pharmacists, policy makers and public health and research workers. The charity aims to enhance understanding and management of malnutrition.

BSDH (British Society for Disability and Oral Health)
Aims to improve, preserve and protect the oral health of disabled people.

Disabled Living Foundation (DLF): Solutions for Independent Living
Practical, unbiased information and advice on disability equipment.

Kids with Tubes
Kids with Tubes is an American organisation run by parents offering a variety of support services for parents and caregivers of tube-fed children.

PINNT (Patients on Intravenous and Naso Gastric Nutrition Therapy)
(Half PINNT is the section for children)
Encourages contact and mutual support between members and promotes public awareness and research.

Royal College of Speech and Language Therapists (RCSLT)
The Royal College is the professional body for speech and language therapists in the UK.

Mealtime Difficulties

This brief introduction to some of the issues around mealtimes is not exhaustive, nor about diagnosis, but information for staff and others working with our pupils.

Bite reflex
This is when the person being fed immediately 'locks' their mouth onto anything that is introduced into it. They have no control of this and it may only happen occasionally. Sometimes a speech and language therapist can advise on techniques that may help with this and demonstrate how to 'unlock' the jaw if the reflex occurs. The use of a plastic spoon will lessen the chance of injury to the mouth or damage to the teeth.

Choking is often caused by poor positioning of the head and trunk. Regular choking can cause considerable anxiety at mealtimes for both the enabler and the disabled person. In the worst case scenario it may even result in death. Receiving advice about how to react to choking may help lessen any anxiety and make those concerned more confident that they know how to react in an emergency. A doctor, physiotherapist or speech and language therapist should be able to advise. Persistent choking should always be investigated by the doctor.

This is common in people with reduced mobility. An underlying medical problem, poor diet and/or inadequate fluid intake may be the cause. Often the situation can be improved by adding more fruit, vegetables and whole grains to the person’s diet. If the problem is happening frequently, seek medical advice.

A nourishing and balanced diet is an important factor in maintaining health and well-being. This can sometimes be difficult to do for some people who experience difficulty eating, especially if they can only eat certain types of food or can only manage small amounts. Some people with cerebral palsy experience a lot of involuntary movements. These movements burn up energy, which needs to be taken into account when the person’s diet is being planned. A person with cerebral palsy may need to consume extra calories to compensate for the additional movement. Sometimes a food supplement is suggested or prescribed to help ensure that a person’s nutritional needs are being met.

Health Visitors can advise on food consistencies and suitable diets. Speech and language therapists can also advise especially in relation to the food texture and consistency an individual will find most manageable.

This is a technical term for swallowing difficulties.

Equipment and utensils
As children mature and begin to attempt to feed themselves, there are as number of utensils that may be helpful. Special plates, bowls, cups, adapted cutlery and non-slip mats to help keep the dish in place are all available. The Occupational Therapist should be able to advise on what equipment would be most appropriate and how it can be obtained.

Excessive drooling
This difficulty can be particularly troublesome for a person who has no awareness that they are dribbling or is unable to wipe their mouth themselves.

High palate
This is not uncommon in people with cerebral palsy. Should food gather in this space, it is likely to stick there. If this occurs it needs to be removed during the meal to avoid the possibility that it may later drop down and cause choking.

Some disabled people will experience additional difficulty with eating because they are unusually sensitive to being touched on their face or in their mouth.

Positioning is important for the disabled person to be in the best possible position for eating. This will vary from person to person depending on their medical condition. The physiotherapist or occupational therapist, together with the speech and language therapist, are the best people to advise on positioning.

Reflux is a problem resulting in discomfort during or after eating. On occasions it may cause vomiting. There are several reasons for reflux such as medical or anatomical problems, allergy, or limited movement patterns.

Tongue thrust
This occurs when there is a strong, inappropriate and unconscious forward movement of the tongue that pushes food out of the mouth. This should not be confused with behaviour that looks similar but is really a conscious attempt by the person to communicate that they do not wish to eat what is in their mouth.

Tube or non-oral feeding
Tube feeding may be necessary for some people who are not able to suck or swallow adequately to get proper nutrition or to avoid food passing into the lungs rather than the stomach.

Frequent vomiting may be distressing for all. Sometimes the problem can be helped by improved positioning and avoiding lying down too soon after eating.