Taking a Closer Look at Baby Food Pouches

We recently received a great question from a parent:

"Are there any concerns with using baby food pouches?"

Baby food pouches are a convenient way to feed your little one while on the go. It is easy to simply hand the pouch over while you are out on the go, but is there a down side to these pouches? YES!

Pouches remove several aspects of the normal developmental progression of eating. Children typically begin to add foods between 4-6 months just as they begin to increase their head control and their GI systems are becoming more developed. Parents often note that at first babies push the food back out. That is because this tongue thrust is needed for bottle feeding, but typically developing children soon learn new oral skills from spoon presentations which ultimately leads to mature chewing. Just sucking from the pouch takes out the practice with spoon feeding and continues the tongue thrust pattern; therefore, disrupting the typical development pattern for chewing. In addition, you are taking away time to practice self feeding with a spoon which would increase independence with all utensils- an essential fine motor task!  If you are using a pouch, use a spoon with it as often as possible.

The pouches tend to have smooth pureed textures. Limiting your child to these foods may limit their willingness to accept and handle new textures of food down the road. A child used to just sucking from the pouch will likely gag when presented with textures because he is used to just swallowing and unaware of the need to chew. Without experiences with new textures, your child will likely be "stuck" on purees.

Have you noticed there aren't any see-thru pouches? When children eat straight from the pouch they never actually see the food. Visual awareness of food increases the acceptance of other foods as we make mental comparisons- I like sweet potatoes and carrots are the same color, so I will try carrots. We need to give children the opportunity to see the food, but also touch, and smell as all the senses should be involved with eating.

We are a busy society always on the go. However, meal times should be pleasant social experiences sitting around a table enjoying the conversation of others. Remember to involve your baby in this social routine so it can become an enjoyable experience for him/her. Your baby will be watching you eat and use utensils; therefore, motivating him/her to imitate your actions and create a desire to eat what you eat. Consuming meals "on the go" limits this learning experience. Schedule time several times a week to allow yourself to sit and enjoy a family meal.

Like everything in life food pouches are ok in moderation. However, it is important to be aware of the consequences of only relying on these as it may unintentionally cause long term feeding problems.   

Baby Steps

Sumi Chatani, PT attended a course at Children’s Medical Center in Houston,  geared towards teaching therapists new tools to get children moving and walking . The course, Baby Steps- Building Ambulation Intervention for the 0-3 Population with Posture and Movement Dysfunctions, was taught by Jan McElroy and hosted by Education Resources Inc.

Learning to walk involves a complex interplay with a child’s motor, cognitive and sensory skills. Most children begin to walk independently between 10 -15 months. There is growing research that with the ‘Back to Sleep’ program and less tummy time, motor skills including walking are delayed. The norm is now for children to walk between 10-18 months. Children with low or high muscle tone can sometimes be even further delayed.  Following a developmental pattern is important. Children typically reach, then roll, then sit up, then crawl, then stand up and then walk. But, they do not have to perfect each skill before we can progress them forwards. Teaching a baby to walk starts from day one! The more they explore, reach, shake, rattle and roll, the faster they will walk.  

Important take home messages:

• Children should have the desire and reason to move. Incorporate lots of play with different sensations (music, light, textures, etc). Engage them and encourage them to move in any which way they choose. 
• Learn to love your feet’- Babies first explore the world by kicking. Rub their feet together, have them press their feet against your hands, and help them hold their feet. Kicking and reaching for feet helps build abdominal strength to allow them to sit up.  Any pressure through the feet also helps babies get used to putting weight through them when they are ready to stand. You can use little musical anklets on their ankles to motivate them even more to kick and reach for their feet.
• Tummy Time- This is HUGE! There is so much sensory input and strength children can gain from being on their bellies. They learn to lift their heads, stretch their hips and develop core strength for ALL motor skills.
  
  Tummy Time tricks:
  
  •  Have your baby lie on his/her belly on your chest looking towards your face- what better motivation than to look at mom or dad?  
  •   Lying on a therapy ball *Have your Occupational or Physical Therapist show you some cool ball tricks before attempting!
  • Lying over a boppy pillow - This helps support some of their weight and make it easier to lift up. Always supervise tummy time!  
  
  
  
  • Important skills to incorporate in play: crawling over obstacles, pulling up to stand, cruising, and crawling/walking on different surfaces- grass, carpet, mats etc
  • Walker and Jumperoos- As a therapist, I have seen many children rely on walkers and jumpers to stand. Using them for 10 minutes or so is fine to give them a new way to explore.  It is hard to wean children off these, so use them in limitation. If your child only stands or walks on tiptoes, discontinue using walkers/jumpers.
  • Braces and other supports- Sometimes children just need a bit of extra help to align their legs/feet. Your Physical  Therapist is the best resource for this. At Building Bridges, we have an on site orthotist weekly who can also measure and order any equipment for your child.       
    
    
    
    

DIR Approach to Pediatric Feeding

Several of our therapists (Lorissa Alexander M.A. CCC-SLP, Rachel May M.S. CCC-SLP, & Sarah Norris OTR/L) recently attended a pediatric feeding course in Marietta, Georgia. The conference introduced the therapists to the DIR Approach to Pediatric Feeding (www.pasadenachilddevelopement.org). This program was presented by a wide range of professionals including a pediatrician, occupational therapist, speech-language pathologist and nutritionist.

The DIR Approach to Pediatric Feeding focuses on building relationships first and foremost to achieve better feeding skills. It is a very child directed form of therapy. In traditional feeding therapy, the therapist presents preselected foods in a hierarchy based on texture and consistency; however, in the DIR Approach, the therapist presents preselected foods in a play-based manner before introducing a hierarchy. This approach puts the child at ease with the therapist and the food, building a positive relationship with both.

The relationship is based on the child’s current milestone (emotional state). There are 6 milestones that a child develops with time and maturity. The DIR method seeks to meet the child at their current milestone and then work towards the next milestone. One skill leads to another skill and they are all tied to the child’s ability to organize his/her social emotional skills. The milestones are important because they build on each other.

The six milestones are: regulations and shared attention, engagement, two-way communication, sustained co-regulated interactions, creative use of ideas, and logical bridging of ideas.

1. Regulations and Shared Attention: Feeding therapy at milestone 1 would seek to explore food together once the child is calm and relaxed.  We should not expect a child to attempt a disliked food when they are not able to stay calm or not aware of his/her surroundings.  An example of feeding therapy at this milestone might include a game such as hiding a food item and finding it or imitating sounds and movements.
2. Engagement: At milestone 2, the therapist and the child are building trust at this stage. The child begins to trust that the therapist will not force food upon them. An example of feeding therapy at this milestone might include simple songs, chants or rhythms to create a familiar fun interaction around eating.
3. Two-Way Communication: Feeding therapy at milestone 3 would seek to create reciprocal interactions during food play. The therapist should provide time and opportunities for the child to become more deliberate and interactive (i.e. gestures to indicate more, taking from you, handing to you) during feeding/eating together. An example of feeding therapy at this milestone might include an activity to describe how a food might look, smell, or taste using descriptive words (i.e. delicious, sour, sweet, etc).
4. Sustained Co-Regulated Interactions: At milestone 4, the child negotiates around their wants and needs. It is the therapist’s responsibility to find the right balance of control between the child and adult by working trough emotional responses. An example of feeding therapy at this milestone might include games in which the child negotiates the rules (i.e. which food is first, pace, how they will eat it).
5. Creative Use of Ideas: Feeding therapy at milestone 5 involves the child’s ability to use pretend play to express emotions and introduce ideas to make eating fun and acceptable. An example of feeding therapy at this milestone might include child leading by picking up a food item (i.e. carrot stick or celery) and pretending it is a sword.
6. Logical Bridging of Ideas: At milestone 6, a child is able to use reason and logic to discuss feelings and anxieties about foods. An example of feeding therapy at this milestone might include making stories up about a food and/or making a restaurant and menus.

Feeding therapy is subjective to special considerations including: allergies, reflux, constipation, chronic illness, tube feedings (feeling hunger), obesity, and failure to thrive. The DIR feeding approach is one of many feeding therapies and should be used in conjunction with other strategies to achieve optimal feeding skills. It is important to treat each child individually and create a therapy routine specifically for each child.  

Questions? Comments? Respond below or email us at bbtherapyinc@gmail.com  

Georgia Vision Educator Conference

Cadie Denbow was a presenter at the GVEST conference in Macon, Georgia with her mother, Barb Denbow, Read Naturally Consultant.  The two presented “Reading for Meaning – Fluently” with the emphasis on the adaptive materials for the blind and visually impaired.  

 In the 90 minute presentation, Cadie and Barb reviewed research on reading fluency and explained how three powerful strategies (teacher modeling, repeated reading, and progress monitoring) significantly improve overall reading development.  Read Naturally has supported teachers of sighted students for over 20 years offering non-fiction stories ranging from first grade to eighth grade reading level.  As students work through a series of steps with each story, incorporating the research-based strategies, they accelerate their reading development.  Struggling readers across the country have benefitted from these materials. 

Now these high interest stories are available in braille and large print for teachers of the blind and visually impaired.  Participants at the session experienced the power of the strategies first hand with a demonstration using a passage written without vowels.  With Cadie’s Occupational Therapy background, she was able to assist in this specialized presentation by addressing specific questions about contracted and uncontracted braille as well as discussing with the teachers the other health challenges (such as dyslexia, shunt-created papilledema, retinopathy of prematurity and retinal detachment) these students often exhibit along with their reading difficulties.   The presentation was very well received.  

As always, please feel free to leave us your comments and questions. Or, email us at BBTherapyInc@gmail.com to find out more about what you've read on our blog.

Music Therapy at Building Bridges Therapy!

Therabeat, Inc. is proud to offer services at Building Bridges Therapy in Cumming, GA on Monday's! Check us out on Facebook at https://www.facebook.com/pages/Therabeat-Inc/206414486044116 or online at www.therabeat.com! Call 770-345-2084 for more information or to schedule therapy!

Jennifer Puckett MT-BC, Owner, Therabeat, Inc.

What is Music Therapy?

According to the American Music Therapy Association, "Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program."

So what does that really mean?

Music therapy uses music to achieve non-musical goals.

How is this accomplished?

Singing supports speech production, rhythm supports gross motor skills, and playing instruments supports fine motor skills. Live music is engaging and can be utilized to help peers interact with one another, working on social skills at age-appropriate levels. Memory for song lyrics can aid memory for academic materials, helping children learn colors, shapes, even multiplication and division. While singing songs and playing instruments can help increase overall attention span to activities, it can also be used to decrease agitation and calm children.

Examples of outcomes that can be provided through music therapy sessions:

• Increased Attention
• Increased Self-Expression
• Improved Verbal Skills
• Enhanced Sensory-Motor Skills
• Increased Cognitive Functioning
• Decreased Self-Stimulation
• Improved Behavior

And all of this happens while children are having fun engaging in music!

Why did I chose music therapy?

In high school I had the incredible opportunity to work with a group of pre-schoolers with special needs in my community. I was battling between the decision of becoming a special education teacher or a music educator and was hoping that my volunteer work would lead me to the right decision. My amazing experience in the classroom actually led me to decide on not one or the other, but to combine my love for both special needs children and music. By the end of my year volunteering in the classroom, I had decided to become a music therapist.

I had only been volunteering for a few weeks when I overheard a boy with autism sing. This was astounding to me because this young boy did not talk or use any means of adaptive communication. As I waslked closer to the child I realized that I was definitely hearing the voice of this littler four-year-old singing "Home on the Range." I walked over to the boy and began to sing with him and for the first time in my three weeks in the classroom, he made eye contact with me and smiled. From then on, I sang with this sweet boy and used music to teach him the alphabet, colors, and farm animals, as well as using music as a way for him to engage with other children in the classroom.

Whenever people ask me what music therapy is or why I decided to become a music therapist, I think of this sweet boy and smile, silently thanking him for his influence on me and showing me the beauty of music. I grew up around music and have always loved music for its lovely melody and harmonies, its comfort when I'm sad, its excitement when I'm happy, or the memory the hearing of a certain song brings. But seeing a boy communicate for the first time or bonding with a child through music is what makes it truly beautiful and demonstrates music's greatest blessing.

Hanna Ivey Bush, MT-BC

Speech Sounds

Many times speech-language pathologists and other therapists will hear questions including “My child has a hard time saying certain sounds, while other children his/her age say these sounds fine” or “I can understand my child, but others can’t.”

Articulation, or the process of making sounds in words, is a complex motor skill involving multiple articulators including the jaw, tongue, teeth, lips, and cheeks. According to Super Duper Publications, an analogy that helps understand articulation and the process of developing sounds is similar to riding a bicycle. Some children will take months to coordinate the steps to riding a bike while others will get on the bike, possibly wobble a little bit, and then take right off! The children that get it right away quickly learned how to peddle, steer, balance, and brake simultaneously. The same goes with our mouth and learning how to speak. The teeth, lips and tongue are the pedals, handlebars, and brakes that need to work together to carry out the speech sounds needed to communicate. Sometimes it takes a little extra work or explicit instruction to achieve this skill.

Early or first sounds (mastered around 2 years old) usually include p (pup), b (ball), m (mom), w (what), h (high chair), & n (nuts). Around 3 years old, the following sounds are achieved: t (top), d (dog), k (kite), g (go). The following sounds are mastered around 4-5 years old: f (fun), v (vase), y (yes). The later developing sounds mastered around 5-7 years old are s (sun), z (zebra), j (jar), l (laugh), r (run), sh (shoe), ch (chain), th (thumb), ng (ring), and blends including sk as in Skittles, sp as in spot, bl as in black, and br as in break, etc.

If your child does not have these sounds by the specified age, consider seeing a speech-language pathologist who will evaluate your child’s speech and language skills and provide further recommendations.

Below is a chart that will help you identify which sounds your child should have at what age:

As always, we'd love to hear your comments or questions! Respond below or email us at bbtherapyinc@gmail.com

NEW Building Bridges Online Bookstore!

We are thrilled to announce that we now have our very own online bookstore! You can order books, toys and other activities that our therapists recommend--all from the comfort of your home! More items will be added in the coming days, but in the meantime, check it out at the link below:

http://astore.amazon.com/builbridther-20

PS. If you have any suggestions for other items we should add, please feel free to email us at BBTherapyInc@gmail.com

Have fun shopping!!

Sensory Issues & Learning

Article by Sarah Norris, MS, OTR/L

Sensory integration, or sensory processing, refers to an individual's ability to organize internal and external sensations (touch, body position, movement, sight, sound, taste, and smell) and to react appropriately. Most individuals exhibit mature sensory integration by 7 or 8 years of age. Unfortunately, not every child automatically develops mature sensory integration abilities. When a child experiences difficulties with sensory integration, he or she may experience stress during daily life because processes that should be automatic or accurate are not.

Although sensory issues can take a variety of forms, they are considered to be a significant problem when a child is having difficulty participating in and succeeding in every day childhood occupations (such as playing, learning, and socializing). When sensory issues impact learning, a child is at risk of suffering in life-long consequences from missed opportunities. So how can you tell if your child or a child you know is struggling with learning due to sensory issues?

Red Flags

Here are some red flags to look for that may indicate a child has sensory issues that are interfering with his or her learning. This is not a comprehensive list, and some of these indicators can be due to other developmental, emotional or physical issues. When in doubt, seek input from a medical professional.

• Child seems overly sensitive, has multiple fears or anxieties, or overreacts, withdraws from or avoids certain sensations or situations.
• Child seems under aware of his or her environment and sensations, lacks safety awareness, misses details that are obvious to others, or seems to get bored or lose interest more easily than others.
• Child prefers to observe others for a long time before he or she will attempt a new task, has difficulty with problem solving, is resistant to change, seems more rigid or inflexible than others, or has difficulty coping when things do not go as he or she expects.
• Child is unable to complete work independently and is overly dependent on others despite demonstrating adequate capability to complete his or her work (may seem like an attention or behavior problem)

When to Seek Help

If your child displays any of the above behaviors and you are concerned that he or she is struggling with school, it is time to seek help. Start by talking with your child's teacher to get a better picture of how your child is functioning at school. ask what kinds of supports or services might be helpful to your child. You may be surprised at how much your child's teacher is already doing to try to help your child.

Your next step should be to discuss your concerns with your child's pediatrician. Some pediatricians are very  familiar with sensory issues, while others are not. However, it is important to involve your child's doctor in the process of seeking help for your child, as they may be aware of resources that will help you and your child.

Finally, seek an occupational therapy evaluation. Occupational therapists are uniquely qualified to identify and address sensory issues. Most privately practicing pediatric occupational therapists are very familiar with sensory issues and will be able to help you and your child.

How Sensory Issues are Evaluated

Most occupational therapists use a combination of parent interviews, sensory checklists or questionnaires, and clinical observations of your child to assess a child's sensory issues. Many therapists will also look at your child's motor skills in order to determine if there are any motor issues that may be impacting your child's learning as well.

References
Parham, L. D. and Mailloux, Z. (2005). Sensory Integration. In J. Case-Smith (Ed.), Occupational Therapy for Children, Fifth Edition (pp. 356-409). St. Louis, MO: Elsevier Mosby.

Anxiety: Treatments and Techniques that Work

The therapists of Building Bridges Therapy are constantly seeking out new therapy research, ideas, and techniques. Ongoing education allows our therapists to provide the most up to date therapy techniques. We are excited to have the blog to share what they are learning.

Jill Feldman, one of the occupational therapists at Building Bridges Therapy, has just completed the continuing education course "Anxiety: Treatment Techniques that Work." Jill sought out this course due to the increase in the number of children being referred to occupational therapy due to anxiety disorders.Trends have shown over the last few years that there is a steady increase in children being diagnosed with anxiety, either as a primary or secondary diagnosis. When children are referred for occupational therapy, the reasons they are evaluated are usually for Sensory Processing Disorder, Autism Spectrum Disorder, Attention Deficit Disorder, Cerebral Palsy, Low Muscle Tone, etc. Occupational therapists may chose to view these symptoms as sensory processing and motor planning delays that result in anxiety or the anxiety causes the child to struggle with maneuvering in his/her own environment. Completing this course has provided Jill with new techniques to help children who are having trouble coping and other avenues for help have been unsuccessful.

The most helpful suggestions that were applicable in the pediatric setting were as follows:

1. Understand what the triggers of the anxiety producing behaviors are, if possible.

2. Ask the right questions, i.e. "What would make school more bearable for you," and "Now that we have a plan, what is your willingness to actually follow through with this plan," and "What if your worst case scenario happened?  Let us plan around that and then there is no longer a need to focus on the 'What will I do if...'" 

3. Giving concrete visual cuing is helpful, specifically when discussing what is the child in control of and what is out of his/her control.  This is referred to as the "Circles of Influence."

4. Have the child actually tell a trusted adult or peer (friend), "This type of activity makes me anxious," stating that typically reduced stress.

5. Take the negative thoughts or comments and turn them positive, or talk through them to show the negativity.

These 5 tools alone have greatly improved the knowledge, understanding, and the flow of treatment sessions.  If the children are happier, the more likely the chance of carry over of these skills in other environments, and therefore control over how anxiety impacts the child's day-in day-out life.

Questions? Comments? As always, please feel free to leave a comment below or email us at BBTherapyInc@gmail.com.