Does my child need feeding therapy?

What is Feeding Therapy? How do I know if my child qualifies?

Contributed by one of our pediatric Speech-Language Pathologists, Stacey Rosensteel, M.S., CCC-SLP

Raising a happy, healthy eater is a difficult job for anyone, however with the right tools and support your child can be thriving. Early feeding development includes finding the correct utensils for little hands. Here are some suggestions and things to look for:

1. Utensils with a short, wide handle: To set kids up for success, give them something to grip that won’t easily fall out of their messy little hands. Adults may prefer a long, narrow handle on a utensil, because our fine motor skills are more developed to poke, scoop and rotate towards our mouth.
2. The end that goes into their mouth matters too! Spoons should have some curve to them and not too wide for their mouths. An often-made mistake is to give kids a deeper spoon, with the thought that it will hold more food with a deeper “bowl” and therefore the kids will eat more food, faster. Actually, the opposite is true. When kids have too big of spoon, filled with too much food for their little mouths, the experience is overwhelming.  This leads to spilling, coughing, choking or gagging. A flat spoon or one that is not too deep will help kids develop lip closure skills.  Lip closure is  an important part of learning to eat. To be able to keep our lips closed around the food not only keeps it in the mouth, but assists in chewing and swallowing foods safely. Lips play a big role in manipulating food in our mouths and propelling the food backward for swallowing. This is also helpful for early speech development as well.

What is Feeding Therapy?

Feeding therapy helps individuals learn how to eat or how to eat better.  This specialty is provided by trained Speech Pathologists and Occupational Therapists. Occupational Therapists evaluate and treat those with picky eating from a sensory perspective (aversion, avoidance, refusal based on smell/appearance/presentation), as well as teaching utensil use and more. Speech Pathologists provide feeding therapy for those with feeding mismanagement, as in low oral muscle tone and coordination, difficulty chewing and swallowing, acceptance of new foods, increasing diet repertoire, bottle feeding, tolerance of new foods and more.

Feeding therapy begins at different stages depending on an individual’s needs. Therapy is spent teaching how to eat new foods (limited diet) or how to eat (if they don’t know how to chew or manage food in their mouth).

Depending on the child’s underlying challenges, you may see your child participating in sensory integration activities or completing exercises to strengthen the muscles they need for eating.  Exercises will likely be things like blowing bubbles, making silly faces, or using whistles.

Before therapy can begin, an evaluation is completed which will consist of observations of feeding and parent interview. Recommendations will then be made and goals will be written that guide the direction of therapy anywhere from cup drinking, utensil use, increasing dietary intake and learning to chew and swallow.

Who Needs Feeding Therapy?

Depending on the challenges a child is facing, age does not matter.  From newborns to adults, feeding therapy may be needed. For infants not able to latch, picky eaters and everything in between, feeding milestones are important and should not be ignored. Tongue-ties, sensitive gag reflux, enlarged tonsils, low muscle tone/coordination are just a few of the causes of feeding disorders. In these cases and more, your child may end up qualifying for therapy where you will get suggestions and activities to try at home.

What Should you Expect with Different Feeding Approaches?

As you can imagine, there are different approaches to feeding therapy, some of which you may be comfortable with, and some that you may not, but most of them can be summed up into two different categories:

1. Behavioral– This is the traditional method of feeding therapy that uses rewards to gain new foods in a child’s dietary preferences. For example, your child may be given a sticker, toy, candy for successfully taking a bite of a new food. To get another sticker, toy, or more candy, they need to take another bite. Over time, these rewards should be phased out, so the child does not become so dependent on them, they will only eat if rewards are given.
2. Child directed– This is a more modern approach and is positive in nature. Parents are more involved with this type of treatment and there is a focus on addressing the underlying cause of the problem (i.e. sensory, medical, etc.). While this approach can take longer to see results initially, there is research that supports the effects and benefits are longer lasting.  The SOS or Sequential Oral Sensory, approach to feeding falls under this category.

If you or someone you know is struggling with eating, do not hesitate to reach out to our team!

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What does “teletherapy” look like?

The whole world has had to shift our way of working and learning during this challenging time. We are quickly becoming accustomed to virtual meetings, virtual school, virtual play dates, even hanging out with friends and family. Virtual speech and occupational therapy, commonly known as teletherapy, has been around for years. The American Speech-Language Hearing Association (ASHA) and American Occuptaional Therapy Association (ATOA) acknowledge teletherapy as an appropriate means of providing therapy.

We have offered teletherapy in our office for several years. While this method of therapy may not be suitable for every client, most clients can make significant progress through teletherapy. We do miss our face to face, in-person visits but we are thankful for our virtual therapy sessions that are helpful in filling the gap of time that we are apart.

Some families have found that teletherapy sessions have been helpful in reducing travel for therapy. Our clients are loving their virtual face time with our creative therapists. Therapists are challenged to think outside the box and create new engaging therapy ideas. We can still use therapy materials that we use in the clinic. We can also play online games that fit into our clients goals. We have even become very creative with using virtual backgrounds to meet specific goals.

Your therapists may see a big mess in their home but your child sees a magical wall of learning.

What we see…

What they see…

We can’t wait to get back to in-person therapy but in the meantime, we are having fun with teletherapy!

Contributed by one of our former speech-language pathologists, Noelle McNeil who is now learning the excitement of teletherapy in Alabama.

Handwriting

This blog post was written by one of our outstanding occupational therapists.

Occupational Therapists frequently receive referrals to work on handwriting. But why does handwriting matter? Simply put, it’s been an important method of communication for thousands of years, and continues to be important for everyday life. In school, at work, when completing application forms, and planning our days, people often pick up their pens. However, in these times of increasingly advanced technology some people wonder if handwriting is becoming obsolete. In some ways perhaps, but there are many reasons that it shouldn’t. For one thing, the simple act of writing helps with brain development. Increased brain activity occurs whenever we use this complex skill in a way that does not happen when we type. This is because writing involves fine motor skills, spatial skills, eye-hand coordination, memory, and planning. As a child, the development of neural connections through writing is incredibly important. Secondly, studies have shown that when we write things down (think classroom notes, grocery lists, and to-do lists) we are more likely to remember them. Additionally, for purposes of safety, writing can also be important. If for some reason, we become unable to communicate verbally (in incidences of injury, for example) writing can become a primary form of communication.

What does it mean to have “good” handwriting? Generally speaking, it means that the writing is legible, and there are several pieces to the puzzle when it comes to legibility, including motor skills, visual skills, and the combination of the two. Let’s take a look at this through different age groups.

Preschool and Kindergarten

At this age:

• Kids are playing fine motor games and doing simple eye-hand coordination tasks like drawing pictures, learning to color within the lines of a shape, trace simple lines and shapes, learning to use scissors. By age 5 or 6 they are using one hand predominantly, with the other hand as a helper. In kindergarten they are learning how to write letters and draw more challenging shapes.

Things to look out for:

• A fisted or otherwise awkward grasp on crayons or markers, from age 3 and up.
• Difficulty copying simple shapes (lines and circles) or starting to draw features of people and common objects.

What you can work on:

• To get little hands ready to hold a pencil (down the line), have them pick things up with tweezers, bread tongs, or clothespins; play with finger puppets; fingerpaint with a different color on each finger; play crawling games to help develop the muscles in their hands; and color with small pieces of crayon or chalk (like one-inch long).
• To get them ready for more precise eye-hand coordination, have them put stickers onto designated spots as part of arts and crafts activities, do simple mazes, string beads with holes of different sizes, and play with constructional toys.
• To help establish hand dominance, never force them, but have them play with games that involve using both hands together, such as toy nuts and bolts, wind up toys, and grinder or crank toys (like some play-dough toys).

Elementary school

At this stage:

• Writing becomes an increasingly important skill, and by the upper grades the majority of the child’s work is likely to be handwritten. Kids complete worksheets, journals, answer questions about reading assignments, and later on write paragraphs on notebook paper.

Things to look out for:

• Difficulty with letter formation, letter size, spacing between letters and words, and letters that float or sink below the baseline.
• Messy but fast writing; or neat but slow writing.
• Difficulty learning cursive.
• Hands getting tired easily.

What to work on:

• Perceptual tasks such as puzzles, spot-the-differences, and hidden pictures.
• Precision tasks such as mazes, dot to dots, mirror image drawings, and grid drawings.
• Adaptations to the type of paper/lines your child is using; adaptations to the pencil/writing tool

Middle school and high school

At this stage:

• Your kids are taking notes in class, and often have worksheets to complete as well as longer written assignments.

Things to look out for:

• All of the same signs as in the elementary age group.
• Teachers and other people having difficulty understanding what the child has written.
• Avoidance of work.

What you can work on:

• Talk to an occupational therapist about adaptations that can be made to the tasks, setting, or materials used if writing is posing a significant challenge.
• Depending on the child’s strengths and needs, it may be helpful to revisit cursive as an alternative to printing.
• Children should start becoming more proficient with typing at this stage.

If you have concerns about your child’s writing, talk to his or her teachers about school strategies, and consider an occupational therapy screening to find out more information about what can be done to help.

References:

Handwriting Without Tears (2013). Research Review. Retrieved January 23, 2015 from http://www.hwtears.com/files/HWT%20Research%20Review.pdf

Handwriting Without Tears (n.d.). Importance of Handwriting. Retrieved January 23, 2015 from http://www.hwtears.com/hwt/why-it-works/handwriting-standards/importance-handwriting

Konnikova, M. (2014, June 2). What’s lost as handwriting fades. New York Times. Retrieved February 5, 2015 from http://www.nytimes.com/2014/06/03/science/whats-lost-as-handwriting-fades.html?_r=0

Mueller, P. A. & Oppenheimer D. M. (2014). The pen is mightier than the keyboard: Advantages of longhand over laptop note taking. Psychological Science, 25(6), 1159-1168.

The University of Stavanger. (2011, January 24). Better learning through handwriting. ScienceDaily. Retrieved January 23, 2015 from http://www.sciencedaily.com/releases/2011/01/110119095458.htm

What is Sensory Processing Disorder?

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

What Does An Occupational Therapist Do?

Our OTs Miss Farah and Miss Kelsi put together this informative brochure about occupational therapy.
Occupational Therapy Services
Thank you Farah and Kelsi!

What Can OT and a Sensory Gym Do For Your Child?

Occupational Therapy in the Sensory Gym
written by Kelsi Knife, M.S., OTR (Occupational Therapist)

We are extremely excited about our new sensory gym. It is big, bright, and full of fun equipment! What’s not to love? However, you might be wondering how all of this will help your child meet their occupational therapy goals.

In therapy, we use the gym equipment to improve the fundamental skills that children need to be successful in their everyday lives. With a little bit of creativity, we can use the same activity to address many, many skill areas! Below, I have given some examples of how the sensory gym can help your child reach their OT goals.

Swings: With so many swings to choose from, the therapeutic possibilities are endless! The movement of the swing provides input to the vestibular system, which can be calming or alerting, depending on the child. This can help your child to focus on fine motor activities during therapy. The swings can also be used to build upper body and core strength, improve balance skills, and encourage your child to use both sides of the body in a coordinated manner.

Slide: Like the swings, the slide is wonderful for providing vestibular input. It can also be helpful for children with a fear of heights. Sometimes, we like to change things a little and climb up the slide! This is great for improving full body strength and coordination.

Monkey bars and rings: The monkey bars and rings are great for building upper body strength, endurance, and coordination which are very important skills for fine motor and handwriting development. By having a child pull up their legs while hanging from the bars (to kick over objects, for example) we can also address core strength and, as a result, improve balance and posture.

Zip line: Like the monkey bars, the zip line is awesome for building strength and endurance in the upper body and core. It also helps us teach children to be aware of and regulate their strength and speed.

Rock wall: The rock wall is perfect for working the entire body at the one time! It also requires your child to think about their end goal and create a plan to achieve it. This really exercises their sequencing and problem solving skills.

Obstacle Courses: By combining several pieces of gym equipment we can create an obstacle course that works on a ton of skills at once! Obstacle courses are also great for teaching your child to plan and sequence motor activities. Participating in this type of activity can really improve your child’s self-esteem and enable them to approach new activities with confidence!

These are just a few of the ways that our sensory gym can benefit your child. We look forward to helping them learn and grow, all while having a blast!

Should you get help or wait and see?

The Importance of Starting Therapy Early
By Ashley Ward, B.A., SLPA

Decades of research demonstrate the importance of beginning speech-language and/or occupational therapy early in a child’s life. Otherwise known as early intervention, this strategy is centered on building and improving a child’s speech, language, communication, social-emotional, and play skills. Infants and toddlers who are not reaching their developmental milestones or are at risk for a delay or impairment can greatly benefit from early intervention services.

A child’s earliest experiences have a huge impact on their brain development. Research shows that the time between birth and 36 months is a critical time for progress and growth where specific circuits in the brain, which create the foundation for learning and behavior, are most “flexible” (The National Early Childhood Technical Assistance Center, 2011). These early years present a window of opportunity for development that will not be available later in life. Early intervention therapy can minimize, and even prevent developmental delays, in children with impairments.