Category Archives: Special Topics

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!

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!

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Is the PROMPT approach effective?

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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.

What is Sensory Processing Disorder?

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Here’s a story about “Johnny.” It’s morning! Time to get up and get the kids ready for school. While this can be difficult for many kids, it can be especially difficult for a child with Sensory Processing Disorder. Getting out of bed is the first challenge. Mom gently shakes him, talks to him softly, pulls down the covers. But it is hard for him to get going; he does not want to leave his bed. It takes quite some time, but eventually she rouses him. In the bathroom other roadblocks occur: washing his face, brushing his teeth, getting in the bath. Often the water feels either too hot or too cold, the water splashing against his face really bothers him, and the brush feels uncomfortable. Some days the bathroom can be a bit of a battle. Getting dressed can be challenging too. Clothing with tags or tight seams really irritates him, and socks are the worst! After he is clean and dressed, it’s time for breakfast; but this is hard for Johnny too. He tries, but some foods he just can’t stand the smell of, and others he refuses on sight. Fruit, oatmeal, and eggs are out of the question. He ends up having the same thing he’s had for the last three weeks – a few bites of dry waffle. Mom doesn’t push it, because she doesn’t want him to be upset before heading to school. Eventually they leave the house and it’s off to school. Johnny is calm and happy and ready for school, but mom worries about what the day will bring, because even a slight change in his routine at school can affect his whole day.

Does any part of this sound familiar? Kiddos with Sensory Processing Disorder have difficulty registering or tolerating different kinds of sensory information, such as touch/textures, sounds, smells, light/visual stimuli, movement, and even information from their own bodies telling them where they are in relation to others. Because of these challenges, they may seek and/or avoid different kinds of sensory input. For example, one child may be overly sensitive when it comes to textures, avoiding certain materials and messier activities, while another may constantly touch things, to the point of being inappropriate or irritating to others. Some children become extremely and inconsolably distressed by certain sounds, such as a car horn, vacuum, or even other children playing, while others (or even the same child) may not register typical sounds such as his/her name being called repeatedly. Some children may seek out lots of movement by running or spinning or constantly moving around the room, while others may be afraid to sit on a swing or climb on a play structure. Because they are working overtime trying to manage their sensory needs throughout the day, these children can often become very easily frustrated or sad, as they exhaust their resources for tolerating life’s occurrences much faster than children who do not have these challenges.

If you notice any of these challenges in your little ones, an occupational therapist can work with you and your children to figure out their specific sensory needs, and how to help them integrate these sensations and tolerate experiences more easily.

Take a look at these websites for some great information about SPD:
www.spdfoundation.net/about-sensory-processing-disorder.html
www.sensory-processing-disorder.com
lemonlimeadventures.com/sensory-processing/#_a5y_p=1260983

written by the occupational therapists at Capital Area Speech

World Down Syndrome Day

Abby and Bailey
Today is a special day that we can help to raise public awareness and advocate for people with Down syndrome. World Down Syndrome Day is recognized on March 21 to symbolize the the extra 21st chromosome which causes Down syndrome.

Ways to support people with down syndrome:
Join you local buddy walk
Support a local nonprofit organization
Support Ruby’s Rainbow and help young people with Down syndrome fulfill their dreams
Wear lots of socks on World Down Syndrome Day!
LotsofSocksWeblink - big

Great blogs about Down syndrome:
Ellie’s Gift I love the blog post about how to teach young children about Down syndrome.
Down to Life
Noah’s Dad
Dear Tessa
There are many other blogs out there written by parents and other families members specific to Down syndrome.

For more information please visit the following websites:
Down Syndrome Association of Central Texas
Down Syndrome International
National Down Syndrome Society

Joy

Joy
by Christy McDonald

A year or so before I became pregnant with Bailey, our family was having {what seemed at the time} to be a never-ending string of bad things happening in our little world. The details aren’t important, other than it just seemed like there was one thing after another that made me wonder if we were ever going to experience happy times again. I was working for a woman who was a life coach and during team meetings she would ask us frequently to share one word that represented what we wanted in life. Joy. My word for months was joy. I just wanted to have more of a reason to smile, more of a reason to laugh, to not take life so seriously. It was just one of those times when what we needed was some good, old-fashioned joy.

Things settled down a bit, and circumstances improved here and there. I forgot about how deeply we had needed that extra joy in our lives.

Several months later, I was 18 weeks pregnant and we went to the perinatologist’s office for our 18 week ultrasound. While the 18-20 week ultrasound is useful for many reason, the only one that we ever thought would be applicable to us was to find out the gender of our baby. We went in to the appointment excited to find out whether we were having a boy or girl, and came out shell shocked, knowing we were having a baby girl, she had a life-threatening heart defect that would require open heart surgery when she was still a little baby, and more likely than not, had Down syndrome. To say that we had never contemplated that our child would be anything but perfectly healthy and or would have special needs is the understatement of the century.

We found out a week later that yes, our daughter did have Down syndrome. The rest of the pregnancy continued with frequent visits with the perinatologist as we had officially been moved to the rank of “high risk pregnancy”. We had visits with the pediatric cardiologist, pediatricians, etc, all in anticipation of Bailey’s birth. During the last few months of my pregnancy I remember thinking that our lives were about to be awful. I didn’t know anyone with Ds personally, and was thinking only of outdated, untrue stereotypes. I (now very regretfully) that any joy we had regained in our lives was gone for good.

When Bailey was born, we fell in love with the gorgeous little fighter of a girl that had just joined our family. She was the cutest, squishiest, sweetest little thing ever. Before she was born, we had decided to name her Bailey Joy, the middle name of Joy coming from our niece named Joy who had passed away a few years before.

Bailey spent a couple of weeks in the NICU before coming home. One of my favorite pictures of Bailey is this one – she was just a few days old and still in the NICU. And was already grinning this huge, infectious grin. That should have given me some indication of what was to come.
Bailey newborn
Eventually, Bailey came home from the NICU and we spent five months preparing her for open-heart surgery. Our job was to keep her away from viruses and help her to gain weight so that she would be big enough for the surgery. We fought for every calorie that entered her little body but finally, when she was 5 months old, it was time.
The morning of her surgery, she of course had no idea what was happening. We fought back tears as we waited for them to tell us it was time to hand our little baby over to the surgeons. Bailey’s infectious smile made the morning more bearable.
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She came through the surgery with flying colors, and thankfully now has a healthy heart.

After getting through the surgery and her recovery, life finally settled down and we were finally, finally, able to live a normal life without worry of calories and viruses and heart failure. We started plugging along and months went by.

One day as I was giggling yet again at a famous big Bailey smile I had a startling revelation that had not once occurred to me in all of the months that had passed since I was pregnant with her. Those years earlier when I was praying and hoping for more joy in our lives? We were given more joy – pure joy – to be exact, in one little bundle of smiley girl named Bailey Joy. When she smiles (which is often!), she smiles with her entire soul. People stop and comment on her smile – how her smiling at them was the best part of their day. That her grin lights up the room. That she was named so appropriately for her personality. That JOY describes her completely.

Bailey just turned three and is still turning heads with that big ‘ole grin of hers. She is just like any other toddler in that she throws tantrums (and her food, sippy cup, and anything else she can find), steals toys from other kids, and tells me “no!” when she doesn’t want to do something. And she is the answer to our prayers – perhaps the most unexpected answer to prayer we’ve ever had. We didn’t know years ago when we needed more joy in our lives that it would come in the form of a little girl with Down syndrome who would change our hearts and minds in the best way imaginable.
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When I was still pregnant with Bailey I spoke to a woman who has a son with Ds. She told me that she wished everyone could experience the joy of raising a child with Ds – that she almost felt sorry for those who didn’t get the opportunity to do so. Honestly, I was floored at her statement – I wondered how anyone could feel that way. But she was right. The joy that comes from raising a child with special needs is 100 fold what you give as a parent. We are truly blessed.

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Christy McDonald, her husband, and three children live in Austin. They have a son, Taylor (7), daughter Abby (3), and Bailey (3). Abby, who also has Down syndrome, was adopted from Eastern Europe in January, 2013.
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For more information about Down Syndrome please visit the National Down Syndrome Society.