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Simple environmental modifications optimize students' eating and swallowing skills during mealtimes at school:
- Provide a neutral, pleasant atmosphere with no forced or coerced feeding or comments on intake.
- Encourage independence in feeding—even if it's messy.
- Encourage use of utensils over fingers when possible.
- Use a consistent alerting cue prior to presenting a bite (e.g., "Here's your bite, Sarah").
- Encourage use of adaptive feeding equipment to improve independence in feeding when possible.
- Present all food from the student's plate or cup to assist in developing orientation to the table setting.
- Reduce distractions in the environment when needed to improve student focus. Some students will benefit from eating in the classroom rather than in the cafeteria. It may be helpful to turn students away from visually distracting environments or play soft, rhythmic music as background noise. When students can handle the distractions of a school cafeteria, facilitate and support their opportunities to be included in the lunchroom with peers with and without disabilities.
- Direct verbalizations to the student you are supporting; reduce interactions with others in the environment. Respond to all of the student's communication attempts.
- Facilitate opportunities for communication during the mealtime. Use visual strategies (see Hodgdon, 1999), or other low-tech augmentative/alternative communication options when appropriate.
- Allow students to dip fingers or spoons into new foods to provide novel taste experiences in a non-pressured environment.
- Give no food unless the student is seated; do not permit walking around during meals.
- Give choices when possible and respect the choice the student makes (e.g., "Do you want orange juice or apple juice?").
- Sit directly in front of a student or within his/her line of vision when providing assistance.
- Use evidence-based positive reinforcement methods (e.g., Alberto & Troutman, 2005; Bailey & Angell, 2005; Kerwin, 1999) to encourage positive mealtime behaviors, food acceptance, and eating-skill development.
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