Mealtime Observation & Reflection Study: SEEM Version: 1
Research type
Research Study
Full title
The SEEM Study: Safe Efficient and Enjoyable Mealtimes: Creating a toolkit for families of children who need assistance with eating and drinking – an observational study
IRAS ID
325687
Contact name
S Morgan
Contact email
Sponsor organisation
City, University of London
Duration of Study in the UK
0 years, 3 months, 2 days
Research summary
Children with neurological disabilities (neurodisability) e.g., Cerebral Palsy can have difficulties with eating, drinking and swallowing (dysphagia). Some consequences are severe e.g., choking, parent stress, with risks higher when children need mealtime help e.g., physically fed.
Speech and Language Therapists (SLT) give parents personalised recommendations to support mealtime safety and enjoyment e.g., changing food textures. However, parents do not always notice difficulties or follow recommendations, and we are unsure which strategies help parents follow mealtime recommendations.This study has two questions:
What are the family-carers’ and children’s experiences of and thinking, during mealtimes, including what stops or helps them follow mealtime recommendations?
Do family-carers see signs of dysphagia and how do they respond?School-aged children (5-15 years) with neurodisability and family-carers (10 pairs, 20 people) will be recruited through east London NHS sites via their local SLT.
The researcher will video one mealtime at home while also recording swallow-sounds with a neck microphone. The child will be asked about their mealtime, in a child-friendly way.
Another day the researcher will meet (1-hour max) the family-carer (home or videocall; audio-recorded). They will watch the mealtime video and discuss mealtime experiences including mealtime guidelines. Clinical information will be collected from the child’s SLT.
The researcher will use the mealtime video and swallow-sound recording information to describe the child’s eating and drinking skills and difficulties e.g., food loss, atypical swallow sounds. They will watch the mealtime videos to see how the pair interact and how the family-carer responds to difficulties e.g., coughs. They will look at how the family-carer follows their personalised mealtime recommendations. They will analyse the child’s views and family-carers thoughts and feelings about the mealtime video and mealtimes generally, including the guidelines.
The study findings will be used to develop a future ‘strategy toolkit’ to improve mealtime safety and enjoyment.
Lay summary of study results: The SEEM Study: Safe Efficient and Enjoyable Mealtimes: Creating a toolkit for families of children who need assistance with eating and drinking – an observational study
Who carried out the research?
This study was completed by Sally Morgan as the lead researcher. She carried out this research as part of her PhD studies based at City St George’s University of London and was funded by Barts Charity.
What public involvement was there?
Three parents of children with disabilities and dysphagia helped plan this study. They gave advice on how to make the information given to parents and children easier to understand and how to make the study less time consuming. A group of Speech and Language Therapists also gave advice on how they could approach parents to talk about the study and could provide information about the children safely and securely if parents agreed to take part.
Why was the research needed?
School-aged children with disabilities can have difficulties with eating, drinking and swallowing (dysphagia). The consequences can be severe e.g. choking, death, stress for parents who feed them. The risks of these negative things happening is usually higher when children need mealtime help e.g., fed by someone.
Speech and Language Therapists work with children who have disabilities and dysphagia. They advise parents and other family-carers, providing personalised recommendations to support mealtime safety and enjoyment e.g. changing food textures. However, there is little guidance of how to support parents’ mealtime assistance abilities and experiences.
What were the main questions studied?
This study had two questions:
• What are parents’ or family-carers’ and children’s experiences of and thinking, during mealtimes, including what stops or helps them follow mealtime recommendations?
• Do parents see signs of dysphagia and how do they respond?What happened during the study?
School-aged children (5-15 years) with neurodisability and parents were asked to take part. We aimed to visit 10 pairs (10 children and 10 parents, 20 people).
The researcher visited them at home for one mealtime. She videoed the child and parent during the mealtime using two video cameras. This was a close-up view of just the child and another of the child and parent together. She also recorded swallow-sounds with a neck microphone if the child agreed. Children were asked about their mealtime, in a child-friendly way.
On another day the researcher met the parent at home or on a video call. They watched the mealtime video and discussed mealtime experiences including mealtime guidelines. This visit was recorded. The researcher also requested information from the child’s Speech & Language Therapist including their current mealtime recommendations.
The researcher then used the mealtime video and swallow-sound recording information to describe each child’s eating and drinking skills and difficulties e.g., food loss, different swallow sounds. They watched the mealtime videos to see how the pair interacted and how the parent responded to difficulties e.g., coughs. They looked at how the parent followed their personalised mealtime recommendations. They also analysed the child’s views and parent’s thoughts and feelings about the mealtime video and mealtimes generally, including the guidelines.
The study took place in people’s homes in north and east London and Essex. Visits took place in 2024.What were the results of the study?
Six child and family-carer pairs took part. Five were mothers and one a kinship carer. All pairs had two videos taken. Four children allowed the researcher to use the neck microphone. One child talked a little about their thoughts about mealtimes. All the parents watched their mealtime video and discussed it at the second meeting. All parents gave information about themselves and information on each child was given by their Speech and Language Therapist.
The parents and children were diverse ethnically and the children had different reasons for their neurodisability (diagnosis). Five of the children had learning disabilities which meant they showed their opinion about the mealtime through their behaviour and general communication, instead of words. Children had different levels of dysphagia difficulty (mild, moderate and severe). Children did not show many signs of eating and swallowing difficulty e.g. coughing. They did show more signs through their behaviour e.g. turning away from the spoon. One child’s swallow recording did not work so the researcher listened to three recordings. Two children’s swallow sound recordings showed some signs of difficulty that was not seen or heard on the video.
Parents responded positively to watching the videos. All parents picked out moments of pride and pleasure in their child and their own skills. Five parents spotted something they wanted to try changing in the future. Parents had many abilities, especially in-depth knowledge and skills developed over time. Many said they had not realised their expertise until watching the video and having the conversation. Parents’ knowledge and skills came from many places. These included professional recommendations from Speech and Language Therapists and other health professionals. They also had learnt from their childhood mealtimes, cultural practices, general knowledge, other parents or family-carers and sometime critical events e.g. child being in hospital. However, the most important teacher was their child. They talked about continually learning in a cycle. Parents would try an approach, watch how their child responded, make changes if they thought they were needed and try again. Parents had different main priorities with some focussing more on mealtime safety or enjoyment. They had hopes for their child’s future mealtime safety, skills and enjoyment.How has this study helped patients and researchers?
Mealtime videos and swallow sound recordings gathered useful information, and parents used the video to spot things they wanted to change. Use of mealtime video recording with children with disabilities by Speech and Language Therapists may be a useful extra tool. This study is part of a larger PhD project aiming to improve mealtime recommendation discussions with families of children with disabilities who have dysphagia and need assistance at mealtimes.Details of any further research planned
The information from this study has been used within a co-design study to plan a future resource. The resource aims to support Speech and Language Therapists when providing mealtime recommendations to parents.Where can I learn more about this study?
This study will be included as a chapter in Sally Morgan’s PhD thesis. When she has completed her PhD studies it will be available at: https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fwww.citystgeorges.ac.uk%252Fabout%252Fpeople%252Facademics%252Fsally-morgan%2FNBTI%2FBhrCAQ%2FAQ%2Fe93c7ad9-74d9-4822-943a-c5cbae6f3c47%2F2%2FK-PcDzkWyj&data=05%7C02%7Cnottingham1.rec%40hra.nhs.uk%7Cd73e9861120a488b437808de3d7d2e82%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639015805019963227%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=UQ8DwgO7LfsUmmId%2B9nM3Es2iixjY45cPiX38nsU8Lw%3D&reserved=0Has the registry been updated to include summary results?: No
If yes - please enter the URL to summary results:
If no – why not?: N/A - not on a registry
Did you follow your dissemination plan submitted in the IRAS application form (Q A51)?: Pending
If yes, describe or provide URLs to disseminated materials:
If pending, date when dissemination is expected: 23/12/2026
If no, explain why you didn't follow it:
Have participants been informed of the results of the study?: Pending
If yes, describe and/or provide URLs to materials shared and how they were shared:
If pending, date when feedback is expected: 30/04/2026
If no, explain why they haven't:
Have you enabled sharing of study data with others?: No
If yes, describe or provide URLs to how it has been shared:
If no, explain why sharing hasn't been enabled: The majority of data collected is personal data of children with disabilities and their parent or family-carer, video and audio recordings and so is not being shared with others. Some parents have given consent for secondary data analysis of the data and this will be shared with potential additional members of the research team but only under supervision of the Chief investigator, as agreed within the ethics application and stated in the Participant Information Sheet and consent form.
Have you enabled sharing of tissue samples and associated data with others?: No
If yes, describe or provide a URL:
If no, explain why: N/A - no tissue samples collected
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Submitted on: 17/12/2025REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
23/EM/0208
Date of REC Opinion
21 Sep 2023
REC opinion
Favourable Opinion