Teaching Students with Feeding Tubes: What You Need To Know

Posted on July 11, 2024 by specialneedsresourcetrainingblog

If you work in a special education class or a day habilitation setting, more than likely you are teaching a student or an individual with complex needs including the use of a feeding tube.

According to the Tube Feeding Awareness Foundation, there are over 300 conditions that require students and individuals to receive nutritional support through tube feeding.

What is a feeding tube?

A feeding tube is a device that is inserted in the stomach wall and goes directly into the stomach. It bypasses chewing and swallowing in a student or individual who no longer has the ability to safely eat or drink. This allows for students and individuals to receive adequate nutritional support.

A feeding tube is also used for students and adults who cannot take in enough food by mouth. Feeding tubes can be temporary or permanent .

Reasons to use a feeding tube

The student or individual may have a swallowing disorder or dysphasia. This means there is an increase risk for the student or individual to aspirate their foods or liquids into their lungs. Causes of swallowing problems include low-muscle tone, brain injury, genetic conditions, sensory issues, neurological conditions, cleft lip/palate and birth defects of the esophagus or stomach.

Types of Feeding Tubes

Gatro Feeding Tube

The gastrostomy tube (G tube) is placed through the skin into the stomach. The stomach and the skin usually heal in 5-7 days. This type of tube is generally used in people with developmental disabilities for long term feeding.

Nasogastric Feeding Tube

The nasogastric (NG tube) is inserted through the nose, into the swallowing tube and into the stomach. The NG tube is typically used in the hospital to drain fluid from the stomach for short term tube feeding.

Neurological and Genetic Conditions Requiring Tube Feeding

Some students and individuals with neurological and genetic conditions often require tube feeding due to gastrointestinal issues including constipation, reflux, and abnormal food-related behaviors. It For example, it is estimate that 11% of children with cerebral palsy use a feeding tube due to difficulty with eating, swallowing, and drinking.

The following are different types of neurological or genetic conditions that may require the use of a feeding tube.

22q11.2 Deletion Syndrome

Angelman Syndrome

Aspiration

CDKL5 Disorder

Dysphasia

Fetal Alcohol Syndrome

Fragile X Syndrome

Hydrocephalus

Lennox-Gestaut Syndrome

Microcephaly

Ohtahara Syndrome

PPD- Not Otherwise Specified

Turner Syndrome

Trisomy 18

Spastic Diplegia

Traumatic Brain Injury

West Syndrome

Williams Syndrome

Signs and Symptoms of Issues related to a g-tube

Complications due to tube feeding may include:

constipation
dehydration
diarrhea
infections
nausea/vomiting

Aspiration

Aspiration can be caused by:

reflux of stomach contents up into the throat
weak cough, or gag reflux
the feeding tube is not in place
delayed stomach emptying
The head is not raised properly.

Students should be observed for aspiration during feeding. The following are signs and symptoms of aspiration:

Choking or coughing while feeding
Stopping breathing while feeding
Faster breathing while feeding
Increased blood pressure, heart rate and decreased oxygen saturation.

What is an ISP?

Posted on February 26, 2024 by specialneedsresourcetrainingblog

People with disabilities that are eligible for community habilitation, day habilitation, supportive employment and support services will receive an Individual Service Plan (ISP).

What is an ISP?

An Individual Support Plan (ISP) is an ongoing process of establishing goals for individuals and identifies supports and strategies that reflect the person’s strength and abilities and details all of the services and supports needed in order to keep the person in their community. The ISP should reflect an opportunity for the person to live in the least restrictive home setting and to have the opportunity to engage in activities and styles of living which encourage and maintain the integration of the individual in the community through individualized social and physical environments.

Who should be included in the development of the ISP?

The person receiving services.
family members, caregiver, or designated representative

The ISP Planning Process

The ISP should be developed with participation from the following people:

The individual
Members of the individual’s family
A guardian, if any
The individual’s Service Coordinator

When is an ISP meeting held?

The meeting is held when it is desired or needed. Some State require meetings every 6 months while others every 2 years, so check with your state regulations.

What is discussed at ISP meetings?

The meeting should focus on 5 areas:

Review and gathering information including any new changes or discoveries. Has the person’s health status changed?
The person’s goals and desires
Review or identify personal value outcomes.
Recent events that may affect the person’s health, safety and goals
Review and develop next-step strategies and resources

What must the ISP include?

The ISP should include:

Specific goals
The supports the individual needs to reach those goals without regard to the availability of those goals.
Who is responsible for providing those supports.
How often and how much support are needed.
The criteria foe evaluating the effectiveness of the supports.
Team members responsibilities for monitoring the ISP implementation.
The date of the next ISP review.

Updated 2/22/24.

Angleman Syndrome and Adulthood

Posted on February 15, 2024 by specialneedsresourcetrainingblog

Angelman syndrome is a genetic disorder that affects the nervous system. Characteristics include developmental delays, intellectual disabilities, epilepsy, short attention span, hyperactivity, hand flapping and speech impairments. It is a rare disorder that affects 1 in 12,000 to 20,000 a year. there are less than 200,000 cases a year and affects all ethnicities and sexes equally.

Typically, there is a severe developmental delay and learning disability as well as near absence of speech and ataxia including ataxia including jerky movements of the arms and legs. People with Angelman syndrome generally have a happy demeanor and an inappropriate laughter.

Life expectancy appears to be normal. As people with Angelman syndrome age, scoliosis tends to worsen and for many people born with epilepsy, there are cases where seizures stop, however, they tend to return as the person gets older.

Health Issues in Adults

Several research studies show a number of health complications for adults with Angelman syndrome. Less than half of people with Angelman syndrome also have a diagnosis of seizures. Seizures begin in early childhood and can continue through adulthood. Poor sleep in adults continue to be a challenge. This includes difficulty falling asleep, frequent waking up during the night and waking up too early. Other issues include, constipation, scoliosis, self-injurious behavior and obesity.

Due to cognitive and medical needs, a person with Angelman syndrome will always require support. Most people with Angelman syndrome attend a day habilitation setting. Support should include

staff trained on identifying seizures and providing assistance.
programs that support the person’s short attention span
evaluation for a communication device or a means to communicate.
support for self-injurious behavior.

Updated 2/15/24.

What is Augmentative and Alternative Communication (AAC)?

Posted on October 1, 2020 by specialneedsresourcetrainingblog

According to the American Speech Language Hearing Association, there are over 2 million people with significant expressive language impairment who use AAC. AAC users including people with the following disorders; autism, cerebral palsy, dual sensory impairments, genetic syndromes, intellectual disability, multiple disabilities, hearing impairment, disease, stroke, and head injury.

According to the International Society for Augmentative and Alternative Communication Organization. AAC is a set of tools and strategies that an individual uses to solve everyday communicative challenges. Communication can take many forms such as: speech, a shared glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, speech-generating devices, etc. Everyone uses multiple forms of communication, based upon the context and our communication partner. Effective communication occurs when the intent and meaning of one individual is understood by another person. The form is less important than the successful understanding of the message.

The types of AAC includes both low-tech and high tech. Low tech AAC includes symbol charts, PECS, and communication boards, while high tech AAC include electronic devices such computers, tablets and devices.

The following information provides resources, articles and tips on using AAC:

3 sets of AAC goals for interactive books

5 quick and easy games that build AAC skills

50 simple switch or low tech activities

AAC and Echolalia

AAC for caregivers manual

AAC Quiz

Augmentative and alternative communication (AAC) systems for students with CVI and multiple disabilities

How to make an AAC symbol library

Language opportunities to use AAC at home

Low-Tech AAC Ideas

Promoting inclusion and participation for people who use AAC

Reducing prompt dependence in AAC learners: 5 things to try

The periodic table of AAC

Using AAC more in the classroom

Using LIST in PODD communication books

What does it take to implement AAC

Adult Provider Training Resources

Posted on August 11, 2020 by specialneedsresourcetrainingblog

Abuse and Neglect

Sexual Abuse of People with Disabilities

Sexual Abuse Definition-The ARC

Preventing Abuse of Children with Cognitive, Intellectual and Developmental Disabilities

Abuse and Neglect: Individuals with Developmental Disabilities

Choking/ Aspiration

Teaching Material on Choking

Arizona Department of Economic Security

Eunice Kennedy Shriver-Dysphasia, Aspiration and Choking

Ohio Department of Developmental Disabilities

New York State Choking Prevention Resources

Washington State Department of Social and Health Services

State Agencies Choking Alerts

Georgia Department of Behavioral Health and Developmental Disabilities

Minnesota Mental Health and Developmental Disabilities

New Jersey Health and Safety Alert Choking

CPR Training for Disabled Students

Cerebral Palsy Training PowerPoint

Posted on April 14, 2020 by specialneedsresourcetrainingblog

This blog article is an introduction to cerebral palsy. In the past, very few educational programs offered courses on specific information pertaining to disabilities. I am hopeful this is beginning to change. Ions when I started working in the field, I felt that there was simply not enough information so I started to do my own research by reading books, journal articles and talking to both professionals and parents.

Here, I have included a short PowerPoint presentation on a brief introduction of Cerebral Palsy. The objectives include, the definition, prevalence and causes, types and the causes. This format can be used in various ways including a teaching course since most of us are currently learning online, or as a self-study course. Below, you will find a quiz along with the quiz answers.

[office src=”https://onedrive.live.com/embed?cid=90748358AD4AA436&resid=90748358AD4AA436%21859&authkey=ABuzc_FO-xzum58&em=2″ width=”402″ height=”327″]

If you would like to print out a copy of the PowerPoint, Download here: Cerebral Palsy PowerPoint

Download quiz test here: cerebral palsy QUIZ

Download quiz test answers here: cerebral palsy QUIZ answer

Self- Injurious Behavior Resources

Posted on March 4, 2020 by specialneedsresourcetrainingblog

Working with individuals- both children and adults diagnosed with self-injurious behaviors can be challenging at the very least. Some examples of self-injurious behaviors include head banging, handbiting, and excessive scratching. There are many reasons why a student or individual may cause self-injurious behaviors including the inability to communicate needs, the environment, sensory issues and physiological issues. The following are articles on identifying cause of self-injury and ways to prevent it.

Autism, head banging and other self-harming behaviors– Autism Parenting

3 techniques to stop self-injurious behavior of children with autism– Steinberg Behavior Solutions

6 Strategies for Addressing Self-Injurious Behaviors– Wonderbaby

Effective evidence-based strategies to minimize self-injurious behaviors in young children with autism- CSUSB Scholarworks

Essential guide to self-injurious behavior and autism– Research Autism

Head banging, self-injury and aggression in autism– Treat Autism

Self-injurious behavior in people with developmental disabilities-crisis prevention.com

Self-injury in patients with intellectual disabilities- Nursing2020

Understanding and treating self-injurious behavior– Autism Research Institute

Understanding self-injury among autistic individuals- Good Therapy

Understanding and Treating Self-Injurious Behavior

What You Should Know About GERD and Developmental Disabilities

Posted on January 8, 2020 by specialneedsresourcetrainingblog

Feeding problems are common in people with an intellectual/developmental disability. For example, it is reported that 37% of individuals with diplegia or hemiplegia and 86% of individuals with quadriplegia experience GERD. It is very common in people with cerebral palsy and can show up as anemia, failure to thrive and reoccurring infections.

It is usually missed by people who have been feeding and serving food to individuals with disability due to its subtle signs.

What is Gastroesophageal Reflux? (GERD)

GERD occurs when the muscle connecting to the esophagus is weak and opens under pressure, allowing the stomach contents to flow back into the esophagus. It is the acid from the stomach to the esophagus. this will irritate the lining of the esophagus and causes heartburn. Without treatment, GERD can cause complications.

What causes GERD?

GERD is usually caused by inflammation from the exposure of the esophagus to the stomach acid. The following can cause GERD:

diet such as fatty foods, coffee, peppermint and chocolate
decreased muscle tone
overweight
backup in blockage of the intestinal tract.

There are many reasons for the high incidence of GERD in individuals with intellectual disability including immobility and positioning, abnormal postures, medication use and excessive drooling.

What is a developmental disability?

A developmental disability is described as an assortment of chronic conditions that are due to mental or physical impairments or both. For example, you may have a child or an adult with an intellectual disability or perhaps a person diagnosed with cerebral palsy and an intellectual disability. It is also considered a severe and chronic disability that can occur up to the age of 22, hence the word developmental. A developmental disability can occur before birth such as genetic disorders (i.e. cri du chat, fragile x syndrome,) or chromosomes ( i.e. Down syndrome, Edwards syndrome); during birth (lack of oxygen) or after birth up to the age of 22 (i.e. head injuries, child abuse or accidents).

For people with limited communication, the following are possible signs of gastroesophageal reflux:

If you suspect GERD, make arrangements for the person to be evaluated by a physician.

Aspiration Precautions

Posted on September 18, 2019 by specialneedsresourcetrainingblog

Children and adults with developmental disabilities often face challenges with eating, drinking and swallowing disorders than the general population. It is estimated that adults with intellectual disabilities require support from caregivers during mealtime. It is common among people who have a diagnosis of cerebral palsy, intellectual disability, physical disability and muscular dystrophy.

Dysphasia is a medical term used to describe any person having difficulty swallowing foods and liquids taking more energy and time to move food from the mouth to the stomach. Signs of dysphasia may include:

Drooling
Food or liquid remaining in the oral cavity after swallowing
Complaints of pain when swallowing
Coughing during or right after eating or drinking
Extra time needed to chew or swallow
Reflux of food

Dysphasia can lead to aspiration. Aspiration is defined when food, fluid, or other foreign material gets into the trachea or lungs instead of going down the esophagus and into the stomach. when this occurs, the person is able to cough to get the food or fluid out of their lungs, in some cases especially with children and adults with disabilities may not be able to cough. This is known as Silent Aspiration.

A complication of aspiration is Pneumonia which is defined as inhaling food, saliva, and liquids into the lungs

According to the Office of People with Developmental Disabilities Health and safety Alert, factors that place people at risk for aspiration include:

Being fed by others
Weak or absent coughing, and/or gag reflexes, commonly seen in people with cerebral palsy.
food stuffing and rapid eating/drinking
Poor chewing or swallowing pills
GERD- the return of partially digested food or stomach contents to the esophagus
Providing liquids or food consistencies the person is not able to tolerate such as eating whole foods.
Seizures that may occur during eating and/or drinking.

How to recognize signs and symptoms of Aspiration:

Choking or coughing while eating or just after eating
Drooling while eating or just after eating
Eyes start to water
Shortness of breath
Fever 30 minutes after eating

Intervene immediate if there are signs of aspiration:

Stop feeding immediately
Keep the person in an upright position
Call 911 if the person has difficulty or stops breathing and no pulse
Start rescue breathing

Minimize aspiration from occurring by serving the appropriate food texture and liquid consistency. If you are not sure of the right consistency, check with your health care provider. The following are pictures of food consistencies.

Courtesy of OPWDD

Whole. Food is served as it is normally prepared; no changes are needed in
preparation or consistency

Courtesy of OPWDD

1 ” Pieces cut to size. Food is served as prepared and cut into 1-inch pieces
(about the width of a fork).

Courtesy of OPWDD

1/4 Pieces Cut to Size. Food is cut with a knife or a pizza cutter or placed in a food
processor and cut into ¼ -inch pieces (about the width of a #2 pencil)

Courtesy of OPWDD

Ground. Food must be prepared using a food processor or comparable equipment
until MOIST, COHESIVE AND NO LARGER THAN A GRAIN OF RICE, or relish
like pieces, similar to pickle relish. Ground food must always be moist. Ground meat
is moistened with a liquid either before or after being prepared in the food processor
and is ALWAYS served with a moistener such as broth, low fat sauce, gravy or
appropriate condiment. Hard, dry ground particles are easy to inhale and must be
avoided.

Courtesy of OPWDD

Pureed. Food must be prepared using a food processor or comparable equipment.
All foods are moistened and processed until smooth, achieving an applesauce-like or
pudding consistency. A spoon should NOT stand up in the food, but the consistency
should not be runny. Each food item is to be pureed separately, unless foods are
prepared in a mixture such as a soup, stew, casserole, or salad.

Aspiration Precautions

Make sure the person eats slowly and takes small bites of food
Ensure the person takes small sips of liquids
Focus on the person’s swallowing
Make sure the person remains upright for a minimum of thirty minutes after eating