Changing Colors: The Blog of Spectrum Pediatrics

Archive for the ‘Feeding’ Category

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!

 

April 25, 2017

Feeding Friday: Tube-Free Superstar Carlin

Carlin was born with a syndrome called CHARGE syndrome.  Kids with CHARGE can have a number of difficulties, including vision, hearing and heart problems.  Carlin also aspirated food and drink into his lungs making it unsafe for him to drink, so he got a feeding tube at 5 weeks old.  When he was 6 months old he could begin to take baby food purees safely, and at a year, he was finally able to drink liquids without it going into his lungs.  Unfortunately, all of the medical procedures and the inability to practice eating safely and positively had resulted in a feeding aversion.  In Carlin’s view, food was scary and frightening.  He would eat some bites of yogurt if he was distracted, but he didn’t like to drink, and his mother had to work very hard to get him to take anything at all.  His parents did everything the doctors and therapists suggested, but he made little progress in his intake.

Carlin’s family contacted Spectrum, and treatment started in the Virginia location when he was 18 months old.  On the first day of treatment, the focus was on offering food without forcing or bribing.  Once Carlin was able to initiate tastes himself, he actually swallowed a little bit more than when he was being rewarded or bribed.  By day 4, he was asking for milk and drinking up to 4 oz of at a time.  At first, most or all of the solid foods he tasted came back out of his mouth, but slowly more of each bite stayed in.  By day 6, he was using his fingers to help keep the food in his mouth and his skills got better, but he still often needed to have his shirt changed after a meal.  By day 7, he was taking enough so that he could discontinue tube use.  He sat up straighter at the table, and began putting two words together more consistently in his speech.  In the next week, his skills continued to improve.  He was willing to try most solids, and all of the foods were now staying in his mouth.   His mother commented that in a restaurant they could order him something from the menu, and didn’t need to worry about all of the food falling out of his mouth and making a mess all over the floor.

Carlin was able to have the tube taken out 10.5 weeks after the 10 day intensive treatment.  He loves to eat and will eat almost anything now.  Carlin is definitely a tube-free Superstar!

 

April 21, 2017

Mealtime Stress: When Professional Opinions are Conflicting

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

What happens if the medical team disagrees with you or with each other. This can sometimes feel like families are being bullied into believing one person or another, or into doubting their own beliefs and knowledge about their child. Many people report that dealing with conflicting medical opinions add a considerable amount of stress. We know that stress can derail mealtime progress considerably, so it isn’t surprising to find that any doubts and pressures from the medical team can show up and take a seat at the table, resulting in even greater stress.

Here are a few things to consider:

  • Have they considered the facts? Many people, even professionals, have an emotional response to novel approaches then look for the facts to back them up. Feeding has an additional layer of emotion that makes it difficult to separate feelings from facts. However, once them emotion is addressed, it is almost always helpful to address medical professionals factually, rather than emotionally.
  • * Do they need a paradigm shift? This can be true in many areas, but there is a particular need for a change in perspective regarding feeding tubes. Many medical providers view them as a positive factor, or at the worst a “neutral” factor in child development. However, that is far from the truth. It is true that they can start as a positive, but they can often become a negative.
  • Is this their area of expertise? The gastroenterologist specializes in the GI system, but isn’t really trained in feeding development, swallowing, or how to progress in feeding therapy. Pediatricians likely get a two hour lecture during their training about nutrition, and even less about feeding therapy.
  • Do they feel that they have failed?: Professionals are also people. When patients seek other input, it can feel like they have failed, making it difficult to separate emotion from facts.
  • Do they offer this service? Everyone has a lens through which they view information. Many big hospitals believe that their programs and personnel are the best. If they offer this service themselves, asking for them to refer out is actually a conflict of interest, or at least a conflict of philosophy.

Once you realize the direction of their hesitation, it may help you to prepare for the most positive interaction. Here are a few more general tips:

  • Remember that most medical providers want to help. Come to them and state clearly that pressure from any direction will have a negative impact on eating. Ask for their support in decreasing pressure around food and in strengths-based care. See our previous post on how to build a medical team!
  • Bring your own team to the appointment – If you are fearful that you will be entering into a confrontation with a medical bully, it is almost always helpful to bring someone with you. Both parents making a united front can help the conversation stay on task and become less emotional
  • Send advance information: Find out the best way to get your question or findings to the provider in advance of the appointment.
  • Try to remain positive and factual, and tell them specifically what you would like their input to be. For example, “Because we have made no progress with traditional treatment, we have decided to that we are pursuing this for our child and would like some parameters to ensure that we are being safe” Or you could try saying something like, “We have been successful with our treatment so far, but would like some help with monitoring future progress. We hope that together we can minimize the stress about weight, which will allow him to develop and grow on his own.”

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April 13, 2017

Mealtime Stress: Adding Fuel to the Fire

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

When you have a child with a feeding problem, it can be very difficult to find people who understand how tough it is, and how pervasive the fear and pressure can be. It is tempting to talk about the problem you are having with everyone around, in hopes of finding someone who can help. However, we have found that there are some people who can make the problem worse instead of better. We have also added a few strategies or phrases on how to handle some of these personalities to avoid increased stress.

Well-meaning friends and family: People who are genuinely concerned, but keep asking about how the feeding is going can unintentionally increase stress levels around parenting a child who struggles with eating. Whether the questions induce guilt, anger, frustration, or just fatigue, these emotions will not be helpful if added to your own stress.

  • Re-direct the conversation to other topics.
  • If you do have a “safe” person in the family, you may talk to them about being a go-between so that the rest of the family can stay updated, without interfering.
  • Have an honest conversation with the person or people that you need to take a break from thinking and talking about eating: “This is a tough time for us, it helps me to take a break from talking about it so much.”
  • Reassure them that you are seeing help: “I appreciate your concern, we are working through this with our feeding team.”

Fellow worriers: People who may not add negative emotions, but are more than happy to worry with you. If you know someone is prone to worrying, it won’t be helpful to bring up your concerns to them.

  • Avoid going to eat or feeding your child when they are around
  • Tell them you are struggling with worry around your child’s eating, and ask them to help you re-direct your own thoughts when you become too anxious: “I know I worry too much. Can you help me practice re-directing my thoughts?”

Bullies: People who make negative comments about eating or feeding, or your approach to either one. It can be unintentional, but often has an element of superiority. It can be from people who feel strongly about topics such as parenting, nutrition, breastfeeding, feeding or discipline

  • It rarely seems helpful to argue, as bullies usually don’t have an interest in meaningful dialogue. Their main concern seems to be making sure that you understand their approach and why they believe they are right.
  • If possible, avoid interaction with them, especially around feeding.
  • Be prepared to tactfully change the topic.
  • Remember the truth about what you believe so they gain less emotional leverage over you.
  • You may say that you appreciate their input, but that they don’t have the full story or you have differing philosophies: “I’m glad that worked for you, but we find that those strategies actually didn’t work in our house.”
  • Sometimes a neutral, factual comment can help: “That’s interesting, because there is a lot of research that shows that adult pressure around mealtimes can actually make food struggles worse, instead of better.”

Stay tuned for next week’s post on what to do when the bully is part of the medical team!

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April 5, 2017

Is Baby-Led Weaning Right for Your Child?

By: Heidi Liefer Moreland, MS, CCC-SLP, BRS-S, CLC

Baby Led Weaning is becoming more popular as an option for transitioning children onto solid table foods.  This involves introducing the child to bigger pieces of foods that they are allowed to pick up independently and bring to their mouths.  Initially, they develop the ability to pick up large “graspable” pieces and accurately find their mouth.  As they become more skilled, they mouth the food, and eventually learn to manage small broken pieces that break off inside their oral cavity.  Once the food is in their mouth, they develop safety skills to protect their airway, including gagging and pushing pieces out with their tongue. With time and practice, they develop the control to hold the pieces still for biting, mashing, and early chewing.  Finally, their skills are mature enough to move the bites back in the mouth for swallowing.  As they develop the skills to control the smaller pieces of food orally, their hand abilities are also becoming more refined.  These increasing fine motor skills allow them to accurately pick up smaller pieces of food, which are more easily chewed and swallowed when their mouths have become ready for them.

As a therapist, I believe there are a number of factors that indicate this is developmentally appropriate method to help children learn about the properties and management of solid foods.  These factors are typically emerging or present at the age of approximately 6 months, which is when this process is recommended to begin. Of course, it is always important to discuss this with your pediatrician, as well.  The factors to consider are discussed below:

  1. Infants develop the hand control to pick up bigger stick-shaped foods before they develop the pincer grasp to pick up smaller foods or to self-feed with a spoon.
  2. Infants are experiential learners that are self-motivated, and will continue working with tasks that remain interesting and meaningful, until they appear to be mastered.  They are not designed to learn from a “teacher” or through adult-directed learning, which is what happens when an adult feeds them.
  3. Infants have reflexes and drives that facilitate this process that are no longer present at a later age.  These reflexes include:
      • Predominant oral exploration drives the child to bring things from hand-to-mouth, rather than banging or flinging.
      • Gag reflex remains at the front of the mouth at earlier ages, and this allows for important safety responses.
      • Tongue thrust is present, which helps them expel foods that are unsafe for swallowing.
      • Lateral tongue movement to stimulation is present, which will be used to develop control of the food.
      • Brain development takes place as neural connections are made during functional multi-sensory activities.  Therefore, the learning that happens on a banana pieces may be slightly different than learning that takes place on a teething toy.
  4. Brain development for motor skills also requires fine-tuning that happens with repeated   experiences that allow for on-line adjustments.  An example that many adults may remember is the experience of learning to ride a bike.  The only way to really learn balance while pedaling is to wobble around while the body learns to anticipate and adjust for the rolling and tipping movements of the bike.
  5. Because babies are “in charge” of the process, they control how much they eat.  This is consistent with the self-regulation of hunger and satiety that is developed during nursing, and has been found to be a positive influence in the prevention of obesity.
  6. Because the baby is exploring at their own pace, children frequently become less resistant and afraid than those who are presented with foods at the pace and interest of the feeder.

 

baby eating riceAlthough this approach is likely consistent with the way infants were fed long before the development of prepared baby foods, modern child-rearing dictates that we need to investigate a process, before it is recommended to ensure that it is safe and appropriate.  There is a study that is available through the National Institutes of Health (NIH).  In this study, it looked at developmental skills and available evidence of baby-led weaning, and it indicated that this is a feasible process for children who are learning to eat.

As with many child-rearing strategies, your supervision and judgment is crucial in determining readiness and to keep the process safe.  Your child is ready when he or she is able to sit with upright head control and be stable in a chair with supports.  Although the following considerations should be addressed for all children, those with developmental delays or motor deficits may require further assistance in these areas, or might need more time to develop complete readiness.

  1. Sitting stability – If your child is very unstable, you need to wait until he is a little more steady, or make sure he is well supported.  Imagine drinking from an open cup while walking a tightrope.  It is hard to develop aim and fine oral control if you are trying hard to keep your body stable.
  2. Hand to mouth control – If your child has significant difficulty with other refined hand movements (such as reaching for objects, picking up and dropping toys, or opening and closing their hands with appropriate timing), they will likely have the same difficulty with learning self-feeding skills.  Wait until their motor control is mature enough to be a little more accurate and consistent
  3. Oral control – It is important for your child to be responsive to items in their mouth in a timely fashion, so they can expel big pieces, rather than choke.  If their motor responses are over- or under-reactive, the same is likely to be true of food items in their mouth.  Giving breakable solid foods too soon will result in a greater risk for choking, which is an obvious problem.  Additionally, too many fearful experiences with food is likely to result in more refusal later as a self-protective mechanism.
  4. Allergy precautions – If there is a high likelihood of allergies, discuss food exposure with a physician or nutritionist to determine which foods are more likely to cause allergic reactions, so you can be wise in the order of presentation.

 

child with food on faceImportant considerations in food selection:

  1. Look for foods that hold together well enough to be picked up, but are soft enough to easily fall apart in the mouth (such as baked sweet potato logs)
  2. Never leave your child alone with food items.  They are still learners, and they must be supervised.
  3. Avoid foods that become sharp when broken (such as potato chips).
  4. Avoid foods that are too sticky to be easily controlled (such as a big spoon of peanut butter).
  5. Avoid hard foods that require teeth to break down (Raw apple pieces or small raw carrots are the most frequent culprits in food related choking incidents).
  6. Avoid foods that are too slippery to be easily controlled by an immature eater (such as canned peaches).
  7. Be familiar with infant and child CPR, and to look for that in a child care provider.  It is recommended for children learning to eat solids, but also because food is not the only thing kids put in their mouth!  Here are some links for CPR information:

Looking to learn more about Baby Led Weaning? This website continues to discuss the benefits and even shares a few great recipes for your child!

Sources:

  1. How Feasible is Baby Led Weaning as an Approach to Infant Feeding? A Review of the Evidence.
  2. Web summary from book author
  3. Video
  4. Glasgow Study Reviewed

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March 27, 2017

Mealtime Stress: Traumatic Stress

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

Most children and families with a child who has had a life-threatening illness or prolonged medical intervention have experienced a significant amount of stress. Everyone copes with these experiences in different ways. Those coping strategies make changes in the brain that will affect the way you react in future stressful situations. Some families are able to move beyond the initial crisis. They may continue to worry, but are able to develop new thought patterns and behaviors without getting stuck in the same cycle of worry.

However, other parents and families experience symptoms of Traumatic Stress which continue long past the time of the initial crisis. Traumatic Stress is a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. These responses are often more related to the person’s own perception of how traumatic the event was, rather than how medically traumatic the event would appear to be to a medical professional or to others involved.

Having a reaction to stress is normal, but it is not helpful if the symptoms persist once the crisis is over. In fact, those symptoms can impact the ability to develop new healthy patterns of coping that are more appropriate for a non-crisis situation. Not everyone experiences on-going symptoms, but those who do tend to fall into a few different categories.

  • Re-Experiencing: Thoughts and feelings pop in your head, you get upset over reminders, or feels like it is all happening again.
  • Avoidance:  You try not to think of those things, or avoid any reminders of them. Sometimes busyness and list-making are functional ways to help you distance yourself from those thoughts and feelings.
  • Increased Arousal:  You always fear that something bad is going to happen, or you remain on constant alert in order to prevent it. You are jumpy and easily started. This can lead to difficulty sleeping and concentrating.
  • Dissociation:  You distance yourself physically or emotionally, or even have difficulty remembering all of it.

Information from the National Child Traumatic Stress Network reports that about 20% of families whose child suffered a traumatic event or illness showed symptoms of Traumatic Stress that were significant enough to impact treatment for the child. It is more often mothers who are affected, and the consequences can be seen months or years after the initial crisis is over. We have also found that about 20% of our families would benefit from treatment specific to dealing with trauma. There isn’t a lot of information to predict who will experience Traumatic Stress that lingers, or why some people are able to move past it, while others’ get “stuck,” but we do know that seeking treatment is extremely helpful.

Many parents, especially mothers, would rather focus on their child’s treatment and don’t want to spend time or resources on themselves. In this case, though, treating your own symptoms will actually make it easier for you to help your child and the outcome is actually better. If you are experiencing any of the symptoms above, or realize that you are having trouble getting past your child’s early medical history, it is possible that you are impacting your child’s recovery process, as well as the relationships around you. Treatment is usually not long-term, and can be extremely helpful to both you and your child.

For more information click here or talk to your child’s pediatrician or your own primary care provider. You can also look for counselors, psychologists, or social workers with experience in dealing with Traumatic Stress, particularly medical stress if possible. Consider providers who utilize telemedicine if there are no providers near you, or if child care is a problem.

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March 21, 2017

Mealtime Stress: Why Can’t I Stop Worrying? How Do I Make it Stop?

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

Worries and anxious thoughts can sneak in like smoke under a door, coloring everything in the room. They can be disruptive to relationships and experiences, but also SO difficult to stop. Even in the middle of worrying, we have a sneaking suspicion that the anxiety isn’t healthy. The problem is that worry can also feel protective. That it means you are a good parent, a conscientious person and that you care. If you want to stop worrying, you need to give up the belief that worry is productive and that it serves a positive purpose.

Telling yourself to stop doesn’t work. Most of us have tried it, but it can even make the anxiety stronger because now you are focusing even more energy on those thoughts! Here are a few tips from HelpGuide.org, which is a mental health website that is affiliated with Harvard Health Publications.* We have found these tips to be incredibly helpful in our own lives and in working with families of children who struggle with eating.

1. Learn to postpone worrying. Write down thoughts as they occur to you, remind yourself to think about it later. It will break up the constant worry, and allow you to begin control your thoughts rather than allowing them to control you.

  • For current concerns, you can allow yourself a period of time every day to think about them, but limit the thoughts to that window of time. Set a timer if you have to!
  • For concerns about the future, you need to recognize the limitations of fretting in the present about a future problem.

2. Ask if the problem is solvable.

  • If it is, start a plan and take action. Ask the doctor specific questions or start a treatment process to address your feeding concerns.
  • If it is too far in the future to start a plan, write it down to worry about later. Logistical problems for the first day of Kindergarten can’t be resolved while your child is only 6 months old.
  • If it isn’t, accept the underlying emotions, such as fear or anger that lurk beneath the worry. For example, “if my child fails, everyone will believe that I am a bad mother.” Accept those emotions as part of being human and being a parent. Because worrying also protects you from feeling those emotions, embracing the emotion can help you create a better balance between your intellect and your emotions.

3. Challenge the anxious thoughts. Are you making the world or the situation more dangerous than it really is? The way in which you view a situation discredits you and your child’s ability to handle life’s problems and assumes that neither of you will be able to rise to the occasion and conquer new situations. These thoughts are called cognitive distortions, and can actually result in shielding you or your child from an opportunity to learn and mature. Take a look at your thought patterns to see if any of these seem familiar:

  • All-or-nothing thinking – looking at things in black or white categories, with no gray middle ground. “If my child isn’t eating all healthy foods in a meal, he is eating nothing.
  • Overgeneralization – generalizing from a single negative experience. He only ate two bites at breakfast, he doesn’t ever eat enough.
  • The mental filter – focusing only the negatives. Our parents often report their concern when their child didn’t eat their brussel sprouts, forgetting that he tasted them, which he has never done, AND he ate a bigger lunch than he has ever eaten before!
  • Diminishing the positive – Coming up with reasons that the positive doesn’t count. Yes, he ate a whole serving of ice cream, which is the most he has ever eaten, but it’s ice cream, not broccoli. Plus, he ate ice cream last year at the beach.
  • Jumping to conclusions – Making negative assumptions without the facts. The doctor didn’t call me back in an hour, I’m sure there is something seriously wrong with the tests.
  • Catastrophizing- Expecting the worst-case scenario to happen. This is especially difficult for families when there has been traumatic illness and difficult things did happen.
  • Emotional reasoning – Believing that your emotions reflect reality. “I am really scared about the doctor’s phone call. That must mean that he has bad news.”
  • Should’s and should not’s – making a list of what you should and shouldn’t do, and being upset with yourself if you break the list. For many of our parents, that can reflect some of the beliefs you made on how you were going to parent. “I wasn’t going to allow my child to have any sugar.” That can make it difficult to feel successful if one of your child’s first desired foods is flavored yogurt.
  • Labeling – Labeling yourself completely on your mistakes or on your shortcomings. “I can’t do this myself, I am a failure.”
  • Personalization – Assuming responsibility for things outside of your control. “I should have stopped the doctors, or asked more questions about the feeding tube before they put it in.” Realize that you made the best decision you could at the time, based on the facts that you had, and move forward.

4. Accept uncertainty – Worrying can feel like you are predicting the future, which will allow you to prevent any unpleasant surprises and control all the outcomes. Too bad that doesn’t actually work! Thinking about things endlessly doesn’t stop them from happening. At the very least, it can ruin the present. In some situations, especially with children and eating, it can actually cause the problem you are so worried about avoiding!

5. Be aware of how others affect you – Anxiety is incredibly catching and sneaky. In fact, we make sure that each staff member has another clinician to consult with during treatment. It helps to have someone who is not in the situation to de-escalate anxious thoughts and ground decisions in reality. Choose the people that you discuss your child’s eating with carefully.

6. Practice mindfulness – Acknowledge your thoughts, instead of trying to push them away. Don’t try to control them, hang on to them or analyze them endlessly. Engaging in those thoughts is what leads to being stuck in that cycle. Stay focused in the present.

Dealing with anxiety takes practice, so don’t be discouraged if your thought patterns don’t change overnight. Some people need help with changing these thought patterns so they don’t become more destructive. Next week, we will talk about the signs and symptoms of Traumatic Stress, and when to seek professional counseling.

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March 14, 2017

Mealtime Stress: What if It’s Me?

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

Although children with health and developmental challenges are at a higher risk of developing feeding problems, all children are susceptible to mealtime pressure. Last week’s post discussed the fact that mealtime pressure or a focus on healthy eating can actually backfire by creating more stress around mealtimes and food intake, resulting in even greater discord around food.

However, it is also a parent’s job to provide healthy foods and develop appropriate limits and expectations for their children. Navigating that balance can be extremely difficult. Here are a few questions to ask yourself to determine if you are bringing greater stress to the table.

1. Do I talk about anything besides food and eating at mealtimes?

2. Do I have a mental tally of the number of bites my child has eaten during the meal or over the day?

3. Do my childrens’ books and toys tend to focus on food and healthy eating?

4. Do I spend more time looking for recipes or foods to tempt the picky eater(s) at my table than I do reading them stories or playing with them?

5. Do I find myself saying “take a bite,” or “eat your food” more than 5 times per meal?

6. Do I bribe my kids to eat or to eat certain foods?

7. Am I the only one who can feed my child “the right way”?

8. Do I cheer or clap at every bite to encourage them to eat another?

9. Do I focus so much on intake that I don’t allow other people to enter the room, talk, or do anything that might “disrupt” the flow of eating?

10. Do I know the calorie and nutrition information of any food that makes it to the table?

If a number of these sound true for you, it is likely that you are contributing to the mealtime stress. This week, take a look at your mealtime behaviors and put yourself in your child’s place. Does it feel like you are trying to sell something? Would you want to listen to you if you were seated together at a dinner party? Too much focus on food, even praise, can have a negative effect. If you can’t stop thinking about it, it probably shows. Next week we will look at some things you can do to protect your child from your stress about food.

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March 8, 2017

Mealtime Stress: Should I Be Worried?

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

Should I be worried about my child’s nutrition? How do I know if my child is getting enough of the right nutrients? Will I know if my child isn’t getting enough to eat? My child is a picky eater, what if they are missing important foods that they need to reach their full potential?

As a parent, it is hard to stop the cycle of anxious thoughts, especially those around food. Our culture exacerbates the problem with continuous reminders about the importance of healthy eating. Because there is no better customer than an anxious parent, the marketing community takes full advantage of that to sell various products to solve the problem. Can you have too much focus on health?

Actually, too much of a focus on healthy eating CAN cause problems. Pressure to prepare and eat healthy food can bring a significant amount of UN-healthy pressure to the mealtime that backfires with greater refusal. It is especially harmful to children who already have an uncertain relationship with food due to medical problems, prematurity, prolonged hospitalizations or sensitivities to the way foods smell, touch, taste or feel. Katja Rowell explains how families get trapped in what she calls The Worry Cycle, which leads to counter-productive feeding practices and increased food refusal and anxiety.

What if it’s me? Next week we will go through some of the most common mistakes parents make in an effort to get their children to eat more healthy foods.

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February 14, 2017

Cup Drinking: Where to start?

By: Jamie Hinchey, MS, CCC-SLP

As a feeding therapist, I often have parents ask me about where to go next when transitioning to a cup. Finding the appropriate cup for your child can be a difficult task. Although there are a variety of sippy cups on the market today, the most important transition for your child is eventually to either an open cup or a straw cup. If your child has a specific reason for a certain cup, your feeding therapist will help you with this transition. We often recommend practicing with open cup drinking or a straw cup once your child is around 6 months old or sitting independently. This depends on where your child is developmentally and it is important to keep in mind if your baby has any difficulty with swallowing. Although these two versions of drinking may be a little messier than the sippy cup, try practicing outside or in an easy-to-clean environment so that your child can learn.

Many parents view sippy cups as a developmental milestone, but drinking from a sippy cup is not a specific milestone a child must reach. When focusing on the developmental milestones, we look at a child’s ability to transition from the breast or a bottle to an open cup or straw drinking. As a child’s oral motor skills develop, they gain more control over their lips, tongue, and swallow. As feeding therapists, we notice that children are typically most interested in the cups they see their caregivers use. At around 9 months, your child may be able to start to drink from a straw or at least start to practice. There are certain cups that can be helpful when “teaching” straw drinking, although many kids learn through practice as their oral motor skills develop. We would not expect your child to be able to pick up an open cup without assistance and drink from it, there are a few great transition open cups that we often recommend to families.

Here are a few tips when looking for a cup for your child:

Handles: Handles are important when introducing a new cup since this allows your child to easily grasp onto the cup and start to learn how to independently bring the cup towards their mouth. When a cup is hard to hold, it is difficult for a child to focus on holding the cup, bringing it to their mouth, and learning how to drink from the cup.

Focus on the “top” of the cup: The transition open cup allows for the child to learn the motor pattern of drinking from an open cup. We often recommend the Miracle 360 cup for a transitional open cup. Since the top of the cup is mainly closed, the liquid comes out at a slower pace and allows the child to have better oral motor control. This cup has a lip on the top where your child learns how to position their top and bottom lip while drinking. There are also straw cups that have “weighted” straws, which means that the straws hold liquid even when the cup is tipped up, allowing the child to be successful even if they attempt to tip the cup up. Parents have recommended the Zoli cup for a first weighted straw cup.

Allow your child to explore: It is important when introducing a new cup that you give your child the time they may need to explore the cup. This means that when you are first starting, take the time to put the cup out while your child is playing with their toys. Although they may not drink from the cup yet, they will become comfortable with how to hold the cup and bringing it to their mouth. Your child will learn best from what they see you do, therefore mealtimes are a GREAT time to model drinking from either a straw or an open cup!

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