Sara Is a 4-Year-Old Girl Who Has the Diagnoses of Prematurity

Sara is a 4-year-old girl who has the diagnoses of prematurity, cerebral palsy, global developmental delay, chronic lung disease, and seizure disorder. She presents with low muscle tone in the trunk and increased muscle tone in all four extremities. She is unable to sit without support and uses a wheelchair that places her upright with hips at a 90-degree angle, and her head, neck, and trunk are well supported. Given her motor impairments, Sara primarily uses a suckle pattern with bottle-feeding and takes purées by spoon. She is dependent for self-feeding and is held by her mother for meals. She occasionally takes some higher textures such as soft dissolvables. An occupational therapy evaluation finds Sara functioning at an 18-month level for fine motor and cognition. Oral phase swallowing characteristics include an elevated and retracted tongue, slow bolus formation, and lack of tongue mobility. Sara loves to eat but vomits frequently. Her mother reports coughing and occasional choking during meals. There has been slow weight gain, and weight has now plateaued.
-What is the best way to complete an oral motor/feeding evaluation?

A) Position in her mother's lap because this is her preferred position, and present her with bottle and spoon.
B) Use different positions, first in her mother's lap and then in the manual wheelchair, and present her with bottle and spoon.
C) Position in her mother's lap, and present her with higher-textured foods and a cup because this is more age appropriate.
D) Position in manual wheelchair, and present with only higher-textured foods and cup.