Changing Colors: The Blog of Spectrum Pediatrics

August 11, 2017

Feeding Friday: Tube-Free Superstar Caden

Caden was born 37.5 weeks, with a birth weight of 6 lbs., 4 oz and was a described as a “fighter from birth” by his family. He had an extended hospital stay following a heart surgery and respiratory complications. He had significant reflux, and received his G-tube prior to discharge home at almost 2 months of age. By the time he was discharged home, he was not sucking and there was concern that any oral feeding attempts were burning additional calories. Caden’s family worked very hard over the course of the next few months to get him to eat and drink by mouth as his medical status stabilized. He would take small sips or bites of foods while distracted or tricked, showing his family he was capable however; he eventually stopped eating all foods he previously showed interest in.

Following multiple failed attempts to increase oral feedings via different methods Caden’s family decided to do a supported tube-wean. His journey started at 10-months old with the team at Spectrum Pediatrics at the Virginia location. On the first few days of treatment, the focus was to give Caden space to explore and initiate eating while his family decreased pressure to eat. Caden showed increased interest in some foods he ate previously like his grandmothers meatloaf by eating small bites and picking pieces up to throw them on the floor. Caden was curious but unsure about food during the first few days of treatment. He slowly became more comfortable putting more pieces in his mouth instead of the on floor but was very reluctant to allow his family to help him. To his families surprise he soon started enjoying milk at meals too! At first, he let a lot of the milk fall out of his mouth but eventually he used his straw cup with greater efficiency to swallow liquids and keep his clothes dry. By day 5 of treatment, he was drinking enough milk and taking small amounts of purees and solids to discontinue his tube use. Eventually, he began drinking yogurt pouches and found a new love for fettuccini and alfredo sauce. Caden worked hard learning how to use his hands to get enough food in his mouth eventually allowing his family to help him with a spoon too! He started to communicate at mealtimes by using reaching, new sounds, and screams to get what he wanted. He also got much better at letting his family know he was finished at a meal. In the weeks following he continued to build his skills and became very fast at eating his favorite foods.

Now just a few months after his 10 day intensive treatment, Caden loves mini pancakes, alfredo (of course), chia pudding, veggie straws, oreo cookies, and trying to steal whatever his older brother is eating. His favorite activities are dancing to “Hand Clap” by Fitz and the Tantrums, playing with Tupperware containers, climbing everything, and yelling “mamamamamama!”

Caden celebrated his first birthday, learned how to walk, and was able to get his G-tube removed. We are so proud of Caden and all the things he has accomplished, he is a tube-free superstar for sure!

Photos provided by Caden’s wonderful family!

July 23, 2017

Feeding Friday: The Impact of Unwanted Guests

By: Heidi Moreland, MS, CCC-SLP, BCS-S, CLC

Do these personalities show up at your family table?

It is important to interact with your child at the table and respond to their attempts to communicate.  However, if you are always trying to “push” food and eating, you are probably having the opposite effect than what you hope.  Despite your good intentions, pressure can turn you and your mealtime into an endurance event for you and your child, which is unpleasant for everyone present.

  • The Mafia – Force feeding with a smile
  • The Rodeo Clown – Offering a distraction for every bite so they don’t notice what you are really doing
  • Pushy Waiter – Hovering over the meal
  • Papparazzi – Cheering and taking pictures with every bite
  • The Voice-Over Narrator – Self-talking every bite in hopes of drawing attention to eating
  • Home shopping Network Salesperson – Always displaying and showing food, utensils and plates, hoping that your child will suddenly want one.
  • Used Car Salesman – Talking only about food, the benefits of food, the tastiness of every bite.
  • Human Calculator (or actual calculator) – Keeping track of every single bite, gram and calorie.
  • Perfectionist – failing to recognize and be satisfied with small attempts such as touching or tasting because they aren’t as big or as varied or as frequent as hoped.
  • Bad First Date - Going straight to the mouth with the spoon without allowing an  “introductory period”
  • Bad Date. Always.   - Continuing to pressure after a child says (or communicates) “No.”

Do any of these look like your alter ego, or is there someone else in your child’s life who has a tendency to take on one of these personalities? Picture what you would do and feel if you were seated next to one of these people at a dinner or event.  What would your response be?

 

July 23, 2017

Trick of the Trade from Tracy Magee,M.Ed., CCC-SLP

Behavior Strategies

I have recently been learning some of the behavior philosophies of Dr. Harvey Karp. He is the man behind the successful books, Happiest Baby on the Block and Happiest Toddler on the Block. A few of his strategies for dealing with toddler meltdowns were brand new to me, and I thought they might be good to share with others, too! Here are some of his ideas about how to cope with toddler tantrums:

1. “The Fast Food Rule:” Karp suggests that before you can help another person move on from something that is upsetting, you need to acknowledge that the child is upset. You can do this by repeating back the child’s “order” to him/her. This makes the child feel heard and his/her feelings are validated. It is important that the parent use short sentences and the same emotions as the child. Karp models what this looks like by stamping his foot and saying, “I want the bus! I want the bus! I want the bus!”

2. “Feed the Meter:” This idea from Karp suggests that we all need to hear praise from others (i.e. “feed” our ego meter). He also brings up the point that everyone enjoys overhearing this praise from others. We all would love to overhear our boss singing our praises to another boss. Karp says that toddlers are no different. He states that one adult should cup their hand, as if whispering, to another adult to give the toddler praise. This way, the child thinks he/she is overhearing the compliments about his/her behavior. Karp believes this praise is very effective in continuing that positive behavior, and it may even be more effective than praising the child directly.

These are just a few ideas from Dr. Karp, but I have found them to be very beneficial with toddlers I am working with lately. It has also been a success with my own two year old at home!

If you want to learn more about Dr. Karp’s behavior ideas, you can find his book HERE and his website HERE.

Photo

July 12, 2017

Trick of the Trade from Jamie Hinchey, M.S., CCC-SLP

DIY Kitchen

There are many different play kitchen sets on the market today for young children. As a speech therapist, I often see children in their home where there may be limited space. I recently had a family share with me their version of a Do-It-Yourself kitchen to help save space. Pretend play is such an important part of development, it is crucial that your child has the ability to use their cognitive and play skills to engage in activities such as pretending to clean, cook, or copy what they may see you do around the house. To create this DIY kitchen you need two things: a plastic  container (size may vary) and a sharpie marker. On the top of the plastic container, this parent chose to draw a stove, similar to the one they had at home. You can customize this kitchen to look like your stove or oven so your child is familiar with it.

To help with storage of all of the various “kitchen toys”, the container opens up and is able to fit all of the accessories, even while fitting under the bed! In this version, there are toy pots, pans, and utensils. Feel free to use your own pots or pans that may be in your kitchen. This DIY kitchen would also be a great way to work on safety directions and helping your child recognize what is “safe”. For example, you could use the pretend stove to work on what it means for something to be “hot” or what it looks like when the stove is on or off. I hope you enjoy this DIY kitchen as much as this family does! Time to get cooking!

Picture credit from one of our Spectrum families who created their own kitchen!

June 30, 2017

Summertime Motor Fun!

By: Colleen Donley, PT, DPT

As the temperatures are rising and the days are getting longer, summer is just around the corner. After being cooped up inside all winter, I love to take advantage of nice weather and getting outside during my therapy sessions. Below are some of my most favorite summer games to foster motor development across many ages and stages:

Sidewalk Chalk

Chalk can be used with kids of all ages to address different motor skills. I love incorporating fine motor skills in with gross motor activities and sidewalk chalk is a perfect way to do that. For a toddler working on moving backwards, balance, and different locomotor movements- see who can draw the longest snake by squatting down and walking backwards while drawing a squiggly snake on the ground. Once you get to the end of the snake, you can walk or tip toe along the snake back to the beginning like walking on a balance beam. Or you can practice jumping forwards and backwards over the super scary snakes!

Water Guns

These plunger guns are great at developing shoulder strength and coordination to fill them up each time. And then think of the fun they will have chasing parents, siblings, and friends around while using different arm muscles to shoot the water and cool down on a hot summer day!

Sponge Toss

Often times, we forget we have to help our kids learn how to catch and throw. Try soaking big, squishy sponges in water buckets and play catch. It keeps everyone cool while the kiddos work on pre-ball skills. I like the use the words “catching hands” or “pinkies together” to help little ones learn how to hold their hands out and open when getting ready to catch. I work with kiddos on different throwing motions when tossing sponges: two hands overhand, one-hand underhand, one-hand overhand, or tossing it up high then catch.

Beach Trips

The beach offers great benefits for a growing toddler! You can go on a treasure hunt for the best-looking seashell. Be sure to let you child go barefoot to get the sensory experience of sand in their toes and encourage them to carry the bucket as it gets heavier with all their treasures. They can help build the biggest sandcastle on the beach that day by carrying buckets full of water, digging up sand, and dumping out buckets of sand or water.

 

Bikes and Scooter Rides

Head to any local playground blacktop or quiet, open street with ample open space with your favorite bicycle, balance bike, or scooter. All of these help teach postural control and coordination to stay upright. Bicycles work on great bilateral coordination to move the pedals. Balance bikes are great choices for younger kids who have difficulty with pedals but still works on the postural control and balance. Scooters are a great choice to address single leg balance and leg strength as a child has to push off the ground with a foot to move forward.

Enjoy a moving and busy summer!

Photo

Photo 2

June 14, 2017

Feeding Friday: Tube-Free Superstar Piper

Piper is a twin who was born at 27 weeks weighing 1 lb. 5 oz. Piper had many medical complications during her stay in the NICU.  A G-tube was placed prior to heading home from the NICU after a 4 month stay. While at home, Piper was on continuous feeds and continued to refuse the bottle. Although Piper underwent swallow studies which showed that she was safe to swallow liquids, Piper continued to refuse the bottle. While at home, Piper was not tolerating the tube feeds well and her parents felt she was always suffering from reflux or throwing up her feds. As Piper continued to make progress in other areas of development after leaving the NICU, she continued to refuse any oral feedings. Piper would push away the bottle and become upset when her parents would attempt to feed her. Piper’s parents expressed constant concern with the negative consequences of tube feeding including vomiting, movement limitations as she was developing, and chronic discomfort. Despite Piper’s continued development in other areas, Piper’s oral intake continued to decrease.

Piper’s family contacted Spectrum and treatment started in Virginia location when Piper was 9 months old. On the first day of treatment, the focus was on establishing Piper’s relationship with food and working with Piper’s family on offering food or liquids without forcing. Piper showed interest in yogurt and immediately showed her independent side! Piper loved to drink from her pouches and any cup that she saw her parents using! Piper immediately wanted to try out some solid foods, as this allowed her to be independent. She was picking up puffs and attempting to eat all on her own. Piper eventually started to show interest in yogurt and oatmeal for breakfast!

Piper now loves to sit at the table with her twin sister in her booster seat! She loves putting her cup in the circle of the tray and also occasionally likes to throw the cup. Piper loves milk and pretty much all fruit and veggies (especially cucumbers). She loves to eat buttermilk biscuits! Piper’s parents are so proud of her and should be! Piper has come so far in the past year and we are SO happy to say she is our new tube-free superstar!

 

June 14, 2017

Ways to Beat the Heat

By: Krystina Burke, MS, CCC-SLP

Summer is here! It’s time to pull out the sprinkler, put on the sun screen, and enjoy time in the hot sun with your little ones! Achieving proper hydration is always important for young children, especially during hot summer months! When it is hot out, it is important to have your child drink more often throughout the day. If you know your child is going to be outside in the sun for a an extended period of time or will be participating in physical activities, offer them extra fluids beforehand to drink. In addition, it is recommended that children take a break about every 20 minutes during increased physical activity to hydrate.

If a child does not drink enough liquids, they may become dehydrated. Some signs of dehydration include: dry mouth, few or no tears, less wet diapers or decreased urination, a darkening in urination color, and drowsiness. It is important to contact your medical team if you become concerned regarding your child’s hydration level or state.

In addition to offering fluids before outdoor activities and taking frequent drinking breaks, incorporating liquid filled summer snacks and treats is a great way to increase hydration levels in small children during hot months. Fruits like watermelon, melons, and peaches are full of liquids and can be a great choice for a sweet refreshing snack. You may also try blending your favorite fruits, frozen fruits, ice, and water and freezing this mixture in popsicle molds for a cold and healthy summertime treat!

Source

Photo

May 17, 2017

Why the Push for Tummy Time?

By: Colleen Donley, PT, DPT

Often as physical therapists, we push and push for tummy time. We work with families on how to make tummy time easier. We help parents figure out how to fit tummy time into their schedule, while hitting the recommended amount of tummy time. Lastly, we educate parents and caregivers on the reasons tummy time is essential to development.

Back in the early 1990s, The American Academy of Pediatrics advised parents to adhere to the Back to Sleep program to reduce the risk of Sudden Infant Death Syndrome (SIDS). Following this start of this suggestion, there was a significant decrease in the incidence of SIDS. However, doctors and therapists have seen a rise in developmental delays, torticollis (twisted, tight neck), and plagiocephaly (flat head syndrome) since babies were spending more time on their backs and less time on their tummies. We now recommend Back to Sleep, Tummy to Play!

Tummy time is essential to integrate primitive reflexes, develop muscle strength throughout the trunk, and begin to experiment with early movement.

Integrate Primitive Reflexes

Initially, a newborn is curled in a ball because of the “primitive flexion” present at birth. Think the “fetal position” or how the newborn was curled up in the womb. Spending time on the tummy helps break up this flexion tone by providing deep input from weight bearing. This input helps relax the muscle tone of this primitive flexion and allows the baby to spread out their limbs and begin to extend through their neck and back muscles. As the flexion muscle tone continues to relax and fade, baby will begin to move their arms and legs separate of one another.

Develop Strength

When lying on their tummy, babies have to use the muscles neck and back to hold their head up or turn their head to look at parents or toys. This is the key to developing head control early on. As the baby gets stronger during tummy time, they will push up their elbows or arms and begin to hold the chest up. This weight bearing thru the arms will help develop proximal stability to hold the shoulder blade on the back. This is necessary for the baby to begin to bear weight thru one arm at a time to crawl.

Explore with Movement

As the baby gets stronger on their tummy and those muscles begin to relax, they will begin to move their arms and legs. They will continue to experiment with his movement and learn how to roll off their tummy to their back or to move towards a toy. The movement and exploration continues as they start to push up on straight arms and reach for toys. You might see they begin to kick or push their feet. As they learn to combine this reach and kick movements, they will begin to move forward in a belly crawling motion!

Tummy time should start as soon as you come home from the hospital with baby. Start off with small bursts, such as 1-2 minutes, throughout the day. Some parents find it easy to remember to fit in tummy time by making it a part of the routine after each diaper change. Gradually work up to a 60-90 minutes spread out over several increments by the time baby is 3 months old. By the time baby is 4 months old, they should enjoy tummy time since they now have full head control and push up on their elbows to play with toys. Around this time, you might see that baby sees tummy time as play time and nor work time.

Check out some of our other resources about tummy time here:

Making it Easier

Using a Boppy Pillow

Tummy Time Tips Video

May 8, 2017

Safe Sleeping Positions

By: Colleen Donley, PT, DPT

In October 2016, the American Academy of Pediatrics released new sleep guidelines for children up to 1 year of age. Our SLP, Tracy, summarized those suggested guidelines here.

As a physical therapist, I often work with families on safe and appropriate positioning for play and sleep. Frequently, I run into positions that may be unsafe, or safe but position baby improperly. Unsafe positions often put the baby at an increased risk of harm or Sudden Infant Death Syndrome (SIDS). Other positions may be considered safe as they adhere to AAP guidelines but baby’s head or body may be placed in a position that puts them at risk for other developmental issues. Here are some of the most commonly used undesired sleep positions:

  • Tummy: We always want to remember back to sleep and tummy to play. Tummy time is appropriate for playtime and a wonderful activity for baby to develop strength and motor skills. It is always recommended that you put baby to sleep by placing them on their back. Once baby learns how to roll, they may roll in their sleep from back to tummy and tummy to back. Many experts feel that once your baby has learned to roll, it is safe for them to sleep on their tummies but they still recommend starting sleep on their backs.
  • Bumpers in the crib: Bumpers serve as the purpose to protect the baby from getting their little hands or feet stuck in between the crib rails and cushioning the head should baby roll into the crib side in their sleep. AAP recommends babies should be placed to sleep on a firm crib mattress with no soft bedding or stuffed animals. Bumpers pose a serious risk of suffocation should baby roll into them or get pinned against them in their sleep.
  • Car seat: Riding in the car can be very soothing for baby and often a trick parents use to help get a fussy baby to sleep. Sleeping in a car seat poses a similar risk to sleeping on the tummy. If the baby’s head flops down, it could get pinned against the side of the car seat and put the baby at risk for suffocation. Additionally, prolonged positioning in the car seat creates uneven pressure on baby’s head, especially if this is where they sleep and their head falls to one side. Uneven pressure and the head dropping down to one side can lead to plagiocephaly (flat head syndrome) or torticollis (tight neck muscles on one side).
  • Rock ‘n Play: The Rock ‘n Play is widely popular in the world of baby gear must-haves. The Rock ‘n Play places the baby in a semi-reclined position, which goes against the firm, flat surface recommended as a safe way to reduce the risk of SIDS. Additionally, it allows gravity to help pull baby in their most preferred position, exacerbating slight preferences to one side. This can cause or exacerbate torticollis. The soft surface of the Rock ‘n Play makes it harder for the baby to move their head out of a certain position, which allows pressure to remain in a focused spot for longer periods of time. This is often why physical therapists see plagiocephaly associated with prolonged positioning in these soft sleepers.

Remember, it is always best to ask your pediatrician questions or share concerns about sleep positions. Your pediatrician will work with you to educate you on safe sleeping and determine what is best for your baby and family.

Photo

May 8, 2017

Tummy Time Tips

At Spectrum Pediatrics, we often focus on helping parents make small changes during their daily routines to help build their child’s overall development. Many people hear that tummy time is a crucial part of a child’s motor development, but often times parents are unsure why or how to incorporate tummy time into their routine. Our occupational therapist, Ashley, and our physical therapist, Colleen, are sharing some helpful tips on how to make tummy time easier! Check out the video below to hear both Colleen and Ashley discuss various ways to make tummy time less challenging and how much tummy time your child should be getting!

Stay tuned for another video full of tips on behaviors during mealtimes!