What Parents Need to Know About Feeding Therapy

Should I Have my Child Evaluated for a Feeding Disorder?

Does your child…

  • Experience extreme anxiety or exhibit behaviors during mealtime?
  • Find mealtime to be an exhausting process that requires too much time and energy to complete?
  • Have difficulty tolerating a variety of food groups?
  • Require you to prepare a separate meal from the family dinner or snack time at school?

If so, a feeding evaluation by a qualified speech-language pathologist or occupational therapist may be warranted.

What Does an Evaluation Look Like?

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The parent interview often provides the most valuable information and it is important to fill out all case-history information completely. The therapist may inquire specifically about your child’s medical history of any respiratory, gastrointestinal, renal, and craniofacial issues. Report any food allergies or restrictions (soy, gluten, dairy, egg, nuts) to ensure your child’s safety. If time allows, a 3-4 day feeding diary that includes a detailed report of all the food/drink ingested would allow the clinician to analyze any patterns of behavior and preferences related to feeding. The therapist should know the child’s regular feeding times, a list of all foods and drinks preferred/tolerated, any foods the child used to enjoy but no longer accepts, the length of a typical mealtime, and any positive or negative behavioral or physiological reactions to foods.

The clinician will examine the oral cavity (jaw, tongue, hard/soft palate, dentition, etc.) for appropriate symmetry, strength, and range of motion for feeding. Based on your child’s level of comfort, food and/or drink brought by the parent may be presented. The clinician will observe the child’s postural stability, acceptance of food/drink, munching or rotary chewing patterns, chewing side preferences, and the timeliness/success of the swallow response, and overall rate of feeding. The clinician will take note of signs/symptoms of airway penetration such as coughing, wet vocal quality, watery eyes, or excessive throat clearing. All of this information will assist the therapist in making appropriate referrals and/or developing a feeding treatment plan tailored to fit your child’s needs.

What’s the Difference Between a Picky Eater and a Problem Eater?

A picky eater is a child who accepts 30 or more foods, requires repeated exposures prior to eating the food consistently throughout varying food environments, and has specific routines with food presentation (e.g., needs crust cut off, no foods can be touching, will only eat one specific brand of chicken nuggets). Children who are picky eaters are still able to maintain adequate nutrition and hydration without nutrient-based supplements. Parents complain that new food experiences such as going to restaurants and birthday parties are often difficult due to their child’s feeding preferences.

A problem eater is a child who accepts roughly 5-10 foods and has no more than 20 foods in their food repertoire. The child presents with extreme phobic reactions to new foods such as crying, screaming, throwing foods, and most often times, absolute refusal if their foods are not preferred. Physiological symptoms become evident with facial grimacing, gagging, or vomiting when presented with or during mastication of foods. Parents often feel obligated to allow their child any food so they will eat something. A problem eater likely has underlying medical or functional impairment such as autism spectrum disorder, gastroesophageal reflux disease (GERD), reduced strength and coordination of the oral musculature, and/or sensory processing disorder. Extreme self-restriction can occur if problem eating is left untreated and most often leads to pediatric undernutrition (PUN). Most parents express that the “wait it out” approach does not work with a problem eater and they will continue to self-restrict for days until preferred foods are presented. Children who are problem eaters often require nutrient-based supplements to maintain their health.

A speech-language pathologist can treat both a picky and problem eater to expand the food repertoire and increase tolerance of various tastes, foods, and textures.

What Does Feeding Therapy Look Like?

There are many different approaches to feeding therapy. Your speech or occupational therapist will choose a technique and plan of care that suits your child’s needs most appropriately. Since feeding is a daily activity that requires parent assistance and preparation, you will likely be included in the sessions for education and training purposes.

A feeding therapy session will focus on creating a positive mealtime experience for the child. Intervention targets will likely include increasing awareness, stability, or strengthening the oral cavity, improving the motor plan sequence for feeding, and/or imposing behavioral modifications during feeding, and educating the parent. Behavioral modifications may include a daily mealtime schedule, with no “grazing” in the kitchen allowed, restricting the amount of preferred foods presented to the child, or implementing positive reinforcement for when a child is trialing a new food (access to a favorite toy for 1 minute.) Parents also benefit from behavioral modifications, such as allowing the child to choose foods from two choices, reestablishing trust after hiding something nutritious in the food, and maintaining the promise of “just 5 more bites.”

A technique called “food chaining” uses the child’s core diet (what they will reliably eat across all settings) to “chain” or transition to another similar flavor and texture of foods.

Here is an example of the steps taken while food chaining:

  1. Core diet – what the child will eat reliably across all settings.
  2. Flavor mapping – analysis of your child’s flavor preferences
  3. Flavor masking – use of a condiment or sauce to mask a new taste
  4. Transitional foods – favorites used to transition a child to a new food.  These foods cleanse the palate in-between bites of new foods
  5. Surprise foods – new foods that are significantly different – something you make together, for example: chocolate to peanut butter, apples to pears, and chips to veggie sticks.

Food chaining often incorporates all senses to transition to a new food using a feeding hierarchy. A feeding hierarchy is a tool to teach the child how to taste/trial food in slow increments in attempt to reduce the amount of anxiety associated with trialing new foods. The feeding hierarchy may include providing the child with a goal to interact with the food, or an item of similar consistency a number of times.

Some examples of what may be included in a feeding hierarchy are:

  • Tolerating the food and its scent in the room
  • Allowing the food on the table or on the child’s plate
  • Touching the food with a utensil or hands
  • Touching the food to the lips (kissing) teeth, and tongue
  • Licking or sucking the food
  • Sinking the teeth into the food
  • Taking a small “nibble”
  • Taking an average bite of food

If your child is experiencing these symptoms consult with your physician regarding your concerns. Should you have any questions regarding a feeding evaluation/therapy, consult with a qualified speech-language pathologist or occupational therapist as soon as possible.

References:

  • Fraker, C., Fishbein, M., Cox, S., Walbert, L. (June 2004). Food Chaining: A systematic approach for the treatment of children with eating aversion. Retrieved from Journal of Pediatric Gastroenterology and Nutrition: Volume 39, pg. 51.
  • Fraker C., Fishbein M., Walbert L., Cox S. Food Chaining: The proven 6-step plan to stop picky eating, solve feeding problems and expand your child’s diet. Cambridge, MA: Da Capo Press; 2007.
  • Roth, M., Williams, K., Paul, C. (August 2010) “Empirically Supported Treatments in Pediatric Psychology: Severe Feeding Problems”. Journal of Pediatric Psychology, vol. 24, no. 3, 193-214.
  • Toomey, K. Ross, E. “SOS Approach to Feeding”. Perspectives on Swallowing and Swallowing Disorders (Dysphagia). 2011. 20: 82-87. Retrieved from http://spdfoundation.net/library.html#effectiveness.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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10 Signs of Auditory Processing Disorder

What is Auditory Processing Disorder?

Auditory processing refers to what we do with the messages we hear. An auditory processing disorder occurs due to an auditory deficit that is not the result of other cognitive, language, or related disorders. However, children with an auditory processing disorder may also experience other difficulties in the central nervous system, including learning disabilities, speech-language disorders, and other developmental disorders. Auditory processing disorder may also co-exist with other diagnoses, such as ADHD or Autism. Blog-Auditory-Processing-Disorder-Main-Landscape

10 Signs of Auditory Processing Disorder

  1. Difficulty understanding speech in noisy environments
  2. Inability to consistently and accurately follow verbal directions
  3. Difficulty discriminating between similar-sounding speech sounds (i.e., /d/ versus /t/)
  4. Frequently asking for repetition or clarification of verbally presented information
  5. Poor performance with spelling or understanding verbally presented information
  6. Child typically performs better on tasks that don’t require or rely on listening
  7. Child may not speak clearly and may drop ends of words or syllables that aren’t emphasized
  8. Difficulty telling stories and jokes; the child may avoid conversations with peers because it’s hard for them to process what’s being said and think of an appropriate response
  9. Easily distracted or unusually bothered by loud or sudden noises
  10. Child’s behavior and performance improve in quieter settings

How is Auditory Processing Disorder Diagnosed?

An initial diagnosis of auditory processing disorder is made following a comprehensive audiological evaluation, which is completed by a licensed and ASHA accredited audiologist. Following the diagnosis, the speech-language pathologists at NSPT work closely with the audiologist and collaborate on an ongoing basis. Children with an auditory processing disorder benefit from working closely with both speech-language pathologists, as well as occupational therapists. Professionals at NSPT can collaborate with teachers and other professionals to provide recommendations to help set up a successful learning environment for your child. Therapy will include activities to increase auditory closure skills, vocabulary building, discrimination skills, grammatical rules, and auditory perceptual training.

Resources:

 Bellis, Teri James. Understanding Auditory Processing Disorders in Children. American Speech-Language-Hearing Association. Retrieved from http://www.asha.org.

www.understood.org

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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What Comes After the ADHD Diagnosis?

Many times parents leave a doctor’s office with more questions than when they came in. This is true for medical doctors as well as for clinical psychologists. After a parent is informed that his or her child has Attention Deficit Hyperactivity Disorder (ADHD) the next phase is to start to develop a treatment plan to help the child reach his or her potential. Treatment of ADHD should be thought of as a possible three tier system: medication, therapy, and school based accommodations. Blog-ADHD-Diagnosis-Main-Landscape

Medication for ADHD

Research indicates that stimulant medication is one of the primary treatments of choice for ADHD. Many parents are very cautious and scared about putting their child on medication. One of my first pieces of advice for parents is to stay away from doing their own on-line literature search. Anyone who has access to a computer and the internet is capable of creating their own website. A website that I refer parents to all the time is www.chadd.org which is the national resource on ADHD. The literature this website provides is empirically supported and often times created by some of the biggest names in ADHD research. The other piece of advice I give to parents is to schedule a meeting with the child’s pediatrician and have a discussion regarding medication; from how the medication works to what possible side effects to look out for.

Therapy for ADHD

Children and families often get referred for therapy when the child is diagnosed with ADHD. I am a proponent of therapy that is done correctly. There first needs to be a focus on what the targets of the therapy are as well as what specific goals will be worked on in the sessions. The therapy goals need to be specific and measureable. There needs to be some metric implemented to assess for change in the child’s behavior. Finally, parents must be active participants in the therapy. There needs to be homework assignments to work on during the week as well as specific strategies that parents can implement in the moment to help modify behavior.

School Accommodations for ADHD

The final domain that needs to be considered after a child was diagnosed with ADHD is accommodations in the classroom setting to help alleviate symptoms of inattention and impulse control which have a negative impact on the child’s academic performance. Many times after I diagnosis a child with ADHD, I discuss with the parents about creating a 504 Plan in the academic setting. A 504 Plan consists of a variety of classroom and testing based accommodations to help address academic symptoms of ADHD. The plan is always individually tailored based upon the specific concerns that a child exhibits.

The diagnosis of Attention Deficit Hyperactivity Disorder is only the first step of helping the child. Parents frequently will have to seek out outside resources such as pharmacological intervention, therapy, and school based accommodations in order for their child to reach his or her potential.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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What You Need to Know About Sensory Diets

  1. While it is called a “diet,” it’s not a FOOD diet, but it should be considered nutritional intake that your child’s body/brain need daily. Blog-Sensory-Diets-Main-Landscape
  2. Consistency is key and it is important to find a schedule that works for you. Work with your occupational therapist and teacher to develop a timeframe that works best. Do not overdo it if it does not seem sustainable.
  3. As much as possible, sensory diet activities should be completed around the same time each day.
  4. Many sensory diet activities can be adapted to be used across many environments in order to promote consistency i.e. at home, in school, while traveling.
  5. When appropriate, get other siblings and family members involved!
  6. Watch your child’s responses before, during, and after sensory diet activities and be sure to address any abnormal changes you see with your occupational therapist.
  7. The best sensory diet combines tactile, proprioceptive, and vestibular based activities.
  8. Just as no two children with sensory processing difficulties will present the same, no two sensory diets will be identical.
  9. As your child’s brain continues to develop, the sensory diet will likely eventually need to be updated in either types of activities or frequency.

Examples of sensory diet activities for each sensory system:

  • Proprioceptive: jumping and crashing on pillows, heavy work activities such as pushing a heavy laundry basket or helping carry grocery bags to put away, wheelbarrow walk or animal walks (bear crawl, crab walk), joint compressions.
  • Vestibular: log rolls, cartwheels, swinging, head inversions over the edge of a couch, yoga poses, rocking chair.
  • Tactile: messy play (shaving cream, water, finger painting), sensory bins (uncooked rice or pasta noodles, kinetic sand), exposure to novel materials (i.e. corduroy, velvet, sandpaper, sand, silk).
  • Auditory: participation in Therapeutic Listening program under the guidance of your occupational therapist, listening to calming music, listening to white noise, play exploration with various instruments or toys/books that make sounds.
  • Oral: blowing bubbles, use of straws, use of chewy tubes or “jewelry”, food texture exploration (i.e. creamy, dry, wet, lumpy), having a chewy or crunchy snack to provide “heavy work” to the mouth”.
  • Visual: activities such as “i-spy”, spot the difference picture games, and word searches, de-clutter the home environment, oculomotor exercises, dim lights and avoid fluorescent bulbs.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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