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Picky Eater’s Guide to Thanksgiving

Ahhh, Thanksgiving. For some kids, it’s their favorite meal that comes just once a year! For others, they may dread the sticky mashed potatoes that get plopped on their plate or the smell of Aunt Cathy’s green bean casserole. Preparing your picky eater for this time of year might help you avoid the epic battle you fear is coming!

Here are 5 tips to help this time of year be fun and festive, not frustrating and frightful for a picky eater:

  1. Exposure!- Don’t let the Thanksgiving meal be the first time your picky eater sees all the new foods. Thanksgiving foods are not commonly seen throughout the year and can add stress to an already overwhelming situation. In the weeks leading up to the big meal, try to incorporate one or two Thanksgiving-type foods a week into your family meals or snack time. Even if they don’t want to eat it, they can touch it, smell it, play with it, and talk about it!
  2. Encourage your child to be your sous chef– Incorporating your picky eater into the cooking and creating of meals gives them a varied sensory experience, even if it’s a food they’ve never had (or have tried and disliked). This way, they get to see and feel the ingredients, use spoons and mixers to combine it all, and smell the final product, and feel accomplished for helping!
  3. Let your child choose something to make- Allowing your child to choose a menu item guarantees they will have something they like! Macaroni and cheese, mozzarella stick appetizers, chocolate chip cookies, or homemade rolls may be some favorites.
  4. Bring sauce!- Sauces and dressings can be the key to kids eating new or less-preferred foods. Even if you’re not hosting, bring it with you. If they love barbecue sauce, put a small bowl next to their plate and let them add it to whatever they want!
  5. When in doubt…bring foods they like– If you’re going to someone’s house where you have little to no control as to what is served, you can always bring a few healthy foods you know your child likes. You can re-heat it when the other food is served, and explain to the host that your kiddo doesn’t even eat your cooking to avoid any offense. Just prepare for all of the other kids to be jealous!

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

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What Parents Need to Know About Feeding Therapy

There are a variety of reasons why a child may need feeding therapy. To many of us, it would seem like Feeding Therapyeating should be a basic instinct. However, eating is one of the most complex activities we do, especially for the developing, young child. Eating involves several processes in the body, including sensory, oral-motor, muscular, neurological, digestive, and behavioral systems. Feeding problems can arise involving any one of these systems, and often more than one of these is implicated.

The following are reasons why a child may have feeding difficulties:

  • Sensory processing issues
  • Picky eating
  • Food allergies or severe reflux
  • Autism
  • Developmental delays
  • Complex post-op recovery course
  • Transition from feeding tube to oral nutrition

Feeding therapy is usually done with one or more clinicians. Depending on the type of feeding problem, therapy may involve a speech-language pathologist, an occupational therapist, a registered dietitian, a social worker or behavior therapist, and/or a physician.

A speech-language pathologist will approach feeding in a comprehensive manner, looking at the actual physical swallow mechanism as well as the sensory aspect of feeding. Before beginning a more structured feeding treatment approach, it is key to rule out any medical reasons that a child is not safe to be taking food or drink orally. If there are concerns regarding vomiting, choking, gagging, etc. then the family should seek further guidance from their pediatrician who may recommend a modified barium swallow study. This test looks at the actual swallow mechanism in real time using x-ray to determine whether or not food or liquids are being aspirated (i.e., food items may slip into the lungs rather than where it is supposed to go). If a child is aspirating, physical symptoms may or may not include choking, wet/gurgly voice, and refusal to eat. Feeding therapy can move forward once it has been determined that a child is safe to take food by the mouth.

In addition to safety concerns, therapists will also look at the various chewing and swallowing stages to see if there is a breakdown in this complex process, once food is in the mouth. There is a developmental sequence of chewing for a child as well as development of independent feeding, first using hands and then moving to use of utensils. Each child will have different needs and a feeding therapy plan should be developed that is unique to your child. One approach to feeding therapy that has high success and is evidenced based is the Sequential Oral Sensory Approach to Feeding.

The Sequential Oral Sensory Approach to Feeding is a therapeutic intervention developed by Dr. Kay Toomey. Certification by Dr. Toomey and her associates through a training course is required for therapists to utilize this technique. Once certified, occupational therapists, speech language pathologists, dieticians, social workers and other health care professionals can intervene using the SOS approach. Under this approach, children are exposed to a variety of foods to increase their comfortability with a range of foods, focusing on exploration of the foods using all the senses: sight, sound, touch, smell, and taste.

Each week, the therapist will send the family a list of 8-14 foods based on sensory characteristics that will help the child experience foods that he/she might never have tried before. The family then brings these foods to the therapy session that week. During the session, the child and therapist (and often the caregiver) engage with the food in a playful manner to move up the “Steps to Eating” with each food, a 32-step process involved in eating developed by Dr. Toomey.  The ultimate goal is for the child to explore a variety of foods and expand the range of foods that he/she tolerates. The goal initially is not for the child to eat the food, rather discover and interact with a variety of foods and develop the skills needed to do so. Parents receive feedback after each session and are given recommendations to continue practicing these techniques at home during the week for ultimate success and generalization across environments. Using this approach, children become more comfortable with and generalize the skills needed to eat a wide variety of foods.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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This blog was co-written with Julie Paskar.

J-PaskarJulie Paskar is a speech-language pathologist, and the Branch Director at the Lincolnwood clinic. She joined North Shore Pediatric Therapy in August of 2012. Julie obtained both her Bachelor of Arts in speech and hearing sciences and her Master of Arts in speech-language pathology at Indiana University in Bloomington, Indiana. She has lived and worked in the Chicago area for the past eleven years. During that time, Julie worked for a pediatric clinic providing Early Intervention services as well as speech-language therapy services to children ages 3-12. She has her Early Intervention credential in speech pathology as both a provider and an evaluator. Julie’s areas of interest include: phonological disorders, motor speech disorders: specifically childhood apraxia of speech, feeding disorders, and expressive language disorders/delays. Julie is a Hanen certified therapist, has also attended both the Introduction to PROMPT and Bridging PROMPT trainings, has attended Picture Exchange Communication System (PECS) Level 1 and Level 2 trainings as well as the Kaufman Speech to Language training. She has been trained in the Orton-Gillingham program which is a treatment program for dyslexia. Julie is a member of the American Speech-Language Hearing Association and is licensed to practice in the state of Illinois. Julie is dedicated to working with children and their families to make communication both fun and functional.

My Child Vomits When I Encourage New Foods

If this describes your child, then it’s important to contact your pediatricianBlogNewFoods-Main-Landscape to rule out any food allergies, swallowing dysfunction, or other medical conditions, as these can lead to gagging or vomiting and need to be addressed. If you know that your child is not experiencing any of these challenges, then it’s likely your child struggles with oral hypersensitivity affecting his ability to tolerate different textures and temperatures of foods. Oral sensory aversion can negatively impact a child’s diet. There are many signs of oral hypersensitivity, but one sign that is concerning for many parents is vomiting or gagging with new foods. This often occurs when a child’s sensory system is overloaded, and as a result, his body perceives the new food as noxious.

When your child is a problem feeder due to hypersensitivity, mealtime often causes stress and discomfort for both the parent and child.

Here are 5 tips to reduce stress and help your problem feeder to conquer sensory aversion with new foods.

  1. Set aside a specific time each day to work on introducing new foods.

Mealtime is stressful as it is, adding new foods in the mix when you have a problem feeder on your hands can not only escalate your frustration, but can overwhelm your child’s sensory system. Setting aside a separate time to work on feeding with your child will help to reduce the demand, establish a calm and safe environment, and provide the structure of a daily routine that will help support your child in being successful.

  1. Warm-up, provide regulating oral and tactile input prior to beginning.

Your child’s sensory system needs to be in an optimal state of functioning for him to be able to accept novel foods. Providing regulating input prior to beginning feeding time can help to reduce sensitivity and also warm his system up to prepare him. Some regulating oral activities include blowing through a straw or biting on a washcloth. Consider tactile activities as well, such as finger painting, playing with dry rice or beans, or playing with putty or clay.

  1. Set the stage—Reduce additional sensory stimuli to avoid over-stimulation.

Prepare your child’s environment in order to support his success. This includes turning off the television and the tablet and reducing other visual and auditory distractions. Introducing new foods provides a lot of sensory input. By reducing additional stimuli in the room, a parent can prevent over-stimulation and help a child to more successfully interact with the foods presented.

  1. It’s ok to play with your food!

When working with a problem feeder with oral hypersensitivity, it’s very important to allow a child to feel safe playing with his food. This means that he will need to learn to interact with new foods, whether this includes eating the food or not. Start slow, with tolerating the food on the plate, working up to touching the food, and eventually bringing the food to his mouth. Children often require several exposures to a new food before they will feel comfortable trying it.

  1. Praise and encouragement for all improvements, no matter how small.

Remember that the new food that is causing your child discomfort or distress is noxious to his sensory system. Trying and interacting with new foods is hard work, and any progress made deserves praise. Remain positive and provide positive reinforcement for each new interaction your child has with a food.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Turn “I Don’t Want That!” into “More Please!”: How to Help Your Picky Eater

As a parent, it is probably not difficult to know when you have a picky eater on your hands. Meal time should be a pleasurable experience for everyone and an opportunity to spend quality time with family. Read the tips below to alleviate stress during meals with a picky eater.

Tips to Make a Better Mealtime for Your Picky Eater:

Make a routine, and stick to it. Make a routine out of meal time. Set expectations such as setting theHow to Make a Better Meal Time for Your Picky Eater table, turning off the TV, and sitting at the table as a family.

Stay relaxed and calm. The more relaxed and calm you are during mealtime, the more likely your child will be relaxed and calm too.  Model the behaviors you want your child to display.

Remove Pressure. Don’t place pressure on your child to eat certain foods. Delete the “you have to” and “if you don’t eat this…” sayings from your vocabulary. This fosters negative feelings and experiences with feeding. We want positive and happy feelings associated with meals in order to support healthy eating habits!

Eliminate distractions, grazing, and long mealtimes. Turn off the TV and put away the toys and electronics! Additionally, keep meal time to 30 minutes or less. The longer a mealtime becomes, the less pleasant mealtime may be. Consume solids first and liquids last, since liquids are more filling. Discourage snacking and grazing throughout the day, because this can lead to decreased appetite at meal times.

Serve a variety of food consistencies and tastes. This ensures that your child has exposure to multiple tastes, textures, and temperatures of food. Involve your child in grocery shopping and in meal preparation. The more a child understands about food and is an active participant in making food and mealtime happenings, the less surprising a new food is likely to be.

Explore new foods and make it fun. This may help decrease anxiety caused by unfamiliar or nonpreferred foods. Play with food, and don’t worry about making a mess! Smell, touch, lick, and bite foods to explore them and increase your child’s exposure. Talk about the food and describe it. How does it feel, what does it look like?

Don’t feel discouraged if you feel like nothing is changing. Your child may not be requesting a well-rounded meal tomorrow, but these tips will help you get there!

Seek the guidance of an occupational therapist or speech language pathologist if your child is particularly resistant and consumes a limited diet, as these may be signs of being a problem feeder.

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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!
Reference: North Shore Pediatric Therapy (2011). Picky eating: when to be concerned and how you can help. [PowerPoint slides].

texture aversion

Help! My Child Has a Texture Aversion

“Just take a bite!” “Just try it!” “One bite and you can eat the rest of your food.”

Does this sound all too familiar to you? Do you recognize this battle during mealtime? Your child may have a food texture aversion.

Signs your child may have a texture aversion:

  • Only accepting a narrow range of food choices
  • Extreme preference for certain brands of food
  • Anxiety when faced with a new food item
  • Inability to eat any foods, including foods regularly chosen within the home, when not at home
  • Preference toward avoiding food, often for an entire day, instead of trying something new
  • Difficulty chewing or swallowing
  • Frequent gagging when served certain foods
  • Facial grimacing or spitting out foods
  • Vomiting when new food is introduced
  • Refusal of food is not related to a food allergy
  • Prolonged mealtimes

What you can do to help with a texture aversion:

  • Reactions
    • Keep a journal of the types of foods your child eats and his reactions to these specific foods. This list will be extremely helpful for the speech-language pathologist or occupational therapist when taking your child in for a feeding evaluation.
  • Don’t push
    • Don’t reinforce the food aversion. Many parents believe that withholding favorite foods as punishment will force the child to give in, but this will only worsen the problem. Also, promising rewards for trying disliked foods will also reinforce food aversions.
  • Modeling and fun
    • Model the behavior you want to instill in your child by eating a wide variety of foods. Children will often adopt the behaviors they are exposed to. With positive reinforcement your child will reduce stress around new foods. Also, get your child involved in meal preparation. Make playing with new types of food fun. Learn about foods and where they come from. Teach your child how foods help our bodies. Expose your child to new foods or averted foods in a fun, stress-free environment.
  • Evaluation
    • Take your child for a feeding evaluation with a speech and language pathologist or occupational therapist. These professionals will help you determine if further therapy is necessary and can introduce the concept of food chaining to your child.
      • Food chaining is the systematic process of slowly introducing averted or new foods to your child. This should be done with professional guidance.

If you believe your child may have a texture or food aversion consult with a professional feeding therapist. Remember, take the stress out of eating for your child and make eating foods a fun and exciting activity. The goal is to reduce stress for you and your child.



baby finger foods

Finger Foods for Babies

How many times have you tried to give your baby a bite of his food and he reaches for the spoon, ready to do it himself? Probably just about every time you feed him. When your baby is about 9 months old, he has begun to develop the fine motor skills needed to start feeding himself. This is often a favorite (and very messy) activity for little ones.  It’s important to remember that finger foods for babies don’t have to be bought in the baby food aisle. Many of the things we eat can be adapted for baby! This will reduce your worry about always having something for him to eat as well as expose your baby to a new foods and textures.

Allowing your baby to feed himself as much as possible will help to encourage independent, healthy eating habits. This gives your child some control over what, and how much, they eat. There will be days that he will clean his plate, and there will be days where everything ends up on the floor…but that’s okay! He is learning the process of self-regulation and learning to recognize when his tummy is full.

 Rule number 1: Always try the food first.

Here is your finger foods checklist:

  • Is it soft?
  • Is it cooked enough so that it’s mushy? Overcook those veggies!
  • Does it melt in your mouth? (Think puffs or Ritz crackers)
  • Can you gum it? (i.e. eat it without teeth)
  • Is it cut into small pieces?

Rule number 2: Give your baby a variety of foods.

It can take up to 10 times for a baby to accept a new food into their repertoire. Don’t give up if the avocado ends up on the floor the first 4 (or 7) times.

Rule number 3: let him get messy!

Food play is an important learning experience. You have similar nerve receptors on your tongue and fingers so playing with food will help your baby experience different textures and temperatures.

With those three rules in mind here is a list of great finger foods to try with your little one!

  • Bananas-To make bananas easier to pick up, try dusting them in crushed Cheerios first.
  • Mandarin orange/peach/pear cups.
  • Grapes without the skin
  • Blueberries-If they aren’t small enough, cut them in two.
  • Watermelon (seedless, of course)
  • Cooked veggies: zucchini, carrots, sweet potato, butternut squash, etc.
  • Avocados or guacamole
  • Extra soft pasta
  • Small pieces of slow cooked or ground meats like meatballs, etc.
  • Fish
  • O-shaped cereals
  • Egg yolks-Once your baby is one year, they can have egg whites too.  Try chopping up hard boiled eggs!
  • Rice cakes
  • Cheese-Start with something bland like mozzarella or cheddar.
  • Quesadillas
  • Waffles and pancakes

Remember, now that your baby is eating these foods, the biggest issue to avoid is choking. Make sure your baby is strapped into his high chair and your eyes are on him at all times when starting these finger foods. Don’t give him any foods that could get stuck in his throat: popcorn, raisins, raw veggies, fruit with hard skin, hot dogs, etc.

Have fun with it! Get creative! And, don’t think you can only give him “baby” food!  If you have questions about your baby’s feeding, contact our Speech-Language Pathologists for answers.

Phonological Process Disorder vs. Childhood Apraxia of Speech

A phonological process disorder and Childhood Apraxia of Speech (CAS) are two speech disorders that affect your child’s intelligibility and in some cases, can present similarly. However, characteristics of these two are different.

Phonological Process Disorder:

A phonological process is a predicted and patterned speech sound error.  Speech sounds developmentally progress in your child’s speech. If a sound is too difficult to produce or developmentally inappropriate, children naturally simplify it to an easier sound, thus producing a phonological process. For more information on sound development, click here to read my blog entitled Speech Sound Developmental Milestones.

Click here to learn more about phonological process elimination.

Below are some red flags of a phonological process disorder:

  • Unintelligible speech (a child should be understood 75% of the time at age 3, 80% of the time at age 4, 90+% of the time at age 5)
  • Frustration from your child when his/her speech is not understood
  • Patterned and predicable errors: consistent substitution of P for F such as “peet” for “feet”  Read more

Infant Soy Formula: A Review of Recommendations from the American Academy of Pediatrics

Parents often ask me about giving their infant a soy formula when their infant shows signs of difficulty tolerating breast soy formulamilk or cow’s milk based formulas. Soy seems to be a common go-to alternative; however, there are actually only a few scenarios where soy formula is recommended. The American Academy of Pediatrics published a journal article that reviewed the use of soy based infant formulas in 2008. Here is a summary of the main points.

A Review of Infant Soy Formula:

  • Soy formula is not indicated as an alternative for breast milk or for cow’s milk based formulas except in the case of Galactosemia and hereditary lactase deficiency (both are rare diagnoses). Soy formula may also be an option for parents who desire a vegetarian diet for their infant, if breastfeeding is not possible.
  • Soy formula is not indicated for children diagnosed with cow’s milk protein allergy. Instead, an extensively hydrolyzed formula should be considered, because 10-14% of these infants will also be allergic to soy protein. Read more

Nutrition Implications of Pediatric Congenital Heart Defects

Congenital heart defects in the pediatric population are a serious condition. Many defectscongenital heart defects require surgical intervention to correct or improve the problem. Often, there are nutrition-related implications associated with heart defects. Here is more information about how nutrition may be affected to help you understand this aspect of your child’s health.

The Link between Nutrition and Congenital Heart Defects:

  • Digestion and absorption of nutrients. The major job of the human heart is to pump blood throughout the body. The blood carries nutrients and oxygen to be used for energy and to support all body functions. With a heart defect, blood circulation may be suboptimal, since the heart may not be pumping strongly or efficiently. This can result in poor blood flow to the gut, which means that the gut is not getting the nutrients and energy it needs to perform digestive functions effectively. Nutrients may not be absorbed well, which can lead to poor weight gain and general intolerance of feeds (diarrhea, reflux, delayed gastric emptying). Read more

What is a Videoflouroscopic Swallow Study?

Many children experience feeding and swallowing difficulties and they present in a variety of different ways. In order to provide the VFSSmost effective and appropriate therapy, it is often that physical or physiological abnormalities of the swallowing mechanism must first be ruled out. In order to do this, a video swallow study – Videofluoroscopic Swallow Study (VFSS) or Modified Barium Swallow (MBS)- must be ordered by a physician. These are extravagant,  complicated sounding words that can be intimidating to parents; they may sound even more intimidating to children. In order to explain this procedure to your child, it is vital that you must first understand it yourself.

What is a VFSS?

In the simplest of terms, a VFSS is a moving x-ray that examines the process of swallowing food or drink from the mouth and down through the esophagus. A Speech-Language Pathologist and a Radiologist will be in the room to operate the x-ray machine, offer barium-based food and drink items and to decipher the results. The x-ray machine often resembles a large, robotic arm that is aimed at the side of a patient’s body. Patients are placed between this machine and a raised table that serves as the ideal back-drop to capture the best view of the swallowing mechanism.

The barium food products are white in color and taste slightly chalky, but they are typically flavored sweetly. An SLP will watch the Read more