feeding therapy

[Anonymous]

This is from a link that Johnny´s mom provided…. i don´t think it works for young kids like matthew but hey, looks interesting and def will have to try if matthew continues like this!

Working With Therapists

If your child has feeding aversions that are related to fear of eating or sensory issues, I would encourage you to get your child some feeding therapy. There are many good therapists out there, and each has their own style and philosophies. If a therapist’s techniques don’t work for your child, or it doesn’t feel right to you, try it for a short time and then start shopping around for a new therapist. Sometimes it just takes a good match to make things work smoothly.

Nitara started out in a feeding clinic until our insurance switched over and therapy was no longer covered for her. At that point I called Early Intervention and Nitara was able to get therapy through the our state services for free. The state therapy worked out better anyway, because it took place in our home. For a child who has been medically traumatized, it’s tough trying to do therapy in a clinical setting with people wearing badges. Nitara was much more relaxed in our home and made better progress. The state also decided to provide Nitara with an Occupational Therapist to help her overcome sensory issues. It was the two therapies together that made a difference for her.

The following techniques were either taught to me by the therapist, or inspired by my own instincts, or a combination of both.

Let The Child Take Control, and Respect Your Child’s Cues

Feeding can be a scary thing for a child who associates it with vomiting and pain. It is even more scary to be forced to eat. It can make a child shut down and further worsen their feeding aversion. The best thing is to let the child do it on their terms. Some of the methods we used for this were:

• imitation games: Babies love imitation games! I started out by giving her a toy (so it’s not threatening) and holding a similar toy. Whatever she did, I would do. Pretty soon she figured out the game and was giggling and making me do all kinds of funny things with the toy including touching it to my faces and even biting on it. Later, I had her imitate me with touching it to my tongue, blowing on it, biting it. This became very important as the toy was replaced with a food object. Imitation became key to the whole therapy experience.
• making a mess: For the sensory kid, exploring the food through play is essential. Expect the child to make a mess. It’s okay, and it’s fun! Using imitation, show the child how to paint purees on the high chair table, other toys, foods, and even their hands. Then try to get the child to touch their tongue briefly to the hand or object with the food on it. Make a silly noise as you do this yourself, such as “boop!”
• use foods that will stimulate the senses: Dry crunchy foods were what worked for Nitara. Veggi stix, Funyions, Pringles, Cheetos, Pirate’s Booty. First we smashed and broke them, then we stuck the crumbs on our wet fingers. Finally we licked our fingers to taste the crumbs. Also allow the child to smell the foods.
• use foods that the child can control in her mouth: Logic says that you start out with babyfood purees, but for the orally defensive child, this doesn’t always work. Purees cannot be controlled well in the mouth. They glob up on the tongue and slip down the throat even when the child doesn’t want to swallow. They are hard to spit out. Solid foods are easier for a child to control. Start out with Gerber Puffs or tiny bits of veggie stix. They taste good, can be controlled, and dissolve easily.
• let the child play with feeding tools and be comfortable with them. Buy an assortment of fun bowls, silverware for toddlers, cups, and straws. Have these available at mealtime and during playtime. Encourage the child to pretend to feed her dolls. Encourage her to touch the spoon to her tongue with a “boop!” sound when food is not present. Then it takes the pressure off the child to eat, and she is just using the spoon as a toy. Later she will trust the spoon when it’s used for eating. Use the bowls to fill and unfill with blocks and other toys. Use the straws to blow bits of paper around or blow bubbles in the bathwater.
• feeding purees: If your child needs to eat purees because of swallowing or tongue control issues, avoid the spoon at first.Use a medicine syringe that is 1 teaspoon or smaller (if it’s too thick it won’t work). Suck up some smooth puree such as jarred bananas or Stage 1 applesauce. Put the syringe to the inside of the child’s cheek and squeeze out 1/2 cc. Let the child taste it and get used to it. Then squirt no more than 1 cc at a time. 5 cc make a teaspoon so if you are persistent with it, you’ll eventually finish the jar of food.
• liquids:If the child will not use a cup or bottle, give the child a large 60cc syringe filled with water and let them learn to suck it out of the syringe. Then give a disposable sippy cup (it will drip water out but not too fast, and will not require sucking). After the child is comfortable with that, try a real sippy cup with a valve. Use the same technique when introducing a straw cup (first disposable cup with no valve, then valve straw). I have gotten Nitara to try liquids other than water by letting her dip a spoon into a mug of the liquid and dipping a spoon in it, and slurping it off the spoon. She associates milk with vomiting so she won’t normally drink milk in a cup.We are still working on this.

Don’t Expect Table Manners, or Even a Table

Some kids just are not interested in sitting at the table or a high chair. Don’t force it. Leave a chair open for them. If they want down, let them down. With both my kids I have fed them on the go. They will eat a few bites and then be off and running. I just kept popping food in their mouths as they played. People said my oldest would never learn to sit at a table and eat. Many therapists frown on this behavior of not sitting and eating. I just believe it’s not natural for some toddlers to sit quietly and eat, and I’m going to choose my battles. My oldest is now five and she will eat anything put in front of her. She will sit at a table when we are out to eat and has good manners most of the time. I’m glad I followed my instincts with this one.

Nitara’s Favorite Foods

Here are some of Nitara’s favorite foods, listed in order from easiest to more challenging. These are not meant to be nutritious in the early stages. They are meant to convince my child that eating can be fun.

Early stages

• Gerber Puffs, all flavors
• Veggies Stix
• Pirate’s Booty (corn puffs)
• soft Cheetos
• Funyions
• Teddy Grahams
• Kix, and Panda Puffs (health food version of Kix)
• Kashi Hearts and O’s
• Cheerios, all flavors
• Pringles, all flavors
• Dried bananas

Later (all cut into tiny pieces)

• Garlic bread
• pan pizza, cut into bite sized pieces
• soft processed cheese. Later, aged mild cheddar cheese
• Nutri-grain bars
• bananas
• canned carrots
• canned green beans
• steamed broccoli (cooked until it’s almost falling apart)
• toaster waffles
• pretzels
• Metamucil wafers in tiny bites, for constipation
• canned kidney beans and navy beans
• french fries
• baby corn
• breaded cheese sticks
• Fig Newtons (but use the blueberry or strawberry ones instead)
• Quaker Graham breakfast bars. Spead with peanut butter, it’s 220 calories!
• sandwiches, peanut butter and grilled cheese.*

* For sandwiches, I take a piece of white bread and smashed it with the rolling pin very carefully. Then I cut it in half with scissors and spread the peanut butter and honey, or put the cheese on it to grill on the skillet. If you flatten the bread first it is less likely to cause gagging. Also, white bread works better than whole wheat in the early stages.

• Licorice bites are great to help increase chewing endurance.

Currently

Nitara takes forever to eat. Each meal of the day takes about 2 hours. She did not have the benefit of sucking a bottle or breast for most of her first year and into her second year. So her mouth is not very strong. I found it very useful to buy a Baby Food Mill to grind up the more channeling foods such as pasta and rice dishes, Boca burger (we are vegetarian), spinach and other fibrous veggies, and so on. It allows us to feed her more during her waking hours. She now will eat almost anything, but some things need to be cut up. As she learns to eat faster, she can eat more during her waking hours, and we can gradually reduce her tube-feedings.

Introducing New Fluids

Nitara vomited so, so much that she now associates the taste of milk and formula with vomit from her tube-feedings. She will not drink milk. I had some luck getting her to drink it very watered down, and then she was hit with the flu again and no longer wanted it. One of the criteria she must meet before the tube comes out is to drink milk or a milk equivalent. Her nutritionist said to try Carnation Instant Breakfast juice drinks. I started out adding 1 teaspoon to 5 oz of water. Every day I add just a little more and after 2.5 weeks she was drinking it full strength! Then I took a chance and tried her on strawberry flavored Pediasure. The first day I did it 50/50. The second day I mixed it 4 oz Pediasure to 2 oz water. She finished a whole can’s worth by the end of the day. When I tried strawberry Pediasure a few months ago she refused it. I have learned to introduce things more gradually now.

Know When to Push and When Not To

Nitara has gone beyond her fear of food so it’s time for her to practice more and work on getting off her tube. She doesn’t feel hungry like normal kids. She will feel some hunger and be satisfied after just a few bites. Or she will want the food because it tastes good, not because she’s hungry. I need to stretch her stomach to hold more, a reult from being tube fed small amounts for most of her life. I also need to learn to read her cues, and then push her just beyond– but not too far– her comfort zone. Currently I will expect Nitara to finish a meal even if it takes 2 hours because she needs to practice eating. If she refuses to eat or blows me off I will take her into my lap and hold the food in front of her and tell her that when she eats it she can then play again. It’s a hard balance to find and sometimes I don’t read her cues right. We are both learning.

Be Patient! Expect Progress, Followed by Regression

Eating is very scary for these kids. Nitara’s pattern is to jump forward, then make no progress or even regress for a few weeks, then advance to new territory. The first few times this happened I was so frustrated. Now I know it’s normal and I expect it. Nitara probably won’t be fully off her feeding tube until at least 3 years old, maybe longer. That’s okay. I know that eventually she will be off her tube and eating normally. It’s just a matter of time.

[Anonymous]

thank you so much for this, Thais!

[Anonymous]

Great post Thais! Thanks.

[Anonymous]

We started seeing a new OT and we had out first visit yesterday. She seems like she is going to be so much more helpful than the previous OT. I wanted to share some ideas that she gave me. First off, for babies who are behind in eating solids, it is important NOT to give them meltable foods just yet.(ie: biter biscuits, crackers, veggie bootie etc). She said that you should give them a hard munchable before moving on to meltable foods. Examples of hard munchables are: raw carrot sticks (thick), dried fruit strips, licorice thats been left out to harden, beef jerkey, Dutch sour dough pretzels that have been left out to harden, frozen bagel strips etc.

“The point of the hard munchable is for your child to practice moving a hard solid food into his mouth WITHOUT GETTING A PIECE OFF. The goal is not to bite or swallow this food. It should be about the size of a fat marker so the child can hold one end with his hand and put the other end into his mouth. His hand will help the tongue learn to move the food. The hard munchable also helps to desensitize the childs tongue and move the childs gag reflex further back into the back of his throat. Allow your child to play with these foods on their tray while you are spoon feeding them. Everytime your child sits down to have a meal or snack, put a puree and a hard munchable on his tray. The point of putting these foods on the tray is so your child can explore and learn about the food before it gets into their mouth. This means that the child needs to get messy in order to properly explore the food.”

In therapy yesterday, we gave Noah a dried apricot and he loved it. Granted, he didnt chew on it yet, but he loved sucking on it. I’m going to buy the large sour dough pretzels and let them get stale and then try those out. I’m hoping he learns how to chew using this technique so we can move on to softer and disolvable foods and foods with texture.

lisaann2006-3-31 13:49:49

[Anonymous]

Lisa – that sounds excellent! So glad you found a good OT and great
news with the dried apricot too. Keep us posted and good luck!

[Anonymous]

We have a 16 month old that we are teaching to eat by mouth. Our feeding therapist said to put finger foods in the cheeks of his mouth where he will chew so he could get used to food being there. She also said to put finger foods on the hight chair tray. She said to have him always eat at the table with the family and to be consistant. He is making steady progress and doesn’t gag when I put things in his mouth. I use freeze dried fruits because they dissolve quickly and puffs. http://www.justtomatoes.com has great fruits and vegetables freeze dried and they are really sweet. I hope this helps.

[Anonymous]

Just curious if anyone has been to feeding therapy lately and has any new ideas to share.

[Anonymous]

We haven’t had feeding therapy in a month now. First the therapist had to cancel due to a family issue, then the next week she threw out her back, then Hailey was sick, and now me. But I do talk to her on the phone. One thing she told me to do was to take food out of the feeding environment and let her play with it. So for foods that she won’t touch (mostly wet slimy things like pasta etc.) I make a big bowlful and then take it to the bathroom and let her throw it around and make a big mess with it. The idea is that the more comfortable they are playing with it, the more comfortable they’ll be eating it. What about you guys… any new tips to share?

[Author]

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