Changing Colors: The Blog of Spectrum Pediatrics

Posts Tagged ‘feeding’

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

August 6, 2018

Family Mealtimes for Tube-Fed Kids

We have discussed in the past the importance of family mealtimes for all children. This is essential for kids who are tube-fed, but it is often more difficult. Stringent tube-feeding schedules and extended time spent on the tube feeding itself can make sitting down and eating together feel like either an additional chore, or an impossible luxury. Add in a history of stressful mealtimes that feel like failures, and the result is often allowing tube-fed kids to opt out of the family dinner table. Sometimes medical and behavioral complications have disrupted daily routines so much that family mealtimes have never even been attempted. Unfortunately, this results in a crucial missed opportunity on the road to becoming a healthy eater. In addition to the advantages mentioned in our family mealtimes post, kids who are tube-fed benefit by:

  • Being a part of a family routine.
  • Seeing food as enjoyable.
  • Having mealtime expectations that are not just volume or eating related.
  • Being exposed to a variety of foods through sight and smell.
  • Watching parents and siblings eat, which research has shown be the most powerful tool in the development of healthy eating habits.

Even if kids don’t put food in their mouths, there are other measures of success:

  • Helping to prepare food, making it clear that eating is not an expectation. It allows children to feel the pride of contributing and increases food experience.
  • Staying at the table for a certain period of time. Even if it begins at 2 minutes, time at the table can then be extended. If your child shows significant anxiety just with being at the table, this is an even more important step in becoming an eater.
  • Completion of mealtime chores such as helping to set the table, cleaning up the silverware, and helping to pass the serving plates can put the child in proximity to food that doesn’t force eating.
  • Participating in family conversation, even if it begins with one or two responses. Non-food conversation is important for family bonding and for helping the child to become a part of the “eating world” in preparation for becoming an eater themselves.

Talk to your therapist about other ways in which to build up to pleasant mealtimes. Past fears may need to be worked through before any food is part of the equation. If this is frustrating, remember that many families struggle with this, not just families with tube-fed children. If you missed it, check out the resources for family mealtimes here.

Photo

July 3, 2018

Tube-Free Superstar: Meet Lucas

Lucas was born full term and diagnosed with an esophageal atresia and a tracheoesophageal fistula at birth. Lucas underwent surgery following birth for repairs and remained in the NICU for 2 weeks. While in the NICU, Lucas began eating by mouth with some success and he was discharged from the hospital. At home, Lucas began to refuse bottles and his mother described feedings as extremely difficult and stressful. He underwent multiple tests to attempt to find a reason behind the increased vomiting, reflux, and food refusal. When Lucas was 4 months old, he was hospitalized due to dehydration and food refusal. At this time, an NG tube was placed for primary nutrition. His parents report that following the NG tube placement, Lucas did gain weight, although any interest in oral intake decreased. Lucas’ parents reported that following the NG tube placement, Lucas continued to refuse food, despite decreased pressure.

Eating CookieFollowing multiple failed attempts to increase oral feedings via regular feeding therapy, Lucas’ family decided to do a supported tube-wean after learning about the program through their doctor. Lucas’ journey began at 8 months old with the team at Spectrum Pediatrics in his natural home environment in New York. Lucas’ GI doctor worked closely with his therapist throughout his tube weaning journey. During the first day of intensive treatment, Lucas began to show interest in both solid foods and purees. He immediately showed his independent side and started to feed himself! Lucas enjoyed crackers, cheese puffs, and anything his parents were eating. Lucas was so excited to start his tube-free journey that he decided to pull his NG tube out on the first day. His parents and therapists felt confident in Lucas’ overall interest in food and increased oral intake.

Over the course of the next few days, Lucas started to increase his oral intake each day. He quickly learned to love to eat oats for breakfast and wonton soup for dinner! He loved to munch on cookies, puffs, and anything dipped in ricotta cheese. Within the first 4 days of treatment, Lucas learned to love to drink milk from his cup and water or apple juice from his straw cup. He learned how to hold and drink from his straw cup all by himself. It was clear tat Lucas was slowly starting to trust food and build a relationship with his caregiver’s during mealtimes. He began to show signs of hunger and thirst by crying or reaching for food or his cup. He worked very hard to feed himself, drink through different cups, and swallow purees, liquids, and soft solids!

During the follow up period, Lucas was happy during mealtimes with his family. His parents quickly started to recognize his clear cues to request more food or signal he was all done. He learned to eat various foods and became a more competent and confident eater. Lucas loves going out to restaurants with his family, especially when he gets to go to Panera Bread for his favorite, mac and cheese! Throughout the first month of follow up, Lucas’ parents observed that he was starting to eat more consistent meals and have fun during mealtimes! Lucas is continuing to show his independent side, he is learning how to feed himself with a fork and spoon, as well as pick up small pieces from his tray.

We are so proud of Lucas and all the things he has accomplished! Congratulations to Lucas and his entire family for being a tube-free superstar!

Photos provided by Lucas’ family

 

 

 

February 12, 2018

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

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

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

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

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

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

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

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

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

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

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

Sources:

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

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

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

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

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

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

Photo 1

Photo 2

January 31, 2018

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.

 

October 20, 2017

Spectrum at NPC-QIC: Lessons from a Tube-Weaning Program

Our wonderful feeding therapist and clinical coordinator of our Tube Weaning Program, Heidi Moreland, is presenting at the National Pediatric Cardiology Quality Improvement Collaboration conference in Chicago this weekend. Throughout this presentation, Heidi discusses the philosophy behind Spectrum Pediatrics tube-weaning program and provides a glimpse into what the program looks like for children and their families!

Check out Heidi’s presentation here along with helpful resources for the tube-weaning program:

References for Spectrum Pediatrics Treatment Program

Spectrum at NPC QIC Presentation

Photo