Santino continues to demonstrate satisfactory oral motor abilities during feeding; however he eats homemade pureed foods and refrains from chewing any solid food options that are offered to him. Today he did not eat his pureed lunch of potatoes; its consistency appeared more liquefied than usual. He ate cereal snacks instead. I've been continuing to work on desensitizing him to the presence of these (solid) foods. Santino will bring the food to his mouth, upon prompt, when reinforcement contingencies are applied (i.e., the provision of the I-pad is made contingent upon attaining desired, or targeted, performance objectives).

Santino continues to make steady progress in his overall relationship with food and mealtime. He will interact with different foods without displaying aversion, and we continue to work towards increasing his tolerance and acceptance when the food items are placed in his line of vision. We are currently targeting pureed table foods while working on sensory oral skills and expanding his food repertoire. Santino eats his food with good bi-manual and eye-hand coordination, and he will request additional cereal snacks if still hungry for more. He is offered water from a bottle or cup to remain hydrated, but rarely requests it on his accord. Given assistance, Santino has also enjoyed drinking from the water fountain when outdoors as well. Today, he drank water from the fountain on his own, entirely without assistance.

This afternoon, Santino followed simple 2 step directions or object function regarding food set up and preferred choice of utensils. He required minimal multi-modal cues for answering questions and commenting and is making slow but consistent progress. Santino set up his lunch in accordance to his preferences; he obtained a prop item with which to set up/support the linguistic activity he requested while eating. He ate his homemade puree with ease and facility. Santino has made progress with complying with oral motor and desensitization exercises and we will continue to target expanding his solid/table food repertoire when needed, while improving the efficacy of his oral motor skills.

Santino demonstrated social reference upon greet and immediately requested the green I-pad. Support to guide placement of his lunch box was provided and goal expansion into increased sentence variation and length was reinforced. Santino is making progress in his communication skills - expanding requests and speaking more fluently when requesting preferred activities and tasks. He demonstrated excitement upon seeing the contents of his thermos, and ate it in its entirety. Santino has a healthy appetite and continues to demonstrate a strong preference for smooth pureed consistencies.

Santino engaged for sustained social greet and followed line of regard with gesture to reach for his lunchbox. I have been encouraging Santino to identify food items in his lunchbox. He understands expectations regarding requesting lunch, requiring a minimal prompt to add the interjection 'please' to his polite request. He has been exhibiting increased eye-hand and motor control when feeding himself and will request supplemental snacks during our time together. Mom kindly provided additional cereal snacks which we will keep at school for Santino.

Santino 45 min’s feeding skills: Upon seeing me enter the classroom, Santino asked to eat his lunch. He verbalized his request in a complete sentence - only minimally prompted to add the word 'please' following his request. After finishing his pureed lunch and feeding himself independently, Santino worked on identifying six (6) eating utensils and food-related items that were aligned in front of him: a plate, fork, spoon, knife, napkin, and straw. He did well on this activity and succeeded in 2 out of three trials - correctly identifying 17 out of 18 choices (94% accuracy). Santino also consumed his cereal snack and requested more when done. His mom will be adding some additional cereal packs in his lunch box this week.

In efforts to broaden his food repertoire, Santino was introduced to additional kernels of popcorn aligned on the table as he was eating his lunch. He was prompted to count each kernel with his finger, but the number of kernels was increased today, doubled to 6, and prompts were gradually faded to consist of verbal cues alone - eliminating physical prompts. Santino did well on this in 5 consecutive trials, meeting objectives. He required physical prompts for only 1 trial at the onset, to clarify expectations and objectives. Santino requested his snack of Fruit Loops and was prompted to add the word "please' at the end; he did so with only one prompt, indicative of improvement towards his language goal. Santino had water in a bottle from home, but I provided him with water in a cup, from which he drank independently and without spillage. Before putting away his thermos and cleaning off the table, Santino brought the kernel of popcorn to his mouth, given just one verbal prompt. I am very pleased with the progress he has been making increasing his tolerance aroiund and when shown alternative food items.

Santino was absent today.

Today's mealtime added a new component today - offering Santino gradual exposure to different food options in efforts to increase his comfort level around different foods. While eating his lunch of pureed potatoes, I included 3 kernels of popcorn alongside him on the table. Since he eats using his right hand and so as not to disturb his eating, the kernels were placed to his left. I intermittently took his left hand to count the three kernels and touch each one as he counted. He was not pressured to eat them, but only to count them, in efforts to desensitize him to a food he selectively chooses not to eat. Santino repeated the word "popcorn" and we counted and placed them in size order. Again, the main objective is to increase Santino's familiarity and comfort around foods of different tastes and textures and minimize any fear or anxiety he might have with them. I assured him he doesn't have to eat the popcorn but guided him to just to touch the kernels with his finger. I then used play-based language such as "I challenge you to touch each kernel on your own.” Santino grew comfortable enough to count independently as he touched each kernel on his own. He was eating his lunch at the same time and appeared relaxed and comfortable during this trial exercise. Prompts will gradually be faded as Santino's tolerance to small incremental changes regarding the addition of different foods are added to his food repertoire during mealtime while following a consistent lunchtime routine.

Santino was absent today.