Global aversive behaviors
Confusion and in- coordination hinder or prevent many different activities, including eating. Indicates global brain pathology.
1. Resistive behaviors
May indicate reflex protective responses to being physically disturbed. Often actively resist other activities (e.g., bathing and dressing).
Recommend
A quiet environment and a coaxing, non-threatening approach. Repeated efforts are usually needed. Favorite foods may enhance feeding efforts.
Dyspraxia/agnosia
Demonstrate neglect or failure to recognize food, or the ability to use utensils. Initially precede and then accompany oropharyngeal dysphagia.
Recommend
A non-distracting environment, continuous prompting, coaxing and/or cueing, favorite foods, and frequent small meals.
Oral aversive feeding behaviors
Affect only the act of eating. Probably indicate localized mesotemporal or basal brain pathology.
1. Selective behaviors
May represent early oropharyngeal dysphagia because of unconscious need to change food consistency (thinken liquids and puree solids). May be associated with speech impairment. Potentially the most amenable to enhanced feeding strategies.
Recommend
Frequent small meals, change food consistencies, offer favorite foods.
2. Oropharyngeal dysphagia
Indicate impairment of chewing and bolus formation. Patients lack speech, ambulation, volition, and/or continence. Indicates pre-terminal/terminal stage dementia.
Recommend
Limited therapeutic options. Continue efforts at spoon feeding. Time trial of artificial nutrition and hydration for an acute change of eating status. Consider palliative care if no recovery within set time.
3. Pharyngoesophageal dysphagia
Permits laryngeal penetration by liquids and/or bolus.
Recommend
Requires speech and swallow examination. Strategies to minimize aspiration. Trial of tube feeding for an acute change in feeding status. If problem and complications persist consider gastrostomy feeding or palliative care.
For further information contact Dr. Blandford at (718) 920-4696 or by e-mail at DrGB@aol.com.
For copy of chart on assessing aversive feeding behavior, which was included in the newsletter, contact the ethics network at (718) 796-2444.
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