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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?

Blog-Feeding-Therapy-Main-Landscape

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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Why Are Occupational Therapy Screens Necessary for Schools?

Occupational therapists are skilled in assessing how a child’s sensory processing abilities, fine motor skills, visual motor skills and gross motor skills impact performance and function in daily life including self-care, play and academics. Proficient skills in these areas are imperative for children to be successful in the classroom environment.blog-occupational-therapy-screenings-main-landscape

  • Sensory processing skills support a child’s ability to learn. A child who is unable to process environmental stimuli effectively and efficiently will be unavailable to learn. Children with sensory processing dysfunction may have difficulty sitting still for an extended period of time in their desks or during circle time, they may be unable to pay attention when others around them are talking or they may have difficulty standing in line without touching, or hanging on a friend in front of them. These behaviors are a result of poor processing of the vestibular, auditory and proprioceptive systems, respectively.
  • Efficient fine motor skills are necessary to complete academic work. From writing to cutting with scissors and keyboarding to making crafts, fluid fine motor skills help children complete classroom activities and homework.
  • Efficient visual motor skills provide a foundation for writing and copying from the board as well as completing math work.
  • Efficient gross motor skills are important within the school environment for moving safely throughout the school and classroom, engaging with peers on the playground or during gym, and sustaining appropriate posture while sitting at a desk to complete work.

When a child struggles in any of these areas, it may not always be obvious. Oftentimes, sensory processing difficulties go unnoticed for many years and the child is left with academic or behavioral challenges. Therefore, occupational therapy screens are essential for schools.  An occupational therapist’s knowledge of child development, and its impact on daily functioning, can help identify children who would benefit from therapy services.

The screens can also be used as a preventative measure to ensure that a child’s development is on track and the child will have the foundational skills necessary to be available to learn. Occupational therapy screens also allow the opportunity for OTs to educate and collaborate with teachers and educators to provide suggestions that they can share with families and use in the classroom.

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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4 Ways to Better Handwriting before Pencil Hits Paper

Your child’s handwriting skills will affect his performance in school, beginning as early as preschool.    How your child holds his pencil, sits in his chair, and attends to the task of handwriting can affect your child’s ability to feel successful in completing a handwriting task. 

4 ways you can promote your child’s handwriting skills before his pencil hits the paper: 

  1. Address his posture: Your child’s posture at the table is directly associated with his fine motor control.  He Handwriting skillsdoes not just use his hand muscles to write—his core muscles are important too.  Make sure that the height of his chair allows for his feet to be placed flat on the floor.  Ideally, you want your child to be sitting so that there is a 90° angle at his knees and his hips.  This will put his body in a position that supports good handwriting.  Sitting on a wedge cushion (move ‘n sit cushion, air-filled cushion) that provides vestibular activation can sometimes help to improve his posture. 
  2. Address his grasp:  Your child’s pencil grasp can hinder or support his ability to write neatly.  Encourage your child to hold his pencil between the tips of his thumb and pointer finger.  The pencil should rest on the side of the tip of his middle finger.  Keeping the space between his thumb and pointer finger (the web space) open will ensure that he is utilizing his muscles in the most efficient manner and will reduce fine motor fatigue.  Sometimes, utilizing an adaptive grip on his pencil can help him to maintain the grasp with decreased difficulty. 
  3. Address his attention:  Your child’s attention can support or detract from his ability to accurately complete a handwriting task.  To support his attention, minimize the distractions in the room.  Your Read more

Why Is A Full Occupational Therapy Evaluation Beneficial When My Child’s Only Difficulty is Handwriting?

Child practicing handwriting

Handwriting is a complex task that involves many prerequisite skills, including visual skills, ocular motor control, body awareness, fine motor planning, shoulder stability, and hand and finger strength. Each prerequisite skill contributes to efficient and fluid handwriting:

  • Visual skills are needed to accurately distinguish and interpret letters and shapes on a page, essential for writing. Ocular motor control is needed to move one’s eyes across the paper to write in an organized manner.
  • Body awareness is required to accurately move the hands for writing, as well as knowing how much force is needed to make marks on the paper with the pencil or pen.
  • Fine motor planning is needed so that your child can easily identify, plan and execute the task of writing letters, words and sentences.
  • Shoulder stability is required to control the pencil.
  • Hand and finger strength is required for endurance that is needed to write many letters to form words and sentences. Hand strength is also needed for an appropriate grasp on the pencil.

In order to address handwriting in therapy, it is imperative for the occupational therapist to assess your child’s current level of functioning in each of the above areas. The root cause of your child’s handwriting difficulties may be his or her struggle in either one area or multiple areas. A full occupational therapy evaluation is very comprehensive; it allows the therapist to get a baseline level of performance to identify your child’s strengths and weaknesses in the prerequisite skill areas, and unveil the source of your child’s difficulty with handwriting.

Following the evaluation, your therapist will develop goals based on your child’s performance and design a treatment program that concentrates on improving these foundational skills, and ultimately improve his or her handwriting organization and legibility.

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Executive Functioning Activities At Home

Many kids have difficulty mastering skills such as problem-solving, organization, sequencing, initiation, memory, attention, and breaking downgirl with homework books tasks.  These skills (and many more) fall under the category of executive functioning.  As children get older and begin middle school, these skills are expected to advance quickly.  It is usually in about 5th grade where teachers and parents start to notice their child may be having more difficulty than her peers in executive functioning skills. Academic specialists, occupational therapists, and neuropsychologists are just a few of the professionals who address challenges in these areas, but there are also a variety of activities that can be done at home that are both fun and target the development of certain executive functioning skills.

Here is a list of activities that build certain aspects of executive functioning and are fairly easy to orchestrate in the home:

  • Using Playdoh, blocks, or Tinkertoys, build a figurine and have your child build an exact replica in size and color.  This works on multiple skills, including initiation, breaking down tasks, sequencing, organization, and attention.  If you are unable to build an example, or if you have an older child who enjoys playing independently, there are often pictures of structures to build that come along with block sets or images online that can be printed.
  • Have your child go through a magazine and make a list of all the toys/items wanted. Then, have her organize the list in some sort of order (most wanted at the top, alphabetical, price, etc.).  For older kids, you could also have them write a description of the item, cut the pictures out, and type up a list with descriptions and pasted pictures, or even plan a presentation.
  • There are many board games that target executive functioning skill development.  A few of the games used in the therapeutic setting that would be easy and fun options for home use include: Rush Hour (a problem-solving and sequencing game involving getting a specific car out of a traffic jam when the other vehicles can only move in straight lines), Mastermind (trying to determine what the secret code is by process of elimination), and Connect 4 Stackers (a game of attention, organization, and planning to be the first to get four in a row, like the original, but this game involves different dimensions).
  • There are many resources that can be printed from the internet. Logic puzzles come in many different levels of difficulty and involve taking given clues, making inferences from those clues, and eventually solving some sort of problem through the use of the clues. There are often charts that accompany these puzzles and require attention, organization, sequencing and problem-solving.
  • Have your child choose a recipe from a magazine. After verifying that it is a realistic recipe that can be made in your home, have her write a grocery list containing everything needed to prepare that dish, create a list of the necessary cooking supplies, and for older children, have them look up the price of each item at the store and create an estimated budget. If possible, let them be part of the entire process, and take them with you to the grocery store. Again, with older children, you could even put them in charge of pushing the cart and finding the items in the store. For older kids, they may also act as the “head chef” and be responsible for completing most of the cooking. For younger kids, if there are safety concerns, assign specific tasks as their job in the cooking process.

One of the most important aspects of doing therapeutic activities at home is that your child is having fun. These are just a few of the many activities that can be done at home to develop executive functioning skills and are also engaging and enjoyable for school age kids.




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Are Premature Babies Delayed?

The term premature refers to any infant that was born earlier than 37 weeks of gestation. Premature births occur in 10% of all live births. Premature babies (“preemies”) are at risk for multiple health problems, including breathing difficulties, cerebral palsy, learning disabilities, and delays in their gross and fine motor skills.

Premature baby

Why are babies born pre-term?

The cause of premature labor is not fully understood. However, there are certain risk factors that can increase the likelihood of premature labor: a woman that has experienced premature labor with a previous birth, a woman that is pregnant with multiples (twins, triplets, etc), and a woman with cervical or uterine defects. Certain health problems can also increase the risk of premature labor, including diabetes, high blood pressure and preeclampsia, obesity, in-vitro fertilization, and a short time period between pregnancies.

What are the effects of being born pre-term?

In addition to multiple medical complications, a baby that is born before 37 weeks of gestation is at risk for developmental problems in gross motor skills, fine motor skills, sensory integration, speech and language skills, and learning. The baby may take longer to reach specific developmental milestones or need help to reach those milestones. The earlier babies are born, the more at risk they are for having delays. Each child is different as well, and no two preemies will be delayed in exactly the same manner.

If you or your pediatrician suspects that your baby is developmentally delayed, there are a variety of professionals that can assist your child in achieving his or her full potential. A physical therapist can help facilitate development of gross motor milestones such as sitting, crawling, walking, running, or jumping. An occupational therapist can help develop fine motor skills such as object manipulation, hand-eye coordination, and reaching, as well as sensory integration. Speech therapists can help improve language skills and articulation.  Consult with your pediatrician or talk with one of our Family Child Advocates to receive more information on setting up an evaluation with a skilled therapist at NSPT.

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How To Teach Your Child Pre-Writing Skills | Pediatric Therapy Tv

In today’s Webisode, a pediatric occupational therapist explains strategies she uses to teach pre-writing skills.

Click here to check out our previous Webisode, suggesting games for fine motor practice to develop handwriting skills.

In this video you will learn:

  • How an occupational therapist uses shapes to teach a child beginning to advanced handwriting
  • At what age a child should master all shapes for writing

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics, to a worldwide audience, this is Pediatric Therapy TV, where we provide experience and innovation to maximize your child’s potential. Now your host, here’s Robyn.

Robyn: Hello, and welcome to Pediatric Therapy TV. I’m your host, Robyn Ackerman. I’m standing here with Lindsay Miller, a Pediatric Occupational Therapist. Lindsay, can you explain to us, what are some exercises you can do with a child to help with pre-writing skills?

Lindsay: Sure. With some children who are too young to begin writing their letters, we work on practicing making particular shapes. These shapes include horizontal lines, vertical lines, circles, diagonal lines, crosses, Xs, squares, and triangles. So with younger kids, we would probably start off working with the simpler shapes, such as the horizontal and vertical lines, and also the circles.

Once they’ve mastered those, then we would move on to the more complex shapes, like the diagonal lines, the crosses, the Xs, the squares, and the triangles. We work on these shapes in particular, because these are the shapes that you generally use when you’re writing. So if children learn how to write their horizontal and vertical lines and their circles, then it helps them once they’ve begin to start writing their letters, because these are the shapes that we use for upper and lowercase letters. So generally, by age five a child should be able to make all of these shapes.

Robyn: Wow. That’s really great tips. Thank you so much, and thank you to our viewers. Remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of mind to your family with the best in educational programming. To subscribe to our broadcast, read our blogs, or learn more, visit our website at learnmore.me. That’s learnmore.me.

Using Games as Fine Motor Practice to Improve Handwriting | Pediatric Therapy Tv

In today’s Webisode, an Occupational Therapist introduces us to beneficial games and tools to aid efficiency of handwriting practice for children.  For more on your child’s handwriting, click here.

In this video you will learn:

  • How certain game pieces prepare your child for writing
  • Which games are recommended to use for handwriting practice
  • Useful tools to warm up hands for writing

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now, your host, here’s
Robyn.

Robyn: Hello, and welcome to Pediatric Therapy TV. I’m your host, Robyn
Ackerman and today I’m standing here with a Pediatric Occupational
Therapist, Lindsay Miller. Lindsay, can you explain to us what are some
games that you can play with children to help with their fine motor and
handwriting?

Lindsay: Sure. Some of the games that I like to play with children involve
small pieces and small pegs, such as this piece right here. This is from a
game called HiHo CherryO, and you use it by holding your thumb and your
index finger and middle finger to hold onto the piece. So that kind of
mimics the way that you would hold a writing utensil, such as a pencil.
Other games include Lite-Brite and Battleship. This is a piece from Lite-
Brite, and, again, you can see that I’m holding it with my thumb, index,
and middle finger. So it’s kind of a way to warm up the hands, before we do
handwriting tasks.

Some other games that I like to use with children involve tongs or
children’s’ chopsticks or tweezers. These are tongs, and, again, you can
see that I’m using it with my thumb, index, and middle finger, which mimics
the way that you would hold a writing utensil. Some examples of games that
use tongs and tweezers would be Operation and Bed Bugs. So those are just
some of the ways that I like to warm up the hands before we do handwriting
tasks.

Robyn: All right. Thank you so much, Lindsay, and thank you to our viewers.
And remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of mind
to your family with the best in educational programming. To subscribe to
our broadcast, read our blogs, or learn more, visit our website at
learnmore.me. That’s learnmore.me.

Monkey Bar Mania

It is time. Lunch is over and the weather is finally allowing our children to break free of their heavy winter coats and boots to enjoy the warm, fresh, and invigorating air on the playground. Antsy children struggle to contain their excitement as they take their final steps to the great outdoors- slides,Little girl climbing on monkey bars teeter-totters, swings, and kickball fields galore. Only the bravest of the brave dare take on the tall metal intimidators commonly known as the monkey bars.

Monkey bar climbing has been right of passage for children all across the playground. Conquering their cold frames take time, practice, and determination. Here are the developmental steps to achieving the ultimate goal: swinging from one end to the other without touching the ground as our ape-like friends seem to do so effortlessly.

  1. First, ask your child to reach for the monkey bars and let their feet dangle. Cheer them on and encourage them to hang on as long as they can. This will help them to strengthen the muscles in their hands and upper body.
  2. Next, encourage them to swing their legs back and forward while maintaining their tight hold on the bar. This swinging will in turn, give your child the burst of momentum they’ll need to eventually move across the bars.
  3. Next, help them coordinate the swing of their legs with the movement of an arm to reach for the next bar. Keep in mind that your child may need you to support them at their waist in order to complete the first few swings. It may also be a good idea to encourage them to first reach with their dominant hand as they may have an increased rate of success at grabbing the bar.
  4. After successfully completing one swing, talk your child through bringing their other arm to same bar that the first is holding. Once your child can successfully cross the monkey bars one at a time, they may then practice alternating hands on sequential bars. Once they’ve mastered the monkey bars, they can move on to eventually skipping one or two bars at time!

For other playground tips and tricks, see Amanda Matthews’ blog suggesting tips to work on motor skills at the park.

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How to Promote In-Hand Manipulation in Everyday Activities with Kids

In-hand manipulation skills are important for many everyday tasks, such as eating, writing, dressing, playing, and drawing. With all the busy schedules these days, it is often hard to find time to practice such skills enough.Mother practices hand manipulation with daughter

Here are ten ways to encourage development of in-hand manipulation through tasks and activities that you and your children already do!

  1. When putting change into a piggy bank, have your child pick up several coins with her fingers, one at a time, and transfer them onto her palm. With all of the coins securely held in her palm, she should then transfer one coin at a time into the bank.
  2. Play board games or any game involving small pieces (for example, connect-4). Have your child hold all the pieces in her hand, transferring pieces from her palm to her fingers, one at a time, as needed for the game.
  3. While eating snacks, have your child hold multiple small pieces in her hand, letting go of one at a time. Also, while eating a larger snack like a chip, have your child rotate it in-hand (turn it in a circle) before eating it.
  4. Use tongs or tweezers to pick up game pieces. You can also use them for crafts!
  5. Encourage your kid to do buttons, skips, and snaps independently or help you with yours.
  6. Ask your child for help with various baking and cooking tasks such as rolling bread or shaping cookies. She can also use tubes of frosting to help decorate cakes and cupcakes.
  7. If you are about to enjoy a pop, ask your child to help you open it. Do the same for opening and closing bottles or jars of various sizes.
  8. While drawingplace the crayon inverted (upside down) on the table so that your child has to turn it around with one hand before drawing.
  9. Complete a puzzle together. While figuring out where the pieces go, encourage your child to use one hand to rotate a piece until it fits in a spot.
  10. When writing with a pencil, practice rotating it around to erase with one hand or have races to see who can “shift” their hand down the pencil the fastest.

Do not let a learning opportunity pass you by! Keep an eye out for these everyday opportunities that can promote continued development of in-hand manipulation skills for your children. Without any planning, you can still easily help your children blossom and reach their full potential!

For more information on in-hand manipulation, see my previous blog.

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