Changing Colors: The Blog of Spectrum Pediatrics

Posts Tagged ‘spectrum’

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 29, 2018

The Pressure of Praise: What else can I do?

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

As a feeding therapist, I always thought that I was being helpful when I “coached” children through their bites, cheered, and “whoo hoo-ed!” for all their eating attempts. I also observed well-meaning parents, grandparents and caregivers cheer, clap, and praise any attempts at eating, but we often did not see a consistent increase in eating as a result.

“‘Positive’ pressure is still pressure and turns many kids off from new foods.” – Katja Rowell, MD

Kids hat have little or negative experiences with food have limited experience with the smells, tastes, and textures of foods, and any new sensation or movement can make them even more anxious.  Attempts to “help,” can actually bring so much pressure to the situation that they have difficulty participating.  What adults may view as positive reinforcement, may actually sound like  “noise” to a child in an already challenging situation. It might also feel like you are taking on different personalities during mealtimes.

Natural reinforcers for eating are satiation of hunger, enjoyment of tastes and textures, and socializing in a relaxed and supportive environment.   Mealtimes are naturally meant to be social.  Nevertheless, the social interaction during mealtimes in families with a child with feeding challenges often becomes unnatural, scripted, and clinical.

Here are a few suggestions on what to do in place of praise during mealtimes:

  1. Remember to talk about things other than food and feeding at meal times. Check out the Family Dinner Project website for some great conversation starters!
  2. Reduce the number of questions you are asking your child.  Mealtimes should not feel like an interrogation.  Imagine a waiter standing over your table asking a bunch of happy questions as you are trying to eat.  No matter how good the food is, the questioning would likely ruin your appetite.
  3. When chatting with your child at mealtimes use a speech pattern, talking volume, and rhythm of speech that is more “Mommy”or “Daddy” and less “Cheerleader” or “Therapist.” Be yourself, and think about how you interact with your child when it isn’t a mealtime.
  4. Read your child’s cues.  If they are telling you they don’t want the spoon, honor it.  Take a pause and set it down nearby.  This gives the child the sense of security that comes with feeling understood and the space to initiate when the child is ready.
  5. Enjoyment is the name of the game.  Children that feel safe and relaxed at the table are more likely to develop healthy eating skills and try again at future sittings.  Quality leads to quantity.
  6. Sometimes, when safe, it is helpful to have a midday “snack” period where your little one is allowed to play with foods without obviously being watched.  Playing with their food is crucial for development and building trust during mealtimes. 
  7. Everything in moderation:  Be careful not to give extra attention or praise to food, but also remember to praise the non-feeding accomplishments of your child. For example, “I love how your sitting” or “Thank you for listening!”

 

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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.

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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

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