There is a small group of students with physical or multiple disabilities who have difficulties with eating and drinking.

Many of these students have an increased risk of choking, reflux and/or aspiration of food and drink into the lungs and therefore their health and safety during meals is an essential aspect of our "duty of care" responsibility. For these students it is imperative that staff are adequately trained in assisting with meals and that a meal management plan is developed and implemented.

The following guidelines are provided to assist schools to satisfy their "duty of care" responsibility.

General principles

Training

All staff members involved in assisting students with meals must undertake an approved training course. This course should include information provided by a registered first aid instructor about standard infection control procedures, the principles of feeding and swallowing, and choking management.

Approved training should be documented and updated annually.

Staff members who assist students with meals should be specifically trained to meet the needs of the individual student. A speech pathologist, an occupational therapist and or nurse (as appropriate) should provide this training. This individual training should be recorded.

After initial training the staff member should be observed and re-trained as necessary.

Some students may not be able to eat or drink sufficiently to support their nutritional needs. For these students meals are provided by non-oral methods usually via a tube to the stomach. A meal management plan is critical for these students; a dietician and nurse usually develop the plan. Staff involved with assisting these students must be trained in the necessary procedure before assisting the student. Training should be provided by a nurse or the student's parent. Evidence of the training must be provided. (See the section on Training and Credentialling of Staff)

The following procedures are recommended:

• more than one staff member should be trained in meal management with a particular student and that the additional staff member assist the student on a regular basis in order to maintain skill level (weekly). This will assist the student in responding to a variety of assistance and increase flexibility within the school in the event of excursions and teacher aide absence

• a senior teaching staff member or nominated teacher should be trained in meal management in relation to students attending the school and assist students on a regular basis (monthly), in order to adequately supervise relief staff and satisfy "duty of care" responsibility

• relief personnel assisting students with meals should be directly supervised by a trained staff member and must read and be familiar with the meal management plan for the student.

Meal management plan

The school is responsible for ensuring that a meal management plan is in place for every student who has difficulty with eating and drinking. A speech pathologist, an occupational therapist and others should devise the plan as required.

Meal management plans should be updated at least annually and it should be signed the Speech Pathologist/Occupational Therapist signs the meal management plan. The plan must be made available for staff members who assist students with meals.

A meal management plan should contain:

• information on a student's abilities in eating and drinking
• safe eating and drinking practices for the student
• type of food and texture
• seating and positioning of student
• specialist equipment
• precautions
• emergency action plan
• signatures indicating the plan has been read by staff assisting the student
• signatures indicating an annual update.

The meal management plan should be read in conjunction with the student's individual educational plan, where broader issues in relation to functional skills, communication and social aspects are considered.

Duty of care

To satisfy the 'duty of care' responsibility, an accident or incident form must be completed for any unusual incident eg ongoing coughing/choking. A choking episode or ongoing coughing may indicate that food or drink has been aspirated and the student may be at risk of developing pneumonia.