NBCOT Registered Occupational Therapists (OTR) Quiz: Feeding Interventions

A 3-year-old child with sensory processing disorder consistently gags and refuses to eat foods with mixed textures, such as soups with vegetables or yogurt with fruit. The child's diet is limited to smooth purees and crunchy crackers. An oral motor examination reveals age-appropriate strength and coordination.

Based on this information, which intervention approach is BEST for the OTR to use initially to expand the child's diet?

An OTR is working with an adult client with moderate Parkinson's disease who wishes to remain independent with self-feeding. The client has a significant intention tremor, which causes food to spill when bringing the utensil to their mouth.

Which combination of adaptive equipment would be MOST beneficial for this client?

A child with spastic quadriplegic cerebral palsy has a strong tonic bite reflex that is elicited when a spoon touches the teeth or gums. When this occurs, the child clamps down on the spoon and is unable to release it, causing distress and potential injury.

What is the BEST technique for the caregiver to use when presenting a spoon to this child?

A 9-year-old child with a history of g-tube dependency is now medically cleared for oral feeding. However, the child demonstrates significant food refusal, crying, and turning away from food. The parents report mealtimes are extremely stressful.

What is the BEST intervention approach for the OTR to recommend to the family?

An OTR is working with an adult who sustained a TBI. A videofluoroscopic swallow study revealed a delayed swallow trigger, with the bolus pooling in the valleculae for several seconds before the pharyngeal swallow is initiated. The client is currently on a pureed diet.

Which technique would be MOST effective to facilitate a more timely swallow initiation?

A 2-year-old child demonstrates a vertical munching pattern but has not developed tongue lateralization. As a result, when given a piece of dissolvable solid, the child gags because the food remains in the center of the tongue and moves directly posterior.

Which intervention activity is MOST appropriate for developing tongue lateralization?

An OTR in a skilled nursing facility is preparing to work on feeding with an 85-year-old resident with poor head and trunk control. The nurse's aide typically leaves the resident in a semi-reclined position in a geri-chair for meals.

What is the FIRST action the OTR should take before initiating a feeding intervention?

A client in inpatient rehabilitation following a severe stroke is NPO and beginning a dysphagia program. A swallow study indicates significantly reduced laryngeal elevation and incomplete epiglottic inversion during the swallow, leading to penetration of the airway.

Which swallowing maneuver is specifically designed to improve laryngeal elevation?

An OTR is working with a child who has poor oral sensory awareness. The child holds food in their mouth for long periods without chewing or swallowing and frequently has leftover food in their mouth after a meal is finished.

Which intervention strategy would be MOST effective for increasing oral awareness?

A client with muscular dystrophy demonstrates weakness of the tongue, resulting in poor bolus propulsion. The food trickles slowly and in a disorganized way over the back of the tongue into the pharynx, increasing the risk of aspiration before the swallow.

Which compensatory strategy would be MOST effective for this client?

An OTR is treating a 5-year-old child with hypotonia who demonstrates poor lip closure, anterior spillage of liquids when drinking from a cup, and persistent drooling. The goal is to improve oral motor control for feeding.

Which intervention activity would be MOST effective for improving the child's lip closure?

A 7-year-old child with autism spectrum disorder has an extremely restricted diet, eating only five specific foods. The parents wish to expand the child's diet. The child has good oral motor skills but shows extreme distress and tantrums when presented with new foods.

What is the MOST effective intervention strategy for the OTR to implement?

A 4-year-old child demonstrates poor jaw stability and grading. When biting a hard cookie, the child bites down forcefully but cannot sustain the bite and grade it appropriately, often breaking the food into unmanageable pieces.

Which intervention would be MOST appropriate for improving jaw grading and stability?

An OTR is working with an older adult who had a left CVA and now presents with right facial weakness and hemiparesis. During a mealtime observation, the OTR notes that the client consistently collects food in their right buccal cavity and is often unaware of its presence after swallowing.

Which compensatory strategy is MOST appropriate for the OTR to teach the client to manage food pocketing?

A premature infant in the NICU is transitioning to oral feeding but demonstrates a disorganized suck-swallow-breathe pattern. During bottle feeding, the infant takes 8-10 sucks in a row before pausing, resulting in oxygen desaturation and fatigue.

What is the MOST effective intervention the OTR should implement to improve feeding safety and efficiency?

An OTR is designing an intervention for a school-aged child with Down syndrome who exhibits a persistent tongue thrust pattern during swallowing. This pattern pushes food out of the front of the mouth, making mealtimes inefficient and messy.

Which feeding technique is MOST effective for inhibiting this tongue thrust pattern?

An older adult with moderate dementia shows difficulty with initiating self-feeding. When a plate of food and a fork are placed in front of her, she does not attempt to eat. However, if a caregiver starts by guiding her hand, she can complete the meal independently.

This client's difficulty is MOST likely due to which deficit?

An adult client with amyotrophic lateral sclerosis (ALS) is experiencing significant fatigue during meals due to progressive jaw weakness. The client reports that it takes too much effort to chew standard-texture foods, leading to decreased nutritional intake.

What is the MOST appropriate recommendation for the OTR to make?

An OTR is working in a long-term care facility with a resident who has moderate Alzheimer's disease. The resident is ambulatory but is highly distractible in the main dining hall, often getting up mid-meal and demonstrating poor food intake. The resident has no physical deficits affecting self-feeding.

Which environmental modification is the MOST appropriate initial strategy to improve mealtime participation?

A client with a right CVA exhibits significant left inattention and impulsivity during meals. The OTR observes the client attempting to put too much food in their mouth at once and failing to notice food on the left side of the plate.

Which combination of interventions is BEST to address both of these deficits?