Allison LeBouef

Mess is a Sign of Eating Success!

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If you have ever been around a baby or young toddler learning to eat solids and feeding himself, then you KNOW that it is a messy situation.  There is food everywhere…on the floor, all over the high chair, all over the baby, on the walls, and even on the dog! It leaves you wondering how in the world you are ever going to clean up everything before it is time for the next mess.  And where do you start? The high chair, the baby, … the dog?! The clean up process can be quite an undertaking. Yikes!

Raising kids, it seems like there is always a mess to clean up somewhere. Trying to avoid mess in the first place becomes a parent’s daily mission.  So of course, if you can get your child fed without the mess, it seems like a no-brainer, right?! Do the math, and that’s about six potential messes in the high chair that could be avoided!  As a mom, I am screaming “Heck yeah, let’s avoid that messy face, bib, outfit, highchair, hair, ears…(you get the picture)!”, but as a feeding therapist, I have to tell you that the mess is necessary.  I know, I know…I am apologizing in advance for the many wipes, towels, outfits, and bibs you will go through, but if you want a child who eats a well balanced diet, the mess is a must.  

A vital part of eating is experiencing the food with all of the senses. When we see a child in therapy who has aversions to touch and avoids interacting with wet substances or objects, this can interfere with the development of feeding. A pilot study recently was conducted and published in OT Practice that incorporated increased sensory play with food and discussions about the sensory properties of food with children that had problematic feeding issues, and while the study sample was low, the study discovered an increase in the number of foods the children ate. So what does this mean for parents? It means we have to accept the mess, and even more than that, we have to encourage the mess. 

Encouraging the mess is opposite to the commercial trends right now. Food pouches are marketed to parents on the go as an easy way to get fruits and vegetables into their child, and it has even extended to grains and proteins. The mom in me is screaming “Thank goodness for something easy and neat!!!”, but the trend I am seeing as a therapist is that babies love these pouches too, so much so, that they don’t want to stop eating them! 

I am a pretty practical mom, so I am not saying get rid of all pouches, but what I am saying is there needs to be multiple opportunities a day for a new eater to explore his food with all the senses, not just taste or get a little feeling in the mouth. Pick a time that you know you can get that baby in the bathtub after he is done eating and playing, and maybe when your spouse or partner is home to help out with the clean up. Let the food be the entertainment, and turn off the TV or other distractions.  Offer dry foods, wet foods, sticky foods. Put a mat under the child’s chair that can be easily shaken off outside or thrown in the washing machine. Strip down the baby to only his diaper to make him easy to wipe down. And hey, if you have a dog, let the dog help with the clean up on the floor!  Find ways to make cleaning up the mess easy on you, but still allowing your child to explore and learn about foods in the messiest way possible. 

Source: Gettier, M. “Children with problematic feeding, selective restrictive eating: A pilot program.” June 2022. OT Practice. 

Occupational Therapy. What is it and why do you work with kids???

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“Wait…you are an occupational therapist…who works with children? Aren’t there child labor laws prohibiting that kind of thing?”

This was a real question. I had been an occupational therapist for only a couple of years at the time, but I remember thinking that the guy asking me was not that smart or not that worldly. Either way, I had to figure out how to answer him to hopefully enlighten him, because SURELY he should know better! (Haha)

Over the many years I have now practiced as an occupational therapist, I have come to expect questions like this one. Some people introduce me as a speech therapist (“you do work with kids with special needs, right?!”); some people introduce me as a physical therapist (“well you are kind of like a physical therapist because you work with muscles and help people get stronger.”). To be honest, some days I feel like a speech therapist, and some days, I feel like a physical therapist, but I am neither of these. I am an occupational therapist. I also work with children. So what does that mean, and what the heck do I do?

Occupational therapists work in many different areas, and that is because the “occupation” part of our title was given to us many years ago, when an occupation was better understood as any activity that a person spent time doing. Occupation certainly could be a job, but it could also be past times, hobbies, or any meaningful activity that a person participated in. Now that occupation is synonymous with a profession or work, the profession of occupational therapy gets a little misunderstood. Hopefully, I can help shed some light on that!

Occupational therapists work with individuals of all ages, of all abilities. One of our superpowers is to analyze a task or activity to figure out why a person might be having difficulty with it. You can find occupational therapists in hospital settings, outpatient settings, schools, nursing homes, and also in the home health setting after an illness or injury. You may even find occupational therapists in some non-traditional places, like in dance studios working with dance teachers to assist children of all abilities; or corporations working on the ergonomics of the work environment. We occupational therapists can show up in a variety of settings, helping identify the difficulties in tasks and modifying those tasks to allow individuals to work smarter and become more successful and efficient. So that is why we work with children…to identify what their strengths are and what areas are contributing to their challenges.

Working with children, occupational therapists assess a variety of areas. Typically, the parent or caregiver will identify some concerns and/or tasks that his child is having difficulty with, and the occupational therapist will assess many factors that contribute to the child being successful with the task. Those could include, posture, strength, attention, sensory processing, visual perceptual skills, fine motor skills, gross motor skills, sequencing tasks, and much, much more. Once the underlying challenges are identified, the therapists will work directly with the child and family to help strengthen the problem areas, make modifications until the child is able to effectively complete the task independently, and help educate the child, parent, and other caregivers, such as teachers, to ensure that the child is successful in the occupations he wants or needs to participate in his daily life.

The “R” in DIR

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It is not new news that children on the autism spectrum typically have difficulty with communicating and socializing. This, in fact, is criteria for obtaining an autism diagnosis. Many times parents notice these differences as first signs that their child may not be developing along the typical developmental sequence. Parents may notice difficulty connecting with their child or that their child seems to enjoy playing with objects more than playing with them.

Parents notice difficulties in relationships first because having a relationship with your child is such a desired aspect of having a child! As a parent, you love your child so much, and you are always striving for him to know just how much you love him, so of course when that love seems to go unnoticed, it leaves a parent concerned and desiring to find a way to have her child be able to reciprocate.

The relationship is what drives the DIR philosophy. The R in DIR stands for RELATIONSHIP! Helping a child to stay regulated and engaged in order to interact and communicate is the foundation of the DIR approach, and it is a beautiful thing to watch a child grow and expand his interest in the people in his life. To only redirect behaviors or ensure compliance is not typically what people look forward to in the role of parent, and while it is necessary, building safe relationships with your child is what allows the child to feel safe and secure to go into the world and build relationships with other people.

So how do you work on relationships with children? One of the most important aspects of building relationships is to find common ground and shared interests. Oftentimes children who are having challenges in relationships have limited or different interests, so instead of having the child join YOU, you have to join the CHILD. Finding shared joy in an object or game that the child loves helps the child to work within a familiar, comfortable activity on skills that may be more challenging for him, such as shifting attention between his favorite object and a person or connecting facial expressions to the emotions that underlie them. If the child loves roaring like a bear, then we have to love roaring like a bear, petting the bear, feeding the bear, and all the other things that the child likes to pretend to do as a bear. If the child loves stacking books, then we can love to stack our own books, color code them, and center them on top of each other.

It can be difficult to understand why a child enjoys an activity as much as he does, especially when it is repetitive and simple, and quite honestly, boring! For whatever reason, whether we see it or not, it is the child’s love, and it is the entrance into shared joy that allows for a deeper relationship with the child. Children tend to feel safe when participating in these favored activities, and when we not only allow them to continue them, but join them, the feeling of safety is even further enhanced. So, even when it is hard to do, get down on the floor with your child and see the world through his eyes.

For more information on DIR/Floortime, visit www.profectum.org.

Does my child need THERAPY???!!!

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My child seems like maybe he is behind; can he catch up on his own? How long should we wait to see if he can catch up? Can we do anything at home to help him catch up before pursuing therapy?

My child seems more clumsy than the other kids in her class; does that mean she needs therapy or just that she won’t be the star athlete?

My child’s teacher says my child is having trouble keeping up in class and is having trouble with writing; is the school program too hard or is my child developing behind his classmates?

These are questions that many parents ask themselves but that often go unanswered. Determining whether your child needs therapy can be tricky. Every child is different, with different strengths and different challenges. And while development follows a general pattern, figuring out if your child’s challenges are significant enough to warrant therapy is not always easy to decipher. Fortunately, there are many resources that can help a parent decide whether she should have her child evaluated.

The internet has a wealth of information, but sometimes the amount of information can be overwhelming,  contradictory, or unclear, especially when there is expected variation in typical childhood development.  One website that offers valuable, accurate, and clearly presented information in the form of checklists and videos is pathways.org.  This website emphasizes development in the first three years of life and helps parents determine whether their child is on track.  In addition it provides tips and games to play with baby from week-to-week until two years of age, just by entering the baby’s birthdate.  This is a great resource for parents, especially if parents have concerns that their baby or toddler may be behind on developmental milestones.

For school aged children, there is an even greater variety in abilities, as well as in academic programs, making it even more difficult to discern whether a child’s difficulties are enough to warrant therapy.  If you are having concerns regarding your school-age child’s development, please fill out the checklist at https://goo.gl/forms/7XeBDibk3d6Co0na2. The checklist is a list of red flags related to a child’s performance at home and at school. If you find that several of the red flags pertain to your child, a pediatric occupational therapist may be able to help you determine if your child needs therapy or if there are some things that can be done at school or at home to help him be more successful. A pediatric occupational therapist can help you discern where the line is between worry and need for action.

As a parent, there are many things to worry about when it comes to your child.  Just because your child is having some challenges, it doesn’t always have to mean that he is behind developmentally or academically.  When a child is demonstrating some difficulties, it may not necessarily be an indication that the child will have difficulty throughout his academic career either.  Pediatric occupational therapists (OTs) are specialists in child development, including the developmental milestones that impact academic performance, such as visual motor skills, fine motor skills, handwriting, and coordination that impacts executive functioning and organizational skills.  They are also devoted to helping children and families succeed, making pediatric OTs a wonderful resource for families that are trying to help their children excel. Many clinics offer free phone consultations to help the families discern if therapy is the next step.  If the OT feels that therapy may be necessary, it can be a wonderful experience and great tool to support your child with any struggles he may be enduring.   Therapy can also support you, the parent, in offering strategies to support your child at home and in the classroom, not only now, but in the future.

If you have questions, please don’t hesitate to contact an OT; they are ready to offer any support they can to help your child.

 

Allison LeBouef, LOTR, is a mom of 2 and has been a practicing pediatric occupational therapist since 2002.  She is the co-owner of Pediatric Therapy and Learning Center, LLC, in Lafayette, LA where she assesses and treats children of all ages, works diligently with parents, supervises other OT clinicians, and trains students and new graduates. She is SIPT-certified and has traveled around the country to attend the best courses and mentorships available in her field.

Mom Guilt

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Mom guilt. Such a familiar term these days. But where does mom guilt come from? Why do so many moms fall victim to it? Is it worse now than it was when our mothers were raising children?

For me, the internet is a blessing and a curse. It helps me answer the question of how much medicine I can give to my coughing child at 2 am. It reassures me that a quotient really is the answer to a division problem while I’m helping my child study for math. But the downside of the internet is it shows me what moms all around the country are doing. It depicts gorgeous back drops for a pre-k class party. Articles on Google or social media share dietary tricks , multi-vitamin do’s and dont’s, how to make sure your house is the cleanest it can be, how and when you should get your baby to sleep through the night….  it’s all informative…and exhausting! So not only do we have to figure out how to keep these little people alive, but we have to make sure they have a wonderful, well-adjusted childhood where they get the best education so that they can become citizens of this hustling, bustling world and start to raise well-adjusted children of their own! Whew!!

Enter mom guilt.

Mom guilt is the feeling that you’re not meeting the expectations of what a mom should be, therefore disappointing your future adult child by not affording him/her of the best childhood experience available. And we all do it! Do I work too much? Do I spend enough quality time with my child? Do I not spend enough time away from him? Do I have a stronger bond with one child over another? Do my kids watch too much TV? Do they spend too much time on electronic devices? Are they getting enough physical activity? Is he getting the best nutrition from his diet? Does my daughter have the basis for a good body image? Is my son learning how to treat women with respect? Do I savor these crazy moments that everyone tells me I will one day miss? So many questions…so few answers.

What complicates this story more is having a child with disabilities. There are thousands of other moms out there to compare how you should be being a mom when you have a neurotypical child, but who do you look to when you have a child with special needs? These moms are special people, because unfortunately for them, mom guilt gets amped up even higher! I am  this child’s mom! What did I do to cause these problems my child now has to endure? How and what can I do to make this child’s life easier? How can I be frustrated with this child that needs extra help??

Moms, you are not alone!!!! We are all guilty of not cutting ourselves enough slack. The ironic thing is that there are moms who question every stage of their pregnancy, examining what they did wrong to perhaps cause their precious baby to struggle so, and then there are women who become pregnant and don’t receive prenatal care, stop drinking or using drugs, and they go on to deliver healthy, full term babies in the back of a taxi. Some things we just don’t have that much control over, and even when we do everything right, watch everything that goes into our mouths, take every prenatal vitamin prescribed, receive the best prenatal care, have a well-designed delivery plan…things still may not happen as we expect.  Yet, we guilt ourselves that WE, the MOTHER, are responsible for things going off plan!  Why do we do that to ourselves?

Our expectations of OURSELVES is astounding and disproportionate to what we are capable of doing and what we have control of. I write this not just for you moms out there with mom guilt but for myself as well, because I am just as much a victim of inflated expectations that no one should hold themselves to. Let’s ask ourselves this question when we get in our loop…what will happen if I don’t worry about this today or if this doesn’t get done?  Will it negatively impact my child or our family if this doesn’t happen?  How much extra value does this add to my child’s life or to my family’s life?

Because in the end, we all have fond memories and memories we wish to forget…those from our childhood and those from our parenting experiences!  The truth of the matter is that our children will also have fond memories and memories they wish to forget.  None of us is perfect, and being a mom is hard work! Let’s all take some of the pressure off ourselves and reduce the expectations…because, as I humbly admit, none of us will EVER be perfect. So let’s release the guilt, support each other as moms, recognize the fluff for what it is, and just do the best job we can of loving our sweet angels!

To all those moms out there that are trying to give their babies, both big and small, the best life there is, always remember YOU are one of your child’s most treasured gifts.  Even with all your imperfections, you will always be their one and only MOM.