Changing Colors: The Blog of Spectrum Pediatrics

August 23, 2017

What is Responsive Feeding?

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

Responsive Feeding: Mealtime guidance that depends upon the feeder’s ability to read the eater’s cues in order to make the meal manageable, enjoyable and successful for the eater, without giving up developmentally appropriate structure and expectations.

Every parent has a parenting style which is formed by their own personality, the way their own parents interacted with them, the community in which they live, and how the child’s personality responds and interacts to that style. Their interactions are characterized in part by how they respond to their kids and their views on how to set limits, with some parents leaning more towards being more permissive, others towards being more authoritarian.

The truth is that both responsiveness and limits are important. Responsive parenting includes a balance between being the authority, while still recognizing their children’s cues and responding positively to them. Parents acknowledge the child’s needs and desires, and may provide developmentally appropriate reasons for the rules, but have high expectations for their kids and expect that rules will be followed. Research has shown that kids of responsive (also called “authoritative”) parents have higher levels of attachment, are more secure and have more self-control.

This role evolves over time. When children are infants, the parents’ primary job is to notice the child’s needs by responding promptly. However, in order to mature past the demanding nature of infancy, children need to develop the ability to safely and successfully interact with a changing world independently. This means that parents can’t just respond to the child’s needs and expect them to mature, they must also teach their child to cope with stress and novelty (Landry, Smith, and Swank, 2006) by allowing them opportunities to be independent, even if they struggle a little. This should look different for each child and family, and your expectations should change over time as your child matures, but it will continue to follow the same process.

This style of parenting seems to work well for developing healthy eaters. Most research that looks at parenting style and eating finds that kids of responsive (authoritative) parents are more likely to develop self-regulation, be less picky, and have less food battles than parents of authoritarian or permissive styles.

Most parents do this naturally in many areas, but struggle with applying this to the mealtime relationship. Check in next week for a little bit more on how this applies to feeding and the mealtime relationship.

Sources:

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.

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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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August 18, 2017

Feeding Friday: Tube-Free Superstar Rusty

Rusty was born full term, yet had many complications during his hospital stay such as noisy breathing, poor feeding, and poor growth. Rusty was initially breast fed, but due to difficulty with weight gain, Rusty received an NG tube for primary nutrition at 1 month old due to concerns of aspiration. Rusty then was diagnosed with significant retrognathia and has mandibular distraction surgery in July at 2 months old. Although his breathing improved, Rusty continued to have difficulty with feeding. While at home, Rusty’s parents continued with tastes of puree and allowed Rusty to explore with solid foods through the baby-led weaning approach. Although Rusty did well with eating for a few weeks, his parents observed more crying and refusing feedings. His oral intake dropped and he again had difficulty with weight gain. Rusty received a G-tube in September when he was 4 months old. After this G-tube placement, Rusty would take a few bites from the spoon, but relied 100% on his tube for nutrition and hydration. During the time prior to the tube wean, Rusty was diagnosed with DiGeorge Syndrome, also known as 22q syndrome. He underwent brainstem decompression surgery at 7 months old.

Following multiple failed attempts to increase oral feedings via different methods, Rusty’s family decided to do a supported tube-wean. His journey started at 9 months old with the team at Spectrum Pediatrics at the Virginia location. Due to Rusty’s history with aspiration, his swallowing was closely monitored and the first few days of treatment focused on allowing Rusty time to explore and demonstrate interest in food. Rusty’s parents describe him as a generally happy baby and he could not have been happier to be in a new place and meet new friends! Rusty initially showed interest in pouches and reaching for foods that his parents were eating such as crackers and bananas. Rusty quickly learned to love to eat oatmeal for breakfast while his mom spoon-fed him. Rusty also demonstrated a need for independence, he loved to munch on puffs, cheese crunchies, and strawberries. Rusty quickly learned how to drink independently from a pouch and eventually a straw cup with milkshakes and smoothies!

Rusty also started to enjoy home made meals that his parents ate as well, such as Dad’s butternut squash soup! Rusty slowly started to trust food and learn how great it made him feel! Rusty was eating enough by day 4 of treatment to discontinue his tube use. Rusty worked very hard to learn how to finger feed himself, drink through different cups, and swallow purees and liquids. Rusty started to show clear cues to his parents during mealtimes such as pushing away the food when he was all done and reaching for his cup or the bowl when he wanted more.

During his transition home, Rusty was happy to be back having mealtimes with his older brother. Rusty quickly learned to eat various foods and became a more competent and confident eater. Rusty started to learn what he needed to make him feel good, as he continued to learn how to crawl, cruise around, and take a few steps independently. Rusty now loves grilled cheese, kielbasa, meatloaf, roasted broccoli, peanut butter toast, and smoothies! These are just a few of Rusty’s favorite foods, but he loves a wide variety of food now. During the past summer months, his family learned that he loves to eat ice cream straight from the cone and strawberries straight from the patch!

 

Rusty recently had his G-tube removed. We are so proud of Rusty and all of the things he has accomplished! Congratulations Rusty on being a tube-free superstar!

Photos provided by Rusty’s family.

August 11, 2017

Feeding Friday: Tube-Free Superstar Caden

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

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

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

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

Photos provided by Caden’s wonderful family!

July 23, 2017

Feeding Friday: The Impact of Unwanted Guests

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

Do these personalities show up at your family table?

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

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

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

 

July 23, 2017

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

Behavior Strategies

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

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

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

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

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

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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!

June 30, 2017

Summertime Motor Fun!

By: Colleen Donley, PT, DPT

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

Sidewalk Chalk

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

Water Guns

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

Sponge Toss

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

Beach Trips

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

 

Bikes and Scooter Rides

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

Enjoy a moving and busy summer!

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June 14, 2017

Feeding Friday: Tube-Free Superstar Piper

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

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

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

 

June 14, 2017

Ways to Beat the Heat

By: Krystina Burke, MS, CCC-SLP

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

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

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

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