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.

Summer is here! Now What?

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School is OUT and summer is here. It’s hot outside and you don’t know what to do with the kids. Many people dread this time of year because there can be a lot of boredom and frustration, and too much screen time!

Most of us thrive on some sort of structure. After a few days of freedom, it may be time to get into a routine. Whether the child is home with a parent or a sitter, here is an idea that might help everyone feel happier and more productive.

Try the time-chunking method. Create and name chunks of time that you can either use consistently each day or move around when you have other appointments. Here are a few ideas to illustrate the principle; however, the possibilities for “chunks” are endless!

1. Chore time–everyone pitches in to do a few things around the house. It can be very short and might include you pushing your child around in a laundry basket! Get a few things done, but don’t stress!
2. Outing time–pick a place to go everyday that will get you out of the house for at least a little while. Go somewhere that has air conditioning, like the public library, the museum, Chick-Fil-A, Little Gym, or a family member or friend’s house. Try to stay out for a couple of hours.
3. Craft time–play with playdoh, construction paper, markers, paints (make the medium different each day). This may be something that the child can do independently, freeing up time for mom or dad to start a meal.
4. Outside time–Figure out when the outside temperature is bearable and, if developmentally appropriate and safe, send your kiddos out to play. Give them ice or water activities that can keep them cool, including spray bottles, plastic hammers and pieces of ice, and side walk chalk. Of course, bikes, scooters, and running through sprinklers can be so much fun!
5. Cooking/Baking time–This might be a tough one to incorporate every day, but could be a fun add-in. Your child can help out with cooking or baking tasks. Give him/her a job such as being “the Measurer” or “the Pourer” or “the Stirrer.”
6. Reading time–This means that it is time to look at books, read books together, listen to audiobooks or act out stories.
7. Screen time–If your child is old enough and loves doing things on the phone or tablet, or has his/her favorite shows, designate a chunk of time for this. If the child knows there is a designated beginning and end, they will be less likely to beg you all day for the iPad.

In order to get used to time chunks, you may initially have to be very actively involved, showing the child the many things they can do during these times and teaching them about how the time chunks work. Using a timer and a visual schedule can help support your child’s understanding of what the day will look like and the predictability of the day. Use a whiteboard or bulletin board to draw or post pictures that indicated what “chunks” will be happening that day. As the child gets used to what the different time chunks mean and how long they last, he or she will enjoy the predictability of it and may become more independent, allowing caregivers to have more time to take care of other responsibilities.

Here’s to a fun and productive summer!

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.

Messy Play with Food

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As early as 4 months of age, Pediatricians are encouraging parents to expose children to baby foods. This milestone is pivotal in staging the rest of the child’s feeding experience. The main goal of this exposure is not for ingestion, as calories are still predominantly from breastmilk or formula, but for exploration.

Encourage your child to get messy! Show them how to smash their food, touch it with both hands, and smear it on their highchair tray. Is in in their hair? No problem! What you are encouraging is learning about the foods! Is it soft or hard? Can it break? Is it warm or cool? Does it have a big flavor or a small one? How can the child manipulate the food? Provide opportunities for children to use their fingers, a tool (such as an infant spoon), or a celery rod. The opportunity to be creative are endless!

Suggestions for messy play at home:

  • Mix baby cereal with preferred breastmilk/formula
    • Can be mixed with more or less milk to alter the consistency
    • Can mix with water as an alternative
    • Can be warmed in the microwave
    • Can be cold from fridge milk
    • Can put in freezer for a few minutes before serving
  • Stage 1 purees (can mix different flavors once introduced one at a time and checked for allergic reaction- consult your Pediatrician before mixing textures)
  • Smashed banana
  • Smashed avocado
  • Smashed sweet potato
  • Celery rod (at least 6 inches long)
  • Carrot rod (at least 6 inches long)
  • Cooked then pureed squash (Acorn squash, Butternut Squash)

Learning to Eat with “Hard Munchables”

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What are Hard Munchables?

Hard Munchables are rod shaped food items that a child can hold independently and when inserted into the child’s mouth, it does not break apart and is long enough that a portion of the food remains outside of the mouth. The goal of hard munchables is NOT to eat, but for the child to explore the inner surfaces of their mouth and learn about this food texture. Exploring hard munchables is extra important for teaching the tongue to put foods to the back of a child’s mouth, thus enabling the child to eat more complex foods in the future, such as steak and baby carrots. Hard munchables are also useful in moving the gag reflex towards the back of the mouth as well as teaching the mouth how to accommodate for different size food objects.

When to introduce hard munchables?

– Child is mouthing toys without prompting.

– Child has neck and head control to sit independently.

– Number of teeth are not a prerequisite….. it is preferred to introduce hard munchables BEFORE children have teeth!

What are examples of hard munchables?

– Raw carrot rod

– Raw celery rod

– Raw jicama rod

– Beef jerky stick

– Hardened pizza crust/bread stick

– Hardened Twizzler stick

– Rib without meat on it

– Frozen French toast sticks

As always, only expose your child to foods under direct and constant supervision. Feeding skills vary and change frequently, so be mindful that one day a celery stick does not break apart and a few weeks later, the child is shredding pieces off!

Once your child’s molars protrude and jaw strength increases, the hard munchables are no longer used for exploration and become a food for ingestion purposes.

Happy Exploring!

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.

Why Does a Non-Verbal Child Need Speech Therapy?

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“You are a speech therapist.  How can you help a child who does not speak?” When speech therapy is recommended for a non-verbal child, many people who are not familiar with the role of the speech-language pathologist (SLP), aka “speech therapist,” wonder why this recommendation was made.

In order to answer this question, it is important to understand that SLPs are communication specialists and that communication is not just verbal.  Imagine the messages you send with just a look to your loved ones.  Think about how you know what other people might be thinking or feeling, even if they don’t say anything.  How often do you point or gesture throughout the day to communicate?  Now imagine what it would feel like if you had none of these ways of communicating.  Not only is your voice silenced and your mouth motionless, but you also can’t use your hands or your facial expressions to convey meaning to others.  Try it.  You might get a sense of the frustration that some of our non-verbal or low-verbal children experience.

As SLPs, specifically those trained in DIR/Floortime, we start with the most basic form of communication, which is back and forth emotional signaling with a trusted partner. This could be in the form of eye contact and smiling—a basic human connection.  We then use techniques to  help the child explore his sound system, as well as use his body and face to gesture.  We help the child and his/her family communicate in continuous circles, even if not a word is spoken.   When children achieve this level of communication and they still can’t talk, we can introduce alternative communication devices that will give them a voice while theirs continues to develop.

“Speech therapy” is crucial to the overall communication development of a non-verbal child.  If any professional tells you that speech therapy can’t help, they are misinformed.  If an SLP tells you that he/she can’t help your non-verbal child, thank them for their honesty and find one who can.