Inclusion is for life, not just for Christmas

In the UK, it’s the week where the John Lewis Christmas advert comes out.  This is something of a pre-Christmas tradition these days, and the ads have a reputation for being heart-warming.

In this year’s ad, Edgar the excitable dragon tries hard to join in with the same things that everyone else likes, but he just keeps getting himself into trouble by accidentally setting things on fire.

At one point he ties a scarf around his face, hoping to stay out of trouble this time, but to no avail.  Edgar ends up unhappy and alone. Until a friend finds a role he can play (lighting the Christmas pudding), and all is well.  Consider your heart warmed.

edgar

Image by John Lewis and Partners

I know I am not alone in seeing this as a metaphor for inclusion.  The part where he wraps his face with the scarf felt heart-breakingly like masking to me (masking is a term for inhibiting your natural tendencies in order to fit in, quite possibly at the cost of your mental health).

And while the ending was heart-warming, what I actually thought was, “what’s he going to do for friends the rest of the year then?”.  It reminded me of the children who are not being well-supported in school, but who everyone feels appropriately gooey about when they are given angel wings and a halo in the Nativity.

Inclusion means providing environments that are open to making the most of everyone’s gifts, all year round.  Appreciating what they have to offer, not only when it’s convenient or heart-warming.  And accepting all parts of a person, even when that is difficult for the rest of us.

So next time you see the John Lewis ad, think about making these inclusive gestures an all-year-round thing – that would be a real Christmas miracle.

If you are looking for practical help with supporting your child’s communication, I’d be glad to see you on my Facebook page (Find the Key Speech and Language Therapy), or in my new group, Find the Key for Families.

Or think about signing up to my newsletter here, for monthly tips, resources and offers.

No hard sell, just the stuff you need to help your child!

Angharad

key trans

 

 

Why you are missing out on ideas and support for your child’s communication

I am an NHS Speech and Language Therapist, and run my business on the side at the moment.  When you work in the NHS, you don’t really need to worry about ‘finding your market’, because we all know that there is way too much work for our NHS Speech Therapists to do!

It’s a bit different when you are a private Therapist though, and you need to ‘find your people’ who are a good fit for your skills and knowledge.  This is a bit of a learning curve for me.

One of the things you do to get yourself ‘out there’ is to put out free content and help people to find your social media and website pages.  So with this in mind, I was writing a ‘freebie’ yesterday, about things you could do to support your child whilst you waited for a Speech Therapy appointment.  I posted it in one of my online business groups, to see if the Parents in the group felt I had hit the mark.  The feedback I got really got me thinking.

The feeling was that the information would be valuable but that in order to get people to read it, I would need to present it to a very niche group.   So for example, ‘Things you can do to support your child who is a late talker whilst you wait for a Speech Therapy appointment’, ‘Things you can do for your child with Down Syndrome whilst you wait for a Speech Therapy appointment’.  The advice wouldn’t be any different, I would just be changing the front cover and title to attract the groups who needed the freebie.

This made me feel frustrated.  I want to get my knowledge out in front of people who need it.  If I was going to have to market this information to every individual group of people, it will take me all year just to get it to the families who would benefit.  Now, there is a thought process, business-wise that says this is a good thing, because I can repackage the same information endlessly and sell it over and over again.  I see this, business-wise.  But I’m telling you, when you know families are desperate to be doing the right things for their children’s communication, and you know you have the information they need, this feels a bit depressing.

The internet is a wonderful place, full of information.  But I have lost count of the conversations I have had with families who have been online and either failed to find the info they needed to support their child, or have been overwhelmed with information.  People are often looking for information based on their child’s diagnosis, or their suspected diagnosis.

I’ll let you into a secret- children are all fundamentally the same.  No matter what their diagnosis (or none), all children need the same underlying communication skills, and the same approaches will often benefit children with many different diagnoses.  Your Speech Therapist doesn’t think all that much about your child in terms of their diagnosis (though that has a bearing), they think about them in terms of what skills they have and what skills they need.

If you are just looking for diagnosis-based information, you are probably missing out .  Think about what skills your child needs instead:

  • Attention skills?
  • Speech clarity?
  • Independence?
  • Learning vocabulary?
  • Social skills?

Try looking for these instead of a child’s diagnosis.  Ignore the fact that the page says ‘Autism’, and just think about whether the information might suit your child.

So, the world being how it is, I’ll market to families of children with all types of diagnosis, and none, if that means families get the information they need.  But I’m also sending the message that you can help your child, right now, if you get help to understand the skills they need to develop.

If you are looking for help filtering through all the information out there…..

If you are looking for simple things to do with your child that work…..

If you want to inform yourself and feel confident that you are doing the right things to support your child’s communcation..

Come over and see me on ‘Find the Key Speech and Language Therapy’ on Facebook, and sign up to my ‘Find the Key for Families’ group, where you can get information and support that works

Or

Sign up to my newsletter to get monthly info and freebies

https://findthekeyslt.co.uk/p/contact

No hard sell, just the stuff you need to help your child!

Angharad

key trans

 

Everything you wanted to know about feeding tubes but were afraid to ask

I’m squeaking in at the end of feeding tube awareness week with a post for anyone who has ever wondered why children would have feeding tubes.

My special area of interest is in working with children and families who are tube-dependent (in fact, I’m hoping I will get to do research in this area some day!), and so it is a pleasure to write this post, a quick run-down of FAQs and info about feeding tubes.

What’s a feeding tube?

A feeding tube is a way of children/adults getting nutrition into their bodies that is not via their mouths.  The one you are most likely to see (because it is most visible, and also a popular solution for more short-term needs) is an NG, or Naso-Gastric tube.  That means it goes into your nose and down into your stomach.

The other tube that is fairly common is a gastrostomy (not, as a lot of people think, a gastronomy tube, though that would be great, wouldn’t it?).  This is a tube that goes directly into the stomach.  Sometimes people call it a PEG (percutaneous endoscopic gastrostomy), though technically, that is just a term for one type of gastrostomy that is put in in a certain way.

Other less common tubes are oro-gastric (from your mouth into your stomach) and naso-jejunal/naso-duodenal tubes (from your nose, though your tummy and into different areas of your small intestine).

Why would a child need a feeding tube?

There are a few main reasons:

  • The child physically can’t eat- they do not have the necessary skills to eat, or they are too unwell to eat.  This may be temporary (e.g. if the baby is premature, or they are having an operation or treatment) or it may be permanent (e.g. if the child has an unsafe swallow, leading to food or drink entering the lungs).
  • The child is finding it difficult to eat for other reasons- this can be for lots of reasons, but some children who have had a lot of invasive medical treatment, sensory difficulties or pain associated with eating, may develop aversive behaviours in response to food that stop them eating, or stop them eating a good range of foods.  These children may need all or some nutrition through their tube to support them.
  • The child is not eating enough- this might be because they have a condition that means they require more calories than average, or perhaps their physical condition means that they eat very slowly and it is difficult to get through enough food to grow.

If a child has a feeding tube, does it mean they will never eat?

Not at all!  The long-term picture for feeding tubes depends a bit on why they have been put in in the first place, but many children are able to leave them behind and move onto oral feeding.  Some children will always need them for all or part of their eating and drinking.

Won’t a feeding tube make the child too lazy to eat?

This is not the case.  Feeding tubes help us to support children to grow and develop.  There are some children who can find it difficult to move on to oral eating, but these are children who have physcial, developmental or psychological reasons why this is the case.  These children are not lazy, and neither are their families.

When a feeding tube is introduced as a short or medium-term solution, there should always be a plan for how it is monitored and how and when decisions will be made to support the transition off the tube if it is appropriate.

Children often need therapy support to help them to build skills for future oral eating.  In an ideal world, children will have Speech and Language Therapy/Dietitian/OT/Physiotherapy/Paediatrician/Respiratory Team/Gastrointestinal team/ENT/Nursing in the right combinations for their individual needs to help them and their families.

Want to find out more?

Try http://www.feedingtubeawareness.org/  and/or https://www.feedingmatters.org/

I give thanks to all the families sharing their tube-feeding stories this week, and I hope one day that all children will get the right support to reach their feeding potential.

Weaning your premature baby: When is the right time?

It can be confusing working out whether your baby is at the right age for weaning.  Should you go by corrected age, or uncorrected?  What if your baby has developmental delays, or additional medical needs?

The short answer to ‘when do I wean my baby’, is ‘when they are ready’.  In many ways, this is the same advice as for any baby.

I have seen some advice out there suggesting that premature babies should be weaned at 4 months.  I have never been able to find any evidence for this, but I imagine the reasoning is the idea that there is a sensitive period for learning the skills of dealing with solid foods, and that premature babies cannot lose time.  This means that children are most able to learn to deal with solids within a certain time frame, and likely to find it more dfficult after this.

This is true, to an extent, and we will talk about this more in future posts.  However, like so many things in a child’s development, you cannot make them ready for the next developmental stage, and we can create problems if we push too fast.  Following through on the principle of cue-based feeding that we discussed around introducing oral feeds, we can use the same principles to think about weaning.

So when is your baby developmentally ready?

Babies who are weaning are learning how to chew.  This involves skills of the jaw and tongue.  These jaw and tongue skills are fine motor skills, requiring a lot of coordination.

Your baby will not be ready to develop the fine motor skills they need in their mouth for chewing until they have an underlying amount of stability in their body.  The easiest sign to look out for is that they are starting to sit.

When they start to be able to reach for things, and move them around, in the sitting position, this is a sign that they can both sit and do something else at the same time, which is essentially what we are asking them to do with their mouth.

So as a general rule, sitting is a good indicator of weaning readiness.  This still applies, even if your child is developmentally delayed.  Until your child is sitting, they will not be able to develop their chewing skills, and so they are unlikely to be able to move beyond pureed (smooth) foods.

But…….

The other consideration here is the introduction of flavours.  In some ways, this is the more important consideration in the first instance.  Children who cannot sit are unlikely to be able to make the transition onto more complex textures BUT the period of time during which you can establish tolerance of diferent flavours is somewhat limited.  Of course, we can learn to like new flavours during our whole lifetime, but the period between about 6 months and about 18 months is really important.  After this time, many children go through a typical developmental phase of ‘fussy eating’ ( which I will write about), and it can be much harder to establish newer foods.

So, my advice ……

  • As a rule, look for sitting, and reaching whilst sitting as indicators of readiness for weaning
  • However, if your child is slow to develop these skills, then focus on the introduction of a wide range of flavours through purees.  Do not aim to progress onto more complex textures until your child has developed their gross motor skills.

Posts from Find the Key Speech Therapy are intended for information.  They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language therapist who knows your child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance. 

 

 

 

 

Weaning your premature baby: what skills does your baby need to learn?

It can be confusing working out the best way to introduce solid foods to your premature baby.  There is a lot of advice available, from Professionals and friends and family ,but the truth is that the research isn’t yet definitive.  This means that advice can be dififcult to apply to your baby.

Over the next few posts we’re going to be breaking down weaning in a bit of detail, so you:

  • can make decisions about when to start weaning
  • can make informed choices about what approach to take to introducing solids
  • have tools for managing common difficulties
  • understand when to introduce different textures

As a Speech and Language Therapist, I am not trained to offer advice on food from a nutritional  perspective, and so I won’t be going into detail about nutrition considerations.  For general nutrition advice, please talk to your Health Visitor, or Dietitian if you have one.  I also recommend this Facebook group, https://www.facebook.com/groups/weenourish/  , led by a Canadian Dietitian called Caitlin Boudreau.

What is weaning, anyway?

Like most things in your child’s development, moving onto solid foods might seem like something that just happens, and that is simple.  But in reality, the many milestones your child accomplishes all the time are all complicated, with a series of steps and skills to conquer.

From a Speech Therapist’s perspective, weaning involves (at least) two main skills:

-Learning about different flavours (establishing a range of foods)

-Learning to chew (moving on to different textures)

Together, understanding these two areas of development will help you to make decisions about when to start weaning, and how to progress it.

Keep an eye out for upcoming posts where we will talk more about this subject, and in the meantime, you might find these older posts helpful

 

 

Feeding your premature baby: Pacing oral feeding

One of the skills that babies need to develop is their suck-swallow-breathe co-ordination.  This skill is something that develops with maturity, and not practise, which is one reason why we have to chosoe our starting point for oral feeding very carefully.

Sometimes at the beginning of oral feeding, babies need some outside help to manage the co-ordination of these skills.  This is particularly true of bottle-fed babies.  When babies exert pressure on a bottle teat, milk comes out.  At the beginning of a breastfeed, it takes time for milk to flow.  To an extent, the breast and baby adapt to each other in ways that the bottle does not.  So we need to step in and make sure that we are doing this job for the bottle-fed baby.

Sometimes, babies start to suck and cannot stop.  They suck and swallow, suck and swallow, but they don’t stop to breathe.  At some point the brain recognises this as an emergency situation and they will breathe in.  In the meantime, their oxygenation levels have dropped, and their body will repond as if to an emergency.  Monitors will go off, and all-in-all this is a very stressful experience.  In addition, if they breathe in with milk in their mouth, then they may aspirate milk (breathe milk into their lungs).

We want to avoid this situation if at all possible.  Remember, finishing the bottle at this stage is not the aim, developing skills at the appropriate rate for the baby is.

Some babies find co-ordination difficult through the whole feed, but most commonly, it is the beginning part of the feed that is the issue, where the baby is most hungry and least able to regulate the amount of flow coming from the bottle well.

External pacing is a strategy that helps us manage this situation.  It involves counting a set number of sucks (I often start with three), and then dropping the bottle teat beneath the level of the baby’s mouth.  They may keep sucking for a little while, but usually they are prompted to stop sucking and breathe.  After a few minutes of this, you can experiment with giving your baby back a little more control of the co-ordination experience.  You will probably find, as the baby gets more experience, that you are having to pace them for less and less of the feed, as they mature in this skill.

If your baby is just not stopping sucking, you can actively break their suction on the teat by rolling the teat to the side of the mouth, or even removing the bottle.  This is the least preferred option as it is likely to frustrate the baby who is probably really hungry, and they will have to organise themselves onto the teat all over again.

You can combine strategies to support your baby, for example, pacing and positioning, as discussed in a previous post.

Posts from Find the Key Speech Therapy are intended for information.  They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance. 

Feeding your premature baby-Getting started with oral feeding- Positioning for feeding

There are a few ways that we can influence how successful our baby is likely to be when orally feeding.  It is important to note that we cannot make a baby feed successfully.  Only your baby can tell us when the right time for them will be.  What we can do, is:

  • Introduce feeds at the right time for your baby
  • Only fed your baby when they are showing the right cues for this feed
  • Make the task of feeding easier in subtle ways that will make learning to feed a little bit less effortful.

One of the things we can do is by varying our feeding position.  I am going to talk here about one of the main positions that we recommend for helping establish oral feeds, but it is important that you take your own baby into account, because each baby is different.  Even if you do not end up using this position, you can adapt the principles to support your baby.

The position we are going to talk about is elevated sidelying.  This is technically more of a bottle-feeding position, but it is similar to breastfeeding positions, albeit the baby lies in a different orientation to your body.

What does it look like?

In elevated sidelying, you will usually need a pillow for your legs, and a footstool.  It is very important that you are comfortable,as well as the baby!

      • Sit yourself comfortably, with your feet up on the footstool.  Put the pillow on top of your things.
      • The baby lies away from you on its side, along your legs, with its head towards your knees, and its bottom against your body.
      • You hold the bottle to the baby’s mouth with one hand, and use the other hand and arm to support the baby along their back.

 

Why is elevated side lying a good position?

  1. It gives babies as much support in their body as we can

When we feed orally, it is easy just to focus on the baby’s mouth and what is happening there.  However, your baby’s skills in their mouth are very closely related to what is happening in the rest of their body.  If we hold babies in ways that make them work hard to maintain their body position, then they have less ability and energy to concentrate on what is going on in their mouths.

Term babies have fat pads in their cheeks that help them to stabilise around a bottle or breast nipple.  Premature babies do not have these, and so their mouths are also more ‘wobbly’ and this will make generating suction more difficult.

Elevated sidelying means that the baby is getting a lot of support from your lap and the cushion.  The hand you have at their back is also offering support in ways that will allow you to respond as they need to move and adjust.

2. The position is best to help your baby’s breathing and heart rate. 

Compared to other positions, research indicates that this position maintains your baby’s oxygen levels more successfully and was associated with less variation in heart rate.  This is likely to reduce their chances of becoming stressed during feeding.

3. Keeps them as safe as possible

If your baby gets more milk than they can handle from the bottle, then it is likely to run away out of their mouth to the side.  This might not appear to be a good thing, but when we feed in a reclined position, gravity will tend to take the milk to the back of the mouth.  If your baby cannot cope with the volume, reclined feeding is more likely to make them feel overwhelmed, to be aspirated and to result in stress cues.

When milk comes out of the side of the mouth, it gives us important information about how well a baby is coping, and we are not increasing their risk.

4. Lets you see the baby

You should always do elevated sidelying in a way that let you see your baby’s face.  This is important for observing their cues.  The hand behind them also lets you get feedback from what you can feel.

Don’t be afraid to talk about different feeding positions, for breast or bottle feeding, with nursing staff, and/or your Physiotherapist or Speech and Language Therapist.

Posts from Find the Key Speech Therapy are intended for information.  They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance.