A Set Routine + Family Meals = First Steps to Mealtime Success

 

 

 

 

 

 

 

Mealtime can be stressful, often with your child challenging your attempts to have them try new foods. Some days, your child may not go to the table or sit in their chair long enough to even offer new foods! However, establishing a set routine and regular meals may be the first steps to mealtime success.

What can a mealtime routine look like?

Why is mealtime so challenging for my child? And why is a routine and family meals so important?

Eating is one of the most challenging sensory activities for children. When we eat, all eight senses are working and integrating eight new pieces of information. The properties of the food change as we eat, for instance, as part of our five senses, the taste and smell changes as we chew. Additionally, our sense for self-movement and body position is working to use different amounts of jaw pressure. Our sense for balance and spatial orientation is working to re-adjust our balance as we chew. Lastly, our sense of the internal state of the body is being put to the test by requiring that we track the changes to our stretch receptors (on the stomach) to the changes to our appetite. Processing each of those sensory changes can be and is difficult for many children. Furthermore, eating is a multisensory experience; therefore, we need to help children’s sensory systems to be regulated before, during, and after meals to increase their feeding skills and sensory tolerance for new foods.

What can I do?

If your child is demonstrating some behaviors before or during mealtime and/or is a picky eater/problem feeder, consider contacting one of our speech-language pathologist or occupational therapists, who can provide your family with helpful tips and tricks to make mealtime less stressful and more fun!

Questions or concerns?

If you have questions or concerns about your child’s mealtime routine or feeding skills, please contact us at info@playworkschicago.com or 773-332-9439.

Jaclyn Donahue MS, CCC-SLP
Speech-Language Pathologist

Reference: Toomey, Kay A.. 2008/2010. Family Meals.

Kay A. Toomey, Ph.D. & Lindsay Beckerman, OTR/L., 2016. Explanation of The Role of Sensory Therapy In Advancing Feeding Goas.

Photo Credit: Jennifer Murray and amsw photography via pexels.com

Aspiration: What Is It and What to Look Out For

Have you ever had the feeling that something went down the “wrong pipe?” This is a common sensation that people feel when food or liquid accidently enters their airway instead of traveling to their stomach. Most of us are able to protect our airways by coughing up any material that goes down the wrong way. However, some children are unable to cough up material that enters their airway, putting them at greater risk for material entering their lungs, otherwise known as aspiration. Feeding your child can already be a stressful experience, especially when it comes to their safety. Therefore, it is important to understand the signs, symptoms, and risk factors that are associated with aspiration to identify when it is appropriate to seek medical attention.

What is aspiration?

Aspiration is when food, liquid, saliva, or any other foreign item enters the airway or lungs. Aspiration can occur in infants, children, and adults, and can vary from mild to severe. If persistent and untreated, aspiration can lead to serious health issues, such as pneumonia.

What are the risk factors for aspiration in infants and children?

Aspiration is most commonly caused by a swallowing disorder, otherwise known as dysphagia. Other risk factors for aspiration include, but are not limited to:

  • Abnormal anatomy, such as cleft palate, paralyzed vocal folds, or esophageal atresia
  • Premature birth and related complications
  • Reflux disorders
  • Neurological disorders
  • Other medical diagnoses, such as Down Syndrome

What are the signs and symptoms of aspiration in infants and children?

Aspiration can result in overt signs/symptoms, such as:

  • Coughing or choking during feeds
  • Wheezing and/or breathing problems (stop breathing or fast breathing)
  • Voice sounds wet or gurgly after feeding
  • Signs of distress, including facial grimacing, tearing of the eyes, arching back, or redness in the face
  • Repeated lung or airway infections
  • Slight fever after meals

Aspiration can also occur withoutovert signs of swallowing difficulty, meaning that the child does not cough or show symptoms when material goes into their lungs. This is known as silent aspirationand is best detected by a formal video-swallow study, as it cannot be observed by the naked eye.

What can I do?

If your child is demonstrating ANY signs or symptoms of aspiration, notify your speech-language pathologist or contact your medical provider to discuss the need for a formal swallow evaluation. After a swallowing evaluation, your medical team will be able to determine which consistencies are safest for your child to eat and drink, as well as create a plan of care to improve your child’s swallow function.

Questions or concerns?

If you have questions or concerns about the safety of your child’s swallow, please contact us at info@playworkschicago.com or 773-332-9439.

Jill Teitelbaum, MS, CF-SLP
Speech-Language Pathologist

Reference: Aspiration in Babies and Children. (2018). Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/a/aspiration-in-babies-and-children.html

Photo Credit: Jens Johnsson via unsplash.com

Feeding Therapy: What Is It and Would My Child Benefit?

To someone who has never experienced repulsion at the sight of a non-preferred food, difficulty tolerating certain textures, or an extremely limited food repertoire, eating might seem like an easy task: you sit down and you eat. What’s so hard about that? For someone who experiences feeding difficulties on a daily basis, however, it’s not so simple.

What is feeding therapy?
Many people are familiar with traditional therapies, including speech therapy, occupational therapy, physical therapy, etc. However, feeding therapy is a lesser known intervention that is becoming more widely available as feeding difficulties are more recognized in our society. There are a variety of different feeding therapy approaches across the nation based on your child’s individual needs. Here at PlayWorks, feeding therapy typically includes the following components:

  • Child driven, not volume driven: The goal of a therapy session is not necessarily for a child to sit and eat a full meal. The goal of a therapy session is for a child to interact with food in a way that is enjoyable and motivating. When the fear of trying a new food is removed, a child has the tools to become a successful feeder.
  • Family focused: Unlike other one-on-one therapies, feeding therapy is most successful when the whole family participates. This improves generalization of learned skills, as well as strengthens the social component of enjoying a meal.
  • Feeding should be FUN: Feeding should not be a traumatic experience! Many sessions will focus on simply interacting with non-preferred foods. When a child learns that new or non-preferred foods don’t have to be scary, he or she is more likely to take the steps to try (and actually enjoy!) new foods.

What will my child work on in feeding therapy?
Before deciding on goals for feeding therapy, a feeding therapist will evaluate your child’s feeding skills to determine the root of his or her feeding difficulties. Simply speaking, feeding difficulties typically fall into the following two categories:

  • Sensory difficulties: Children with sensory concerns related to feeding typically present with either hypersensitivity or hyposensitivity. Children who are hypersensitive can have mild to severe reactions to different types of foods. This is typically related to the item’s texture, color, consistency, etc. In this case, feeding therapy will work to increase a child’s comfort interacting with certain foods. For example, therapy may initially target a child tolerating a non-preferred food on his or her plate before moving to touching, smelling, and eventually eating the target food. If a child is hyposensitive to foods, he or she may prefer very spicy or sour foods and avoid foods with less texture or flavor. Additionally, he or she may overstuff his or her mouth or pocket food in his or her cheeks. In this case, a therapist may use varying techniques to increase oral sensation.
  • Oral Motor difficulties: Children with oral motor difficulties typically have difficulty chewing foods with a “tougher” consistency (e.g., meats, crunchy vegetables) and prefer softer and/or pureed foods. Additionally, a child with oral motor difficulties may have a hard time controlling the food in his or her mouth, leading to “messy” eating and, at times, coughing or choking on foods. A feeding therapist will likely implement oral motor exercises into feeding therapy to strengthen your child’s oral musculature.

There may also be feeding difficulties that are caused by reduced pharyngeal (i.e., the muscles in your throat that control swallowing) strength and coordination. In these types of feeding disorders, a child frequently coughs or chokes when eating or, more commonly, drinking. If your child frequently coughs when drinking liquids, he or she could be at risk for aspiration. It is important to have your child evaluated by a feeding therapist to determine the best utensils and strategies to allow him or her to safely tolerate an age-appropriate diet.

How do I know if my child would benefit from feeding therapy?
If you’re wondering when a child’s “picky” or “messy” eating becomes more than just a quirk and something that requires intervention, you’re not alone. While everyone has a food that he or she dislikes, feeding therapy is warranted when a child omits all or the majority of an entire food group or has a severely limited diet. Simply speaking, if your child’s eating habits impact your everyday life (i.e., making a separate meal for him/her to avoid a meltdown) and, most importantly, his or her nutrition, it may be time to consider a feeding therapy evaluation.

Questions or concerns?
If you have questions or concerns about your child’s feeding skills, please contact us at info@playworkschicago.com or 773-332-9439.

Sarah Lydon, MA, CCC-SLP
Speech-Language Pathologist

Photo Credit: life is fantastic via unsplash.com

What to Choose? Self-Feeding Tools for Babies and Toddlers

If you’ve ever browsed the grocery store aisles looking for the perfect cup or utensil set for your child, you may have quickly found yourself overwhelmed with all of the options. With the wide variety of choices available nowadays, it’s hard to determine the best item to for your child. There is no “one size fits all” approach to finding a transition cup and/or feeding utensil that is right for your child, and it may take some trial and error to determine the best fit. However, throughout my time as a speech-language pathologist and feeding therapist, I’ve found some tools to be particularly useful as a child develops his or her eating and drinking skills.

I’ve heard sippy cups are bad? What cup should I choose?

I’ve had many parents tell me that they’ve heard that sippy cups are “bad” and that they’d like a better option for their child. While I don’t label all sippy cups as “bad” (and feel that they are a necessary option for some children with specific feeding needs), research has proven that use of sippy cups can lead to tooth decay, oral motor delays, and speech and swallowing delays. For more information, please see a recent blog post by one of PlayWorks Therapy’s speech language pathologists: http://playworkschicago.com/blog/page/3/

Straw cups and free flow cups are a great alternative to sippy cups. Here are some cups that I have found particularly beneficial for children from all feeding backgrounds:

  • Straw cups: There are a wide variety of straw cups on the market that are specific to babies and toddlers. Some of my favorites include the Nuby No-Spill Sports Sipper(a great option for transitioning from bottles to cups!) and Phillips Avent Straw Cup; however, there are several similar options on the market that work just as well. If your child hasn’t quite grasped the concept of straws yet, the Honey Bear Straw Cupis a great introduction to straw drinking.
  • Spoutless sippy cups: Commonly referred to as the 360 Cup, this no-spill cup is a great tool to teach the oral motor and swallowing skills necessary for drinking from an open cup. Munchin Miracle 360 Trainerand Playtex Spoutless 360 Cupare both great options.

I want my child to use utensils, but he can’t quite grasp a spoon or fork yet. What should I do?

Children learn to eat with their hands, and this is a goodthing! It’s important for children to be exposed to the sensory properties of food, and eating with their hands is the best way to do so. However, there comes a time when it’s appropriate for a child to use a utensil to feed himself. When children aren’t able to successfully use a fork or spoon, I like to incorporate some of the following:

  • Dippers: Dippers are similar to a spoon, except they have no spoon bowl. Children use dippers by dipping the utensil in a thick puree and bringing the dipper to their mouth. This teaches the motor skills necessary for using utensils without requiring as much coordination. Some of my favorite dippers include Numnum Pre-Spoon Goo-tensilsand ChooMee Starter Spoons.
  • Curved spoons: Curved spoons are another good option for children who have difficulty handling typical spoons. Curved spoons are made to match a baby’s natural grasp. Many have shorter, thicker handles which make the spoons easier to maneuver. Playtex Curve Infant Spoonsare a great option!
  • Child size spoons and forks: While I don’t have any particular brand of spoons and forks that I prefer, children learning to self-feed will have more control when using small utensils. Additionally, utensils with a wider handle will be easier for children to grip.

What can I do if my child is demonstrating feeding difficulties?

If your child is demonstrating difficulties transitioning away from the bottle and/or tolerating an age-appropriate diet, consider contacting one of our feeding therapists, who can provide your family with helpful tips and tricks to increase your child’s independence as they transition to the world of self-feeding.

Questions or concerns?

If you have questions or concerns about your child’s feeding skills, please contact us at info@playworkschicago.com or 773-332-9439.

Sarah Lydon, MA, CCC-SLP
Speech-Language Pathologist

Photo Credit: Hal Gatewood via unsplash.com

** Disclaimer: We are not affiliated, associated, endorsed by, or in any way officially connected, with any of the products listed in this blog.

Feeding Milestones: 18 to 24 Months

This blog wraps up a three-part series on feeding development in infants and toddlers. The last group of milestones to be outlined are those for children aged 18 months to two years. Similar to the post below, the skills developed between 18 to 24 months are variable, and not as specific as the milestones met between birth to 12 months. Please contact your child’s speech-language pathologist if you have any concerns regarding feeding milestones.

We hope that by reading this three-part series, any concerns with your child’s feeding skills have been put to ease, or if concerns persist, you feel confident in asking questions. With that out of the way, you can focus on fun at mealtimes!

If you have questions or concerns about your child’s feeding development, feel free to contact us at info@playworkschicago.com or 773-332-9439.

Ana Thrall, M.S., CCC-SLP 
Speech-Language Pathologist

Feeding Milestones: 12 to 18 Months

This blog post is part two of three discussing feeding milestones that a child encounters from birth to age two. Today’s post will focus specifically on the milestones met between 12 and 18 months.

The following chart outlines general guidelines for feeding and developmental milestones that your child should reach between the ages of one year and 18 months. Skills developed between 12-18 months are variable across this age span, and not as specific as the milestones met between birth-12 months. Please contact your speech-language pathologist if you have any concerns regarding your child’s feeding abilities.

Amount of food per day

Children should be eating 46 calories per pound based on their weight. One serving of food is equivalent to one tablespoon per year of life. A serving size for a 12-month-old child would be 1 tablespoon and a serving size for an 18-month-old child would be 1.5 tablespoons.  The following chart summarizes serving sizes of each major food group that a child should eat each day.

Stay tuned for the blog post on feeding milestones for 18- to- 24-months. If you have questions or concerns about your child’s feeding development, feel free to contact us at info@playworkschicago.com or 773-332-9439.

Katie Dabkowski, MS, CCC-SLP
Speech-Language Pathologist
Resources:

Feeding Milestones: Birth to 12 months

This blog post is part one of three that discusses feeding milestones that a child encounters from birth to age two. Today’s post will focus specifically on the milestones met between birth and twelve months.

As an SLP and feeding therapist, I often find parents asking me:

 “What should my child be eating at this age?”

 “Is it too early to introduce solids? “

“Is it okay that I’m still breastfeeding?”

It is important to remember that there is no “magic number” for age when it comes to feeding development. While certain feeding milestones are typically reached by a specific age, many feeding therapists recommend that parents look for the presence of various developmental skills to determine if their child is ready for the next stage of feeding. In the first year of life, it’s important to ensure that a baby’s primary source of nutrition is breast milk and/or formula. During the first year, purees and solid foods should be viewed as “learning to eat” rather than a primary source of nutrition. The following table outlines the age that these milestones are typically met, and the feeding stage that is associated with each milestone:

Stay tuned for blog posts on feeding milestones for ages 12- to- 18- months and 18- to- 24- months. If you have questions or concerns about your child’s feeding development, feel free to contact us at info@playworkschicago.com or 773-332-9439.

Sarah Lydon, MA, CCC-SLP
Speech-Language Pathologist

Resources: Toomey & Associates, Inc. 1990/2016

Photo Credit: http://wholesomebabyfood.momtastic.com/howmuchbabyeat.htm

Why Messy Eating Is a Good Thing for Babies and Toddlers

Do you fear letting your baby get messy? Can’t stand the sight of food in their hair or on the floor and dread the work that it means for you afterwards? You are not alone! Lots of parents have a really hard time allowing their baby to be a complete and total mess while eating. But did you know that this mess is more than just a headache for you later on? It is actually a critical learning experience for your little one! So next time you cringe at the sight of your toddler flinging applesauce across the room or your baby dropping yet another yogurt-covered spoon on the floor, remember that you are helping their development.

Below is a list of reasons why you should let your little one get messy while eating.

Messy eating…

  1. Provides important sensory experiences
    • Messy eating is a form of sensory play! It is an opportunity for your little one’s brain to receive feedback from their food regarding different textures, temperatures, colors, quantities and the difference between solid and non-solid foods. This sensory play promotes exploration and helps build a positive environment around their food.
  2. Leads to greater acceptance of foods
    • Once children are familiar and comfortable with the sensory information of their food, they are more willing to eat it. Sensory play and exploration helps kids overcome their fear of new textures and flavors and results in eating a more diverse diet.
  3. Promotes appropriate self-feeding skills
    • Allowing your little one to explore their food builds confidence and promotes independent eating.
  4. Develops fine motor skills
    • Self-feeding involves pinching, picking-up, reaching, holding a spoon and a number of find motor skills that your kiddo may be missing out on if you are always the one in control of the food container and spoon.

Tips to help the messy eating routine:

  1. Prepare for a mess by feeding your baby or toddler in a room with hard, easy to clean surfaces (i.e. tile, wood) and avoiding carpeted areas. Use placemats, floormats or even lay a towel or sheet down under the highchair.
  2. Ditch the nice clothes and opt for an old t-shit or onesie instead. You can even let your little one eat in only their diaper to avoid excess laundry! As long as it is a comfortable temperature in your house, your baby will not be too cold and it will save you a lot of time and hassle.
  3. Embrace the messy eating. Remind yourself that this GOOD and fun! Enjoy these moments and capture one of those classic-baby-moment pictures.

Kelly Fridholm, MCD, CCC-SLP

Speech-Language Pathologist

Additional resources/related articles:

https://www.reuters.com/article/us-food-fears-children/playing-with-food-may-help-preschoolers-become-less-picky-eaters-idUSKBN0O41MD20150519

Picture: Shutterstock

Let’s Get Cooking!

The benefits to getting your picky-eating toddler in the kitchen!

Cooking with your little one can be so much fun and can help with picky eating! Having your child even in the kitchen while you are cutting veggies, fruits or making toast is a GREAT way to introduce them to new foods and give them a no-pressure look at what you are making! Kids in the kitchen get to SEE, SMELL, and TOUCH their food. It is a great time to label foods, actions (stir, cut, eat, cook, flip), talk about simple sequences (first cut, then cook), and kitchen safety (hot, sharp, adult-only)!

Here are some simple steps to get your toddler in the kitchen!

  1. Place your toddler in the kitchen with you! Booster seats or step stools are great for little ones to see what is happening on the counter. You can give your little one pretend food to “practice” with you if you are using heat or sharp knives. Talk about what you are making, the ingredients and the steps!
  2. Get little ones involved! Help your child make their snack plate, let them place foods onto plates and bowls to carry to the table. Give them a spoon to help you stir batters, butter knives to make toast or sandwiches, or place different fruits and veggies into your blender to make a smoothie!
  3. Start with something FUN and PREFERRED! Your picky eater likes anything tan? Try making toast together and getting out multiple spreads to try! Kids are much more likely to try something when they feel in control. If they get to choose the topping or help spread it on the toast, it may be more rewarding to eat. Cooking is great for experimenting and trying new things! Box brownies or cookies are great for cooking with toddlers! They usually require few ingredients and you can place each ingredient in a bowl for your toddler to pour into the big bowl and help you stir.
  4. Keep it simple! Your toddler likely does not yet have the attention to watch you make a gourmet meal, but may have the attention to make a snack or a simple pasta dish. Keep it simple so you and your toddler can enjoy your time together.
  5. Give choices! Let your child take some control with cooking! Deciding what kind of sandwich, pick the dip for veggies, or decide on fruits and veggies for smoothies! Cookie cutters are a fun way to change the shapes of sandwiches, jello, rice crispies or even sliced veggies!

Some fun, kid friendly recipes are below!

English Muffin Pizzas: http://acraftyspoonful.com/english-muffin-pizzas-simple-toddler-meals/

Ice Cream in a Bag: http://www.growingajeweledrose.com/2013/07/summer-fun-ice-cream-in-bag.html?m=1

Trail Mix: http://www.bsuperb.com/toddler-trail-mix/

Actor Misha Collins shares his adventures cooking with his son: https://www.youtube.com/watch?v=H3pjP79-sJc

Jessie Delos Reyes, MA, CCC-SLP

Eating Habits- Picky or Problematic?

Is my child simply a picky eater? Or should I be more concerned?

Many children go through a phase of picky eating, some longer than others, that is not usually cause for concern. Some days it seems impossible to get them to eat anything other than goldfish or cake pops, and vegetables aren’t even up for discussion! However, some children demonstrate behaviors that may indicate a feeding problem or disorder. These difficulties may present as sensory challenges, such as only eating brown, crunchy foods, or as oral-motor challenges, such as excessive drooling or food falling out of their mouth while eating.

The following is a list of red flags that may tell you if your child would benefit from the support of a feeding specialist:

Children develop feeding challenges as a result of negative associations with eating. These associations may be caused by various medical or sensory complications, such as sensory processing disorder, food allergies, gastroesophageal reflux disease (GERD), or motor-planning disorders.

If you have concerns about your child’s feeding skills, consult with your pediatrician and an occupational therapist or a speech-language pathologist to help you determine if your child may need additional feeding support.

Autumn Smith, MS, CCC-SLP
Director of Speech-Language Services