Changing Colors: The Blog of Spectrum Pediatrics

April 11, 2018

Heidi Moreland featured in Pediatric Feeding News

Check out this weeks Pediatric Feeding News blog post here! Our tube weaning clinical coordinator, Heidi Moreland, is discussing the development of self-regulation and the implication it has for our tube-fed children.  She notes that it is important to view self-regulation as a global skill that needs to be developed, rather than something that is simply present or absent in eating.  She also gives some tips for clinicians working with children and eating, particularly those who are tube fed.

 

February 12, 2018

Happy Mealtimes and Healthy Eaters: Four Things Every Parent Should Know

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

“Isn’t my job to make them eat healthy?”: It is often forgotten that children and parents both have their own roles to play during mealtimes. Ellyn Satter describes the Division of Responsibility (sDOR), which breaks down the different roles between parents and their child.

  • Parents control the what, when, and where of feeding
  • Children determine the whether to eat and how much.
  • Providing limits while being supportive with food can be a difficult balance for families, but it is a worthwhile goal
  • Children should be allowed to explore food, but also able comfortable with saying “no”.
  • It is okay for caregivers to say “no” to certain behaviors and request and set certain boundaries during mealtimes, especially as your child matures.
  • Be intentional about allowing them to develop independence with self-regulation.
  • It may be helpful to focus on something else during the mealtime instead of paying too much attention to your child’s eating. This could be a great time to talk about your day, focus on building communication opportunities, or using the mealtime as a social gathering for the family.

Restricting “Bad” Foods + Pressure To Eat “Good”: “Does it add up to healthy eating?”: As a parent, you want your child to grow and develop. Part of this is can be accomplished by eating healthy and nutritional foods. Although you may want to push the “healthy” foods on your child during mealtimes, this pressure to eat certain foods can cause a decrease in interest. In fact,

  • Take a second look at labels: Look past advertisements such as “low sugar”, “fat free”, and “low carb”. You may be surprised at which foods might be labeled “bad”, but are full of nutritional value.
  • Model healthy eating: Children learn the most about food through the direct experience of observing others eating while eating (Savage, Fisher, & Birch, 2007). That means it is more meaningful to model a healthy diet for your child rather than it is to restrict “bad” foods.
  • Avoid the reverse effect: Research has found that when parents restricted certain foods, the children’s intake of those foods actually increased and put them at risk for excessive weight gain (Birch, 2014).
  • Trust your child to eat the right amount – they know better than you do: Katja Rowell shares in her book, Love me Feed Me, that when children are allowed to eat to “treat” foods such as high sugar foods, they are able to respond to body cues that regulate when their body needs to eat and when they are full. However, when adults interfere by restricting that type of food, it inhibits their ability to learn and respond to cues about how much their body needs.

The Hidden Danger of “Is This On My Diet?”: In today’s society, it is difficult to watch television, read a magazine, or go to the grocery store without hearing about a new diet or a “health fad”. This makes it almost impossible for anyone to feel good about food they are buying or eating.

This may feel like a healthy change, but can it actually be causing more harm. Surprisingly, emotions around food can have a number of negative consequences.

  • The way you think and feel about food impacts not only your enjoyment of food, but also your absorption of nutrients (Crum, 2014.)
  • Your feelings about foods impact family discussions about food. Many parents find that negative or conflicting emotions about food can make it difficult for them to talk about food in positive ways in front of their children (Lytle et.al. 1997).
  • Even at a young age, children are able to pick up on the discussion around food. Although they may not understand complex nutrition talk, they are aware of the focus on “unhealthy” vs. “healthy” foods and conflicting emotions around foods. As they process those emotions through their own lens, this may result in conflicting emotions around food and their bodies. For example, when the focus is “healthy” or “unhealthy” food, children may feel pressure to eat a certain food or feel ashamed for wanting to eat a “treat”.
  • Instead of focusing on discussing or dissecting food in front of your child, take that focus into meal planning and serve a variety of healthy foods that you enjoy.
  • Use mealtimes to have conversations with your child. You can talk about foods you enjoy. If it is interesting, you may also want to talk about how to cook the food, where the food came from, or different types of food that are similar.

Eating Together/Social: “It’s Time for Dinner”: Children develop early patterns around mealtimes through social interactions surrounding feeding (Savage, Fisher, & Birch, 2007). The Family Dinner Project, a nonprofit organization operating from the offices at Project Zero at Harvard University, lists many benefits to having a family mealtime. What they found is that even if it isn’t always possible, it is important to try to make time within your weekly routine to share a mealtime with your child.

  • Children who are part of regular family mealtimes have lower rates of substance abuse, higher self-esteem, and lower rates of obesity and eating disorders.
  • Family mealtimes provide an opportunity for kids to watch their parents and siblings eat, which can provide a foundation for more adventurous eating later
  • A study by Brown & Ogden (2004) found that family modeling has a more lasting influence than control at meals.
  • Family mealtimes allow children to be a part of a routine, see food as an enjoyable, social opportunity, and build exposure to a variety of foods, even if they don’t eat them the first time they are served.
  • Mealtimes aren’t just about nutrients begin consumed. They can also be about caring for others through preparing food, participating in social interactions through staying at the table and being part of conversation, and contributing to the family by completing mealtime chores.

Sources:

Brown, R. and Ogden, J. Children’s eating attitudes and behaviour: a study of the modelling and control theories of parental influence. Health Educ. Res. (2004) 19 (3):261-271. doi: 10.1093/her/cyg040

Crum, Alia and Corbin, William. ” Mind over Milkshakes: Mindset, Not Just Nutritents, Determine Ghrelin Response” Health Psychology (2011): 424-429

Rollins, Brandi Y., Loken, Eric, and Leann L. Birch. ” Effects of restriction on children’s intake differ by child temperament, food reinforcement, and parent’s chronic use of restriction” Appetite ( 2014): 31-39.

Rowell, Katja, MD and Jenny McGlothlin (2015). Extreme Picky Eating.

Rowell, Katja, MD (2012). Love Me, Feed Me. A Parent’s Guide to Ending the Worry about Weight, Picky Eating, Power Struggles and More. Family Feeding Dynamics LLC. St. Paul, MN.

Savage, Jennifer S., Jennifer Orlet Fisher, and Leann L. Birch. “Parental influence on eating behavior: conception to adolescence.” The Journal of Law, Medicine & Ethics 35.1 (2007): 22-34.

Photo 1

Photo 2

January 31, 2018

Family Mealtime Coaching: What is it and how can it help?

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

We all want our kids to be the best that they can be.  In fact, many families hire coaches to pump up their kids’ soccer game, to improve their free throw shot, or to work on their ballet positions.  But a baby?  An eating coach?  That seems like the ultimate in helicopter parenting.  In reality though, working with a coach on your child’s mealtime abilities can be exactly the opposite of being a controlling parent.

One of the foundational aspects of eating is the development of self-regulation.   By definition, that means that the baby or child is learning to be in charge of themselves and their eating.  The job of a parent is to provide the necessary, developmentally appropriate support to help their child be successful to the best of their ability.  It sounds simple, but the mealtime relationship can be complicated by developmental difficulties, medical problems, culture, differing family expectations, and the child’s own temperament.  Often a feeding therapist is recommended to work on the child’s skills, but many times, skills are not actually the problem, or only part of the problem.  Parents need help with defining their own role and responsibilities within that relationship.  The job of a mealtime coach is to teach parents to be aware of their own impact on the mealtime relationship, as well as to read their child’s cues so they can determine when to step in, and when to allow their child to work through a problem with less support.  This balance is what will allow the child to advance their self-regulation skills without allowing them to try things that are unsafe, or inappropriate.

There is good evidence that shows many benefits to the development of self-regulation.  The benefits go beyond healthy relationships with food and weight.  Self-regulation was defined by Shonkoff & Phillips as “gaining control of body functions, dealing with strong emotions, and maintaining focus and attention.” That mean that self-regulation skills can also impact the ability to form and maintain relationships, pay attention in school, control anger and anxiety, and adapt well to new situations.  By working with parents on healthy boundaries and support during mealtimes, a mealtime coach can provide parents with the tools to read their child’s cues and support their self-regulation in all areas of life.

There are a number of reasons why coaching is a better model than therapy or teaching.   A coach may be a therapist or a counselor, or another parent, but the coaching model describes how the professional, parent and child interact in the mealtime setting.

  • The job of a coach is to listen first, to make sure they understand the whole problem.
  • A coach is focused on helping families identify some of the root causes of the difficulties
  • A coach will encourage families to come up with solutions that will work in their own home or circumstances
  • A coach will focus on the family and child interaction and relationship, rather than providing a strategy or intervention and expecting the family to imitate the therapy relationship

If you’re interested in learning more about how a mealtime coach could help your family, we would love to hear from you. Spectrum Pediatrics currently has therapists in Virginia, Tennessee, and New York. We are also able to coach remotely from a different state. Contact us here!

January 29, 2018

Feeding Tube to Family Table: How does that work?

Did you ever wonder why feeding therapy doesn’t look anything like the meals you hope to have?  We did too!  At Spectrum Pediatrics, we believe that tube-fed kids need to learn to eat in the same safe way that other kids learn to eat, utilizing the same principles of healthy eating that are good for everyone.

Meet Jennifer Berry and Heidi Liefer Moreland, as they introduce the philosophy behind the Spectrum Pediatrics Tube Weaning Program.  Watch as they explain how a healthy relationship with food that is shared by the whole family leads to freedom from tube-feeding, enjoyment at mealtimes, and lifelong healthy eating habits.


 

Want to learn more about the people who work with the children in the tube weaning program? Click here to meet Jennifer, the owner of Spectrum Pediatrics, and here to meet Heidi, the clinical coordinator of the tube weaning program. See our Tube Weaning Program featured in the New York Times here.

 

January 3, 2018

Trick of the Trade from Tracy Magee, MS, CCC-SLP

Potty Training

Every parent gets a little nervous, but also excited, when it is time to potty train their toddler. No more diapers! Woo hoo! It’s definitely a daunting task that can be accomplished many different ways based on the child’s personality and the dynamics of the family. When potty training my own child and with the help of this book, I learned some great tips when potty training. Here are just a few:

1. Public Restrooms: They can be terrifying for a little one (and let’s face it, the parents, too ☺). Keep a stack of post-it notes in your purse/bag to put over the toilet self-flushing sensor. The last thing you want is the loud noise and the swishing of the water as your child is doing his/her “business.”

2. On the Go: When the child let’s you know he/she has to go, that usually means NOW. Keep a travel potty in the car for those emergencies. You can also try a red solo cup or mason jar. It’s gross, but good in a pinch!

3. Bowel Movements: Most kids have an easier time learning how to urinate in the potty than using it for bowel movements. Make sure that your child’s knees are above their pelvis when they are sitting. This will physically make the act much easier for the child, and that makes learning that part of toilet training a little less intimidating for everyone.

Hope these tips help a few moms and dads with this big step! I know they helped me!

January 3, 2018

Indoor Play Spaces: A Therapist’s Perspective

By: Tracy Magee,M.Ed., CCC-SLP

I recently went to a new play space, Scramble in Alexandria with my 3 year old and 18 month old, and I just had to share about it with our Spectrum families! Not only did my kids have a ball, but also I couldn’t help but also think of all the therapeutic activities and developmental skills that a parent could encourage in a space like this!

1. Physical activity: In the winter months, it is extra difficult to make sure that kids are getting enough movement during their days due to the frigid temperatures. Obviously, in a soft playroom space, kids can move about with ease, and a parent doesn’t have to worry about every fall and tumble. With all the new sites in a soft playroom, kids are motivated to jump, climb, crawl, and more! This works on their body coordination and hand/eye coordination. Beyond that, kids need to MOVE! Movement helps all humans attain self-regulation. Self-regulation is “the ability to maintain a level of alertness appropriate to a given activity.” A space like this allows kids to achieve adequate self-regulation through movement, which in turn, is essential for development of attention, regulation of sleep/wake cycles, and control of emotions (particularly during transitions from one activity to another). This particular play space offers movements areas for various ages – a baby area to practice tummy time, toddler area with smaller obstacles and slides, and a “big kid” two-level playhouse with mazes, obstacles, and slides.

  • Parents can encourage developmental benefits for physical activity and regulation by having their child to lift heavy things, push heavy items, and use their body in different ways (climbing, crawling, etc.). All these movements work on coordination and help the child feel regulated.

2. Pretend Play: This particular play space has four separate areas for kids to pretend, including a car garage with a giant racecar, coffee shop/café, vet office, and construction zone. The large soft playroom pieces are the perfect size for kids to lift and engage their imaginations in the theme of the room. Pretend play is important because it aids kids in understanding that a symbol stands for something else. Learning this concept can help a child’s language development, as words are a symbol to represent something else, as well. Parents can encourage pretend play by modeling how to use some of the toys for their child to imitate and naming the items or actions as the parent or child uses them.

3. Social Skills: Of course, social skills are naturally a focus during many of the activities listed above. Kids have to learn to take turns and share in the “pretend play” areas and on the slides. Working together is part of the fun!  Parents can encourage social skill development by helping the child ask and answer questions with other kids that are playing. This could include using longer sentences, answering questions with an appropriate response, or formulating questions. Kids may need varying levels of adult help to work on this skill. Turn taking with the toys, balls, and slides is something every kid can always work on, too!

4. Language Development: Language development includes a child’s ability to understand the language of others and use his/her own sentences to express him/herself. Parents can encourage language development by practicing following directions. This includes using descriptors and prepositions (e.g. “Get the red soccer ball and kick it in the goal behind me.”) and practicing safety words (“Stop! Wait!”) in a contained environment. Children also have to use their own language to ask for a turn with a ball or tell their parent what they need.

These are just a few ways that you can turn an indoor playspace, such as Scramble, into an activity that aids in lots of childhood development skills, and it’s so much fun that it doesn’t feel like work for the child or the parent!

Source

Photo

December 11, 2017

From the Other Side of the Table: Giving Up Control with Feeding

By: Hannah Reid, Rusty’s Mom

Life with a tube-fed child is often chaotic and stressful. Each week is punctuated with doctor’s appointments, in-home therapy sessions, and medical supply deliveries. Amidst all of the chaos, it can be comforting to seek control anywhere you can find it. For me, I was able to find control in what went through my son’s tube each day. To add to this, some of his doctors were incredibly fixated on numbers. In a way, it was a huge relief to have something concrete to focus on. I knew how many calories my son needed every day, how many ounces he needed per feed, and the rate the formula needed to be pumped into his stomach. This was all simple math that helped me feel a little bit of calm in the storm that was a medically complex child, dependent on a feeding tube.

Fast forward many months and we had a tube free superstar! Within days of starting our feeding therapy program, my son had weaned off the feeding tube completely. This was truly amazing, I felt like simultaneously crying tears of joy and pinching myself every time we sat down and enjoyed a meal together. However, I no longer had ounces to divvy up, calories to count, and feeding rates to program into a feeding pump. The one area of my life that I had been controlling for so long was now officially out of my control. And for the best possible reasons! But this was pretty tough to come to grips with. I imagine many other parents are in a similar position when it comes to feeding their children (even for kids who haven’t been tube fed in the past). I thought it might be helpful to review how I was able to finally give up control and fully trust my son on his new journey as a foodie.

Ditch the Numbers!

Weeks after tube weaning, I was still obsessing about numbers. I had a little notepad that sat behind our kitchen table and I wrote down how many ounces my son took in and estimated calorie totals at the end of each day. This was probably my last ditch effort to maintain control over something, and, because I’d been so fixated on numbers for so long this felt natural. However, it quickly became useless as my son’s eating fluctuated incredibly from day to day. And the thing was: the number on the scale at the pediatrician kept creeping up. He clearly knew how to listen to his own body’s cues and I needed to respect that as well. The day that I decided to finally throw out that notepad I felt like a totally new person. Freedom to trust, and freedom for my son to eat whatever he desired!

Focus on the Child

Once I was able to kick the notepad habit to the curb, I was able to focus more on my son and his cues. Was he happy? Developing and learning new skills? Having a few wet diapers each day and tears when he cried? The answer to all of these were always YES! In the first two months after tube weaning my son went from barely knowing how to sit on his own to rolling everywhere, crawling, and pulling to stand. He was also so much happier, and exploring his own world in so many ways thanks to his new exposure to food and my new ability to let go. Whenever I started to doubt him, or myself, I would get down on the floor and play with him and notice his incredible zest for life, the biggest indicator I needed to tell me that he was doing just fine.

Seeking Stability and Regaining Other Types of Control

As my son was no longer dependent on the tube, our weekly schedule calmed down significantly. Almost immediately we no longer had a need for medical supplies or certain doctors. We also didn’t need all of the in-home therapies we had been getting in the past to help him eat, because he was now an eater! Many of the daily interruptions that made our lives feel so out of control and chaotic were just GONE. And with this, I began to regain control of our lives. Yes, I wasn’t controlling my son’s intake or his calories, but I was controlling how we spent our days. Instead of driving to the GI doctor, we could go to library story hour. Instead of waiting for feeding therapy, we could visit the local farm and pet the cows. These were all things that we wanted to do together, and this re-instilled a feeling that I had a bit of power in what was going on in our lives again.

It certainly wasn’t easy, and it definitely took time, but the above steps helped me to say goodbye to the feeding tube that lingered in my brain, long after we had stopped using it on my son’s stomach.  And when we have the occasional hard day or illness, I do my best to remember back to how I relinquished control over feeding when it felt like I could think of nothing else. I ditch the numbers, focus on my child, and seek stability in other areas of our life. Because in the end, he is happy and thriving, and it’s just as important for the parents to be happy and thriving, too.

December 8, 2017

Tips and Tricks for a Successful Holiday Season

By: Tracey Urbansok, MS, OTR/L

Just when our kiddos have settled into a good routine following back to school time, it’s already December and that means holidays and winter breaks. It’s a hectic yet very exciting time of year for kiddos and adults alike. All that the season brings, including lots of extra lights, sounds and crowds, can leave our little ones feeling over stimulated, uncertain and overwhelmed. We are here to share some tips and tricks to help make your holiday season a memorable and successful one!

• Preparation is important so plan ahead when you can: Keeping some extra snacks and drinks ready can help avoid a meltdown when that family gathering or holiday parade went a bit too long.

• Write a social story about what to expect: Social stories are short descriptions about anticipated events or activities. These stories can help your child better learn about the environment, an activity or an expected behavior before getting starting. For example: “On Friday night we will go to our neighbor’s house for a party. I can help make a snack to take with us to share with our friends. When I get to our neighbor’s house there may be lots of people there I don’t know and I might feel a bit scared. My mom will be close by and can hold my hand. When people ask my name I can tell them. There will be other kids there and I can play with them. If I need a break or I get hungry that’s okay, I can let my mom know. Going to our neighbor’s house on Friday will be fun!”

• Before going to a new place or visiting old or new friends it can be helpful to share pictures of the places you will go or people your child will meet.

• Calendars and countdowns: Using calendars and countdowns is a great way to help your excited or anxious child organize time. Especially for those kiddos who have lots of extra energy and can’t wait till Christmas morning! For a visual schedule idea check out this site!

• If you are taking a long car ride or plane flight, wrapping up an inexpensive item (such as a new coloring book) or providing your child their favorite special treat especially when they are being good is a great way to break up and celebrate the journey.

• For slightly older children, involve them in your holiday planning such as decorating, picking out gifts, sending or making cards.

• With lots going on, remember to provide simple choices. Kids do well when we provide them simple or two choices rather than just asking what they want.

• Be flexible and encourage your child to be flexible too. Speak to your child in advance that changes might happen and provide several options. Speak openly that back up plans and alternatives can be fun too!

• Most important have fun and use praise. Praise your child whenever possible and praise their siblings, peers and others. Children love to feel good about something they have done well and often will match their behaviors when they see another person getting praised too.

Still have any questions or concerns about helping your little one through the holiday season? Don’t hesitate to reach out to your therapist to help you come up with a unique plan for your child. Finally stay turned for our next Trick of the Trade and keep your eyes on the Spectrum Pediatric Instagram for some simple at home ideas to try this month!

Source 1

Source 2

Photo

November 9, 2017

Trick of the Trade from Krystina Burke, M.S., CCC-SLP

Video Modeling – Keep it in the Family!

Video modeling is a powerful tool I use during my speech therapy sessions throughout the week. The children I work with enjoy video modeling activities and their parents love having the videos to use throughout the week!  Although there are many “premade” video modeling videos available, I have found that using the child and their family members as the “stars” of the video has been most effective in teaching a new skill or desired behavior. Parents can then use this strategy wherever they are because the family members are the actors, producers, and the audience!

For example, to target play skills and overall engagement, parents can film a sibling bringing a toy over to another sibling to engage in play. In addition, making and watching the videos as a family provides an excellent opportunity to build in communication and engagement with siblings and family members.

(Insert link for past blog post)

Photo

November 9, 2017

Lights, Camera, Learning!

By: Krystina Burke, M.S., CCC-SLP
  • Video modeling is a visual teaching method.
  • Students with Autism Spectrum Disorder (ASD) learn best through visual means.
  • A recent study found that students with ASD were able learn new behaviors by watching other people.
  • Video modeling can easily be put into practice!

Smart phones are pretty bright! They wake us up, keep up on schedule, allow us to email and browse the web from anywhere and everywhere, they take amazing photographs that we can share in an instant, and oh yeah.. we can actually use it as a phone to call someone.  One thing you might not know is that you have a powerful teaching tool right in your back pocket!

Video modeling is a visual teaching method. As the name suggests, video modeling provides children with the opportunity to learn a behavior or skill by watching a video of someone else, or themselves in a certain situation or performing a certain skill! Video modeling can be used to support all children, but has been especially affective when working with children with Autism. This intervention has been used support children in the areas of behavioral functioning, social-communication, and functional self-help skills.

Children with autism benefit from using visuals as a learning strategy. A study by Bellini and Akullian (2007) concluded that children preformed best when they were highly motivated and attentive because they enjoyed watching the videos. A study by MacDonald (2009) found that when children were given the opportunity to observe videos of their peers during social, play based, interactions these children were more likely to engage in reciprocal play interactions with typically developing peers.

So how can you put this into practice? First, identify an area of need for your child. What is most difficult for them? Is it engaging with peers during play or functionally playing with their toys at home? Is it getting on or off the bus? Once you know what you want to target, the next step is to find a video that models the behavior or skill you want your child to learn. There are many pre-made videos available to use here. Stay tuned for a trick of the trade on how to learn how to make your own!

Sources:

Bellini, S., & Akullian, J. , Exceptional Children, 73, 261-284, 2007

MacDonald, R., Journal of Applied Behavior Analysis 2009, Spring, 42 (1): 43-55.

Photo