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FaS Team - Richael Fertig, Stacy Edwards, Amy Miller and Sarah Slater

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Please contact us with any questions, concerns or feedback! fsteam@miu4.org

Supervisor, Richael Fertig - richael.fertig@miu4.org

Stacy Edwards - stacy.edwards@miu4.org

Amy Miller - amy.miller@miu4.org

Sarah Slater - sarah.slater@miu4.org

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Our Feeding and Swallowing team supports students with feeding and swallowing difficulties to become safe and independent eaters by providing school staff with student-specific recommendations while in the school setting.

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MIU IV Feeding and Swallowing Referral Form

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No food modifcations or restrictions.

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Must be able to break food apart with the side of utensil. Thumbnail blanches white when pressed down with fork and food does not regain shape.

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Pre-cut food into bite-sized pieces. Thumbnail blanches white when pressed down with fork, food squashes down completely and does not regain shape.

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Food should be fork mashed (lumps can fit through fork prongs) and not firm or sticky. Holds its form when held on utensil and falls off fairly easily if tilted or flicked.

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Does not require chewing and should not be too sticky. Liquid does not dollop or drip continuously through fork prongs (may form a tail), holds its form on spoon and falls off fairly easily if tilted or flicked.

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No modifications, flows like water.

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Natural nectar, 1-4mL remaining in syringe after 10 seconds of flow.

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Nectar-thick, 4-8mL remaining in syringe after 10 seconds of flow.

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Honey-thick, no less than 8 mL remaining in the syringe after 10 seconds of flow.

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Pudding/puree, does not require chewing and should not be sticky. Liquid does not dollop or drip continuously through fork prongs (may form a tail), holds its form on spoon and fall off fairly easily if tilted or flicked.

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Adult in room is aware of dysphagia needs, but able to monitor other children with frequent observation of student with dysphagia, providing prompts and modifications, if necessary, as student works toward independence.

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Adult in vicinity of child with dysphagia, knowing that the child has a potential for incidence, eyes on student's face at all times, monitoring that the child is following recommendations. May assist with more than one student at a time.

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Adult seated next to or across from student(s) who have dysphagia that regularly require assistance/prompts more frequently. Adult needs to be in close proximity of those students to act quickly if needed. May assist with more than one student at a time.

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One adult supervising only one student with dysphagia, focused on that student and helping them to follow recommendations and guidelines, assisting as needed.

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Can be difficult to bite into and chew thoroughly for a safe swallow 

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Examples:

Tough meats like steak, pork

Raw vegetables such as carrots, celery, and broccoli

Pineapple, appleskins, oranges, nectarines, peaches

Nuts, seeds, pumpkin seeds

Grapes, chicken skin, salmon skin, sausage skin

Shredded wheat/bran

Beans, rhubarb

Lettuce, cucumber, uncooked baby spinach leaves

Popcorn with hulls

Hard candy

Hard breads (i.e. sub rolls/buns/crusts)

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Can require more mature chewing patterns and be more difficult to clear 

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Examples:

Fruit snacks (gummies)

Taffy

Licorice

Thick peanut butter

Dried fruit

Marshmallows

Granola bar (i.e. Quaker granola)

Skittles, Swedish fish, Gummy bears, Starburst

Caramel candy (i.e. Milky Way, caramel creams)

Jerky

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Examples:

Doritos

Nacho/tortilla chips

Taco shells

Wheat thins

Pita chips

Cheez-its

Sun chips

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Examples:

Soup with solids (i.e. chicken noodle soup, vegetable soup)

Cereal with milk

Baked beans in sauce

Fruit cocktail (i.e. fruit cups in juice)

Juicy fruits (i.e. watermelon)

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Breaks down easily in mouth, but requires chewing

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Examples:

Thin pretzels

Thin potato chips (i.e. Lay’s)

Graham crackers

Dry cereals (i.e. Kix, Trix, Cheerios, Fruit Loops)

Ritz crackers

Goldfish crackers

Nilla wafers

Cookies (i.e. toll house, sandwich cookies)

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Can become thick and gummy in the mouth, increasing fatigue and/or risk

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Examples:

Pasta (i.e. spaghetti, mac-n-cheese)

Pancakes/waffles with syrup

Grilled cheese sandwich

Apple slices without skin

Bananas

Berries (i.e. strawberries, raspberries)

Watermelon

Soft cooked vegetables (i.e. peas, beans, broccoli)

Raw cucumbers without skin

Tomatoes without skin

French fries (soft-cooked)

Cereal bar (i.e. Nutrigrain)

Chicken (soft-cooked)

Ground beef (i.e. burgers, soft tacos)

Cake, muffins, doughnuts

Cookies (soft-baked)

Soft bread

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Does not requrie chewing, holds its form on spoon and falls off fairly easily when tilted or flicked

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Examples:

Applesauce

Yogurt

Pudding

Mashed potatoes

Smooth oatmeal

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Breaksdown in mouth with minimal manipulation

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Examples:

Hulless popcorn

Cheese puffs/curls

Gerber puffs or ‘Lil crunchies

Veggie Straws

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Strategies are dependent on student-specific need(s) and should be guided by your FaS consultant.

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Never force or coerce to consume presented food and/or drink. Keep all meals and oral experiences positive and pleasant.

Allow student to look at, smell, lick, taste any new items within his/her current diet recommendations/restrictions.

Staff may work with family to pre-determine school menu items that may potentially be accepted. Consider presenting new food(s) prior to preferred food(s) to encourage interaction. Communication of acceptance may be communicated to encourage carryover at home.

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Solid foods that melt into thin liquids when warmed in the mouth

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Examples:

Popsicles

Jello

Ice cubes

Frozen yogurt/ice cream

Sherbert

Slushees

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Strategies are dependent on student-specific need(s) and should be guided by your FaS consultant.

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If student receives PT services, staff may consult with PT for additional seating recommendations.

Positioned upright at 90 degrees with feet flat on floor/hard surface.

Staff should provide assistance as needed for neutral head positioning.

Staff may provide lip/jaw support as needed to improve lip seal and positioning.

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Strategies are dependent on student-specific need and should be guided by your FaS consultant.

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Provide verbal, visual, tactile cues, as needed for slow rate, small bites, complete chew, clear mouth prior to talking/drinking/additional bite. 

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Provide verbal, visual, tactile cues, as needed for slow rate, small bites, complete chew, clear mouth prior to talking/drinking/additional bite. 

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Closely monitor mouth stuffing. Provide verbal, visual, and physical cues as needed to reduce eating rate and bite-size as needed.

Bite size should be limited to bite-sized pieces or level spoonful.

Food may be precut (into bite-sized pieces) prior to presentation.

Encourage student to chew and swallow each bite before taking a drink, talking, or putting more food into their mouth.

Staff may limit items on plate to 1-2 pieces at a time if necessary.

Carefully check the inside of the student's mouth (palate, cheeks, teeth, and tongue) for oral residue throughout the meal and at the end of each meal/snack.

Encourage tongue sweep, puree wash and additional swallows to clear.

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Strategies are dependent on student-specific need(s) and should be guided by your FaS consultant.

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Provide visual, verbal and physical cues as needed to reduce eating rate and limit to 1 bite at a time.

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Provide visual, verbal and physical cues as needed to reduce eating rate and limit to 1 bite at a time.

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limit to one, bite-sized piece at a time

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Strategies are dependent on student-specific need(s) and should be guided by your FaS consultant.

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Meals should be limited to 30 minutes and remain upright for 30 minutes following the meal.

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Meals should be limited to 30 minutes and remain upright for 30 minutes following the meal.

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ensures efficient mealtime use of energy and provide an adequate period for succesfful digestion.

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Private Outpatient Feeding Therapy Providers 

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Outpatient feeding therapy providers from the area are listed for families to explore and determine a good fit for their child's care.

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Private Outpatient Feeding Therapy Providers (2)

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How to test liquid viscosity

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IDDSI Level 6 - Soft and Bite-sized Testing

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IDDSI Level 6 - Soft and Bite-sized Testing

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Demonstration videos of testing appropriate preparation of foods in IDDSI Level 6 - Soft and Bite-sized diet

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IDDSI Fork Pressure, Chopstick, and Finger Tests  - IDDSI Level 6 Soft & Bite Sized

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IDDSI Level 5 (Minced and Moist) Testing

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IDDSI Level 5 (Minced and Moist) Testing

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Demonstration videos of testing appropriate preparation of foods in IDDSI Level Level 5 (Minced and Moist)

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IDDSI Fork Pressure, Fork Drip, Spoon Tilt, Chopstick, and Finger Tests - Level 5 Minced & Moist

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IDDSI Level 4 (Pureed/Extremely Thick) Testing

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IDDSI Level 4 (Pureed/Extremely Thick) Testing

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Demonstrates a spoon tilt test to determine appropriate consistency for pureed/extremely thick items

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IDDSI Spoon Tilt Test - IDDSI Level 4 Extremely Thick

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Don't wait to get help if your child is having trouble breastfeeding, bottle-feeding, or eating solid foods. Getting help early can prevent problems with eating and can foster a healthy relationship with food for you and your child.

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Here are some tips to help families support their child's feeding and swallowing development:

Have your child try a new food many times-this gives them the chance to decide if they like it.

Serve a variety of foods to your child. Don't get discouraged if they don't like it the first few times.

Cook with your child. Share new smells and tastes. Cooking together can make tasting new foods exciting when your child knows that they helped to prepare it!

Children learn through play, so expose them to new foods by making meals exciting or playful. For example, have a picnic lunch outside, or finger paint with applesauce.

Build on what your child already likes to eat by taking food one step further. For example, if they like chicken nuggets, try a chicken patty.

Ask your child to try new foods, but don't bribe or push your child too much. Pushing can cause your child to have negative associations with the act of eating-or with food in general.

Help your child learn their hunger and fullness cues. This creates healthy eating habits and a long-term positive relationship with food.

You know your child best, so don't wait to get help if your child is having trouble breastfeeding, bottle-feeding, or eating solid foods. Getting help early can prevent problems with eating and can foster a healthy relationship with food for you and your child.

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Feeding and Swallowing Milestones: Age Ranges

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ASHA's feeding and swallowing milestones are designed to help you know what to expect as your child grows and develops and to know when to seek the guidance of a speech language pathologist.

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Join Nico, Gabby, Blaze, Jazzy, and/or Keisha during this 1-hour assembly on their first day of lunch in the school cafeteria! They are so excited to eat like the big kids, but aren't exactly sure how they're supposed to behave. Help them learn rules to keep them safe while eating and drinking at school with the use of a familiar song and fun games!