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. 

 

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. 

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.