Resources for Infant Feeding and Oral Motor Concerns

Quick Resources for Infant Feeding and Oral Motor Concerns: Down syndrome, Cerebral Palsy, High Tone/ Low Tone Concerns, or Tube Feedings

Contributed by Capital Area Speech Therapy Staff Speech Language Pathologist:

Dee Arp, MA.,CCC/SLP

The big day is here and you are ready to tell the world; you have just had a sweet little baby!  Then, other news arrives; the sweet little baby also has an unexpected diagnosis that might make it difficult to nurse, feed, or speak some day.  It’s a lot to consider.  There is the added context of having spent hours in preparation for this big day mentally and physically, not to mention the number of hours spent in delivery.  Next thing you know, there are countless appointments lining up with medical specialist after specialist.  Did you ever feel like tuning it all out?  Understandable!  Next comes information overload: What does this diagnosis mean for your baby?  What does it mean for the rest of the family? Will your child be on multiple medications forever? How can you help your child reach his or her best potential?  Breathe in; breathe out.

This post is here to help you find those breaths. It’s a gentle guide for you to some helpful, internet-available resources.  Explore them at your own pace. The hope is that the gathering of resources here will minimize your work in searching.  These sites are full of articles and treatment considerations as your little one develops early pre-feeding and feeding skills. These materials range in topic from the “stages of typical development versus disordered feeding/ oral-motor development” to “reasons why parent training with a speech-language pathologist is important for a baby having Down syndrome”.  Our therapists seek to help you be able to help your child.  We want you all to gain a strong, fighting chance toward realistic progress at home, as well as within therapy by increasing understanding. We encourage high value placed upon early intervention and prevention of further complications.

Resources 

One book resource is extremely helpful and worthy of first mention.  It provides parents (and professionals) with numerous checklists and orderly charts describing some of the various functional issues at hand.  It is a great guide through those earliest stages of feeding and oral-motor concerns.  It may even be a wonderful resource for your Pediatrician or Family Doctor as you enter this unexpected journey.  The book is titled, Nobody Ever Told Me (or my Mother) That! The author is Diane Bahr, a speech-language pathologist.

Here are some favorite internet resources that offer multiple recommended readings for a rich variety of topics related to infants having oral-motor and/or feeding concerns listed alphabetically:

• Debra Beckman is a speech-language pathologist that instructs in the area of specific oral-motor interventions and has developed a specific assessment in this area. Articles cover a variety of topics including: cheek patterns, drooling, jaw & lip patterns, tooth grinding, and tooth patterns

http://www.beckmanoralmotor.com/index.php

• Marsha Dunn Klein is a certified occupational therapist with the company, Meal Time Solutions. The articles include explanations of why its important to manage some of the sensory aspects of feeding as well as new ways to present food items to assist in these issues.

http://mealtimenotions.com

• Suzanne Evans Morris is a certified speech-language pathologist. She and Marsha have written several helpful books together within this topic.  She is a part of a company called New Visions

http://new-vis.com/p-fym.htm

• Sarah Rosenfeld-Johnson and Lori Overland are also two influential, certified speech-language pathologists in the areas of pre-feeding and feeding development. Lori actually offers a course geared toward Pre-Feeding skills in young children with Down syndrome.     http://www.talktools.com/resources/
• Kay Toomey is a pediatric psychologist specializing in feeding disorders. There are several handouts included here to help determine when feeding difficulties may be out of the normal category.  Items such as, “Red Flags for Feeding Disorders”, and another one distinguishing between “Picky Eaters vs. Problem Feeders” can be found here.

http://www.sosapproach-conferences.com/about-us/about-kay-toomey#

Thank you for your time and interest.  Remember, just as babies learn to sit up before they stand, parents also go the processes of learning what is best for their children.  Take your time along the way and enjoy the process.

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Making Food Fun!

5 Playful Ideas to Try When Presenting a New Food to a Child with a Limited Diet

Heather Celkis, OTR/ Capital Area Speech & Occupational Therapy www.capitalareaspeech.com

Making Food Fun!

Reasons Tolerating New Food is Difficult

There are many reasons a child may have difficulty tolerating new foods. These reasons may include but are not limited to difficulty swallowing, difficulty moving the food efficiently within the mouth (oral motor skills), gastrointestinal issues, swallowing difficulties, poor postural control, respiratory difficulties and poor sensory processing. A child who has a very limited diet should be assessed by his or her pediatrician and referred for further testing by a specialist and/or therapy by a professional such as an occupational therapist or speech therapist.  It is important to rule out medical issues that may impact a child’s ability to eat.

Steps to Introducing New Foods

For many children with difficulty with sensory processing and tolerating novelty, the first step to trying a new food is interacting with it, tolerating it on a plate, smelling and playing with it. Yes! We should be encouraging these kids to play with their food!

The following are a few helpful and playful ideas for introducing new foods:

1. Place just a few bites of food on the plate. If the child has a whole plateful of novel food they may become overwhelmed and feel that they will be pressured to eat all of the food presented.
2. Use the food to paint a paper plate with sauce. For example, use a piece of broccoli to brush cheese sauce on a plate. Make patterns with the sauce by using the broccoli as a stamp.
3. Use some familiar foods with a few pieces of novel food and arrange them to make a picture such as a smiley face. Take turns making the face as silly as you can.
4. Stack the food like blocks then knock them down. Bread cubes, crackers and carrot slices are great for stacking.
5. Have a pretend tea party and feed the animals and dolls the novel foods. This is a great way to encourage a child to interact with a new food while not expecting them to eat the new food yet.

Children are more likely to try a new food if they are allowed to explore it at their own pace so be patient and above all have fun!

Is the PROMPT approach effective?

Yay! We are back to blogging about research. You can check out what research says about other speech and language related topics over at Gray Matter Therapy. The blogger does an awesome job of rounding up speech pathologists around the nation to read research and blog about it.

This month I, along with other therapists from our office, are going through the big PROMPT training. While I hear so many good things about the use of this technique in therapy, I really wanted to know what research says about it.

PROMPT stands for Prompts for Restructuring Oral Muscular Phonetic Targets. PROMPT combines auditory input and visual cues with a tactile kinesthetic approach to therapy. So in addition to hearing and seeing, the therapists actually touches the client’s face in order to guide them to their target sound, word, or phrase. You can learn more details about PROMPT at their website.

Here is some research that I found related to PROMPT.

Dale, P. and Hayden, D. (2013) Treating Speech Subsystems in Childhood Apraxia of Speech With Tactile Input: The PROMPT APPROACH. American Journal of Speech-Language Pathology, 644-661.
These researchers examined the effects of using PROMPT with children with childhood apraxia of speech. Childhood apraxia of speech (CAS) is a speech sound disorder involving the planning and programming of movements required for speech sounds. These children are very difficult to understand.
Participants and Method: Four children who had been diagnosed with CAS were divided into two groups. Two of the children received eight weeks of full PROMPT. Two of the children received four weeks of PROMPT techniques without tactile kinesthetic prompts then four weeks of full PROMPT. Target words were chosen for each child. Standardized tests and untrained probe words were used for assessing progress.
Results: All children in the study showed significant improvement in the 16 weeks of intervention. Scores on the untreated probe words and on the articulation test showed some evidence that including the tactile kinesthetic cues results in more success.

Grigos, M., Hayden, D., and Eigen, J. (2010). Perceptual and Articulatory Changes in Speech Production Following PROMPT Treatment. Journal of Medical Speech-Language Pathology, 18, 46-53.
This study was to determine whether speech sound accuracy changed after PROMPT treatment.
Participants and Method: Two three year old males were participants in this study. One was a typically developing 3 year old was assessed. The other child had a speech disorder and received PROMPT treatment twice a week for eight weeks. This study differed in the first discussed in that, in addition to formal testing and untrained probe words, they used a motion capture system to receive a visual of the child’s articulatory movements.
Results: Pre-treatment, the child with speech disorder displayed severe deficits on an articulation assessment. He also demonstrated inappropriate oral motor behaviors. Results of this study indicated improvements in both articulatory movements and speech sound accuracy.

Other research about using PROMPT has been published regarding children with cerebral palsy and autism. You can also find research on the effects of using PROMPT on adults with aphasia and apraxia as well.

Speech and Language Practice in the Car

Do you use car rides as a time to talk to you child? You and your child(ren) are stuck in the car. You might as well use the time wisely. Turn the radio off and make this time fun. Go ahead and practice his/her target speech sounds. Try to come up with words that have the sound in them. Have him/her look for things outside the car that may have their target sound.

There are several “car games” you can play that help with language skills too.

Eye Spy – Maybe this would be best for siblings to play and the driver just listen. This game works on using vocabulary and using descriptive words.

The Question Game (as seen in the video) – We play this one all the time. My boys love to trick me. One person thinks of an object or place. Everyone else takes turns (or in our car, blurts out) questions that have to be answered with yes/no. This game helps with forming questions and vocabulary
No worries…I was not driving here. This video is kind of loud. You may want to turn your volume down before playing.

The Rhyming Game – Someone begins with a word. Everyone takes turns thinking of a word that rhymes. If you can’t think of one, you skip. The last person to think of a word wins. This can help with phonological awareness and vocabulary.

The Sound Game – I sound out a short word pausing between each sound (b—a—t). the kids guess what word the sounds make when you say them together. This can also help with phological awareness and vocabulary.

You can also sing together, make up a stories, and just talk about your day.

If you have any fun games that your children like to play in the car, please leave a comment. I would love have more ideas.

What is a Phonological Processes disorder?

So what is a phonological processes disorder? It’s more than just an articulation (speech sound) disorder. When children have multiple sound errors, we look to see if their errors fall into certain patterns called phonological processes. For instance, if the child produces /t/ for all /k/ sounds and /d/ for all /g/ sounds, he may actually be demonstrating the phonological process, fronting. Children with phonological processes are often hard to understand if you aren’t familiar with their speech.

The following describes some common phonological processes.

Final Consonant Deletion – the final consonant sounds are omitted from words
(bed sounds like “beh”)
Consonant Cluster Reduction – one consonant in a consonant cluster is omitted
(stop sounds like “top”, blue sounds like “bue”)
Syllable Reduction – the weak syllable in a word is omitted
(banana sounds like “nana”, telephone sounds like “tephone”)
Gliding – glides (w, y) are substituted for liquids (l, r)
(run sounds like “wun”, leg sounds like “yeg”)
Fronting – front sounds (t, d) are substituted for back sounds (k, g)
(go sounds like “do”; key sounds like “tea”)
Stopping – stop sounds (p,b,t,d,k,g) are substituted for continuant sounds (m,n,s,z,sh,ch,f,v,th)
(sun sounds like “tun”, funny sounds like “punny”)
Prevocalic Voicing – voiced sounds (sounds that use your voice) are substituted for voiceless sounds
(pig sounds like “big”)
Postvocalic Devoicing – a voiceless consonant is substituted for a voiced consonant
(bed sounds like “bet”, bag sounds like “back”)

Like individual sounds, these processes should be corrected by certain ages. There is a more detailed chart for phonological process elimination here.
Gone by around 3 years old:
Final Consonant Deletion
Prevocalic Voicing
Postvocalic Devoicing
Fronting

Gone by around 4 years old:
Consonant Cluster Reduction
Syllable Reduction
Stopping

Gone by around 5 years old:
Gliding

A website that deserves its own post

The American Speech-Language Hearing Association has made a wonderful website to educate the public about communication disorders. Identify the Signs has topics about identifying early signs of speech and language disorders as well as hearing loss. ASHA is one of the most credible websites for finding information about these topics. I love how this site is organized too. Check it out!

Speech sound development

Let’s talk about speech sounds. Speech is a very complex task. All sounds are not developed the same way or at the same time. Some sounds are much more difficult and complex to produce than other sounds. For instance, vowels typically develop before consonant sounds. Certain consonant sounds develop before others. It is common for very young children to mispronounce sounds in their speech. This is one reason so many of us think our kids are so cute when they talk. I am a speech pathologist and mother of three little ones. I often hear “Mama, do you wite dis?”, “Wet’s doe to duh stuh.”, “I wub oo”. I too love to hear these cute little voices too. When do we begin to question whether it could be a problem?

One thing we look at when we diagnose an articulation disorder is how well people understand him/her. This is referred to as speech intelligibility. Often the parent may understand 75% of what their child says but other listeners may only understand 50%. We also look at the sounds he/she pronounces incorrectly in correlation to their age. It is important to remember that, as with most developmental milestones, every child develops differently. The ages and sounds given below are a general guideline for typically developing speech sounds.

Children should be able to pronounce the following sounds around the ages specified:

By 3 years old: “p”(pot), “b”(boo), “t”(two), “d”(dog), “k”(cat), “g”(go), “m”(mom), “n”(no), “w”(want), “h”(home)
By 4 years old: “ng”(king), “y”(yes), “f”(foot), “v”(van)
By 5 years old: “s”(see), “z”(zip), “sh”(shoe), “ch”(cheese), “j”(jump), “l”(leg)
By 6 years old: “zh”(treasure), “r”(run, tiger), “th”(this)
By 7 years old, a child’s speech should be understood by anyone they speak to. It should be very similar to adult speech.