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Learning Guide
Nutritional
requirements and
feeding issues
27460 Describe a person’s nutritional requirements and feeding
issues in a health or wellbeing setting
Name:
Workplace:
Issue 2.1
Level 3
3 credits
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Contents
Introduction ............................................................................................................................. 1
What is nutrition? .................................................................................................................... 2
Dietary requirements .............................................................................................................. 3
Personal plan ....................................................................................................................... 3
The food pyramid .................................................................................................................... 5
Servings of food ................................................................................................................... 6
Fluid ..................................................................................................................................... 6
Life stage .................................................................................................................................. 7
Infant (0-2 years) ................................................................................................................. 7
Child (2-18 years) ................................................................................................................. 7
Adolescents (13-18) ............................................................................................................. 8
Adult (19-64 years) .............................................................................................................. 8
Older person (65+ years) ..................................................................................................... 8
Health and impairment status ................................................................................................. 9
Nutritional requirements related to health ........................................................................ 9
Diets and culture.................................................................................................................... 14
Nutritional requirements related to culture ..................................................................... 14
Food preparation ................................................................................................................... 15
Liquid diets ......................................................................................................................... 16
Assistance with eating ........................................................................................................... 18
Eating and feeding issues ...................................................................................................... 20
Dysphagia, choking and aspirant pneumonia ................................................................... 20
Techniques for managing eating and feeding ................................................................... 21
Behavioural issues ............................................................................................................. 23
Using adaptive cutlery ....................................................................................................... 24
Nutritional requirements and feeding issues (US 27460) Learning Guide © Careerforce – Issue 2.1 – Feb 2017
Nutritional requirements and feeding issues (US 27460) Learning Guide © Careerforce – Issue 2.1 – Feb 2017
Introduction
Nutrition is about making sure the body has the appropriate food for
sustaining good health, wellbeing and growth. You’ll learn about
nutrition requirements and eating and feeding issues.
How to use your learning guide
This guide supports your learning and prepares you for the unit
standard assessment. The activities should be used as a general guide
for learning.
This guide relates to the following unit standard:
 27460 Describe a person’s nutritional requirements and feeding
issues in a health or wellbeing setting (level 3, 3 credits).
This guide is yours to keep. Make it your own by writing notes that help
you remember things, or where you need to find more information.
Follow the tips in the notes column.
You may use highlight pens to show important information and ideas,
and think about how this information applies to your work.
You might find it helpful to talk to colleagues or your supervisor.
Finish this learning guide before you start on the assessment.
What you will learn
This topic will help you to:
 describe nutritional requirements.

understand how age, health and disability status impact on nutrition
requirements.

recognise eating issues and apply techniques for safe feeding, if
required.
What you will need
To complete this topic, you will need:
 this learning guide.

your trainee assessment for this topic.

forms from your workplace, such as:
 personal plans.

the people you support.

you!
Nutritional requirements and feeding issues (US 27460) Learning Guide © Careerforce – Issue 2.1 – Feb 2017
More info
If you have a trainer,
they should give you
all the forms that you
need for this topic.
1
What is nutrition?
Nutrition is about making sure the body has enough carbohydrates,
proteins, vitamins and minerals to sustain good health, wellbeing and
growth. Nutrition is important because it:
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provides energy.
keeps the cells in the body alive and repairs body tissues.
helps to prevent disease.
helps people recover from illness more quickly.
sustains life.
A person’s nutritional needs will change during different stages in their
life. You may be involved in ensuring that the people you support
receive good nutrition.
Feeding issues are any difficulty, discomfort, reaction, or clinical
condition associated with a person eating and drinking, including if
assistance is required for the person to feed themselves.
Feeding assistance is the physical support that may be required to make
sure the person gets the nutrition they need. It may involve physically
feeding a person, using feeding tubes, and/or special meal preparation
such as thickening or pureeing food.
It is important that any special dietary requirements a person may have
are followed. A good diet will help to ensure a person gets their
nutritional needs met.
Healthy food
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Dietary requirements
For health and wellbeing, each person needs to have their nutritional
requirements met. Nutritional needs are met through diet – the food
choices that people make. The type of food that a person should eat
and how that food is prepared make up that person’s dietary
requirements.
The people you support will all have specific dietary requirements.
These dietary requirements will be based on:
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the life stage they are at.
whether they have any health issues or medical conditions.
the person’s culture, ethnicity and/or religion.
Special dietary requirements include:
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diabetic.
low fat.
low sodium.
high protein.
high calorie.
lactose free.
for weight reduction.
gluten free.
vegetarian/vegan.
excluding particular foods or additives.
boosted with nutritional supplements.
to meet religious or other beliefs.
adapted to a particular culture.
soft or modified food textures.
liquids only.
There is a huge variation in the types of food that people prefer to eat,
and personal food choice has to be considered in every diet regardless
of any requirements that need to be met.
The Ministry of Health have six Food and Nutrition Guidelines and
related health education resources. They are helpful references. They
can be found at www.moh.govt.nz/food and nutrition
Personal plan
People who need support with eating and drinking to meet their
nutritional requirements will generally have a number of health
professionals working together (a multi-disciplinary team) to ensure
that they receive the care that best meets their needs.
Ensure the person you are working with has input into the development
of their personal plan. From time to time, check with the person to
ensure they are feeling comfortable.
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Needs may change as a person becomes more or less independent.
Instructions, including updates after reviews, will be recorded in the
person’s personal plan.
Nutrition, diet and eating and feeding
The personal plan will give you valuable information such as:
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the physical help the person may need.
the best times of the day for the person to eat.
the supervision that is needed while the person is eating.
any problems the person may have and the strategies that are used
to address them. For example, the person leaving their mouth open
allowing food to drop out, or turning their head away when fed.
detailed instructions from a health professional involved in the
person’s care, such as a speech language therapist or dietitian on
how to assist the person.
risk analysis, and what you should do if the risk becomes a concern.
Support may be needed on a temporary basis, for example during an
illness or when a person is recuperating from surgery, or on a
permanent basis, for example for a person who has tetraplegia or
multiple sclerosis. Always communicate with the person you are
working with.
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The food pyramid
Fats, oils and
sweets group
Milk, yoghurt
and cheese
group
Meat, poultry,
fish, dry beans,
eggs and nuts
group
Vegetable
group
Fruit
group
Bread, cereal, rice and pasta group
The pyramid is broken up into sections that decrease in size. The top
section (fats, oils and sweets), is the smallest part and represents the
foods that should be consumed in the smallest quantities. As you move
down the pyramid, the area gets wider and larger, representing the
food groups that should be consumed the most.
Fats and oils should make up the smallest part of a person’s diet but
should not be eliminated completely because they are essential to the
body functioning properly.
Milk and milk products, meats and other protein sources should be
consumed daily, but in small amounts. Fruits, vegetables, breads,
cereals, pasta and grains should be the largest part of a person’s diet.
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Servings of food
Serving sizes, or how much of each food should be eaten, will vary
according to an individual’s age and dietary requirements. For a
standard adult to maintain a balanced diet and get all the essential
nutrients that their bodies need, they should eat the following servings
of the food groups each day:

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two servings of protein food, for example, lean meat, fish, eggs or
pulses (lentils and beans).
at least five servings of carbohydrate foods (potatoes, rice and
bread).
at least five servings of fruit and vegetables.
two servings of dairy foods (low fat is best).
Accurate measuring tools such as scales and cups are not always readily
available so being able to estimate a serving size visually is useful.
Here are some examples:

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a tennis ball
a fist
palm of hand
1 slice of bread
1 cup of milk
= 1 serve of pasta.
= 1 serve of cereals, fruit or vegetables.
= 1 serve of meat or fish.
= 1 serve.
= 1 serve.
Fluid
In addition to the food that we eat, a person must get enough fluid for
good nutrition. Our bodies are made up of two thirds water. We need
to drink enough to remain hydrated so our body can continue to
function properly.
Fluid requirements will vary according to a person’s size and weight, the
amount of exercise they are doing and their body’s metabolic rate. A
rule of thumb is that a person needs 8 glasses of fluid a day. Although
water is the best fluid to drink, tea and coffee are now considered part
of our daily fluid intake; as are fruit juices, milk etc.
Some medical conditions, such as congestive heart failure, may require
that a person’s fluid intake is restricted.
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Life stage
What stage in life a person is at will have an impact on their nutritional
requirements.
The stages of human development and growth include birth, infancy,
adolescence, adulthood and then into senescence (old age) and dying.
The stages of human lifespan are:
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infant
child/adolescent
adult
older person
0–23 months
2–18 years
19–64 years
65+ years
Infant (0-2 years)
Infants need a lot of protein
and iron and other nutrients
to support the rapid growth
of their bodies and brain.
They initially receive this
nutrition from breast milk or
formula. Solids are slowly
introduced at around 6
months of age, until the
infant is fully weaned at 18
months to 2 years.
Child (2-18 years)
At this stage of the lifespan, a child needs a balanced diet with fruit and
vegetables, breads and cereals, lean meats and some dairy products
(milk and milk products such as yoghurt and cheese). They should not
eat too much fat or sugar. They need regular meals, and will often eat
4–5 times a day. Their bodies and brains aren’t growing quite so fast,
but they are becoming more physically active as they learn to walk, run
and engage in play. This is a time when they start developing likes and
dislikes of certain foods and fluids.
Recommended serves that preschoolers should eat are:
 fruit – 2.
 vegetables – at least 2.
 breads and cereals – 4.
 meat, fish, eggs, nuts and seeds – at least 1.
 milk and milk products – at least 2–3.
For school-age children, the amount of vegetables, breads and cereals
and meat increase by 1 serve.
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Adolescents (13-18)
Adolescents will go through growth spurts when they need to eat more,
but they need to eat healthy food. They should ensure that they are
eating the 5+ serves of fruit and vegetables a day, as well as getting
plenty of protein from a variety of sources. Both girls and boys may feel
pressure from peers to be thin, and to limit what they eat. A healthy
body image is vital to children of this age. Poor dietary habits at this age
are likely to be transferred through to adolescence and adulthood and
can lead to obesity, diabetes, stroke and heart disease in later life.
Adult (19-64 years)
As our bodies slow down and our lifestyles change, we need to change
our eating habits to compensate. Most adults need to eat plenty of fruit
and vegetables, plenty of breads and cereals including rice, pasta and
other grain products, some milk and milk products, protein from lean
meats and a small amount of fat, salt and sugar.
Lack of nutrition can be an issue for some people in late adulthood.
Their diet may have insufficient vitamins or minerals, or eating habits of
previous years may catch up with them, for example, osteoporosis from
a lack of calcium.
Having enough energy to get through the day and perform all the daily
tasks as well as extra activities is important. Eating well, getting calories
from food rich in vitamins, minerals and other nutrients is essential. This
will help fight off illness and disease as well as providing energy and
maintaining a good health status.
Older person (65+ years)
As we age, it may get harder to get the daily calories that we need.
Older adults still need to eat plenty of fruit and vegetables, breads and
cereals. They need at least two servings of milk and milk products and
at least one serving a day of lean meat, chicken, fish or eggs.
Older adults may find that they lose the ability to taste or smell food,
and therefore don’t want to eat as much as they need to. It may
become physically harder to stand and move, and to complete tasks
such as cooking. If a person is alone, they may not want to eat, or can’t
be bothered making the effort.
Dehydration is common with this age range. Many elderly people think
if they do not drink they will not have to get up to go to the toilet
through the night.
You can find more on the nutritional needs of people at different life
stages. Use the following link and its related publications, resources and
links to help you at http://www.moh.govt.nz/foodandnutrition
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Health and impairment status
A person’s health and impairment status will influence both their
nutritional needs and their dietary requirements. For example:
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A person with cancer may require additional nutritional support
through supplements.
A person with limited mobility who only performs a small amount of
physical activity may require fewer calories than someone who is
more active.
A person who is recovering after an accident may require more
protein in their diet to help their body do the necessary repair work
to bones and muscles.
A person with congestive heart failure may have to reduce the
amount of salt in their diet.
Nutritional requirements related to health
Diabetic diets
People develop diabetes when their body cannot make (or properly
use) insulin – a hormone that is released in response to the level of
glucose (sugar) in the blood. If not enough insulin is being produced, the
level of glucose in the blood will rise and be harmful to health.
There are two types of diabetes.
Type 1 diabetes requires the person to inject insulin, usually two times
a day, to control the level of glucose in the blood.
Instructions for a person with type 1 diabetes may include:
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making sure that the person eats within a certain period of time
after injecting insulin.
what to do if their blood sugar level gets too low and they become
hypoglycaemic.
Hypoglycaemia
When people become hypoglycaemic they may get shaky and confused,
pale and sweaty or show personality changes. This can often be
mistaken for being ‘drunk’.
When a person becomes hypoglycaemic, it is important to raise blood
glucose levels rapidly, and eating jelly beans is a popular method. This is
a ‘quick fix’ however, and needs to be followed by eating more complex
carbohydrates. A cheese sandwich is ideal.
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It is important to remember that
sugar in the form of jelly beans
or even honey can only be given
to a person who is conscious
enough to swallow safely. Some
people will lose consciousness
when hypoglycaemic and will
need urgent medical attention.
Type 2 diabetes is usually caused by being overweight. The person may
be on a weight reduction diet as well as oral medication to help control
blood glucose levels.
Diabetic dietary requirements are similar to general healthy diet
guidelines, such as to:
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eat regular, small meals.
limit sweet food.
limit carbohydrates.
eat less fat.
limit alcohol.
eat plenty of fruit and vegetable and whole grain foods.
Low fat diets
A low fat diet may be recommended for reasons such as weight control
or to reduce high cholesterol levels.
In a low fat diet, the saturated fat makes up only 7–10% of energy
requirements. It is important not to cut out fat completely as our bodies
need fat to maintain certain functions.
Nutritional requirements may include instructions to:
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choose lean red meat and trim fat off meat.
use lower fat milk.
limit intake of fried foods.
use vegetable oils instead of saturated fats, for example, margarine
instead of butter.
control portion sizes.
limit intake of chocolate, nuts, seeds and cheese.
avoid processed foods.
eat lots of fruit and vegetables, wholegrain bread, cereals and pasta.
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Low sodium diets
People who have heart failure or salt sensitive blood pressure may need
to reduce the amount of sodium (salt) in their diet.
Instructions for low sodium diets may include:
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do not add salt when cooking or eating food.
use lots of unprocessed, fresh foods.
read food labels to check sodium levels.
use ‘salt free’ or ‘low salt’ foods such as cereals and bread.
use alternative seasonings such as pepper, lemon juice or vinegar;
and herbs and spices such as garlic, parsley and chilli.
High protein diets
A high protein diet is when at least 30% of the daily energy
requirements are derived from protein sources. A high protein diet is
likely to be required by people who are malnourished, wanting to put
on weight or to build up more muscle, or who are doing a lot of exercise
and training.
Nutritional requirements for high protein diets may include:
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small, frequent meals including plenty of meat, fish, and dairy
products.
include eggs and nuts.
milk or juice based drinks.
nutritional supplements, for example, Complan and Fortisip.
High calorie diets
A high calorie diet may be recommended when people need to gain
weight, when they are exercising a lot (sports training, competing etc),
or when they are recovering from severe illness.
A high calorie diet involves eating food with high calorie values. It is very
important that a high calorie diet provides calories from nutritious
sources.
Nutritional requirements for high calorie diets may include:
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eat frequent meals.
choose favourite foods.
take supplements in the form of drinks.
eat ‘calorie dense’ foods such as nuts, seeds and peanut butter.
keep snacks readily available.
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Lactose free diets
Lactose is a simple sugar found in milk and milk products. Our small
intestine contains an enzyme called lactase which splits the lactose into
two sugars which the body can absorb and use. If our body does not
produce lactase, the lactose goes straight through into the colon, where
it can cause irritation, gas, abdominal cramps and bloating.
A lactose free diet is a diet where all lactose is eliminated. People with
Crohn’s disease or coeliac disease, for example, may need to eliminate
lactose from their diets. This means that they should not eat any
animal, milk or milk by-products.
Requirements for lactose free diets may include:
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no food or drink that contains animal milk.
products like yoghurt or ice cream must be made from non-animal
milk such as rice, soya bean or almond.
supplements may be needed to provide calcium, riboflavin and
vitamin D.
Weight reduction diets
People trying to lose weight need to have a diet that covers all the
major food groups, but provides less calories than they use during the
day.
Instructions for weight reduction diets will be very similar to those for a
low fat diet.
Following instructions about the portion sizes a person should eat at
each meal is particularly important in a weight reduction diet.
Gluten free diets
Gluten is a plant protein found in grains, mainly wheat.
A person with coeliac disease will need a gluten free diet. There are also
growing numbers of people who are gluten intolerant.
Nutritional requirements for gluten free diets may include:
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avoid food made with flour and/or grains derived from wheat, rye
and barley.
eat bread, baked products and cereals made from wheat
alternatives such as rice.
read labels carefully – products such as soy sauce, tomato sauce and
ice cream may contain gluten.
buy products from specialist bakeries and supermarkets.
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Exclusion diets
People can be intolerant to a specific type of food or additive within
food and will develop symptoms shortly after eating it. If the reaction is
severe it is considered an allergy rather than intolerance. The most
severe type of allergic reaction is called anaphylaxis which affects
breathing and can be life threatening.
Food allergies frequently start in childhood but can begin at any age.
The most common things people can be allergic to are eggs, peanuts or
shellfish.
Instructions for exclusion diets may include:
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be aware of what foods or additives a person reacts to.
check labels carefully for warnings such as ‘may contain traces of
nuts’.
The signs and symptoms that a person may be having a reaction to
something that has been eaten include:
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itchiness of the skin, eyes, mouth or throat.
rash or hives (itchy lumps).
stomach cramps and/or diarrhoea.
shortness of breath and/or wheezing.
swelling, especially of the eyelids, face, lips and tongue.
difficulty swallowing.
If a person you are supporting has a known food allergy, it should be
clearly indicated in their personal plan. Your organisation will have
policies and procedures to follow if someone has an adverse reaction to
food, and guidelines about what to do if medical assistance is required.
In general, the faster a reaction occurs, the more severe it is likely to be.
If a person has any difficulty breathing, call for urgent medical
assistance.
Nutritional supplements
Nutritional supplements will need to be taken by people whose daily
intake of essential nutrients is less than it should be. A doctor or
dietitian will have been consulted, and the required supplements will
have been included in the person’s plan.
Supplements may need to be taken for a short period of time, for
example, when recovering from illness or for an extended period of
time, for example, an iron supplement for a vegan.
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Diets and culture
Nutritional requirements related to culture
Some people require special diets to meet their nutritional needs
because of their personal or religious beliefs or their culture.
Vegetarian and vegan
A vegetarian diet is one where no meat is consumed, but animal
products such as eggs, milk and honey are eaten. Some vegetarians will
eat fish. A vegan diet is one where no animal products are eaten.
For diets such as vegetarian and vegan, careful planning is necessary to
ensure that all nutritional needs are met. Supplements may be needed.
Māori
Anything tapu (forbidden, sacred or set apart by cultural custom) must
not come into contact with any vessel or place where food is kept or
prepared.
Pacific Island
Seafood is the primary dietary protein staple of the Pacific Island
people. Fish is usually eaten raw, grilled or poached. Tubers such as
taro, sweet potatoes and yams are also commonly eaten and coconuts
and coconut milk are common cooking ingredients.
Muslim
Halal meat is meat that has been killed according to Muslim practices.
Non-halal meat will not be eaten by practising Muslims. The Koran
forbids Muslims to eat pork, bacon or products derived from pigs.
Hindu
Most Hindus are vegetarians, but will eat milk and milk products, and
eggs. There is variation in regions and traditions, and some Hindus will
eat meat. Cows are sacred to the Hindu religion, so a Hindu will not eat
beef.
Jewish
Kosher food is food that conforms to the Jewish religion. Non-kosher
foods include those that are a mix of milk and animal products, those
prepared with cooking utensils or machinery that has been used for
non-kosher food, certain types of fat and non-cloven hoofed animals
(pigs, rabbits etc). For seafood to be kosher, it must have fins and
scales, so lobster and shellfish are not kosher.
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Food preparation
The health and impairment status of some people may mean that they
will need their food prepared in a particular way.
Thickened fluids and texture modified foods (mashed/pureed) are
needed for people who have feeding and swallowing difficulties
(dysphagia). These foods may also be given to a person who is
recovering from stomach or bowel surgery or from an illness such as
gastroenteritis (vomiting and diarrhoea).
The NZ Speech Therapy Association (NZSTA) and Dietitians NZ endorse
the following standards for fluids and foods:
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mildly thick fluid will run freely off the spoon, while leaving a
coating on the spoon.
moderately thick fluid will drip off the spoon in thick dollops.
extremely thick fluid sits on the spoon and does not flow off it at all.
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Food textures are classified as:
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soft, which is naturally soft or cooked and cut to alter its texture.
minced and moist is food that is soft, easily mashed with a fork and
any lumps are smooth and rounded.
smooth pureed food is smooth, moist and lump free although it may
have a grainy quality.
A speech and language therapist may have been consulted about a
person with dysphagia, and instructions may be given on:

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
the level of fluid and texture modified diet required.
how to support that person with feeding.
body positioning when feeding.
Liquid diets
A liquid diet is a partial or complete meal replacement. It is usually for
people who are about to undergo surgery and need to lose weight
quickly, or for people who cannot chew, swallow or digest solid foods.
A liquid diet usually includes clear fluids, milk drinks, milk products such
as ice cream, and creamy soup. Protein shakes are available to add
calories and protein. Coffee, tea and sports drinks can be part of a liquid
diet, as are nutritional supplements in liquid form. Yoghurt can be
added to smoothies and milkshakes. Food can be put through a blender
and then thinned with water or milk and strained.
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Write
Think of a person you are currently supporting and answer the following
questions.
What is their life stage?
How does their health or impairment status affect their nutritional
requirements?
What are their dietary requirements?
What are any cultural or religious needs that have an impact on their
diet?
How is the person’s food prepared?
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Assistance with eating
There are different reasons why people need assistance with eating and
feeding.
Reason
Description
A person’s life stage
For example, the effects of old age may create
the need for dentures and/or soft foods.
Cognitive impairment
Conditions such as dementia or an intellectual
impairment may mean a person needs assistance
with eating and drinking eg finishing a meal,
using a knife and fork or remembering to eat.
Physical impairment
Conditions such as cerebral palsy may mean a
person needs assistance with cutting their food
and bringing it to their mouth.
Illness, medications
and pain
These can all mean a person needs support and
encouragement to eat because they may have a
reduced appetite or find it difficult to keep food
down (vomiting).
Medications and pain can also cause nausea
which reduces a person’s desire to eat.
Dental and oral
problems
These make it physically difficult for a person to
eat and drink. These problems may include sores
in the mouth, ill-fitting dentures, gum disease,
tooth pain and dry mouth.
These problems can result from a person’s stage
of life or from an accident, illness or the side
effects of medication.
Difficulty swallowing
Medical conditions such as Parkinson’s disease or
stroke can affect the throat muscles making it
difficult to swallow.
Dysphagia
Dysphagia is when a person has difficulty
swallowing or experiences pain while swallowing.
It can leave some people completely unable to
swallow liquids, foods or saliva.
Dysphagia particularly affects people who have
had a stroke, and people with multiple sclerosis
(MS), Parkinson’s disease and Alzheimer’s
disease. It can also affect people who have head,
neck or spinal cord injuries, or internal burns
from poisoning or radiotherapy.
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Your understanding of the reason why the person needs assistance with
eating and feeding will determine how you approach the person. For
example, you may need to:
Take an active role in feeding the person. This will require you to:
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feed them in an appropriate way (not too fast, not too much food
on the spoon, being patient).
carefully observe them to make sure they are physically managing
to eat the food (chewing and swallowing easily).
check they are eating enough to meet their nutritional
requirements.
Take a more supportive role, for example:
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keep the person company, or share a cup of tea with them while
they eat so they are more encouraged to eat.
be encouraging but respectful if the person is feeling unwell or is
reluctant to eat.
make sure the food is appetising and tempting for the person.
adding a simple garnish to a meal such as a slice of tomato and a
sprig of parsley can also make the food more visually appealing.
be creative and present some alternative food choices to tempt the
person to eat.
make the person feel relaxed. people who are tense when eating
will find it harder to chew and swallow and eating will be more
difficult.
talk to the person about what they are experiencing or feeling and
how you can help them.
A part of your role may be making sure the food is suitable and
appropriate. For example, people with dental problems or difficulties
swallowing may need food that is soft, moist and not too hot. People
who have a serious illness such as cancer may require small meals of
food that are easy to eat, such as steamed fish and scrambled eggs.
Adults with medical conditions that require smooth and/or pureed food
may need to feel that they are still eating ‘adult’ food and not ‘baby’
food. It is your approach that can influence how they feel about the
food they are eating.
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Eating and feeding issues
There are a variety of eating and feeding situations that people may
have that call for adaptations to how they eat and/or drink. These may
include:
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dysphagia, choking and aspirant pneumonia.
swallowing difficulty.
behavioural issues.
managing eating utensils (knife, fork and spoon).
holding anything such as a cup.
hand-eye coordination.
remaining on task (cognitive, for example, thinking they have
already eaten or have eaten but can’t remember).
Always consult the person’s personal plan which will let you know the
person’s eating and feeding issues. Check in with the person as you
work with them to make sure they are comfortable too.
Dysphagia, choking and aspirant pneumonia
Eating and drinking can put some people at a higher risk of choking
and/or aspiration.
Choking is when food gets caught in the oesophagus (gullet) and can’t
move down into the stomach. The trachea (windpipe) can become
partially or completely blocked stopping the person being able to
breathe.
Aspiration is when food or fluids get into the lungs. This can cause
aspiration pneumonia, which is a dangerous infection.
For people who have dsyphagia (swallowing difficulties), it is essential
that you know the warning signs that could indicate the need for urgent
assistance. These are:
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flushed face.
weak cough and attempts to clear throat of increased mucus.
increased heart rate.
coughing or gagging during or after a meal.
choking and inability to speak.
noisy breathing or a gurgling sound in throat.
bluish colour of lips or fingernail beds.
rapid breathing, shortness of breath or gasping for breath.
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Techniques for managing eating and feeding
Your role may be to support the person with techniques to ensure they
can eat and drink safely in order to meet their nutritional requirements.
The personal plan of a person who is at risk of choking or aspiration
should include instructions about how to support the person so that the
risk is limited. These instructions should include:
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the position of people when feeding. If they are lying down, they
need to have the head of their bed elevated to 30 degrees, and have
their head and neck supported.
if they are sitting in bed, they need to have their torso and hips at
90 degrees.
if they are sitting in a chair, they need to have their feet flat on the
floor, with a 90 degree angle in their hips and knees.
position of care staff during feeding.
the proper food consistency such as pureed, thickened, thin liquids,
etc.
using adaptive feeding equipment.
using techniques to help with lip closure, jaw stability and tongue
position.
You need to know what your organisation’s policies and procedures are
for reporting and documenting any difficulties you notice as you
support the person with their eating and drinking. It is also important
that you know how to give first aid if an emergency situation arises.
Assisting with drinking
Helping with drinking.
Remember to communicate with the person to build comfort and trust
between you and the person you are working with. Take the lead from
the person you are assisting.
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Write
Read through the general steps on safe swallowing in the table below.
Tick the steps that you do in your workplace.
Write any additional steps that you follow in the space provided at the
bottom.
Additional steps:
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Behavioural issues
A person may have a number of behaviour issues during eating and
feeding. These can have a number of different causes such as illnesses
like dementia or emotions such as anger and frustration. Examples of
behavioural issues are:
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refusing to eat.
not opening their mouth.
holding food in the mouth.
wandering away from the table.
playing with their food.
spitting food onto the floor.
causing disturbances, for example, yelling, throwing food and/or
objects, eating another person’s food.
The technique you use to address the behavioural issue will depend on
the nature of the behavioural issue and the setting the person is in.
Your organisation will also have policies and procedures that you may
need to follow when assisting people with these issues.
When working with people with behavioural issues, it is important that
you are always:
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patient and understanding.
respectful of the person’s likes and dislikes.
able to listen to their needs.
Always seek advice from your supervisor if you need help.
Here are some suggestions that may help to avoid or reduce
behavioural issues:
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communicate with the person to build trust and to show you
respect them (not treat them like a child)
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limit the number of distractions in the room, for example, by turning
off the television.
if possible, seat the person in a chair to help promote comfort and
good posture.
remove any utensils that are not needed for the meal.
get the person to perform oral hygiene and hand washing.
ensure dentures, glasses and/or hearing aids are in place.
provide clothing protectors, for example, napkins.
position the chair correctly to be the right height for the table.
serve one or two foods at a time.
if the person has difficulty managing utensils, provide finger foods.
use verbal cues that are simple and easy to understand, for
example, “take a bite” and “pick up your fork”.
give the person plenty of time to eat.
be patient. Do not criticise the person’s eating habits.
check the food temperature to ensure it is not too hot or too cold.
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Using adaptive cutlery
A person may also find eating difficult if they have to use normal
cutlery. This is usually because the muscles in their fingers, hand or arm
may be weak or partially paralysed. This makes it hard for them to grip
the cutlery. The person’s coordination may also have been affected in
some way making it difficult for them to lift their hand from their plate
to their mouth.
Difficulties managing cutlery can be overcome by the use of adaptive
cutlery and plates.
These assistive devices can help a person to eat and drink
independently.
Utensils are items like knives, forks and spoons as well as tools that may
be used in the preparation of food, for example, a potato peeler or an
automatic jar and bottle opener.
Cups may have sipper spouts and/or a large or double handle. They may
be shaped to assist people who have difficulty breathing. Attachable
handles can be used for both cups and glasses.
Straws can be a longer length and flexible so that people don’t need to
bend their heads to drink.
Plates and bowls can be weighted or have suction cups on the base to
prevent spills. They can be insulated to maintain the required food
temperature and shaped, for example with a high edge so that food
does not spill off the edge.
Modified utensils
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Write
Think of a person you are currently supporting with their nutritional
requirements and/or eating or feeding issues. Find the personal plan for
this person. Answer the following questions.
What are the nutritional requirements and dietary needs of this person?
What assistance does this person need in order to eat and drink safely?
What (if any) assistive device does this person use? Why do they use
them?
What are any risks associated with eating and drinking for this person?
How do you manage these risks?
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