Category Archives: Feeding

Supporting children who have feeding difficulties (i.e. picky eaters, oral motor delays, sensory preferences).

OT for Babies – Never Too Young

Parents are often surprized I work with babies. I usually hear ‘aren’t they too young’ or ‘what do you do with a baby?’

Babies are always learning new skills and reaching new developmental milestones. As everybody says, they do mostly feed, poop and sleep, but they also, move, play and interact. These skills all develop from birth onwards.  An OT experienced in working with babies can evaluate which foundational areas the baby is struggling with and how to improve them

Here are three scenarios:

1) When a baby struggles with feeding, we would assess their tolerance for touch with their body and in their mouth, oral motor skills in their mouth for nursing or eating foods, muscle control in their core / neck / shoulders, and their body alignment and positioning for feeding.  See more here.

2) If a baby has a flat spot on their head or turns their head to one side (plagiocephaly or torticollis), we assess their core strength, body awareness on the weaker side, motor planning, eye movements, jaw alignment and oral motor skills, which muscle groups are weak or tight, tolerance for movement and motor skills using both sides of their body.

3) Another common scenario is when the child is described as a ‘lazy baby.’  Usually there’s a reason for this.  They may be sensitive or fearful of movement, have difficulty figuring out how to move their body, or have weak body strength and stamina.  Sometimes the baby could have a lower state of arousal and need more sensory input (touch, muscle / joint and / or movement input) to rev up their engines the so they feel the urge to move and play.

When we explore deeper, there are underlying areas we can develop. And as babies are changing and growing so fast thanks to brain plasticity, they have amazing potential to progress at a faster rate. Early intervention helps.

Babies whom I treat usually may have:
-Plagiocephaly (flatness on head)
-Torticollis (turn or bend their head to one side)
-Avoid moving to one side of their body
-Don’t use one arm or leg
-Dislike being on their tummy
-Have difficulties with breastfeeding or transitioning to foods
-Appear colicky or are described as a fussy baby
-Sensitive to sounds or being moved
-Not meeting motor milestones
-Feet tend to turn outwards
-Born prematurely so need extra help to catch up
-Have diagnoses such as Down’s syndrome, Cerebral palsy, Hemiplegia or other genetic syndromes

If you have any concerns about your babies’ development, feel free to contact me to have a chat and discuss further.

For more information:
Sensory and motor developmental milestones month by month by Pathways Awareness:

http://pathways.org/milestones/

What does a baby OT assessment with me look like?

http://ot4kids.co.uk/baby-evaluations-never-too-early

Infant red flags for sensory processing difficulties

http://ot4kids.co.uk/babies-early-signs-how-do-you-know

Breastfeeding & Sensory Processing Difficulties

BREASTFEEDING AS A THERAPY

This is my first blog post in perhaps two years!  I’ve been pretty busy with my now-toddler-then-baby but this is a topic very close to my heart. I lived it and breathed it for a whole year which is how long it took for my little guy, M, to become ‘functional’ at breast feeding. It is also something that many of the families I work with have or do struggle with so I wanted to share our story.

Here’s our abridged story.

Following birth, M immediately struggled to latch on and nurse. He was only 2.2 kilos so we were kept in the hospital for a few days. We received a lot of advice from the midwives of which all were conflicting and really, although my Occupational Therapy head knew better, my new-mum head was a bit overwhelmed and second-guessed myself. I always tell parents to trust their own gutt instinct.

Some feeding difficulties my son had were:

-Gagging (I hated it when the midwives or GPs would say ‘big mouthful’ and to put a lot of breast in the baby’s mouth. This did not work for my baby who was sensory defensive and couldn’t organise his body, let alone his mouth)

– difficulty latching on

-struggled to mould or ‘snuggle’ during feed and other times

– hiccups, gasped for air, guzzled liquid down while bottle drinking

– difficulty getting in a rhythm of suck swallow breathe

– took over an hour to feed

– struggled to move one side of his face, tongue, cheek, lip

– lopsided wonky smile (one side didn’t turn up or move), drooled only on one side, preferred feeding on one side

– jaws seemed to wobble

– held up his head from birth (yes, this is a red flag as he had tightness in his neck and back muscles which led him to always lift his head and arch his back. He could not relax at all when on his back. This position also brought his tongue back so he couldn’t bring it forward to latch on and suck /swallow.)

Our Team:

I contacted a speech feeding therapist of mine whom I hugely respect at day 3! We were so fortunate to have her support as the NHS speech therapist said there’s nothing to do until M eats foods. Not only couldn’t we wait but I knew better. Please know this is so not true. It was important to strengthen and develop M’s jaws, cheeks, lips, and tongue so he could nurse and later, eat foods and talk.

At 4 months, we saw an osteopath I’ve known and worked with. She worked with M using a classical approach, loosening and mobilising tight areas, so he could be more comfortable in flexion and move his body forwards, ESP his tongue. She also worked on his gutt mobility so that his body could best absorb nutrients, digest, pee and poop.

A craniosacral therapist who treated me saw M and worked wonders on his cranial system so he could be less sensitive, relax his body, and again, bring his neck and tongue forwards for nursing

A Jin shin Jyutsu therapist worked with M on relaxing his body via different Asian flows.

I, OT mummy, worked with M to become more comfortable with touch, movement, and sounds, develop his body awareness to move with more flexion and be able to bring his head forwards, move smoothly in and out of positions, and coordinate both sides of his body versus only move via one side. We also worked on positioning M’s body so he could be more comfortable with feeds. Once his body was more comfortable, his mouth followed suit.

The oral motor therapist worked with us on different feeding positions for myself and M to support his breastfeeding needs, supporting and strengthening his jaw, how to strengthen the oral muscles using specific, targeted exercises on the tongue, cheeks, lips, and jaws.

Private DAN doctor inspired by Asian medicine – He confirmed he wasn’t concerned about weight and size, continue with breastfeeding versus formula, but was more concerned about gutt absorption of nutrients. So he prescribed us some chinese herbal supplements, vitamins, probiotics and MCT oil which apparently is a natural ingredient already found in breast milk.

By 10 months of age, breastfeeding had finally become very comfortable.

Later speech and feeding therapy sessions worked on spoon feeding, emerging munching, eating different textures and building interest in foods, working on chewing tougher foods, and developing sounds of consonants and particularly lip sounds such as ‘m’ and ‘n.’

Using breastfeeding as a therapy gave us the chance to work on M’s sensory processing and oral motor skills soooooo many times during and before every feed.

We were fortunate to receive a lot of amazing, private support from very early on. During times, we felt desperate so also tried many ‘wrong’ things before figuring out what they worked. But as they say, it took a village and I really believe we need to support families with breast feeding challenges using a whole body and a collaborative team approach.

What did I, OT mummy 🙂 do that helped?

-Worked on sensory defensiveness, flooding M with calm, sensory input. Deep pressure input, linear movement input, building tolerance for movement in different planes using music, rhythm and predictability, heavy muscle and joint work for added proprioception to his body and mouth, and building tolerance for multi-sensory input. ‘Baby wearing’ was a huge part of our life for all sorts of positive sensory input.

-Before every feed, we did some gentle body work to build motor skills and body symmetry and encourage flexion.

-Targeted oral motor exercises for cheeks, tongue, lips, and jaws before feeds and later, when starting solids, we had therapeutic feeding strategies.

-Used straw and open cups as no concerns with aspiration, or safety of swallow.

-Positioning – Swaddling for feeds was a huge help and he relied on this till 7 months. I laid semi- reclined so M kind of ‘fell’ into me and gravity could help.

-Music –I remember using classical 90-beat Baroque music for children feeding in the hospital so we tried this too.

-Mental stuff  – meditation, imagery, positive self-talk, trying to keep the feeds happy despite it being so stressful

-Surrounded myself by like minded and positive people

 

Resources:

Kellymom.com

-An invaluable source on breastfeeding and busts so many myths.

Dr Jen 4 kids

http://www.drjen4kids.com/

www.talktools.com

Book-

Supporting Sucking Skills in Breast Feeding Infants by Catherine Genna Watson

It’s very in depth, but I love it’s team approach and whole body outlook

 

The Sippy Cup Issue & a Game Plan!

As therapists we often recommend parents to avoid using a Sippy Cup with their child. It’s great to see a blog post by a well-reputed Speech Therapist, Sara Rosenfeld Johnson, which explains why it’s best to transition to a Straw cup.

Reasons to avoid a sippy cup include:

1) Child has to continue using a suckle pattern with their tongue. There are very few sounds produced using this tongue movement pattern.

2) Increased incidence of cavities as sugared liquid (i.e. juice) remains in the mouth.

3) Child tilts their head which allows liquid to enter the Eustachian Tubes (near the ear) which increases the incidence of ear infections.

4) Discourages mature feeding development where tongue moves up-down, side-to-side, and inside the mouth. The sippy cup encourages tongue protrusion (i.e. tongue to move forward outside the mouth).

*** Please do check out this article in BabyTalk by Mindy Berry Walker, a Speech Therapist, for a cup drinking GAME PLAN! 🙂 ***

To Chew…..or Not To Chew!

This article from the Autism Perspective in 2007 looks at whether there is a connection between chewing and not moving.

http://www.zoneinworkshops.com/wp-content/uploads/2008/01/rts_to_chew_not_to_chew.pdf

I’ve heard many parents and teachers in the past 12 years ask why their children grind their teeth, chew through their shirt sleeves or pencils, or put non-edible objects in their mouth.

Although there are lots of theories and ideas regarding this matter, this article looks at the interesting connection between chewing and lack of movement.

As an Occupational Therapist, I believe that lack of movement is certainly a big reason that children mouthe on objects, however, it is also important to consider the impact of other sensory systems (e.g. touch and muscle/joint input). For example, are children who use their mouths for exploration able to use their hands to explore objects adequately and efficiently? And are there other ways to provide the child with more appropriate oral sensory input during their day?

An Occupational Therapist trained in Sensory Integration would be able to identify causes of such difficulties, provide appropriate sensory based activities for home and school, and help determine what intervention or modifications are needed.

Mozart Helping Premature Babies Gain Weight!

Music has a powerful effect on most of us. I know this because I wrote a 200+ page thesis on the Therapeutic Use of Music. 🙂 There has also been lots of research about the scientific, neurologic and developmental benefits of Mozart including its effect on learning. Now, here is an interesting article from the Telegraph about an added benefit…….helping premature babies gain weight! Hope you like it too.