What if the best Speech Therapy was your Physiotherapy?

You may notice that all the blogs I am writing this month are loosely arranged around a theme of  “do your best, don’t beat yourself up”.  This is because this pretty much summarises how I encourage families to think about their child’s Speech Therapy.  I truly believe that beating yourself up is a waste of your precious emotional bandwidth, and it’s not the best way to get things done.

I also think this is a good theme for January, the time of year when you are supposed to be most motivated and coincidentally – a cosmic joke – the time of year you most fancy staying in your pyjamas in the house.

Obviously, I think Speech Therapy is important.  In fact it can be a transformative force in a child’s life.  But the fact is, especially when you have a child with complex medical, developmental or learning needs, it can be just another thing on your list.

So I hope this blog brings you good news when I tell you that there are many children that I work with where I advise families to focus on their Physiotherapy if they want to support a child’s feeding and communication.

Oral skills for feeding and for talking are fine motor skills, growing out of the underpinning gross motor skills such as head control and trunk control.  In addition, movement is an important foundation for:

  • Motivation (if you can move, you can explore, which gives you lots to talk about)
  • Body awareness – the use of your body sensations to understand where your body is in space.  An important underpinning skill for our sensory learners, for children with feeding aversions and for many children with Autism diagnoses.

We need the best skills in the body that we can if we want to support children’s communication.  So next time you are carrying out your child’s Physiotherapy, you might just have their communication work covered too.  And next time you see your Physiotherapist, ask them if you can see them with your Speech Therapist, so they can enhance each other’s work.

Angharad   key trans

 

If you would like support and information about your child’s communication and feeding, I would love to see you in my Facebook group for Families

In March we will be having a Physiotherapist come into the group to talk about the impact of low muscle tone (hypotonia) on children’s learning

 

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? Messy and Exploratory Play, stage 1

As a Speech Therapist working with chidlren’s eating, I spend a lot of time doing messy play.  What’s that got to do with supporting children to eat?

Your hands and your mouth are closely related.  It is very common for children who have an aversion to eating to also find it very difficult to tolerate sensory experiences through their hands (see previous post).  This is because the highest concentration of tactile receptors in the body are in and around your mouth, and on your hands.  This makes sense given the fine discrimination we need our hands to do.  And from a feeding perspective, exploring food with our hands before we put it in our mouth makes sense from a safety perspective (would you let someone put a mystery food in your mouth without a chance to get some more information about it?), and from the perspective of learning to self-feed.

In fact, using our hands in messy play is such an important stage of development (for play and language development as well as eating), that if a child has missed it, for example, because they have spent significant periods of their life in hospital, we may well need to find age-appropriate ways to try to fill this gap in their development.

For children with significant aversion to eating, supporting them to self-feed is often the best choice, as it puts them in control of when and how much they eat.  So we need to help them to tolerate using their hands more.

So, how do we start?  As a rule, I tend to try to get an idea of a baseline for what your child can tolerate, so you can pitch the sensory experiences you are presenting accordingly.  Ideally we are aiming to introduce sensory experiences that are just at the edge of a child’s comfort zone.

So, I will often start with dry messy, sensory and exploratory play (three similar overlapping types of play) first.  Many of the children I work with find dry play easier to tolerate.

Some ideas:

  • shredded paper
  • bubble wrap
  • packing peanuts
  • Everyday things with interesting textures- sponges, loofahs, small hair and nail brushes, pine cones, fabric remants.
  • dry foods-oats,rice, breakfast cereals
  • ‘Bite and dissolve’ foods (be careful- sometimes the smell of these will be off-putting to some children)

If your child has significant aversions, you often do not need to worry too much about them putting things in their mouth at this early stage, but always be around your child when they are exploring their items.  Your child may be able to explore these things by themselves, but more likely, if they have sensory difficuties, they will need you to model how to explore these items.

The important thing to remember is that this type of therapeutic messy play is about modelling, not telling your child what to do or making them do anything.  I have learned to be careful about praising children too- drawing attention to progress can make a child realise what a big thing they just did, and lead them to stop doing it.  You can do the silent eyebrow rasise of the Parent and Therapist who are inwardly dancing with joy instead!

In our next post, we will explore introducing slightly messier things to your child, and using a desensitisation hierarchy to support them and help you to identify progress.  But, for now, why not post your favourite dry messy play item below?

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 #3 Who’s On Your Feeding Team (And Why)?

The world of complex developmental and feeding needs can be a confusing one.  Just why do I need this many people involved?  What do they all do?

Here’s a quick guide to some of the people who might well be the main players on your team. You may well find variations in different countries, and in different parts of the country as to exactly who does which things, because roles in feeding tend to have a degree of overlap (which can be brilliant, or a pain, depending on how well this is managed).

  • Dietitian.  It’s your dietitian’s job to monitor your child’s nutrition, and optimise growth and nutrition in the light of any developmental and medical needs, and any recommendations made by your Speech and Language Therapist, such as texture modifications or supporting your tube-fed child to experience hunger.
  • Speech and Language Therapist (aka SLT or SALT) in the UK/Speech Language Pathologist (SLP) in the US.  SLTs usually have additional training to work with children with feeding difficulties.  We assess your child’s oral skills (sucking, chewing etc) and the safety of their swallow.  We may also do work with their sensory systems in as much as they impact on eating and communication.  In this role we can overlap with OTs.
  • Occupational Therapists (OTs), support children with their ADLs (Activities of Daily Living).  Luckily for us, eating is one of these!  Our OTs help us with sensory processing assessments and therapy, adaptations (such as seating and adapted eating equipment) and with fine motor skills (so important for self-feeding skills). In some countries, OTs take on more of the feeding therapy roles that SLTs tend to take on in the UK.
  • Physiotherapists.  Not always remembered as being part of the feeding team, but Physiotherapists often do the work on which many of our feeding skills are grounded.  We’ve talked previously about the need for both stability and mobility in our motor structures in order for feeding skills to progress.  Without Physiotherapists doing this work, we wouldn’t be able to progress feeding.  Physios also support your SLT to understand how to handle and position your child to optimise their feeding development.
  • Nursing Teams.  Supporting your and your child with issues around tube-feeding (and so much more).
  • Paediatricians and other Consultants.  Your child may be involved with many consulstants.  They may not have a direct day-to-day role in your feeding team, but us therapists need their direction on your child’s medical conditions to know how to proceed safely and effectively.
  • Play Therapists and Portage Workers.  If you’re lucky, you will have access to one or more of these services, to help your team and you make therapy playful and fun for your child, and help you break big targets down into smaller, play-based ones
  • And most importantly……….

 

YOU and YOUR CHILD

The reason we all come to work every day, we love to celebrate your child’s successes with you.

 

Have you got anyone on your feeding team that I’ve forgotten?  Sing their praises in the comments.

 

The Tactile System and your child’s eating-What do I do? Tops tips for the feeding environment.

You may have read previous posts about the sensory systems, and what over- and under-sensitivity look like with regards to eating.  And maybe you’re thinking, ‘yes, but so what?’.  This post begins a series on practical things we can do to support children with these difficulties.

So, first off, we’ll start with tips that are useful for most people.  If your child has difficulties that are not as severe, they might be enough to make a big difference.  Future posts will get more in detail into therapy techniques for more severely effected children.

The biggest thing you can do for your child’s eating is to make efforts to make the eating environment less stressful.  You might need to start by addressing things about your environment that don’t even involve food.

  • If your child has a negative reaction to sitting at the table:
  • Make sure you do other things around the dinner table and/or in their chair that they think are fun.  If they associate their chair and meal times with stress, then their negative responses will kick in way before the food gets there. Try having a time every day where they play in their chair, or you sing songs, or look at a book etc etc.  Let them choose the fun thing- our feeding chair is not a place where we want children to feel powerless.
  • Read about the ‘division of responsibility’ model (see previous post).  It is not your job to make your child eat, but to offer them opportunities.  I know this is easier said than done, but putting power back into balance in the mealtime dynamic can go a long way.
  • Offer foods that you know your child will eat, alongside other foods.  Starving children into eating will usually not work if your child has complex develeopmental and sensory issues.  If it does work, it will often come at a heavy cost with regards to your relationship, and your child’s relationship with food.  Offering a food you know a child will eat will bring down your stress,and their’s, and that’s a good thing.
  • Offer foods you actually like and eat yourself.  It is amazing how often we offer foods that we don’t like ourselves, beacuse we believe them to be good for us.  Your child is not an article in a magazine about nutrition, they will learn to eat the foods they see the family eating.  If you don’t eat kale, then don’t focus your time on it (NB I am not a dietitian- obviously making efforts to eat a healthy balanced diet are a  good thing, but it’s about being realistic).
  • Try and get everyone on the same page.  If you are taking a low-stress approach, but your Partner/Grandparent/childminder etc is putting the pressure on, this is less than ideal.  Our deeply-held views about food are often instinctive, and a child who is not eating will often trigger deeply held unspoken views (you shouldn’t waste food; children who don’t eat are being badly behaved etc).  Make efforts to help people see things from your child’s perspective.  However, if the discussions in themselves are causing more stress, maybe it is more appropriate for you to just control the interactions you can, and let the rest go.  People may well change when they see your way of doing things working.
  • Think about how you serve food.  Giving your child more control can really help the dynamic shift.  Think about serving food ‘family style’ (on shared plates on the middle of the table), and supporting people to serve themselves.  People can take as much or as little as they like, they can try small portaions of new things, and it makes it less easy to track what volumes have been eaten (a good thing, generally speaking!)
  • For children who do not like food touching (there are lots of good reasons for this, which we’ll talk about in another post), consider a divider plate.  If your child knows the foods don’t touch, they will be more able to relax and eat.
  • Check your own stress levels.  If mealtimes represent stress to you, then get the support you need to be able to bring your levels down.  Find a good feeding therapist, friend, counsellor, online support group etc who really gets it and is supportive.  Bringing your own stress down even a notch at mealtimes will support your child.
  • Educate yourself about your child’s developmental stage and their sensory processing.  It is really common for the stress levels at a family mealtime to drop massively once we know that a child is not showing these behaviours on purpose, or as a reaction to us personally.  Keep your eyes out on this blog for information, and for links to high-quality resources.

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

 

The Tactile System and your child’s behaviour- Undersensitivity

Continuing our series of posts on the tactile system….

In our last post we talked about how an over-sensitivity to touch might show up in your child’s behaviour.  This time, we are looking at signs that may indicate that your child is under-sensitive (hyposensitive) to touch.

A difficulty in sensory processing may be apparent in a child’s motor skills, and/or in their emotional and behavioural responses.  There are many areas in which tactile difficulties might show up.  Because my posts are more feeding-oriented in origin, I’ll focus a little more on signs you might see in that area.  Sensory processing is very complicated, so no one post or list will ever quite capture your child.  That is why a good quality assessment of sensory processing is important.  As we’ve discussed previously, a child with a general pattern of under-sensitivity may react passively (not acting to address their needs), or actively (seeking out sensation to meet their needs).

Under-sensitivity:

  • Poor awareness of food in the mouth- poor oral skills, poor chewing skills, gagging (there are lots of physical reasons why children might show these too)
  • Cramming food into their mouth
  • May enjoy very highly flavoured foods, or tend to like highly textured food (like crunchy things)
  • Unaware of food on their face or left in their mouth
  • May drool with little awareness
  • Poor awareness of being dirty
  • Low pain awareness
  • Seems unaware of temperature
  • May seek out tactile experiences- e.g. rubbing their face against the carpet, mouthing excessively
  • May have a poor sense of personal space
  • May eat non-food items

If your child is showing these signs, they might benefit from working with a Speech and Language Therapist with the appropriate sensory training, and/or an appropriately trained Occupational Therapist.

Coming up- Look out for posts on practical ideas to support your child who is under- or over- sensitive to touch.

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