Changing Colors: The Blog of Spectrum Pediatrics

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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!

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

April 24, 2017

Exact Instructions Challenge

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

I recently saw this video on social media, and it really spoke to my “SLP” heart! We don’t often think about how we use language and the importance of the words we use. This dad created a fun game for his kids to practice sequencing, using concept words, like “First, Then, in, on top of,” etc. Watch the video to see how these kids learn the importance of the vocabulary that they use.

You can do this in your own house with your kids to work on prepositions (in, on top, next to, under), time words (First, Then, Last), and other descriptors (color words, long/short, big/small, etc.). Here are some ideas to practice sequencing in your home with this family challenge!

1. How to tie your shoes

2. How to ride a bike/scooter

3. How to put on your jacket

 

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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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 22, 2017

Tips for Improving Your Child’s Communication

At Spectrum Pediatrics, we often find ourselves talking to parents about small changes they can make during their daily routines to help build their child’s communication skills. Two of our speech therapists are sharing four of their all-time favorite tips for parents. Check out the video below to hear Jamie and Krystina discuss these tips and explain what makes them so important and how to build them into your everyday routine!

Stay posted for more helpful videos on tummy time and feeding behaviors at mealtimes!

February 6, 2017

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

Yoga

Lately, I have been doing yoga with many of my clients, and I have found that it has many benefits for speech and language. Here are a few reasons you should try with your kids today!

1. Attention and Imitation – These skills are necessary to develop verbal speech skills. A child needs to be able to look at someone and copy movements in order to copy lip movements and words.

2. Comprehension – A child must focus on the verbal instructions being given to follow along with the yoga “flow” and assume the correct positioning. This skill helps with processing language and learning new words.

3. Breath Control – Yoga focuses on breath. The deep breaths in and out that are required help a child learn how to control his/her breathing. This is important for controlling breath when producing sounds, too. Deep breaths are also a great way to help kids learn how to stay calm and “regulate” their bodies and emotions.

Some yoga resources that are great for kids are:

  • GoNoodle – available for FREE on their website or on the AppleTV app
  • Yoga Kids by Kirsten Hall
  • Once Upon a Mat… Starring Jessie Forston
  • The Kids’ Yoga Deck: 50 Poses and Games by Annie Buckley

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