Children with disabilities may need assistance with eating and drinking. They may require adapted utensils, and/or need special food preparation. Muscle tone, primitive reflexes, food texture, poor positioning, stress factors in the mealtime environment, structural abnormalities of the mouth, and dysfunctional eating patterns and behaviors are factors which may cause the child problems at mealtimes. Intervention strategies focus on modifications in positioning, food selections, adaptive equipment, environmental factors and child specific training.

Area:	Positioning
Considerations:	Look at the support needed for stability. The position needs to be upright and as similar to the other children as possible.
Area:	Foods and Liquids
Considerations:	Check on the texture of foods such as purees, solid or something in between. Consider transitions to solid foods, food temperature preferences, the child's ability to make choices, and liquid consistency. Be aware of chewing and swallowing problems and the risk of choking or aspiration.
Area:	Adaptive Equipment
Considerations:	Determine need for any adaptations based on child's need. There are a variety of cups with handles, straws or cut out edges. There are a variety of spoons such as nylon, thick plastic, rubber coated or built up handles. Other adaptations may include; a universal cuff to assist in holding a utensil, plates and bowls with raised edges for increased scooping, and Dycem to stabilize the plate or bowl.
Area:	Environmental
Considerations:	Things to think about include lighting, noise level, temperature, space needed, and relaxation techniques.
Area:	Child Specific Training
Considerations:	A child may need oral motor stimulation, jaw control, lip closure techniques or activities to reduce gag reflex or facilitate swallowing. Partial participation and teaching methods for developing independence will need to be explored.

A team approach is useful in determining the mealtime routine and the feeding needs of the child. Specific feeding assessments may need to be done in order to establish functional goals and expectations. The following suggestions are strategies for facilitating inclusion of children with disabilities into the mealtime activities:

• Involve therapy staff who have special training in oral motor function, feeding skills and adaptive equipment such as occupational therapists and/or speech language pathologists.
• Encourage parent input on how they feed their child at home and any suggestion they might have for the classroom.
• Consult with a nutritionist on a child's weight gain, fluid intake, food preferences, snack and mealtime food recommendations, etc.
• Use snack time as an opportunity for practicing skills such as social interaction, communication, fine motor skills, self care routines, postural control, and preacademic skills.
• Allow the child to be as independent as possible by using partial participation, task analysis, graduated guidance or finger foods at times.
• Make sure to normalize the process of eating so that the child eats in the same place as the other children, is on the same level at the same table, and uses the least amount of adaptive devices.
• Use the child's augmentative communication system (if applicable) at the table to communicate wants, choices and social comments.
• Be aware of any food allergies or foods to be avoided due to specific physical disabilities.
• Use creative solutions to problems such as if the child needs a longer lunchtime to eat, let a friend stay with the child for social interactions; or if a child is hungry before lunchtime, permit a snack sometime in the morning; or if there is too much stimulation in the lunchroom, have the child sit at the end of the table in the quietest part of the room with a friend.