Adaptive Equipment For Eating

Adaptive equipment for eating

This article covers adaptive equipment for eating, including adaptive feeding equipment, assistive feeding devices, adaptive utensils, plates, bowls, and other tools to support functional feeding skills.

One of the main paths that occupational therapists help people achieve success in their daily occupations is through adaptive equipment and technology. There are so many great feeding products and eating tools available to increase independence, and today we will start off the conversation by introducing adaptive equipment specifically for feeding. 

Adaptive equipment for eating

A great place to start with learning more about adaptive equipment for eating and the possible need for reaching out to occupational therapy for adaptive eating tools or support is this resource on Pediatric Feeding: Is it Sensory, Oral Motor, or Both?

Adaptive Equipment for Eating

When it comes to helping individuals become more independent with daily occupations, feeding and eating skills have a big role. Occupational therapy, being the holistic profession that it is, recognizes the overall piece of eating has on wellness and wellbeing, nutrition, and day to day functioning. OTs focus on both the feeding aspect for nutritional intake as well as functional eating skills in use of utensils, cups, and bowls for independence.

Let’s take a look at various adaptive equipment tools for feeding and eating:

Adaptive utensils for feeding needs

Adaptive Utensils

Adaptive dinnerware includes adjusting handles on eating utensils, adding width to the utensil handle, adding weight or length, and addressing the ability to hold a spoon, fork, or knife. Other adaptive feeding needs cover difficulty bringing food to the mouth or the ability to remove food from the utensil as a result of oral motor issues.

Let’s take a look at various adaptive utensils.

Amazon affiliate links are included below.

EazyHold Silicone Silicone Aide-Basically a silicone universal cuff, this adaptive utensil tool is perfect for feeding! The silicone texture makes it easy to clean, and it comes in sizes for newborns through adults. This piece of equipment can be placed around the hand and hold common objects like forks, spoons, markers, and paintbrushes making it a one-stop device for turning household spoons, knives, and forks into adaptive eating utensils. It can remarkably increase independence for individuals that demonstrate deficits in grip strength. 

Maroon Spoon– This adaptive feeding utensil is a classic! The maroon spoon has a shallow spoon depth that can assist in feeding for users with poor lip closure, oral hypersensitivity, or tongue thrust. 

Weighted, Thick Handled Utensils– These weighted utensils have thick handles that are great for those who can grasp a wide handle but have a harder time holding on to something smaller that requires more grip strength. If this is the case, built-up handles are a lifesaver!

You can also use Viva Foam Tubing to make any household spoon, fork, or knife handles thicker and easier to grasp. The added weight of these utensils is also great for individuals who have tremors – the extra weight helps to combat the motion of the tremor, leading to a more successful meal time. 

Textured Spoons– The texture on the spoon provides oral-motor stimulation to the mouth, increasing wanted oral movement patterns and decreasing hypersensitivity. The texture can also cue the user to engage with the tastes and textures while feeding. This spoon comes with extra-long handles to make hand over hand assist a bit easier, too! 

These bendable textured spoons are great for self-feeding and oral motor stimulation as they have a smaller, hand-held size and can offer different textures for gum and tongue sensory input.

Off- Set Spoon– This tool, and many other utensils like it, allow for easier self-feeding for individuals who have limited mobility. The angle of the spoon is turned toward the person, instead of being straight, so that they can bring their spoonful of food directly to their mouth without having to change the orientation of the spoon or their bodies. 

Adaptive plates and adapted bowls for feeding issues

Adaptive Eating Plates and Bowls

When it comes to a container to hold food, plates and bowls can look like many things. Here, you’ll find recommendations for lipped plates, suction cup

Scooper Plate– A lipped plate is just one way to help individuals scoop food from the plate surface, and not onto the table. This scooper plate is a dinner plate with a lip, or a higher edge. Here is another must-have item for individuals that have trouble scooping or stabilizing their plate or bowl.

This “scooper plate” is a plate with high walls like a bowl that have been specifically designed to make it easier to scoop and pick up food items with a utensil. Even better, there is a suction cup feature at the bottom to secure it to the tabletop for more stability while scooping. You can also get the scooper bowl here.

Plate Guard– Similar to the scooper plate, these plate guards can be added to any of your existing plates to add a wall to scoop against. This reduces spills, food waste, and time spent chasing food around with a utensil. That being said, there is much to learn from messy food play.

4-Square Meal Plate– Some feeding therapy involves increasing food repertoire for picky eaters. This plate can be a great tool to help make mealtime fun and engaging for kids. For more tips on how to improve meal times for picky eaters, check out Kids Eat in Color and ABC Pediatric Therapy Network for more resources. 

Adaptive cups and adaptive spoons for feeding needs

Adaptive Cups

Adaptive cups can help with drinking without lifting the head or chin or can help address other motor control and strength challenges. For individuals that struggle to hold a cup or sip from the edge of a cup, there are straw options as well. Below, you’ll find adapted cups that are designed for those with dysphasia or aspiration precautions. Those requiring thickness needs or safety concerns with swallowing liquids should consult a professional. Read this resource on oral motor issues and feeding needs to get started.

Flexi Nosey Cup– This is a flexible drinking cup that also has a space cut out of it to fit a person’s nose. This is a simple and effective way to improve the independence of those who are limited in their ability to tilt their head back while drinking. With the space cut out for the nose, there is no need to tilt their head back while using this cup. The flexibility of the cup can control the flow of the fluid as well, to promote safe swallowing. 

Bear Straw Cup– This kit can help teach a child how to drink out of a straw. The design keeps the liquid near the top of the straw so that less effort is required to take a sip. This can be great for those with oral motor deficits or those just learning how to suck. The kit comes with a lip block to prevent biting on the straw or having the straw enter the throat, and encourages oral motor exercise as well! 

Recessed Lid Cup– This drinking cup is designed with two handles and a recessed lid that can improve lip closure while avoiding sippy cup use. Why do we want to avoid sippy cups? Short answer: if they are used to exclusively, for too long, they can cause dental issues and speech problems. The recessed lid cup mimics drinking from an open cup without all the spillage. Plus, it improves lip closure and tongue retraction for improved oral motor function. This kind even comes with two lid options, one that is suitable for straw use, and the other for typical drinking. 

Flow Control Cup– This cup helps with oral motor control, lip closure, and tongue mobility that impacts sucking from a straw and managing the flow of liquids when drinking from a cup.

Extra-Long Drinking Straw– This flexible drinking straw is extra long, addressing mobility needs that limits an individual’s ability to move closer to a cup and straw that are positioned on the table surface.

If you are a therapist or another professional looking for brands to support during feeding therapy, take a look at Ark’s products. They make tons of oral motor tools for desensitizing and strengthening a child’s mouth to encourage the development of food repertoire and safer, more independent feeding and swallowing. 

Finally, if adaptive feeding equipment is something that needs to be further adapted to meet the specific needs of an individual, don’t forget the many uses that Dycem will have in addressing specific needs.

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Messy Eating

Benefits of Messy eating for babies and toddlers

Have you ever noticed that small children eat meals with recklessness? Bits of food covers the face, cheeks, hands, lap, floor, belly, and even hair. Part of it is learning to use utensils and manage food on the fork or spoon. But there’s more to messy eating too! Messy eating for a baby or toddler is actually a good thing, and completely normal part of child development. And, letting a small child get messy when they eat, and even playing with their food as they eat is OK!

Messy eating in babies and toddlers has benefits to developing tactile sensory challenges and fine motor skills in young children.

Messy eating

I’m sure that your mother never told you it was okay to play with your food at the dinner table, but I’m here to tell you otherwise. Playing with food is not only okay, it is vital to development of self feeding skills and positive engagement with food. When young children play with their food they are engaging in a rich, exploratory sensory experience that helps them develop knowledge of texture, taste, smell, changing visual presentation of foods and oral motor development.

When play with food is discouraged it can lead to picky eaters, oral motor delays and increased hesitancy with trying new foods later on.

Eating with hands- Messy benefits

When solid foods are introduced to baby, it is often a VERY messy ordeal. There is food on the chair, the bib, the floor, you…everywhere but the baby’s mouth. Often times, parents may feel discouraged or don’t like the mess that is the result, but it is OK. In fact, the messier the better.

Exploring food textures with the hands provides tactile experience to the hands, palm, and individual fingers. Are foods sticky, chunky, goopy, or gooey? All of that exposure to the hands is filed away as exposure to textures.

Picking up and manipulating foods offers fine motor benefits, too. Picking up and manipulating bits of food offers repetition in pincer grasp, graded precision, grasp and release, eye-hand coordination, bilateral coordination, crossing midline, and proprioceptive feedback. All of this is likely presented in a baby seat or high chair that offers support and stability through the trunk and core. When that support is offered to babies and toddlers, they can then work on the distal coordination and dexterity. At first, manipulation of food is very messy as those refined skills are developed, but it’s all “on-the-job training” with tasty benefits!

Research shows that a child moves through a series of exploratory steps before successfully eating new foods. This process involves messy play from the hands, up the arms, onto the head and then into the mouth. The steps of this process cannot happen unless the child is encouraged to touch, examine and play with their food. In today’s culture of sterilization and cleanliness, this often counterintuitive to parents and a hard pattern to break.

Promoting Play with Food

Mealtimes can be rushed affairs, making it hard to play with food, but they are not the only times we engage with food throughout the day.

Cooking and meal prep are two of the most common opportunities for play and engagement with food. These activities present perfect opportunities for parents to talk about color, size, shape, texture, smell and taste of the foods that are being prepared. Use of descriptive words,
over exaggeration when talking about and tasting foods, along exploration opportunities develop a positive interest in foods.

Babies can be involved in kitchen prep as they play with appropriate utensils and kitchen items like baby-safe bowls or pots. Toddlers enjoy being involved in the food preparations and can wash, prep, and even chop soft foods with toddler-safe kitchen tools.

Explore these cooking with kids recipes to get small children involved in all the benefits of the kitchen.

Here are more baby play ideas that promote development.

Food Art

Free play with foods like yogurt, jello and applesauce are also great opportunities to promote messy play and creativity. Utilize these foods for finger painting, or painting with other foods as the brushes. This activity challenges tactile and smell regulation, along with constant changes in
the visual presentation of the food.

Creativity with Food

When presented with food for free play, or at the dinner table encourage their creativity–carrot sticks become cars or paint brushes, and raisins become ants on a log.

The sillier the presentation, and more engaged the child becomes, the more likely they are to eat the foods you have presented to them. Especially, if these foods are new, or are non-preferred foods. High levels of over exaggeration also leads to increased positive experiences with foods, which in turn leads to happier eaters, and less stressful mealtimes
down the road.

Ideas like these flower snacks promote healthy eating and can prompt a child to explore new textures or tastes in a fun, themed creative food set-up.

Messy Eating and Oral Motor Development

Not only does play promote increased sensory regulation and positive engagement with foods, it also promotes oral motor skill development.
Oral motor skill development is promoted when a variety of foods are presented and the mastered skills are challenged.

Here is more information on oral motor problems and feeding issues that are often concerns for parents. The question of feeding concerns and picky eating being a sensory issue or oral motor motor concern comes up frequently.

Foods that are long and stick like such as carrots, celery and bell peppers, promote integration of the gag reflex, along with development of the transverse tongue reflex that later supports tongue lateralization for bolus management.

Foods such as peas, or grapes promote oral awareness and regulation for foods that “pop” when bitten, and abilities to manage multiple textures at one time.

Messy Eating and Positive Mealtimes

Whether you have a picky eater, or are just trying to make mealtimes fun, play is the way to go!

Play with food is critical to development of oral motor skills and sensory regulation needed to support positive meal times. Through the use of creative play, exposure, and over exaggeration these milestones can be achieved.

Development of Oral Motor Skills

Wondering about oral motor skills development or where to start with oral motor therapy? Below you will find information related to the development of oral motor skills. This oral motor development information can be used to guide oral motor exercises and oral motor skills for feeding. This article was written by The OT Toolbox contributor author, Kaylee Goodrich, OTR.

Use this guide on development of oral motor skills to address oral motor skill therapy and as a guideline to develop oral motor exercises in oral motor therapy.

Development of Oral Motor Skills

Oral motor skills are the finest of the fine motor skills we develop as human beings. It begins in the womb, and is fully developed and established by 3 years of age. Like many other skills we learn, oral motor development is supported by primitive reflexes, postural control and other physiological milestones developing in synchrony. When the synchrony is broken, problems arise.

Oral Motor Skills: Where it all Begins

Oral motor skills start in the womb with the development of primitive reflexes that support feeding at full term. It is important to note that these reflexes develop in the 3rd trimester between the 28th week and the 37th week gestation. When working with a pre-term baby, these reflexes have not developed and successful feeding will require higher levels of support from an outside source.

Reflexes Established by Term:

* Gag reflex
* Rooting reflex
* Transverse Tongue Reflex
* Non-nutritive sucking
* Nutritive sucking
* Coordinated suck/swallow/breath
* Swallow reflex
* Phasic bite reflex
* Palmomental reflex
* Sucking patterns are non-volitional

A full term infant is ready to breast or bottle feed with the above supports in place.

Oral Motor Skills Birth to 3 Months of Age

As reflexes begin to integrate, feeding becomes more and more voluntary, and less of a non-voluntary response to stimuli from the breast or bottle. This occurs in a full term infant around 6 weeks of age. This is important to note, as unsuccessful feeding in the first 6 weeks of life, can set the tone for developing eating patterns throughout life.

Oral Motor Skills and Feeding at 3 – 7 Months of Age

By 4 months of age, most infants have gained fair head control and are able to remain in an upright position with support, and parents are beginning to introduce puréed foods. As they have grown, the anatomical structure of their jaws and tongues have dropped forward to support munching patterns. They also may open their mouth when a spoon is presented and are able to manage thin purees with minimal difficulties.

Oral Motor Pattern 3-7 Months

* Munching patterns
* Lateral jaw movement
* Diagonal jaw movement
* Lateral tongue movement

The development of these patterns allow infants to be successful with thin and thick purees, meltables and soft foods such as banana and avocado.

Oral Motor Skills and Feeding at 7-9 Months of Age

Between 7 and 9 months of age, infants are now moving into unsupported sitting, quadroped and crawling. This development supports jaw stability, breath support and fine motor development for self feeding skills. Infants at this age now begin to be able to successfully manage “lumpy” purees, bite and munch meltables and softer foods with assistance and the development of rotary chewing begins.

Oral Motor Patterns 7-9 Months of Age

* Lip closure
* Scraping food off spoon with upper lip
* Emerging tongue lateralization
* Movement of food from side to side

The above skills are clearly noted during the 7-9 month age range. If these skills are missing, eating a larger variety of textures will become difficult.

Rotary Chewing

Rotary chewing is broken into stages. The first stage being diagonal rotary chewing, and the second being circular rotary chewing.

Diagonal Rotary Chew

Diagonal rotary chewing is when the jaw moves across the midline in a diagonal pattern and comes back. This type of chewing often looks like an X from a frontal view.

Circular Rotary Chew

As the child develops, a circular rotary pattern emerges. In this pattern, the child’s jaws line up, slide across, jaws line up, and slide across again, looking like a circle from a frontal view.

Rotary Chewing Supports

Rotary patterns begin emerging around 10 months of age. The child at this time is also developing dissociation of his head from his body. This supports increased independence with biting pieces of food, lateralization of a bolus across the midline, and decreased spillage from the lateral sides of the mouth.

Oral Motor Skills at 12-15 Months of Age

By 12 months of age, the child has developed the oral motor basics to support feeding. As time goes on, the child will practice these skills resulting in less messy eating and the ability to handle more challenging foods. At this age, a child is able to manage foods with juice, and chew and swallow firmer foods such as cheese, soft fruits, vegetables, pasta and some meats.

Oral Motor Skills at 16-36 Months of Age

Between 16 and 36 months of age, the child continues to develop their jaw strength, management of a bolus, chewing with a closed mouth, sweeping of small pieces of food into a bolus, and chewing ‘harder’ textured foods such as raw vegetables and meat. A full circular rotary chew should also be developed at this time to support eating all varieties of foods.

Impact of Delayed Oral Motor Skills

Oral motor skills play a large role in a child being a successful eater and having a positive experience with food. When a skill is missing, feeding becomes difficult and stressful for everyone involved. By assessing where the delay in skill is, new skills can be developed successfully, leading to an efficient eater.

Read here about oral motor skills and the sensory components that play into picky eating and problematic feeding.

Looking for more information on oral motor problems? You’ll love these oral motor skill resources: 

   



Oral motor skill development in kids and how development of oral motor skills translates to feeding problems

Pediatric Feeding: Is it Sensory, Oral Motor or Both?

Below, you will find a blog post on pediatric feeding therapy and answers to initial questions about feeding therapy such as “Are pediatric feeding issues related to sensory needs, oral motor problems or both?” and thoughts about where to begin with pediatric feeding therapy techniques.

Occupational therapists and parents often wonder if feeding problems are related to sensory issues or oral motor skills. This article on pediatric therapy addresses that question.

Pediatric Feeding: Is it Sensory, Oral Motor or Both?

When I was in grad school, we had one, three hour lab on feeding, and were told, Speech would handle feeding, so don’t worry.  Little did I know that what I thought was going to happen, was very far from reality.

Feeding Therapy Evaluation

When a child enters a therapy clinic for an OT feeding evaluation, we are prepared for sensory deficits to be present. What we are not prepared for in school, is the potential, and probable oral motor component. This is a skill that most of us learn on the job, in trial by fire, with limited guidance. Or, so was my experience.

Due to the high level of overlap between Speech and OT when it comes to feeding, this often is a problem that OT’s face. Depending on the setting, and even the facility you are in, can determine whose job it is to handle feeding clients.

A majority of professionals maintain that if it appears sensory based and the child has a limited diet, eats only certain textures or colors, it is for OT. If it appears oral motor in nature and the child cannot chew or manage a bolus well, it is for Speech to handle.

Herein lies the problem and common misconception about problematic feeders. Feeding challenges are more than just sensory, or just oral motor.

It is both sensory and oral motor based. This can lead to a very challenging, and complex situation for an OT who is new to feeding.

Oral Motor Skills and Sensory Challenges in Feeding Therapy

When a child limits the textures and variety of foods they eat, they limit the growth and development of their oral motor skills.

Let’s take a child who eats only pureed foods, and refuses solids of any kind for an example.

Oral motor skills needed to eat a thin puree off a spoon and to eat a carrot stick are vastly different.

Puréed foods require minimal bolus management of a thin food that quickly runs down the esophagus with minimal effort. The puree is also smooth, eliminating any scary “texture” for the child to manage.

The carrot stick, on the other hand requires the child to have awareness of his mouth, tongue, and bite pressure before even creating a bolus with the bite of carrot. The child also has to manage the bolus and break down of carrot efficiently while chewing and then swallowing.

Add in the sensory component of crunchy, wet and constantly changing size of the pieces of the carrot, and the child can become easily overwhelmed.

And so, the vicious cycle of a limited diet begins. Lack of confidence with oral motor skills and sensory deficits can lead to problematic feeders.

Feeding Therapy Goals

The above example is a frequent experience that many OT’s have faced when completing a therapy feeding session. With lack of exposure and continued refusal to attempt new foods, the child’s oral motor skills are never able to develop to support the trial of new foods continuing the cycle.

As occupational therapists, it is our job to help these children become functional eaters through the use of sensory desensitization and remediation of delayed oral motor skills.

Oral Motor Development in Feeding Therapy

As oral motor development is a lengthy topic, the next post will address oral motor development and food pairings to determine gaps in skills and provide effective remediation of delayed skills.

Check out the handout below to show parents and help explain the overlap of sensory processing and oral motor skills in problematic feeders.

Would you like to print this visual guide? Click here to access the printable pdf in our free resources library. You will also receive weekly newsletters full of therapy resources, tips, strategies, and information. The OT Toolbox newsletter is perfect for therapists and those working with occupational therapists.

Disclaimer: Feeding difficulties stem from a variety of difficulties including medical, structural, sensory deficits and skill deficits. The main discussion of this post is to examine the crossover of sensory and oral motor skills. Medical and structural concerns will be addressed in future posts.

A little about Kaylee: 
Hi Everyone! I am originally from Upstate N.Y., but now live in
Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at
Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years,
and practicing occupational therapy for 4 years. I practice primarily in a
private clinic, but have experience with Medicaid and home health settings
also. Feeding is a skill that I learned by default in my current
position and have come to love and be knowledgeable in. Visual development and
motor integration is another area of practice that I frequently address and see
with my current population. Looking forward to sharing my knowledge with you all! ~Kaylee Goodrich, OTR

Click on the images below to check out these related articles: 

Jaw instability is an oral motor problem that results in impaired eating and drinking skills.  Exaggerated jaw movements are an oral motor problem that interfere with feeding including eating and drinking. Here are reasons why this oral motor issue happen and how it relates to feeding in kids. Jaw clenching is an oral motor problem that interferes with feeding and eating. Help to understand jaw clenching and reasons it might occur. Jaw thrust is a common oral motor problem that interferes with feeding. Here are the underlying causes and how jaw thrust impacts feeding in kids.