Changing Colors: The Blog of Spectrum Pediatrics

Archive for the ‘Uncategorized’ Category

September 19, 2018

Tube Free Superstar: Meet Benji

Benji was born 41 weeks with no complications during pregnancy. Due to umbilical cord asphyxiation and meconium aspiration at birth, he went to the NICU. While there, Benji showed limited interest in eating and an inability to coordinate his suck, swallow, breathe reflex.  He stayed in the NICU for 25 days and transitioned home with an NG tube due to poor weight gain and continued food refusal. While at home, Benji’s parents attempted to feed him the bottle but he continued to be inconsistent. In July 2017, Benji received a G-tube. After having his G-tube placed, Benji’s parents worked hard on his feeding schedule and relationship with the bottle. His skills improved and there were some days that Benji did not need the tube.  Unfortunately,this did not last and Benji became aware of his pump and his oral aversion grew. Although Benji would eat around 2 oz purees with meals, he would gag on any other consistency and he regressed to only being interested in the bottle while drowsy or asleep. Prior to starting the program, Benji was receiving 75% of hydration via G-tube. Due to Benji’s strong aversion to the bottle, all of his bottle feeds were done while he was falling asleep or sleeping.

Benji’s family decided to do a supported tube-wean through Spectrum Pediatrics. Benji’s journey began at 12 months old with the team at Spectrum Pediatrics in his natural home environment in New York. Benji’s pediatrician worked closely with his therapist and family throughout his tube weaning journey. During the hunger induction period, Benji’s overall volume was reduced – allowing him to feel hunger and he began to show more interest in eating.  His parents observed that he seemed more interested in eating and being spoon fed. Benji began exhibiting signal cues for acceptance such as opening his mouth or reaching for the spoon. During the transition between hunger induction and intensive treatment, Benji’s dream feeds were dropped. Although formula was offered through the bottle, as well as other cups, while awake, Benji preferred to drink milk through a straw! During the first few days of intensive treatment, Benji’s interest in various purees and finger foods such as puffs or meltable solids grew tremendously. Benji began to show interest in cups that he saw his caregivers using and would accept a few sips from an open water bottle or cup. Benji’s oral motor skills continued to improve as he began feeding himself crackers and veggie straws, however he still wouldn’t accept the bottle.

Throughout the intensive portion of the program, Benji’s oral intake continued to increase as did his comfort with spoon feeding. Benji started to dip his own crackers or veggie straws into the puree to feed himself! When a straw cup was introduced, Benji required assistance at first, but within a few days, he was able to independently drink milk from his straw cup! Benji was consistently eating fruit and vegetable pouches, along with any type of cheese! We quickly learned that Benji loved mascarpone and ricotta cheese! Benji quickly started to increase his oral intake with liquids and solids and did not require his g-tube for any supplementation after the 8th day of intensive treatment. Over the course of 15 days including hunger induction and intensive treatment, Benji fully transitioned from being 75% dependent on his G-tube to becoming a 100% oral eater! Benji’s therapist and parents worked together to read his cues and identify what he was attempting to communicate as his body learned how to self-regulate. Benji was now able to express when he was hungry and let his parents know when he was full.

Benji has not used his g-tube since May 16th, and it was removed on August 20th! During the follow up period, Benji’s oral motor skills continued to improve as he gained more experience and he is now able to drink water, and  milk from a straw cup! Benji’s ability to recognize hunger and learn how to regulate what his body needs has had a lasting impact on his overall development. Throughout the intensive period, Benji began to crawl and became more confident in his skills. Benji has learned to eat various foods and has started to eat larger pieces of foods such as bread with almond butter or cream cheese, spaghetti, and pancakes. Benji’s mother shared that although Benji likes almost everything, he currently loves blueberries, meatballs and turkey!

We are so proud of Benji and his entire family! Congratulations on being a tube-free superstar!

Photos provided by Benji’s family

January 31, 2018

A Family Mealtime Coach: How can we 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?  What exactly does a family mealtime coach do? Throughout coaching, therapists use reflective to help caregivers gain insight into a problem or situation.

Even if a feeding therapist is recommended to work on your child’s skills, we often see that mealtime interactions, expectations, and stress have a greater impact on meals than skills.  Parents need help with defining their own role and their child’s responsibilities at mealtimes. 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.

The job of a mealtime coach is to teach parents to be aware of their own impact on the mealtime relationship, to help them read their child’s cues, and to empower them to determine the right amount of support for their child. 

What does a Spectrum Pediatrics coach do?

Our goal is to help you develop healthy mealtime interactions with your child, instead of expecting meals to look like feeding therapy

  • We will listen first, to understand the whole problem.
  • We will work with your family to determine the root causes of the difficulties.
  • We will build on strengths to improve mealtimes.
  • We will collaborate with your family to create solutions that will work in your home or circumstances.

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!

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.

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October 24, 2017

Responsive Feeding: Do they always have to sit in the chair?

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

Parenting can be tough, and it is easier to find some exact guidelines on how to help your child, or how to get them to “do the right things.” Responsive feeding is a great structure, but it can feel like there are a lot of gray areas when it comes to application.

Picture helping your child learn to walk. In the beginning you hold them upright, and even help them move their feet! As they mature in their skills, you progress to holding two hands, holding one hand or, just using a finger. Eventually, you let them walk to your outstretched hands and you catch them if they wobble. Sometimes you need to let them land on their booty in order to allow them to develop their balance independently. Once they are running on the playground by themselves, you will probably forget all of the months of practice and many steps that you went through! You can apply the same idea to other skills. Rather than giving some exact guidelines on questions such as the wisdom of making your child sit in the chair and other mealtime conundrums, here are some questions to ask yourself to help guide your reactions in the gray areas of the mealtime relationships.

Enjoyment

1. What does my child think about food (or drinking) right now? How do they communicate this?

2. What does my child think about family mealtimes (or bottle times) right now? How do they communicate this?

3. Is his or her response to mealtimes different than other areas of structure? (For example, 2 year olds often do not like to be confined, and would rather explore than eat. This does not necessarily mean that he doesn’t like food, but may dislike sitting for more than a few minutes.

Abilities

4. What do they do at about 80% of mealtimes with ____________ ? No one is 100% at anything, especially toddlers and preschoolers, so 80% is a pretty good measure of mastery. This can be any skill, such as drinking from a cup, sitting at the table, using a spoon, or just taking bites without spitting them out. It can also be behaviors, manners, and food challenges like sitting at the table or tasting new foods.

5. What do I hope they will do at mealtimes?

Shaping rules and expectations

  • If you do an assessment of their enjoyment and find that there is no enjoyment at all, you may need to back up your expectations until they are more relaxed at mealtimes.
  • Once you have some enjoyment of food and mealtimes, you can begin adding structure a little bit at a time.

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October 4, 2017

How does Responsive Parenting Apply to Feeding?

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

The mealtime relationship is extremely dynamic and should evolve over time. In the beginning, the parent’s role is more permissive and supportive with food. Children are allowed to explore and branch out. This allows their tentative interests to develop and stabilize. However, we have found that being too permissive can actually lead to pickier eating and more mealtime “stand-offs,” and even impact weight gain. We also know that being too authoritative or involved can also lead to refusals and difficulty with self-regulation.

We realize this is a hard line to walk. Here are a few thoughts to help with this process.

• The child should be comfortable with saying “no” to foods if they aren’t hungry or don’t feel safe, without fear of reprisal.

  • Learning that they are loved despite the fact that they said “no” is extremely important. However, it doesn’t mean that they shouldn’t experience the consequences of “no,” such as being hungry.
  • They may show interest or refusal in a variety of ways that will change over time. You will need to pay attention now and as they mature.
  • If the child is consistently refusing, the adult may need to re-consider the environment or expectations, so that they are both appropriate and achievable.

• The adult should also be comfortable with saying “no” to behaviors and requests

  • If the situation isn’t safe, it is always appropriate for you to set limits. Playing with knives, standing on the table, or eating non-food are clear examples of appropriate limits. There are others that are less clear, but still important. Eating only at the table is a tricky one, but if that is the rule, it is important to reinforce it.
  • As hunger and trust are more established, mealtime expectations should begin to line up with expectations outside of meals. Ask yourself, “what would I do if this wasn’t food?”
  • There are very valuable lessons that children learn from consequences. Protecting them from consequences of “no” by always setting up the situation so the answer is “yes” deprives the children of learning important lessons. ▪ For example, getting the child to eat every day by only serving highly preferred foods deprives the child of learning the feeling of hunger, as well as the possibility that some new foods are good.

• Just as you wouldn’t expect an infant to drive a car or read a book, you would be disappointed if your teenager waited for you to change their clothes or put food in their mouths. It is appropriate to change your expectations as children mature.

  • If your child is a new or hesitant eater, their abilities with food may look different than their abilities in other areas.
  • Until their trust of food and eating becomes more stable, you may have different sets of expectations for food and for other areas, but it helps to be aware of the discrepancy and make very small steps to make them more similar.
  • If a behavior is new and fragile, it needs more support. Taste, variety, volume, texture, situation, etc., may time to stabilize.
  • Once a behavior is more established, parents and caregivers can begin to shape it or incorporate it into an expectation. For example, in the beginning, the “eating only at the table” rule, may be suspended, but once that behavior is more stable, eating at the table should be consistent and not open to negotiation except for special circumstances.
  • Patterns of interest and response will help you make future choices and determine when your child is ready for the next step.

Source 1

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Darling, N., & Steinberg, L. (1993). Parenting style as context: An integrative model. Psychological bulletin, 113(3), 487.

Hughes, S. O., Power, T. G., Fisher, J. O., Mueller, S., & Nicklas, T. A. (2005). Revisiting a neglected construct: parenting styles in a child-feeding context.Appetite, 44(1), 83-92.

Landry, S. H., Smith, K. E., & Swank, P. R. (2006). Responsive parenting: establishing early foundations for social, communication, and independent problem-solving skills. Developmental psychology, 42(4), 627.

August 23, 2017

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

Visuals for Toddlers in Their Everyday Lives

All people benefit from visuals. Just think of how your daily planner or agenda helps you feel less anxious about your day if you can see all that needs to get done. Toddlers are no different than adults. Visuals aid them in feeling calmer about what is ahead, particularly since they may not understand all the language adults are using. Here are two visuals that I find helpful with the toddlers:

1. Visual schedules: Visual schedules can be cumbersome, but they don’t have to be. Pick a few categories that can give your child a general idea of the activities depicted. An example would be: 1. Breakfast 2. Bathroom (represents shower, brushing teeth, etc.) 3. Play 4. Snack 5. Park 6. Nap

Visual schedules can be used for a whole day, part of a day, or just an activity. Kids feel a sense of accomplishment when they take off the sticker card for each activity and “complete” the task. It’s a win-win for the child and the parent!

2. Sand Timers: I have been using sand timers for quite some time with the kids I work with and my own kids. We use it as a visual way to give kids an idea of time. My own children try to “beat the clock (sand timer)” when cleaning up their toys at night. I also use it before we are about to leave the house. I will put out a three minute sand timer to mentally prepare them for the upcoming transition. A parent could just use words, but the visual of seeing how much sand is left is so much more powerful to a toddler. You can order sand timers here ) or check out a local teacher-resource store.

Check out our post on SoundingBoard, a great app for visual schedules here. We also shared a favorite visual timer app that all of our therapists love! Check it out here!

August 21, 2017

Back to School Time

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

It is nearing the end of the summer, and we all know what that means…school is going to be back in session soon! If your child is going to a new school this Fall, here are some ways to make sure they feel comfortable before the first day arrives.

1. Go to the school’s playground NOW – If your child is in preschool or elementary school, take him/her to the playground a few times before the school year starts. This will get your child familiar with the school grounds and play equipment in a low-stress setting with a trusted person (You!). This will make it easier to navigate the school grounds the first few days because the child will already feel like the area is familiar and safe.

2. Attend school functions – Does your school have an Open House day to meet new teachers and tour the school? Be sure to take advantage of this opportunity if it is offered! Attending any pre-season games is also a great way to meet people and familiarize your child with the school grounds.

3. Talk about it! – Make sure that you are talking often with your child about the big changes coming up. Discuss what a typical day will look like, and maybe even brainstorm with your child what to do if something doesn’t go quite as planned. Preparation is always a good idea, and it makes everyone feel more at ease with big transitions, like a new school.

Every student is going to be nervous on their first day at a new school, but hopefully, we, as parents, can help calm those nerves as much as we can by using a few of the strategies above. Wishing everyone a great start to their school year!

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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!