Abstract
ABSTRACT Background Swallowing difficulties are common and complex in children with physical, behavioural, and cognitive needs. This study (i) describes mealtime management and (ii) identifies barriers and facilitators to implementation of a guideline for school-aged children with feeding difficulties in one specialist school. Method Three data sets were collected: (i) 51 school records, (ii) 48 meal observations, and (iii) seven staff interviews. The model of behaviour COM-B (Capacity Opportunity Motivation and Behaviour) was used to identify barriers and facilitators. Results 28 school records stated diet modifications and five children were enterally tube fed. Seventy percent of children had mealtime assistance. Only 25% of children had written plans and these did not contain all strategies observed. When feeding plans were vague or disagreements occurred, policy did not support decision-making. Conclusions A coordinated approach is needed. Target areas for change include staff and family education; defined processes for cross-agency documentation and more detailed plans for all children.
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