We all love breakthrough moments whether it be in therapy or just in the experiences of life! Lets take the first acceptance of more than one bite of an apple for example. What was 'ok' about the apple or the experience this time around? First of all most of the children seen for feeding therapy do have some inefficient compensatory strategies that are used to manipulate foods and in many cases those patterns appear to develop secondary to abnormal sensory experiences.
Of course some children do have limitations due to issues surrounding strength, tone or range of motion but in this post I am specifically referring to the child who has learned to 'chew' with lips closed, rolling food across the mouth, tongue mashing, 'suckling' food as a result of a combination of factors...not just oral motor. I feel this is sometimes overlooked as a child is put into a category of "sensory" or "oral motor" or strictly "behavioral"....when in fact there is likely many factors contributing.
A child who refuses an apple chunk may readily accept a very thin slice of apple. When looking at strictly sensory you may think "Well, it is visually more appealing, he likes the flat shape" or something to that affect. When looking at strictly oral motor one may say "This is easier to handle from an oral motor standpoint as the flatter, thinner shape is easier to chew".....when applying both sensory and oral motor I can see that the following is also true "The appearance is not only appealing, thus decreasing his anxiety, but he also knows that he can bite AND consistently chew this food creating a more normalized sensory response" The thickness of chunks may be overwhelming from both oral motor and sensory viewpoints resulting in "This is too hard to chew, too yucky feeling in my mouth, too painful to swallow whole...i'll either spit it out or refuse it all together!"
Point being...explore all possibilities and different angles before landing on your own conclusion prematurely! Know your child, observe his whole being, his reactions to sensory stimuli, the types of foods accepted vs the types of foods avoided. This does not always result in a clear pattern and despite identifying your child's favorite spices, flavors, textures, shapes, environments, etc underlying conditions play a role as well. Inconsistent feeding behaviors varying from accepting wide ranges of food one day and next to nothing the next or on another day could indicate gastrointestinal discomfort. This brings me back to the importance of NEVER assuming a child's feeding complication is strictly sensory, behavioral or oral motor. Those who know me know that I am opposed to some of the intensive feeding programs that are out there or behavior approaches that reinforce having to swallow food that is spit out or waiting the entire hour for a 'breakthrough' in which the child is broken down to try a bite. This is not the kind of breakthrough moment I like to experience with my own child or with any child in treatment! I realize each child is different and there is probably a basis for choosing that type of treatment, I hope to encourage parents to have patience as their child learns to eat in a happy and healthy way!
A breakthrough moment for one child may simply be pretending with the food
For another, it is dipping a food into a new sauce!
I wanted to share a sweet story of a little boy and his own breakthrough moment! The fact that these 'new finds' were carried over from the hospital to his home is a very big deal for Jackson and his family, way to go Jackson! Click on Marbles from Heaven to hear about his success!
Fun with Food!
As a speech-language pathologist specializing in pediatric feeding and swallowing disorders, I encounter many children who have experienced negative associations surrounding food. These children often have accompanying oral motor feeding difficulties and sensory processing difficulties--making eating a very stressful experience instead of an enjoyable one.
This website will hopefully serve as an "idea place" for meals as well as questions and support from other parents and caregivers. Enjoy!
Monday, December 6, 2010
Posted by Kristina--Picky Tots at 9:03 AM
Thursday, December 2, 2010
Posted by Kristina--Picky Tots at 4:58 AM
Thursday, July 8, 2010
Posted by Kristina--Picky Tots at 3:43 PM
Wednesday, June 9, 2010
A LOT has gone on in the last several months, hence my very long delay in posting! My family and I have moved from Asheville to Mount Pleasant, SC near Charleston. It will take some time to adjust to our new surroundings and distance from friends and our Asheville nest. Before jumping right back into work I am hoping to volunteer some time and advice to families here in my new community as I am quickly realizing how many families experience feeding difficulties and how little help is readily available in a convenient location for those families.
I love to observe and people watch and through doing that I see that we are all so very much alike--we all want the best for our children and we all strive for a happy, functional life. I am thankful for the many experiences I have had with children and feeding complications over the last 8 years because those experiences have helped me so much with my own daughter! I do feel that we, as parents, put a lot of pressure on our children to follow through with all of our expectations. We can plan for the scheduled meals and snacks with plenty of opportunity for hunger to try new foods or eat what is 'on the menu' , but when it comes right down to it, we tend to forget all of the other factors. For instance--if you have been thinking of PF Changs hot and sour soup and honey chicken all day long and your husband brings home take out BBQ--doesn't it take you a while to adjust to the idea of bbq sauce over soy sauce? We only wish we were 3 years old so we could shout "But I don't Want BBQ for dinner!!!!!!" Or if the pollen has taken over your ability to breathe and sinus drainage takes all of the enjoyment out of any food that doesn't meet your specific requirements at that given moment. We don't always need or want to explain why we want a sleeve of saltines and a REAL coke versus pink lemonade and cottage cheese. We just know that the pink lemonade and cottage cheese would make us vomit and send us running. I am not saying that every situation is like that with your selective eater. What I am saying is that we need to constantly evaluate and learn from our own preferences.
There is a lot to be said about mental preparation and planting the seed. Lets say you want to cook pork chops one night. My daughter loves chicken but she has never had pork chops, so pork chops would be a similar meat in appearance, taste and texture and a good choice for a family meal. I would go ahead and tell her that we are having pork chops "the other white meat" for dinner one night this week. I remind her again that day and I choose some small jobs in the kitchen during dinner prep. If I just threw the pork chops on her plate for dinner she might not be as receptive to actually tasting the pork chops. Take a child with a history of feeding difficulty or selective eating and you can almost guarantee refusal of the pork chops being within sight or smell.
So I challenge you this week to approach new food and new ideas in a new way...and start by planting the seed today for what might happen tomorrow or the next day. Enjoy the journey!
Posted by Kristina--Picky Tots at 5:18 PM
Sunday, May 16, 2010
Fun with Food!: Little Blessings
Posted by Kristina--Picky Tots at 4:09 PM
Saturday, May 8, 2010
Thank you for sending in these photos! I will love having these pictures to look back on and remember all of the fun (and challenging) times in therapy. So many of these pictures really capture their awesome little personalities--love it! I will add more as I get them. I have loved working with the team at Carolina Pediatric Therapy in Asheville--a special thanks to all of you and to the families for making my job so enjoyable!
Posted by Kristina--Picky Tots at 11:17 AM
Sunday, May 2, 2010
Here is a fun recipe to try with your little one!
Thanks Althea for sharing the Potato Mice recipe found on the Disney website. Her little one enjoyed feeding the mice some cheese and although he may not have been ready to chomp down on these cute little critters quite yet...he enjoyed helping his momma in the kitchen and that enjoyment plays a big role in his feeding development! Check out Althea and Ty's creation:
**Instead of using toothpicks to secure the nose, Althea reserved a little of the potato mixture to 'glue' the noses onto the mice.
Posted by Kristina--Picky Tots at 12:18 PM
Tuesday, April 27, 2010
I wanted to send out a special thanks to all of the families that I have worked with in Western North Carolina. I will miss you all so much and you have touched my life in a way I will never forget! I wish I could take you all with me to Charleston! I hope to post some pictures soon. Keep up with your hard work and remember to enjoy the special little moments every step of the way... even when you feel you are miles away. "Faith is taking the first step when you cannot see the entire staircase" --Anonymous fridge magnet :)
***Western NC--send me a favorite picture of your kiddo for me to post!
Posted by Kristina--Picky Tots at 3:04 PM
Thursday, March 11, 2010
Click on the link below to read the post from Food Allergy Assistant:
Posted by Kristina--Picky Tots at 4:56 AM
Wednesday, February 10, 2010
Listed below are ways to create a positive feeding experience for your child, starting with early feeding experiences. It is important to realize that the caregiver and child both have different roles and responsibilities during meal time and showing respect for your child’s choices leads to trust and increased success.
- Let your baby guide you during meals. Wait for cues that let you know he is ready for a spoonful and avoid force-feeding. If your child is refusing food, force feeding will only result in further refusal. There may be an underlying reason for the refusal and you should consult your feeding specialist for further evaluation.
- Messy, messy, messy! Put the ‘clean freak’ side of you aside and allow your baby to make a mess. Exploring food textures is part of the feeding experience and you will be surprised at what your child will be willing to eat when he is allowed to have some independence!
- Give choices and offer a favorite food in addition to new or undesired foods. Make realistic expectations. It may take several tries for your child to accept a new food. If he refuses the first presentation, continue to offer the food and incorporate it into several meals.
- Pair a new food with an accepted food. For example, if your child loves to munch on club crackers, mash a new, soft fruit or vegetable on the cracker or dip in various purees or dips. Place it on the tray for independent feeding.
- The parent’s role is to provide the choices for the meal and to decide when and where to eat. The child’s role is to decide what and how much to eat. If your child is taking an inadequate amount of food, provide plenty of encouragement but do not force. Seek professional help if your child continues to refuse foods.
- Provide regularly scheduled meals and snacks and stick to your routine. Research has shown that children who ‘graze’ throughout the day with eating end up taking in 25% fewer calories.
- Eat together as a family. Children learn from watching others and keeping a meal time structure at home is a vital part of the feeding process.
- Schedule play dates for your children and create an opportunity for the children to watch each other eat.
- Talk about food and interact with it in other ways than just eating. Feed the ducks at a local pond, plant a garden in the back yard, take a stroll down the produce aisle, and build food creations at home.
- Remember to be patient with your child’s feeding. If you are stressed out, he will be stressed out. If his anxiety is up and that anxiety is created at each meal, then the stage is already set for unsuccessful feeding. Start now by creating positive associations and a laid back feeding environment.
Kristina M. Starnes, M.S. CCC-SLP
Speech-language pathologist specialzing in Pediatric Dysphagia
Posted by Kristina--Picky Tots at 3:23 PM
Wednesday, January 27, 2010
Hi! I would first begin working with open cup and straw drinking. I use yogurt drinks, baby food puree mixed with formula, milk, or water and sometimes powder pudding mix for beginning cup drinking. Thickening slows the flow allowing some independence while learning as well as practice with lip closure. You can gradually thin the liquid as he becomes more efficient.
As far as sippy and transitional cups, I like this one without the valve, playtex tumbler....http://www.amazon.com/Playtex-Coolster-Tumbler-Sippy-Girls/dp/B0011E4HBM as it is similar to open cup and does not require as much suckling when valve is out. Also the toss and go cup he was using at school was fine too as well as straw cups...You should allow him opportunities for open cup drinking and sippy without valves. The suction required for sippy cups, especially with valves, often results in the same suckle pattern with manipulation of foods requiring a consecutive lateral munching pattern. I also like this one: http://citikids.com/ProductImages/24026.1.jpg I forgot about those! I need to get those for my daughter for school :) That was Munchkin brand and so is this one: http://usera.imagecave.com/loveski777/Munchkin%20Dora%20Big%20Kid%20Cup.jpg You can also take valves out of this one as well.
Here is a link to a great article by Melanie Potuck related to this blog topic:
**The cup options are plenty, overwhelming at times and since the original date of this blog there have been numerous changes including discontinuation of cups, new products and other options. I'm including some pictures as examples of some cups currently available! My go to practice cups in therapy are still often the very basic open cup with a thickened liquid to slow the flow and straw practice! I love the spoutless options available and you can never go wrong with the basic disposable coffee cup and lids that you would receive at most restaurants, drive thrust or find at the store. I recently bought a cup at the dollar tree (also pictured). My oldest daughter has claimed this one as you can see by the artwork :). Tervis lids are also ideal.
Please feel free to Share your finds! A child who is having a lot of difficulty transitioning from bottle to any other cup is a different scenario in my opinion. Often the anxiety is very much escalated at the idea of any new presentation and in those instances and other child specific examples, there may be acceptance of the silicone sippy cups and straws and this can open the door for other changes to take place! It's difficult to cover all of the challenges and different scenarios in one post, but finding what you have to work with is essential and taking things one step at a time to reach the long term goal is often the key to success!
Posted by Kristina--Picky Tots at 7:37 PM