Teaching Students with Feeding Tubes: What You Need To Know

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.

February 8-12 is recognized as Feeding Tube Awareness Month which is a great opportunity to provide information on tube feeding in an educational setting.  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

Cerebral Palsy

CDKL5 Disorder

Cornelia de Lange

Cri Du Chat Syndrome

Down Syndrome

Dravet Syndrome

Dysphasia

Edwards Syndrome

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

The following are articles on IEP and Accommodations:

IEP/Accommodations

Going to school with a feeding tube- http://www.tubefed.com

Accommodations and supports for children with pediatric feeding disorders- Kids First Collaborative

School-based accommodations and supports– Feeding Matters

Tube feeding at school: 8 tips to prepare your child and school staff– Shield Healthcare

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:

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

The following are articles on signs and symptoms of aspiration during feeding

Aspiration in Children

How to Prevent Aspiration

Life with Aspiration and a Feeding Tube

Pediatric Aspiration Syndromes

Tube Feeding Aspiration

Resources

Book Review: My Belly Has Two Buttons: A Tubie Story

Tube Feeding Awareness Foundation

Accommodations for Students with Dysgraphia

Dysgraphia is describes as a learning disability that affects writing, spelling and fine motor skills. Dysgraphia is a neurodevelopmental disorder that can occur as a stand alone disorder or part of a co-occurring disorder with other disabilities such as ADHD, Autism, and Dyslexia. Typically it is diagnosed or discovered in the early years when children are beginning to learn how to write. Most adults often remain undiagnosed.

Early Signs of Dysgraphia

Signs and symptoms of dysgraphia generally begin to show up when children began to lean how to write. Early signs of Dysgraphia include:

  • Inconsistent spacing between letters
  • Poor spatial planning
  • Poor spelling
  • Unable to read own handwriting
  • Poor fine motor skills
  • Omitted words
  • Writes slow
  • Pain in hand from writing
  • Messy unorganized papers
  • Difficulty organizing thoughts on paper
  • Illegible printing and cursive letter formation
  • Slopping handwriting
  • Tight, cramped pencil grip
  • Tires quickly when writing
  • mixes upper and lower case or irregular sizes and shapes of letters.

The following articles provide resources on accommodations:

6 tips for creating a dysgraphia-friendly classroom

A guide to classroom and at-home accommodations for dysgraphia

Classroom accommodations for students with dysgraphia

Dysgraphia Accommodations

Dysgraphia accommodations and modifications

Dysgraphia accommodations in the classroom

Dysgraphia accommodations that improve learning

Dysgraphia symptoms, accommodations, and IEP goals

How to assist a student with dysgraphia in the classroom

Possible accommodations to consider for children with dysgraphia

Teaching Strategies for Students with Cerebral Palsy

Cerebral palsy is a motor disorder which results from damage to the brain occurring before, during and after birth. Cerebral palsy is the most common motor disability in childhood and it is estimated that 1 in 323 individuals have been identified with cerebral palsy.

Since cerebral palsy is the result of damage to the brain, it impacts each person differently ranging from severe to mild symptoms. It is estimated that many children with cerebral palsy also have at least one co-occurring condition. For instance, 41% had co-occurring epilepsy and 40% of children were diagnosed with an intellectual disability.

Teaching strategies should focus on assistive technology, fine and gross motor skills, and personal care. Accommodations and modifications should include providing extra time for task completion.

The following links provide information on teaching strategies.

Accommodating a student with cerebral palsy

Cerebral palsy in the classroom

How to make your classroom inclusive for students with cerebral palsy

How to teach children with cerebral palsy

Inclusive teaching strategies for students with cerebral palsy

Students with mild cerebral palsy in the classroom: Information and guidelines for teachers

What teachers should know about children with cerebral palsy

10 Steps to the IEP Process

The Individualized Education Program (IEP) is a federal law, part of the Individual with Disabilities Act. The IEP must be written at least annually for all children with disabilities. Below are the following steps to an IEP.

Step 1. Child is identified as possibly needing special education and related services.

“Child Find.” The state must identify, locate, and evaluate all children with disabilities in the state who need special education and related services. To do so, states conduct “Child Find” activities. A child may be identified by “Child Find,” and parents may be asked if the “Child Find” system can evaluate their child. Parents can also call the “Child Find” system and ask that their child be evaluated. Or —

Referral or request for evaluation. A school professional may ask that a child be evaluated to see if he or she has a disability. Parents may also contact the child’s teacher or other school professional to ask that their child be evaluated. This request may be verbal or in writing. Parental consent is needed before the child may be evaluated. Evaluation needs to be completed within a reasonable time after the parent gives consent.

 

2 Step 2. Child is evaluated.

The evaluation must assess the child in all areas related to the child’s suspected disability. The evaluation results will be used to decide the child’s eligibility for special education and related services and to make decisions about an appropriate educational program for the child. If the parents disagree with the evaluation, they have the right to take their child for an Independent Educational Evaluation (IEE). They can ask that the school system pay for this IEE.

 

3 Step 3. Eligibility is decided.

A group of qualified professionals and the parents look at the child’s evaluation results. Together, they decide if the child is a “child with a disability,” as defined by IDEA. Parents may ask for a hearing to challenge the eligibility decision.

 

4 Step 4. Child is found eligible for services.

If the child is found to be a “child with a disability,” as defined by IDEA, he or she is eligible for special education and related services. Within 30 calendar days after a child is determined eligible, the IEP team must meet to write an IEP for the child.

 

5Step 5. IEP meeting is scheduled.

The school system schedules and conducts the IEP meeting. School staff must:

  • contact the participants, including the parents;
  • notify parents early enough to make sure they have an opportunity to attend;
  • schedule the meeting at a time and place agreeable to parents and the school;
  • tell the parents the purpose, time, and location of the meeting;
  • tell the parents who will be attending; and
  • tell the parents that they may invite people to the meeting who have knowledge or special expertise about the child.

 

6 Step 6. IEP meeting is held and the IEP is written.

The IEP team gathers to talk about the child’s needs and write the student’s IEP. Parents and the student (when appropriate) are part of the team. If the child’s placement is decided by a different group, the parents must be part of that group as well.

Before the school system may provide special education and related services to the child for the first time, the parents must give consent. The child begins to receive services as soon as possible after the meeting.

If the parents do not agree with the IEP and placement, they may discuss their concerns with other members of the IEP team and try to work out an agreement. If they still disagree, parents can ask for mediation, or the school may offer mediation. Parents may file a complaint with the state education agency and may request a due process hearing, at which time mediation must be available.

 

7 Step 7. Services are provided.

The school makes sure that the child’s IEP is being carried out as it was written. Parents are given a copy of the IEP. Each of the child’s teachers and service providers has access to the IEP and knows his or her specific responsibilities for carrying out the IEP. This includes the accommodations, modifications, and supports that must be provided to the child, in keeping with the IEP.

 

8 Step 8. Progress is measured and reported to parents.

The child’s progress toward the annual goals is measured, as stated in the IEP. His or her parents are regularly informed of their child’s progress and whether that progress is enough for the child to achieve the goals by the end of the year. These progress reports must be given to parents at least as often as parents are informed of their nondisabled children’s progress.

 

9 Step 9. IEP is reviewed.

The child’s IEP is reviewed by the IEP team at least once a year, or more often if the parents or school ask for a review. If necessary, the IEP is revised. Parents, as team members, must be invited to attend these meetings. Parents can make suggestions for changes, can agree or disagree with the IEP goals, and agree or disagree with the placement.

If parents do not agree with the IEP and placement, they may discuss their concerns with other members of the IEP team and try to work out an agreement. There are several options, including additional testing, an independent evaluation, or asking for mediation (if available) or a due process hearing. They may also file a complaint with the state education agency.

 

10 Step 10. Child is reevaluated.

At least every three years the child must be reevaluated. This evaluation is often called a “triennial.” Its purpose is to find out if the child continues to be a “child with a disability,” as defined by IDEA, and what the child’s educational needs are. However, the child must be reevaluated more often if conditions warrant or if the child’s parent or teacher asks for a new evaluation.

IEP Articles and Links

8 steps to a successful IEP meeting- Great Schools

10 things to cover at your child’s IEP meeting- Autism Support Network

17 things autism moms want you to know about IEP’s and your child- Living Well Mom

All about the IEP- Center for Parent Information and Resources

How can an IEP help someone with autism?- Applied Behavior Analysis

How are IEP’s designed for students with ASD?– Applied Behavior Analysis

IEP FAQ- Wrightslaw

IEP Guidelines- Down Syndrome Association of Ontario

Individualized Education Program for Autism- WebMD

Individualized plan for a student with cerebral palsy- Knoji

Learning about IEP’s– Understood

Learning Disabilities and IEP’s-Focus on Family

The short and sweet IEP overview- The Parent Center Hub

Understanding IEP’s– Understood

What is an IEP? – Great Schools

 

Data Collection for Special Education Teachers

Writing IEP goals and objectives includes collecting data to track the progress of the special needs student. The following links and resources includes information on measuring progression, organizing data and tracking IEP goals

16 hacks for making data collection a piece of cake

Data collection for IEP’s: Measuring progression toward a goal

Data collection for individualized education plan implementation

Data collection for special education teachers

How to organize special education data for easy review

IEP and goals data collection 

IEP data collection

IEP data collection methods

Tips for setting and tracking IEP goals

Using Google docs to collect data for IEP goals