The Tactile System and your child’s eating- What do I do? Stage 3

We’re up to stage three of working on messy and food play as a way to work on introducing foods to your child with a significant sensory-based food difficulty.

At this stage, we’re looking to introduce wetter items that will have an element of stickiness.  These are often not as well tolerated as drier foods, but for many of the children I work with, they are an important texture, because children who have little experience of eating will typically have very delayed oral skills.  So, if we’re doing food play with a view to them ultimately eating the foods, then we’ll need to use foods that are suitable for their oral skills (i.e. foods that don’t need chewing).  Introducing more solid foods may pose a choking risk for children with low levels of food experience to buld their oral control skills.

I typically use food purees for play at this stage, though there are lots of fun messy play ideas for this texture (e.g. shaving foam, soap bubbles, Gelli Baf).  If your child has worked hard to build tolerance of drier textures, you don’t want to have to respond to what may be their first attemtpts to bring food to their lips by saying ‘no’ and removing their hands.

Just a few things to think about with regards to what foods you choose at this stage:

  • You may want to avoid purees that have a strong smell, as this can be over-whelming
  • When you start, you might want to think about whether you are trying to expand the range of flavours your child might already eat (for example, they may eat one sweet flavour, and so you might want to expand this to another sweet flavour), or whether you are looking to expand into new flavours, for example, by choosing a more savoury flavour.  There is no right or wrong here, it is just useful to think about what you are trying to acheive.   Though sweeter foods tend to be better tolerated early on, as a rule, if your child has been on an extensively hydrolysed or amino acid formula, they might be more used to more bitter tastes.
  • If calorie intake is important, then you might need to think about this at the messy play stage.  There is no point doing messy play with an apple puree, and then later trying to feed your sensory-sensitive child the same food with their high calorie milk in it, build in the milk from the beginning.
  • Remember that you might be giving your child lots of opportunities to play with this food before it is eaten.  Make sure it is a food you will be able to source easily.

Next time we will start to look at what progress in messy play might look like, using the desensitisation hierarchy that we’ve talked about before.  In the meantime, let me know any favourite messy play items below.

The Tactile System and your child’s eating- What do I do? Messy and Exploratory Play, stage 2

Today’s post is about how to support children to transition from dry messy play to wet messy play.

Some children will be able to move straight to wet sensory and food items to play with, but for a lot of children, that transition is a difficult one. I have recently been exploring items to help children transition into this stage:

1- Water Play

For a lot of children who find things that stick to their hands difficult, I find that their tolerance of water play is often much easier.  You can add different things to the water to extend this play scenario, like small pretend play items.  You will find lots of ideas online too for using ice as a messy play activity, but be aware that some children can experience extremes of temparature as painful.

2- Water Beads

These are my new favourite thing!  I like these because the child is putting their hands into something, as they will be with the messier play that comes next.  But water beads only really leave a little slick of water on your skin, nothing sticky.  Water beads start very small and absorb water.  Depending on the age and stage of your child, they might find the process of seeing what the beads look like before and after exciting too!

There are loads of ideas online to extend this activity.

3- Use Ziplock bags

If your child is ready to explore wetter items but not ready to touch them yet, then try putting them in ziplock bags, so they can use their hands to explore, but don’t get the stickiness factor.

You can put water beads in them, or you can fill them with cheap hair gel and put items in the gel.  There are lots of good ideas online for this activity, try Google images, Youtube and Pinterest.

4- Kinetic Sand

You can buy or make this (again, loads of examples and videos online).  What’s great about this is that it is an interesting sensory experience, but doesn’t stick to your hands in the quite the same way as normal sand.

5- Slime

There are lots of recipes for non-sticky slime online, this could be another good way to introduce the sensation of wetter items, without the stickiness factor.

6- Tools to interact with the wetter items

In a previous post on the desensitisation hierarchy, we talked about ‘interact’ being a stage of the desensitisation process.  Having a way to explore items that does not involve the hands builds confidence towards using our hands (and ultimately our mouth) to explroe food.  Make sure you have lots of ‘safe’ ways to explore the items available, like cutlery, play items, or foods that are already accepted.

 

Posts from ‘Find the Key Speech Therapy’ are intended for information.  They should not and cannot replace advice from a qualified Speech and Language Therapist who knows your child.  ‘Find the Key Speech and Language Therapy’ always advises you to seek appropriate professional support.

The Tactile System and your child’s eating- What do I do? Using a desensitisation hierarchy

It can be difficult to identify when you’re making progress with feeding therapy.  A child eating a food can feel very far away when you are doing messy play sessions.

One of the tools we use a lot in Speech Therapy is a desensitisation hierarchy.  This is a great way of setting goals, and measuring progress.  You may have come across the ‘Steps to Eating’ model from ‘SOS Feeding Therapy’.  A hierarchy and the Steps to Eating are much the same thing.

A desensitisation hierarchy is simply the steps that we all move through in approaching a new food, before we will eat it.  As adults, we are often very quick to do this, and so haven’t noticed, but trust me, we all do these things (on a side point, how often as an adult do you try a new food?  Hardly ever, I suspect).  One of the things that is so great about using a hierarchy is that is helps us to remember that children are usually acting pretty logically in response to food, from their own perspective, and not nearly as randomly as it can feel to a Parent.

I’ll outline the hierarchy here, and we will explore it a bit more through other posts in the future.

So, the hierarchy goes:

  • Tolerate   I will be in the same room as the food, it is safe for it to be around.  This also might extend to feeding equipment, like a bottle, spoon or high chair.  Sometimes we need to start with supporting a child to feel comfortable around these things first.
  • Look   I will look at the food!  (Not complicated, that one!)
  • Interact   I will explore the food, but not with my hands.  In previous posts, we’ve talked about the role of the hands in eating and why they are especially sensitive.  Interacting might mean exploring food with utensils, or maybe using a ‘safe’ food, like a breadstick, to explore.
  • Pick Up  This is a big step, because it involves the hands
  • Taste/Lick  This means what it says, that tongue tip coming out and tasting, and nothing more.  This is often the stage where Parental frustration creeps in, it is sooo close to being eaten.
  • Put in mouth   Letting go of food in the mouth can be a big deal for children.  Where does it go?  If your child has never eaten, they will not know.  And many children with feeding difficulties will have differences in their sensory processing and motor skills, and not know how to move the food around to prepare it for swallowing
  • Eat  A complex process including having the oral skills to break down the food before swallowing

So, how do we use the hierarchy in Therapy?

  • To give reassurance   Perhaps it feels like your child is never going to eat, but when we look at what stage they are on in the hierarchy, they may be further on than you think.
  • To give a baseline   Knowing where your child started with a food helps us to know when they have made progress.  Children may be on different stages of the hierarchy with different foods, so this can help you to keep track.
  • To measure progress and set goals   Eating a food is a big goal for some children.  Using a hierarchy helps us to break things down into smaller, and more manageable steps.  For smaller children, their progress will emerge out of their messy play sessions, it is a question of us adults slowing down and using the hierarchy to help us to understand what we are looking for.  With older children, I might use the hierarchy to help them talk through what their goals are with different foods.

In terms of your messy play sessions, it can be helpful to focus on just one or two foods to introduce alongside the hierarchy.  This will help keep your Therapy focussed, be less confusing for your child and help us to make progress.  Regular play with the same foods will give your child a better chance of progressing through the hierarchy than trying lots of new foods, without much repetition.

We’re going to keep talking here about messy play, breaking down the hierarchy into smaller steps if needed, and small signs of progress at each stage.  Keep your eye out for new posts.

Posts from ‘Find the Key Speech Therapy’ are intended for information.  They should not and cannot replace advice from a qualified Speech and Language Therapist who knows your child.  ‘Find the Key Speech and Language Therapy’ always advises you to seek appropriate professional support.

 

Things Your Speech Therapist Wants You to Know #4 You Don’t Have to be a Superhero

There are many different types of people in the world, and your Speech Therapist is no exception.

There are Speech Therapists who are very prescriptive and will give you long detailed programmes.  There are creative Therapists whose activities are amazing.  There are loud Therapists, and quiet Therapists.  Speaking for myself, I really enjoy the process of supporting Parents to understand their children.  So that might mean explaining a complex theory, and mapping it on to what a child is doing.  I believe that a Parent who understands where their child is coming from is more equipped to interact with them in ways that support their feeding and communication development, all day.  And more than anything, I love the power of making small tweaks in the ways we do everyday things that produce big results.

I am all about the power of our everyday interactions.  Detailed programmes with prescriptive activities are not my favourite thing to do (because if you understand why your child does things, you might well come up with better ideas than me to target goals!).  I LOVE when Parents and I work things out together.  Don’t get me wrong, I’ll write those prescriptive programmes if it is what is needed, whatever a child and Family needs.

So this is where Parents come in.  When I’m doing an initial assessment, and giving advice, one of the things I am trying to work out is what kind of Therapist a family needs me to be.  I’ll probably start with those everyday activity strategies – I’m thinking that activities you can do without much equipment and that can be flexible are going to suit most people best.  But sometimes I have been working with families for a while and I am finding that we are not progressing, or maybe we are advancing on all goals except one.  I puzzle over these situations (you have no idea how much your Speech Therapist thinks about you and your child outside of your Therapy time), I try and work out what the blocks to progress are.

Please be nice to your Therapist- let them know what works for you.  Therapists want to be effective.  If my approach is to explain theory and make observations and problem-solve, and actually what you want is someone who’ll tell you to ‘do X, 5 times a day’, and you don’t want the explanation, then we’ll we working at cross-purposes.

Equally, if I’m proposing a list of things to do that feel overwhelming to you, now is not the time to pretend to yourself that you are the kind of person who just loves to fit a tonne of sit-down Therapy activities into your busy day. Your Therapist does not expect you to be a Superhero. Or if I accidentally suggest a feeding strategy that pushes an emotional button for you, then it is OK to just say ‘no’.

Sometimes we need specific types of Therapy for specific areas of difficulty, and we don’t have much flexibility.  But sometimes we can approach things in different ways. And we can often tweak things to fit into your life more successfully.  So please let your Speech Therapist know what you need.  Because the best Speech Therapy is the Therapy that gets done.