Things We Love #3 The Kids’ Guide to Staying Awesome and in Control

Today’s ‘Thing We Love’ is something for Parents (or Professionals) with children with sensory needs, or difficulty with regulating emotion for other reasons.

It gives children and adults great ways of describing how their bodies feel (like ‘fast and wiggly’), and then lots of really simple activities you and your child can try to self-regulate when you feel that way.

I’ve used this book in lots of ways in feeding therapy, both individually and in small groups. I think it could be such a great basis for talk about self-regulation in the classroom too.

It is always off the shelf and being used in the Speech Therapy office.

The Author, Lauren Brukner, has two other books on similar themes too.

A great resource that’s really practical.

Sitting at the table when your child needs to move

So many of the children I see with feeding struggles have sensory needs, either with or without other developmental and physical issues.  Sensory issues are a big topic, and not to be covered in just one post.

So, this being a feeding-related blog, I thought I would start with helping your child with sensory processing differences to be still at the table.

I spend a lot of time at work talking to people about how children need to be able to be still and stable in order to progress their feeding skills.  And that’s true (see here for some tips on adding stability to your child’s seating).  But a key part of developing stability is getting enough movement.  And some of our children just need to move more than others!

So, if we want our child to be still at the table long enough for them to explore food, we might need to adapt our seating a little to give them what they need.

  • Add wobble- chair adaptations that let your child stay on the move are great.  They can range from cushions and wobble cushions of various kinds, to whole different pieces of seating that your child needs to stay moving on to stay upright. Adding wobble will give your child additional vestibular and proprioceptive input.             Movin' Sit Wedge Cushion - Senior                  Wobble cushion blue                          Kore Wobble Stool-Junior 36cm-Black
  • Add weight/resistance/deep tactile pressure- Adaptations that add weight will give your child deep tactile pressure (which has a tendency to be calming), and add resistance (which will add proprioception, also generally calming and supportive of improved body awareness).  Wearing a weighted rucksack, sitting with a weighted cushion on your lap, sitting with a weighted shoulder bag on to eat are all examples of this.  You could also try sitting in a bean bag chair (that will give you more feedback through your whole body).
  • Weighted Shoulder Wrap                                     Weighted Lap Pads

 

  • Add movement – Adapting chairs to allow fidgeting with your feet is also a popular thing to try- various fidget bands exist that you can fit to your chair.  You could also experiment with giving the child something to fidget with with their hands.

Squishy Mesh Ball Fidget Toy

There are lots of things we can do more directly to help our children with sensory difficulties to widen their range of foods, and to approach foods with less anxiety, and I’ll be talking about these in other posts.  But it’s important to think about whether we have helped them to get their bodies into a calm and receptive state before we ask them to push themselves and try new things with foods.

All photos in this post are courtesy of sensorydirect.com.  Thankyou to them!

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 you child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance. 

Things We Love #2 Cerebra

Today I’m spreading the word about a great charity that I mention to so many Parents, Cerebra.

No-one ever seems to have heard of them, and yet they do such great work.

To name a few: A free toy and book library, support services around sleep, conferences to support Parents, guides to your rights under SEN law, and their fantastic Innovation Centre, that develops products in response to the things families tell them they need.

It is well worth signing up to their email news letter, as it’s a great way of keeping an eye out for new articles, services and inspiration.

 

 

Eating sense-ably

Eating is a massively sensory-rich activity.  So many of the eating and drinking challenges I work with every day have a sensory component.

So why would sensory processing have an impact on eating?

Your body takes in and processes (at least 7) types of sensation:

  • Vision
  • Hearing
  • Taste
  • Smell
  • Touch
  • Vestibular
  • Proprioception

As a feeding therapist, I spend a lot of time talking about the last three in particular (and not quite as much as you would think on taste and smell).

Your brain gets its understanding of where your body is in space by taking in information from your skin (tactile system), the inner ear (vestibular system) and your muscles and joints (proprioception).  It then integrates all the information so that it gets enough information to stay upright, move around and plan what it needs to do, but not so much that it is completely overwhelmed by everything going on in the body.

All this information goes via your emotional brain centres too, so that your brain can react appropriately to a stimulus on an emotional level.  So if something rubs up against you in a dark alley, you will take appropriate action and not just fail to notice.

If the brain is not getting enough information from the body, then a child is likely to be very distracted by trying to get more of the information it needs.  Not understanding where your body is might make you anxious, rigid or controlling.  When food approaches you, you may be easily overwhelmed by the sensations that it brings, since you don’t have a clear sense of where your mouth is, or how to move food around in it.

A child who is getting too much information from their environment and their body might be unable to explore food because they are so overwhelmed.

All this can look like a lot of confusing behaviour to a Parent.

Over a few posts, we’re going to work our way through the vestibular, proprioceptive and tactile sensory systems, and have a think about how they influence our eating in more detail (and more importantly, how we can help).

If you’ve got sensory-related eating questions, then please comment below and I’ll try to address them.

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. 

Things We Love #1 Ellyn Satter’s Division of Responsibility

As a feeding therapist, I am always on the look-out for things to share with Parents and colleagues.  Ellyn Satter’s Division of Responsibility Model just about sums up everything I believe about children’s competence around food, trusting their instincts and reducing mealtime stress (for everyone).

Put simply (and like all true things, it is both simple on the surface and sometimes hard to achieve), it goes like this:

  • Children do want to eat, and they do have the capacity to regulate their intake (in fact they often do this better than us adults).
  • It is not a Parent’s job to make sure their child eats a particular volume, or even a particular food.

The Parent’s job is to decide:

  • What food to offer
  • When to offer it
  • Where to offer it

The child’s job is to decide:

  • Whether to eat
  • How much to eat

That’s it!  The rest is trusting your child.

I know this may not ring true for many Parents- if your child needs to be a certain weight for an operation, if they need more than the typical number of calories because of a health condition, if they have to be fed to a rigid schedule around their medications, or their vomiting, if they are very rigid and aversive in their approach to food.

Having a child who has complex medical and/or developmental issues can quickly distort this natural balance of responsibility around food.

I believe that one of the jobs of a Speech and Language Therapist is to try and work with you and the team around your child to restore this balance as much as we can.  This balance may look less than perfect a lot of the time, but refocussing on your child’s competence and natural wish to explore food (it is in there, really, it may be buried very deep though) should be part of any good feeding plan.

It can be really difficult to focus on a child’s developmental relationship to food in complex medical situations.  But feeding is more than just calories in.  Hopefully, your Speech and Language Therapist will advocate for your child in this regard within your medcial team, and work with you to nurture your child’s competence around food.

Ellyn Satter has written several very good books, and has a website and Facebook page- Google for more info.

Posts from Find the Key Speech Therapy are intended for information.  They are not intended, 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. 

 

 

 

Towels, your feeding chair hack

“A towel, The Hitchhiker’s Guide to the Galaxy says, is about the most massively useful thing an interstellar hitchhiker can have.”  Douglas Adams, The Hitchhiker’s Guide to the Galaxy

Who am I to disagree with Douglas Adams?  Towels, in feeding, as in the wider Galaxy, are a tremendously useful thing.

Is your baby finding this weaning thing tricky?  Maybe they’re developmentally delayed? Physically small?  Have they got low muscle tone (hypotonia)?

We talked about the importance of sitting as a developmental skill for eating in a previous post. But getting the seating right can help your child a lot too.

Look at your lovingly selected expensive baby seat.  Now look at your baby in it, and see if any of the following might apply:

  • Are they in midline? If your baby is slumping to one side or the other, they are not in a good position to concentrate on their mouth.  Try padding out one or both sides of the seat with towels or cushions to give them more support.
  • Are they sat up?  This is not a trick question.  Your baby might look upright, but they are often really quite far back in their chair.  They might be having to lean forward to get at their food, using valuable energy to do so, which they could be using developing new oral skills.  Try adjusting the seat position if possible, bringing the tray backwards if possible so it’s not so far away, or padding behind them with towels.
  • Is the tray somewhere up in their armpits?  Does using their arms require them to have their shoulders up around their ears?  This is not making the business of developing self-feeding skills any easier.  Try putting towels/a cushion under your baby, or bringing the tray down if you can.
  • Are they on the move over the meal?  If you child is slipping down in their chair over the meal, they are going to be finding it hard work.  If padding out with towels doesn’t work, then try putting a non-slip mat or piece of Dycem or similar (https://dycem-ns.com/) under them.
  • Where are their legs?  If your child’s legs are sticking out unsupported, they might be making more effort than they need to stay stable.  As a general rule, having your feet on something will help.

For children with higher or mixed tone, or problem reflux in conjunction with physical delays, not sitting at all for meals might be a solution.  A standing frame will sometimes be more helpful.

Seating will always be part of any feeding assessment.  Ask your Physiotherapist, Speech Therapist and Occupational Therapist about your child’s seating.

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. 

 

‘Bite and Dissolve’ finger foods- your Speech and Language Therapist’s favourite weapon of oral progression

In my last post, we talked a bit about developmental readiness for weaning, espcially in the context of developmental delays and disabilities.

We’re going to expand today on the subject of finger foods, something that feeding-specialist Speech and Language Therapists talk about all the time!

This can be a bit of a complex topic, because, whilst the principles are the same, our advice might be a little different if your child has complex medical or developmental needs, compared to children with more typical developmental progress.

So, if you have a child with complex needs and you’re not sure, be sure to check with your own Speech and Language Therapist.

Baby-lead weaning is a big topic, and I’m not going to wade into it here, except to say that I do think it has got everyone feeling a bit differently about finger foods, and I think that overall, that is a good thing.

Adults tends to assume that there is a nice logical progression that goes smooth foods- lumpy foods-finger foods.  In reality, when we ask children to learn to chew (one of the major oral-motor tasks of weaning), lumpy foods can give them mixed signals.  They come on a spoon, great!  I know what to do with these, I suck them.  My tongue goes back and forth and – aargh, what is that lump, and why has it made me gag?

Dealing with lumpier foods is actually a really complex skill, you have to deal with the thinner smoother component by sucking, and sift out the lumps and deal with them by chewing.

When we give children finger foods, they can learn so many skills:

  • Hand-eye co-ordination
  • Fine motor skills
  • Self-feeding (spoons are hard!)
  • Biting skills (important for jaw skills, and therefore speech development)
  • Tongue skills (moving foods from side to side)

In general, when it comes to teaching oral skill development, a finger food has many advantages over lumpier purees.

There is lots of good advice out there for good finger foods for children with typical development.  (Try https://www.nhs.uk/start4life/choosing-first-foods).  Don’t forget that your Health Visitor may have lots of good advice and resources too.

But maybe your child is higher risk for introducing finger foods because of medical or developmental issues?  Maybe they have gagged a lot in the past?  Maybe you or they are feeling anxious about finger foods?

Speech and Language Therapist’s go-to foods in these circumstances are ‘bite and dissolve’ finger foods.  These are foods which will help your child along by dissolving on contact with saliva.  This helps them practise skills, but reduces the risk of choking and gagging whilst they learn.  What they are not is great all-round sources of nutrition.  They are often relatively low calorie too, not great news if your child is struggling to gain weight.  So if these things are a concern, your Speech and Language Therapist will run the recommendation past your Dietitian (I’ve never known one say ‘no’, yet!).

Some examples of bite and dissolve foods (not advertising here, there are lots of these about these days, these are just the ones that come up a lot in consultations):

  • Wotsits
  • The Organix range of crisps that includes carrot sticks and sweetcorn rings
  • Pombear crisps
  • Heinz biscotti

If in doubt, buy some and see how long they take to dissolve in your mouth.  Some take longer than others. Rice cakes, whilst they feel like they should fit in this category, are not bite and dissolve. Remember also that they need to be big enough for your little one to hold and bite through too, an important skill. When we give small children tiny cut-up pieces, we’re actually making it harder for them to gain control of these with their tongue.

Does your child have any favourite bite and dissolve foods?  Spread the news below.  And don’t forget that if you have anything you’d like to read about here, let me know in the comments below.

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 and their circumstances.  ‘Find the Key Speech Therapy’ does not take responsibility for the use of any advice without appropriate professional guidance.