I think one of the hardest things about being a parent of a child with special needs is watching them as they struggle to find their footing in the "real world." Many of our kids have challenges that prevent them from being able to participate in the same activities that their peers participate in. When they are younger this may not seem to make too much of a difference but as they get older the differences between what they can and can't do tends to stand out more. They watch as their peers are doing things they can't do and they work on trying to find their own niche in the world - someone that they will be accepted and feel like they belong.
My son has several learning disabilities that cause school work to be a challenge to him but, if that was all he was challenged by, it may not have made too much of a difference with regards to being able to keep up with his peers. Unfortunately my son also has a rare health condition where his body is not able to regulate its temperature when he exerts himself during activities. This basically means that he is not able to fully participate in any sports activities. He can do most of what is required of him in gym class but when it comes to an organized sport such as baseball or soccer it, he is not able to participate. This may not seem like a big deal but at a certain age the friendships are less made over video games and matchbox car collections and more over what sports you play. In middle school you begin to hang out with the kids on your sports team. When you can't play sports, and you LOVE sports, this can be very difficult.
There are still after school activities that many non-sporting children will turn to and gain friendships from but when you have learning disabilities on top of the health challenge the last thing you want to do is be on the yearbook staff or any other after school activity that requires you to have to plan or organize or write. For my son he wanted something that required him to do something physically and allowed him to a part of a competitive team.
I've worried about my son as I've watched the friendships from elementary school fall away as these friends became more involved in their sporting teams. I've worried as I've watched my son try to find where he "belongs" and where he can be accepted for what he can do, instead of what he can't do. And then something surprising happened. Something I never would have expected my son to stick with, let alone find it to be his niche.
Last year an in-door rock climbing gym opened in a neighboring town and it wasn't long before Central Rock Gym became a valued part of our life. My son finally found not just a sport that he can do without getting overheated but also sport where he was not just accepted but welcomed into with open arms. He joined their team and will be participating in rock climbing events this year. He has made friends with climbers not just his own age but also a few years older than him. He loves going there and we joke that he would live there if he had the option. He has become so familiar a part of the gym that he is now even helping out with some of their climbing events.
This may not seem huge to some parents out there but when your son typically will not say "boo" to the person next to him if he hasn't known him for years - hearing that he wants to help out at an event that will require him to talk to people he doesn't know is huge! What's more is that my son, who rarely cracks a smile out in public can more often than not be seen smiling and laughing with his fellow climbers. He will even go in early before team practice to hang out with some of the other climbers or practice a particular skill. What means even more to me is that he will ask other climbers to help him or help other climbers without hesitation. Again - huge! This was a kid who never felt comfortable going to or talking to someone other than his immediate family.
I know how hard it is for us parents, whether your child has special needs or not, to watch as they find their way and find a place to call their "own." I never would have thought it would be rock climbing for my son and I can only suggest that to all the parents that are out there and are in the same boat I've been in - look beyond the typical groups and activities that all the other kids do and see what else might be out there to join. A few things that come to mind, that are accepting and accommodating of our children with special needs, are Boy Scouts/Girl Scouts, bowling (there are teams and competitions, just check with your local alley to see what they offer and they offer special needs accommodations too), rock climbing, local drama clubs (not just for acting but there is a so much that needs to be done backstage such as painting and building, following lines, wardrobe, etc.), and gymnastics (great to develop motor skills but can also often accommodate special needs.)
I know this is a small list but I will gladly add to it. Do you have a place where your child has been able to find their niche? Is there a group that has made a difference in your family's life? I would love to hear about them and be able to share them so other families would also know about the options that are out there. Here's to helping all our children find their niche in the "real world".
Music speaks what cannot be expressed, soothes the mind and gives it rest, heals the heart and makes it whole, flows from heaven to the soul. ~Angela Monet
When I say "Music Therapy " what immediately comes to your mind? Do you picture children sitting in circle time singing songs and doing the hand motions that go along with it? Or do you picture a person playing a guitar and singing to children who are seated at their feet listening and rocking back and forth to the music? I'm sure there are many who aren't in the therapy field who see just that but music therapy is so much more and it's a shame that it is not recognized as such by the majority of our insurances.
Working in Birth-to-three we see many children who respond to songs. Children who may not want to work on range of motion or fine motor skills with toys will move their hands and arms to Itsy Bitsy Spider and Wheels on the Bus. When you think about those songs and the movements you realize that they work on both range of motion and fine motor skills. But to the child it isn't "work" because it's music!
Fine motor isn't the only area that can be worked on through music. Gross motor skills are improved with each pull to stand to swing to the music. Balance is improved with the rocking to the rhythm of the song. Songs like Ring Around the Rosie and Head, Shoulders, Knees and Toes all work gross motor skill areas. YouTube has a list of songs that can help with gross motor skills.
Many children even learn to "sing" before they learn to talk. We sing to children right from the moment we hold them. I know my first song to my sons was "You Are My Sunshine" when they were being rocked to sleep. As they were growing up I'd sing all the nursery rhymes with the hand motions to go along. We learn to sing the songs and then to start leaving out a word here or there to see if they would fill in the blanks. Because they had heard the song so many times they would often fill it in. Old McDonald had a Farm is often an introduction into animal sounds, which can lead to spontaneous words when you later ask "what sound does a cow make?" Rice University School of Music has an excellent page outlining all the reasons why music and singing is important to children.
For some very involved children music is what brings the smile to their faces. When they hear a song either being played in the room or sung to them you can feel a connection being made. Children who can't speak or who can't move much can still "feel" the rhythm of the music. One little girl I work with who is very involved will brighten up with smiles and try to rock her body when we start singing. We have been trying to work with her insurance company to understand how important Music Therapy would be to her but at this time they are not seeing the importance of music to her therapy needs. It's a shame but it's something we hear very often when talking with other Birth-to-three families and pediatric companies.
I am happy to say that there are many hospitals that are now reaching out and accepting more options to help their patients. Here in Connecticut, Connecticut's Children's hospital (CCMC) in Hartford has a program called "ArtReach" which offers music, dance, and art therapies to help with the physical and emotional well-being of their pediatric patients. Yale Children's hospital has Child Life services which offers art and music therapy. They also offer massage, yoga, and Pilate's services to help with their patient's mind and body well-being.
It is important for all of us to promote other types of therapy options to our families and to try and show the insurance companies the important impact it can make to the children we work with. One day perhaps it won't be such a big fight to get these "alternative" therapy options paid for by insurance so more children will be able to reap their benefits.
As COTA who works in Birth-to-Three a lot of my time is spent on driving to/from my visits. I love driving because I get to see so many cool things. The other day when I was driving home I passed a church that had a sign in the front of their yard that read: "Whomever is praying for snow please stop!" I actually laughed out loud. I've lived in New England most of my life and am quite use to the snow but I can understand how, for families with young children, it can be exhausting. I'm sure by now the kids are climbing the walls wanting to get out and play but where I live that hasn't been possible because of how cold it has been. This doesn't mean though that you can't still have fun with the snow. Join me as I share some fun sensory play you can do with snow and ice.
Just because you can't get the kids out in it doesn't mean they still can't enjoy it in the house. Two things I have done both with my own kids and with kids in daycares I've visited and worked in are:
- Snow day indoors - bring the snow inside and place it in a sensory table or large Tupperware container and allow the kids to use their summer beach shovels and pails to play in the snow. You can even color the snow with washable markers (just stick them in and the color will diffuse right into the snow) or use a Kool-aide mixture and spray bottle to paint the snow (this can also be done outside if it's a nice day)
- Make edible snow ice cream - this is best to do when it is the first snow fall that day and there is no chance of anything getting into the snow (salt, sand from plowing, animals running around in it, etc.).
- Snow Glass - If you know there is going to be snow heading out, a couple days before fill balloons with colored water and freeze them. Before going outside for the day "pop" the balloons and take out the frozen circles of colored ice. Place then in a container and go outside with them. You can hide them in the snow (but leave enough for the kids to see a little of the color) and have a scavenger hunt. You can do it by asking "who can find the green snow glass?" or you can just give each child a pail and have them go on a "colored egg" hunt. You can use food dye or Kool aid packages.
- Frozen Bubbles - This is one activity that will have to be done by an adult outside while the kids are inside if it's a daycare activity as most have restrictions on what temperature it can be before children are allowed to go out and play. You will need a very, very cold day and a bottle of "bubbles". Go outside and blow bubbles and watch as they freeze and fall to the ground. If you blow them over snow they will fall and remain intact. You can blow several, gently collect the snow around the bubbles and the bubbles and bring them back inside for the children to explore.
- Frozen Ice Captures - This is another fun balloon activity but if you don't have balloons you can use plastic cups. Fill the cups with water and add anything that kids can play with safely. Some fun things are glitter, sparkles, food coloring/Kool-Aid coloring, small plastic animals, small blocks, colored string, etc... The list is only as limited as your imagination. Add different things to several balloons or cups and freeze them. The next day take them out and pop the balloons or overturn the cups to get the ice out. The kids will then have fun holding, playing with, manipulating what has been captured and frozen in the ice. Best to do this in a sensory table or large Tupperware type container.
- If you or the family you are working with is adventurous they can place snow in the bathtub and allow the kids to either lean over the tub and play or get into the tub after putting on snow gear and play. The cleanup is easy - drain the tub after the snow melts.
These are fun sensory ideas to help make a snow day pass along quicker. The children have fun touching and holding cold snow and ice without having to be out in the cold. It can also help to get them more willing to go outside without being sensory defensive with the cold and/or snow.
Have you done any other types of snowy/icy play with your kids? What have you done and did they like or dislike the activity?
The picture is one that is being shared on Facebook with the caption: "Some see Down Syndrome; some see Pit bull... we see the best tea party ever!" I honestly saw neither - what I saw was two best friends playing together and my heart melted. It wasn't until I read the caption that I looked closer and saw the facial characteristics of Down Syndrome and noticed the puppy was a Pit Bull.
And then I got to thinking. . .How sad it is that people so often do just that. They look at a child with disabilities and see just the disability and not the true child. I can't even begin to tell you how many times I have worked with a child and heard from their parents that they've been told their child will never walk, or talk, or any number of other things. And my heart breaks for them. How can anyone really know what any child is capable of doing? Yes, there are some disabilities that doctors can predict the outcomes for quite accurately but there are others, especially the rare ones that there is just not enough information on, that they can't possibly know what the child might or might not be able to do. And there are some that have a range of abilities. Until any child starts growing and developing I don't think we can predict what they are or aren't capable of achieving.
And that is what I share with the parents.I tell them I don't want to give them false hope but that they should follow their hearts and watch and follow the cues of their child. I share how I've worked with many children who were not supposed to walk, or say "mama", or do any number of things and who have had their own agenda and have surprised the doctors with their determination and development. I advise them to stay off the internet because all too often all that is shared on the internet is the worst case scenario. I've often felt we need to set up a bragging website for each of the disabilities that is out there - if for nothing else but to give a little hope because a little hope can go a very long way.
I think one of the saddest things we can do is put limitations on our children and that goes for whether they have disabilities or not. One of the favorite stories that I share is how my youngest son wanted to do everything his big brother (who is 6 years older) did. So when his big brother played baseball and hit balls pitched to him, my youngest son wanted to do the same. It didn't matter that at his age he should be hitting off a Tee - he wanted the balls pitched to him. So we did what he asked and Nick learned how to hit a ball pitched to him. When he was old enough he joined T-ball and one day they were practicing with the Tee and he kept missing. We asked the coach to please pitch the ball to him. The coach looked at Nick, looked at us, and said "He is too young to be able to hit a ball pitched to him. e doesn't have the eye/hand coordination yet to be able to do that." We finally convinced him to just try it. Sure enough, the second ball that was pitched Nick hit and he hit it hard. It went right over the rest of the players' heads. The coach watched the ball sail away and then looked at us and shook his head. I shrugged my shoulders, smiled and said "Sorry Coach, guess we forgot to tell Nick he couldn't hit a ball that was pitched to him." The coach just laughed. And Nick continued to hit those balls.
As a pediatric therapist, I try to look at the children I am working with and know what their restrictions, what their limitations, might be but I don't stop there. I try to push a little every now and again to see if they have the determination and the heart to move a little further than what is expected of them. If we only see what a child can't do and only work within those "limitations" how will we ever get to see what they might be able to do? What they are capable of doing?
With that said, please know that I try not to give false hope but I believe there should always be some hope. Maybe they won't walk but can they maybe scoot on their bottom? Or maybe roll all over the room to get to what they want? Maybe they can't say "momma" but can they sign it? Can they look into their mom's eyes? As a pediatric therapist, I think my job is not just to know what a child might not be able to do because of their disability but to see beyond that. To see more than just the disability.
So tell me, honestly what did you see? A child with a disability playing with one of the meanest dog breeds out there? Or did you see a child and a puppy enjoying tea together?
I've always said that if I was going to write a book about my son's struggles with Dyslexia it would be titled "Dyslexia is not a gift." I know that the belief behind dyslexia being a "gift" is that it allows those individuals who have it to look at the world in a different way and be able to use skills they may not have otherwise used if it weren't for the Dyslexia. Now that is a very good way to look at it - when you're an adult - but not a good way when you're a child struggling to fit in and praying every school day, in every class that you won't get called on to read.
When my son was in preschool, I began to notice that he was writing several of his letters backwards and mislabeling those letters (b was d, q was g, E was 3). I was concerned about the possibility of him having Dyslexia. I would bring this up to his teacher's attention and was told it was "typical at that age" and to "give it time. I brought it up again in Kindergarten and was told the same thing, "give it time." I volunteered in his Kindergarten class on a weekly basis and would notice him listening eagerly during circle time until it came to the letter recognition and simple math they would do at that age. I watched as his peeked interest would go from bright eyed and excited to turning and looking out the window. I mentioned this to his kindergarten teacher (who was new) and was told that he was just being "lazy." She felt that when the work got too hard he just couldn't be bothered to do it. I never believed this for one moment but felt maybe he did just need a little more time.
And so he was given more time and I brought it up to his 1st grade teacher, his 2nd grade teacher, and each time I would hear those words over and over until he was in 3rd grade and falling behind in anything that had to do with reading and/or math. I asked for him to be tested for Dyslexia, as I was sure he was showing all the signs of having it, but was told by the school that they do not test for that. They would offer him reading help but when I asked if it was "research based" I was told it wasn't but that the program they used was shown to be effective with their students who fell behind in reading.
So I watched as my youngest son who loved going to school, and would go eagerly each morning, came home every afternoon looking like he had just battled all the WWF wrestlers he loved to watch. We worked on his homework and he struggled. Words he had known at the beginning of the assignment he would forget by the end of it. Our nights turned into nightmares as he felt stupid and couldn't understand why everyone else "got it" but he didn't. I lost my patience more times then I care to admit. Gift? No, not by any stretch of the imagination was what my son had to go through a gift.
To make a long story short we paid to have the testing done. Took money out of our retirement fund and paid a Neuro-Psychologist to test him over a couple days' times. We were not surprised when his test results showed he had a fairly moderate case of Dyslexia that resulted in impaired reading and math skills. With report in hand we went back to the school. It took a year and the threat of bringing in our lawyer before he was offered the reading help he needed.
He started the Orton Gillingham reading program in the 4th grade and continued it throughout elementary and middle school. He made really good progress and is age level with his math skills but he still struggles with reading and I can't help but wonder how much stronger his skills would have been if he had received the intervention earlier on rather than later.
The sad thing is that our story is not an exception - our story is being played out in schools all over the states. It is believed that 1 in 6 children have some form of dyslexia. Very few of those children are getting the research based reading program help they need to become good readers. Many children give up and feel "stupid." They are the ones who start acting out and causing trouble because they would much rather be thought of as the class clown or class trouble maker than they would the kid in class who can't read. And if they don't have the parent support at home and the school isn't required to test for Dyslexia and offer the appropriate intervention then they often become the kid that drops out.
I'm sharing this with you because recently Rep. Bill Cassidy (R-La) has introduced a House Resolution (H.Res 456, 113th Congress) that is "calling on schools and State and local educational agencies to recognize that dyslexia has significant educational implications that must be addressed." H.Res 456 is asking that Dyslexia be recognized and the right research based interventions be put into place to help those that have been properly diagnosed. The Resolution points out how significant this issue is (1 in 6 children) and that it is proven early intervention can help these students to be better equipped to handle the struggles associated with Dyslexia when the proper strategies are put in place.
This Resolution is so important that the Yale Center for Dyslexia and Creativity is asking the community to reach out to their Congressional Representatives and ask them to please sign this Resolution. Their website is providing the contact information for each State's Representative and even a sample letter to help you know what to say when you contact your Representative.
Dyslexia is not a gift. Not to a child struggling with it, not to the parents trying to get their children the help they need. Not to the Therapist and Special Education teachers trying to work with the students without having the right interventions available to them.
So if you have a few moments, please take a moment and write to your local Representative and ask them to vote for H. Res 456. My son and I would greatly appreciate it - as would 1 in 6 students who struggle with it every day. Thank you.
On a personal note, I have been working at a COTA/L since 2003 when I graduated from Bay Path College's weekend COTA program. It was a wonderful program that allowed me to work full time and attend college on the weekends. It was hard work but with the support of my family I was able to do it. Did I mention that I was doing it at the age of 41 after already having worked in the travel field for the past 20 years? It took me a couple years to get up the courage to go back to school and I have never regretted that choice and love working as a pediatric COTA but I am coming to another fork in the road and have to decide which direction I want to go in.
As much as I love being a pediatric COTA in the birth-to-three field I can't help but feel that I might be even more valuable to the company I work for and to the therapists I work with if I was to become a OT/R. As it stands right now my case load and the territory I cover is quite large as I'm the only one who services the occupational therapy needs in our office. I'm able to do this because COTAs are not allowed to do evaluations so I have the room in my schedule to see more children. However, this leaves the lion's load of the evaluations that are referred to us with motor concerns to the PT in our office to cover. If I was to get my Master's degree I would be able to take some of that load from her.
So I am at that fork in the road... trying to decide what would be best for me, my family, and my job. I have been accepted into the COTA to OT Master's degree program at New England Institute of Technology. It's a weekend program just like my COTA program of study was at Bay Path. What's nice about this program is that it is every other weekend at the college and then on-line study in-between. Quite doable for a full time working mom like myself.
But I am now 51 and I have to figure in the cost of the 2.5 years of study and weigh it with what the pay increase may be. As I am not independently wealthy or have a wealthy family member who may want to sponsor me I will need to take out loans for what financial aid won't cover. Do I want to have to go back to paying back a student loan again? On the plus side there would be more opportunities for me to work as a pediatric OT/R than there are as a pediatric COTA/L. On the negative side it would mean going back to studying and research papers and classwork assignments and all the fun things that come from being a student. On the plus side, once both my kids graduate from high school we could look into working overseas where there is more opportunities for a OT/R than there is for a COTA/L.
Decisions, Decisions. . .
Has anyone else made the move from COTA/L to OT/R? If you have, are you happy you did it? If you haven't, do you wish you could do it?
The American Academy of Pediatrics recommends that all children receive autism screening when they are 18 months and again when they are 24 months old. Healthcare professionals have been using the MCHAT to do this screening and although it was a good screening tool there was concern that it too often flagged children as being at risk for Autism. No screening tool is perfect but this one helped to identifiy children who might qualify for more intensive early intervention services due to being at risk for Autism.
This past December the MCHAT was revised to improve it's accuracy. The tool is now called MCHAT-R (Modified Checklist for Autism in Toddlers - Revised.) his tool will now show whether a child is at "low", "medium", or "high" risk for Autism. There is also a "follow-up" part to this new screenining tool.
Autism Speaks also has an elecronical version you can access on their site here and they are offering the the Follow-Up Interview part as well.
The Official MCHAT website has a free downloadable version that can be accessed in numerous languages.
Has anyone started to use this revised edition yet? What are your thoughts on it? My thoughts are that if it is going to be better at screening the risk factors I'm all for it. Even if a child may show a "low" or "medium" risk it will alert the parents to the fact that there may be something else going on with their child even if they are not at a "high" risk for Autism. This may help get more early intervention help for the child and the delays they may be showing can be addressed.
What are your thoughts?
As I mentioned in last week's blog a new pilot study has that found children with autism had increased vocalization with the help of augmentative apps used on iPads. It is believed that because the augmentative apps are saying the words the children are hearing the same way each and every time the children hearing those words are better able to repeat them. What is nice is that more and more families are able to afford tablets over augmentative devices as they are less expensive and easily available.
As I mentioned last week I would like to share some of the more popular augmentative apps this week. A few that I have heard children enjoy using and have been found to be useful by therapists are:
- Articulation Station - good for early sounds
- Pocket Artic - over 300 cards (1000 at each level)
- Webber Photo Artic Castle - practice articulation skills at the word, phrase, and sentence level
- ArtikPix - flashcard and matching activities for children with speech sound delays
- See.Touch.Learn - Designed by professionals specifically for those with autism and other special needs.
- Tiga Talk Speech Therapy Games - "is a fun way for children to develop speech sounds through playful voice-controlled games that can improve speech clarity, articulation, and instill confidence."
These are a few of the apps that are available and have been found to be useful by therapists for helping children who are delayed in learning how to vocalize. As I'm sure everyone is aware there are more apps out there but these are the ones that come up the most frequently on everyone's favorite lists.
Have you had any success with a specific app when it comes to working with children with speech delays or with children on the Autism spectrum? I would love to hear which ones you have found useful and which ones have not helped at all.
OT in the News shared information recently on a new pilot study that found children with autism had increased vocalization with the help of augmentative apps used on iPads.
The study found that children between the ages of 5-8 that were able to use iPads to help them communicate vocalized more words than children in the same age range who used other therapies to help increase their vocalization. The study went on to explain that the belief for the increased vocalization is due to the fact that the iPad app will say the same word the same way each time. Why this is found to be more effective is believed to be because when we (therapists, parents, etc.) work on speech with children with autism our voices do not always say the word in the same way each time. Our voice may change in tone or manner and/or the child may hear it differently depending on what is going on around them. Children with autism do better with consistency and when they hear the same word the same way each and every time on the iPad they are better able to imitate it. With the success of the first pilot study a new five-year study is now being set up and supported by the National Institutes of Health's Autism Centers of Excellence with colleagues at UCLA, University of Rochester (N.Y.) and Weill Cornell Medical College in New York City.
I have no doubt that with this new finding iPads and other tablet devices will be in greater demand. What is nice about the use of an iPad or other tablet is that they are usually less expensive than your typical augmentative device and they are widely accepted among peers so the children who will use them will not feel they "stand out" so much.
Once concern families may have is the cost. Even though the tablets tend to be less expensive they can still be more than what some families can afford. Thankfully there are several organizations who will help with funding for iPad/tablets for children with disabilities. Families can check out the following websites and follow their instructions to apply for funding:
Autism Society- Funding for iPads
Bridging Apps - list of funding sources available for children with disabilities looking to get an iPad/tablet/augmentative device
Autism Support Network also has an article on the 5 steps to getting an iPad covered by your insurance.
I know for many parents who have children with autism who are not speaking or have a very limited vocabulary this new study's results will be promising news. I'm sure it will be the same for the numerous teachers and therapists who work with children on the spectrum. Any opportunity we have to help a child learn to communicate is an opportunity worth seeking out as it will not just help cut down on the child's frustration but will also help to bring the family closer and help the parents/care givers know what is needed, what is wrong, what they can do to help, and just "talk" with their child.
Have you worked with an iPad or other tablet device with a child on the autism spectrum? How has it worked for you? What applications have you found to be most successful?
Please join me next week when we look at some of the apps that are out there for children with limited vocabularies that have been found to be successful.
I had mentioned in a previous blog that I would try and answer a few questions that may have crossed one's mind regarding picky eaters and problem eaters. If anyone has any other questions please don't hesitate to send me a message or leave a comment on this blog. I will do my best to promptly answer any and all questions. For now, let's start with the ones from my Picky Eater vs. Problem Eater blog I wrote on December 5, 2013.
1) Will my "picky eater" become a "problem eater"? Yes, there is a chance a "picky eater" can become a "problem eater" especially if you don't work on helping the picky eater to become a better eater. Many toddlers could be considered picky eaters because they tend to go through food jags where they will only eat one type of food for a couple days before moving onto another food. As long as you keep trying to get your picky eater to try new things and to move on to other foods there is a good chance they will not become a problem eater and, actually, become less and less of a picky eater.
2) Can my "problem eater" become a "picky eater"? Yes, by working hard with them to slowly move from the foods they will only eat you can help them to move to a "picky eater" stage and then, hopefully, with patience and encouragement to continue to eat a variety of food textures and tastes. It is often harder to get a problem eater to become a picky eater. Many children on the spectrum are problem eaters and are very set on what they will and won't eat. Several hospitals and therapy centers actually offer feeding workshops for children on the spectrum. These workshops can be anywhere from a few days to a few weeks.
3) Will my child ever learn to eat like a "typical" child? This is a hard one to answer because sometimes no matter how hard you work and how much therapy you go to, you may have a child who will always be a "picky eater" or a "problem eater". Sometimes the child's personality has more to do with how much or how little progress they may make to overcome their feeding challenges. The important thing is to work with therapists that have feeding/eating experience or with a hospital/therapy center that has experience and a good track record of successful outcomes when it comes to feeding/eating challenges. There are also many children who have a definite likes and dislikes when it comes to eating but will eat a variety of food tastes and textures so they may not be considered "typical" but they are willing to at least try new things occasionally.
The bottom line and most important thing to remember when working with children who have eating/feeding challenges is that patience and consistency are important to get your child to eat better. Most eating/feeding therapies are based on moving slowly and having one food related thing always be consistent. Consistency also means working with your child every day and following the protocols and strategies given to you by the therapists. It's hard work and at times when the progress is slow it can be frustrating but when you have a day, like I did today, where a child who refuses to eat anything finally took 4 teaspoons of yogurt and didn't spit it out or throw it up - actually swallowed it and then twice opened their mouth for more - then you can almost see that light at the end of the tunnel. You know it may take a lot of work but it is worth it because although the progress is slow - there is progress!
"Our patience will achieve more than our force." ~Edmund Burke
"The strongest of all warriors are these two - Time and Patience." ~ Leo Tolstoy
I know at the end of my blog last week I said I would try and answer some of the questions that may have arisen during my blogs on feeding but I realized over this past week that I have not done justice to the two strategies that will make turning a problem eater into a typical eater successful. One strategy is "patience." Without it we will not get very far at all.
I am working with a young child who is extremely defensive when it comes to eating. The child is "made" to eat with the help of its parents. When I first started working with this child I could not even get close to their face. As soon as I would go to rub or stroke or touch in any way their face their hands would quickly come up to push mine away. Their head would turn and the whining would start. It has not been easy to bring down that defensiveness but it's now been a month with me going in twice a week for 30 minutes to finally be able to play with their face and have them enjoy it. Today was a really good session with the child laughing and not turning away as I stroked and tickled their cheeks and chin. It has taken time and patience but we are slowly making headway and the child is beginning to trust and even have fun during our sessions. Next week we start introducing food.
Patience is not always easy. Parents want to see their children eat and they would like nothing more than to see it happen quickly. We can't blame them. Being able to take care of our children is every good parent's goal. Taking care of them means feeding them and giving them the nourishment they need to grow big and strong, both physically and cognitively. When we have a child who doesn't eat having to take small baby steps is hard. We want to take big running leaps.
Unfortunately that is not what works. Taking those small steps and having the picky eater begin to feel more comfortable with being touched, with having small amounts of food placed on their lips, with trusting when it comes to meal times, is what is going to work in the long run. It isn't going to be easy, but it will be worth it in the long run. The Academy of Nutrition and Dietetics has a quick blurb on the importance of being patience. Sue Gilbert,who is a nutritionist, hares how important patience is when using her strategies to help the picky eater as she answers questions on picky eating at iVillage.
The second most important strategy is "repetition." If we can keep offering consistent sensory input and exposure to foods - the child will begin to feel more comfortable with those daily "feeding strategy sessions" and be more willing to participate in them. Participation may only begin with looking at the food, then touching the food, smelling or licking the food, and then tasting the food. If the child is exposed to sensory play with food several times a day, every day - they will get use to touching and smelling and playing and eventually trying these "new" foods. If the child only gets the sensory input once or twice a week the acceptance and willingness to participate will take so much longer and it will be harder on both the child and the parent. Repetition, repetition, repetition. The blog "Two Healthy Kitchens" shares tips on helping the Picky Eater with one major one being repetition, repetition, repetition.
Small steps, taken over time, with patience and love and a little humor mixed in, will be what will help your picky eater become a typical eater.
The past couple of blogs I've shared some strategies on what to do and what not to do when it comes to working with a picky eater. One of the questions that has arisen through these blogs is "how do I know if my child is just being picky and there isn't more going on?"
Dr. Kay Toomey has an excellent explanation of what qualifies as "picky" and what would qualify as a "problem" when it comes to childhood eating. Dr. Toomey is a pediatric psychologist who developed the SOS Approach to Feeding. I have attended one of her SOS workshops several years ago and found it to be very informative. I use many of her strategies still today.
So a few differences between a "picky eater" and a "problem eater" would be:
- A "picky eater" is a child who has a limited diet of about 30 types of food where a "problem eater" is a child who has a limited diet of about 20 types of food.
- A "picky eater" may eat one type of food for several meals (or several days) and then not eat it again for several days (or weeks) but after time they will eventually go back to eating it. A "problem eater" may eat a food for several meals (or several days) and then not eat it again. Period. It is very rare that a "problem eater" ever gains back a food they stop eating.
- A "picky eater" is selective about what they will eat but will allow a new food to be placed on their tray or plate. They may ignore it or pick it up and sometimes even try it. A "problem eater" will have a meltdown when they see a new food placed on their tray or plate. Sometimes even just having the new food in the same room as them will cause them to melt down.
- A "picky eater" may eat different foods than what the family is eating at a mealtime but will be able to tolerate some of the same foods on their tray/plate even if they aren't eating them. A "problem eater" will always eat different food than their family is eating and, as mentioned above, will often have a meltdown if a new food is even placed near them.
- A "picky eater" will eat a variety of different food textures, colors, and shapes. A "problem eater" will stick to the same textures, colors, or shapes. If it's not exactly the same as they are use to a certain type of food being (round crackers as opposed to square crackers) they will not eat it and often have a meltdown because it is "different" than what they are used to.
As you can see, once you know what to look for you can easily tell if your child is a "picky eater" or a "problem eater". Next week we'll look at the different ways to work with these two types of eaters. Can we use the same strategies or do we need to use different strategies? Will my "picky eater" become a "problem eater"? Can my "problem eater" become a "picky eater"? Regardless of which one my child may be, can they ever learn to eat like a typical child?
Stop back next week when I try to answer these questions and offer more feeding strategies.
Blogger's Note: When I was younger my Nana would always say "As you get older time will slip by much faster." I found it hard then to believe her because, come on, how could time go any faster? I had planned on having the next Feeding Strategy blog posted prior to Thanksgiving. I had planned to work on it last weekend and have it ready for Monday morning.
I have a feeling that somewhere between putting my house back together after having the inside rooms painted, finally getting back to feeling "normal" after being sick for a week, and preparing Thanksgiving dinner for 12, time somehow slipped away from me. I apologize for the delay. I hope everyone had a lovely Thanksgiving that was spent surrounded by the warmth of family and friends.
As I mentioned in my previous blog when it comes to helping the picky eater become more willing to eat more food and a variety of food sometimes all it takes is changing one small thing at a time. The trouble with this is that we have grown into a culture where we want things to happen right away. We seem to have lost the art of patience along the way. The consistant thing I have learned working with picky eaters is that the family who has the most patience is the family that ultimately will have the child who can go from being picky to being willing to try new foods. If strategies are rushed or not consistently followed through on the chances are higher that the picky eater will remain a picky eater.
One of the toddlers I recently worked with loved crackers and peanut butter "sandwiches". He could eat for every meal and be happy. The suggestion was to either change the peanut butter to cheese but keep the same type of cracker or change the cracker to a different type and keep the peanut butter. The family tried putting cheese in the crackers. The little guy took a bite, looked a little surprised, and looked at the cracker. We all waited to see what he would do next. Would he throw it? Would he take another bite? (breath being held) He took another bite! And then another .. and another, until the cracker was finished and he looked up for more. (breath released)
Over several months the family slowly made more changes. They changed the crackers to pieces of square toast the same size as the crackers. They slowly made the toast a little bit bigger until he was eating quarters of toasted sandwiches. Over the course of several months they have been able to introduce other options in the toast and he will now eat ham and cheese but is not a fan of peanut butter with jelly. J
Another family wanted their toddler to eat more than just noodles and spaghetti with butter. So the change was made to go from elbow noodles to smooth ziti noodles. They kept the butter sauce and after a few attempts the toddler began to eat them. They have tried using other types of noodles (colored elbows, fans, etc) but so far the will only eat either the regular elbows or the smooth ziti noodles. The next option was to chance the "sauce" so they added a small amount of garlic to the butter and he loved it. Next they tried a Alfredo sauce as it was still light in color. Again it took several attempts but he finally would eat noodles with something other than butter on it. They are now trying to use Marina sauce but are slowly adding a little of it at a time so the color of the sauce will change gradually. As I said earlier - patience ... it takes a lot of patience.
Getting a picky eater to change to a better eater also takes a good amount of observation and detective work. What flavor does the child tend to like (sweet, sour, etc.) Is there a certain type of food they will try (crunchy vs soft) or even a certain color (will eat anything green but not yellow.) There are a few good resources to go to when it comes to making small changes:
The hardest thing, and I bare being repetitive here, is encouraging our families to have patience. Teaching a picky eater to become a good eater is not going to happen over night. It is going to take several weeks to several months depending on the child. I have seen how making small changes can make a huge difference. As with any therapy there will always be some children who do not respond but the majority of young children, when allowed to explore and try new foods when combined with their "old" familiar foods, makings small changes over a period of time will prove to be a successful eating/feeding strategy.
Have you tried this strategy? I would love to hear how it worked or didn't work for you.
When you have a child who does not want to eat you may be willing to try anything to get them to eat. You will no doubt run into friends and family members who have "done this" or "done that" and it has worked for them when their child was being picky. Today I want to share some things that you may have heard worked for others but that you shouldn't really try when working to get your picky eater to eat better.
- Force Feeding - I have worked with several families who have "force fed" their picky eater. The parents will gently hold their child's head still so the child can't turn it side to side and the parent will then place the food in the child's mouth and "close" the mouth (tilting the child's head back or placing their fingers on the childs lips) so the child has to swallow and not spit out what is now in their mouths. The parents I've worked with truly do not mean to do their child any harm they are just worried that they are not getting enough to eat to sustain them throughout the day and they feel this is the only way to get them to eat.
When I have a parent who is doing this I try to show them how "force feeding" will not work by asking them to think of the one food that they absolutely hate. The one food that they just would not want anywhere near their mouths and to then imagine someone they trust and love placing that food in their mouths and making them swallow it. I shudder just thinking about this being done to me. I try to show them that this is what is happening when they "force feed" their child and that it will never amount to good eating habits until we can make their child's feeding time a fun and enjoyable time and not an unpleasant one.
- Staying at the table until they are finished - I can remember growing up and not wanting to eat my vegetables or the type of potatoes that were made and being told I had to stay at the table until my plate was clean. When a parent makes their child stay in their highchair or stay at the table until they finish eating it turns into a power struggle. On one side you have the child who just cannot, will not, put the food in their mouths and eat it and on the other side you have the parent who feels their child has to eat their food in order to survive. This strategy really just turns into a struggle of who is more stubborn - the parent or the child. It won't make eating a positive experience and therefore won't make the child want to eat more the next time they sit down for a meal.
- Saving the plate for the next meal - If a child isn't going to eat what is on their plate before them for one meal they almost definitely won't eat it if it is served to them again at their next meal. This strategy is another "power struggle" between the parent and the child and in the long run does not help to make the child's eating experience positive or help them to stop being a picky eater.
- Serving the same food each meal - I know it is so tempting when you have a picky eater to keep feeding them what they will eat. As parents we have this desire to make sure those we love are fed and not going hungry. If our picky eater will only eat grilled cheese sandwiches then we'll serve them those sandwiches at each meal if it means they are eating.
Most children will go through food "jags" where they only want to eat one type of food. These jags may last a couple days to a couple weeks but will normally move onto another type of food after a short amount of time. When you have a picky eater you have a child that will only eat one type of food .. period. Even after months they won't try anything else. This is not a food "jag".
When we serve a picky eater only the few types of food they will eat because it is easier and less stressful, we will end up with a child who will never eat anything but their favorite foods. This will mean even when you go out to restaurants or to family get-togethers you will need to make sure you bring along something your child will eat because there is a good chance where you are going may not have the exact type of food your child will eat. It may have seemed easier in the beginning to give in but as the child gets older it will likely turn into a huge problem.
It isn't easy working with a picky eater. We need to have a lot of patience and creativity. We need to find ways to make the meal time fun and not a power struggle between the parent and the child. We need to work slowly to allow the child to feel independent with their eating skills while trying to introduce nutritious food options for them. We need to come to the realization that it is not something that is going to happen overnight but something that may take weeks, if not months to happen when the right strategies are used.
Please join me next week when I will share strategies that I have found worked in helping the picky eater try a wider variety of food options. For instance did you know that making even just one small change to a favorite food is an excellent way to start to introduce new food options? And what about hiding vegetables in other foods? Does it work or cause more problems?
"Pull up a chair. Take a taste. Come join us. Life is so endlessly delicious." - Ruth Reichl
The holidays are right around the corner and along with them come all sorts of delicious holiday foods. For most of us this is a time of anticipation. What sides will we have with our Thanksgiving dinner? What desserts will be served? What holiday cookies should we make this year? It's a time of family get togethers over the dinner table as we share food and conversation. For the majority of us it is a time we look forward to but for the parent of a child who can be a picky eater it is a difficult, sometimes even dreaded, time of the year.
In the next couple of weeks I will share some thoughts and strategies regarding picky eaters. I will try to offer suggestions that might help to make these meal time get-togethers less stressful and more enjoyable - especially for the picky eater.
There are many reasons why a child may have become a picky eater. The first thing I always ask a parent is if the child has acid reflux and if they have tried any acid reflux medication. Even if there are no obvious signs there has been many cases where the child has "silent reflux" and refuses to eat anything but a few bites of food. Once they are put on medication prescribed by their pediatrician or G.I. specialist the reflux calms down, their body starts to heal, they then start eating more. Why? Because If it hurts to swallow due to acid reflux pain then the child will stop eating. They learn quickly that one or two bites is all they can do before the pain starts. So once they have been on reflux medication it is important to try and encourage them to take that third bite, and then the fourth bite and the child slowly starts to realize it isn't hurting anymore and they begin to eat and try new things.
The second thing I will check is how much liquid is the child getting during the day. It is easy to leave a sippy cup or bottle around and just keep filling it up when it gets empty but this is not going to help a picky eater become a better eater. If they are already feeling full because their belly is full of any type of liquid (milk, formula, juice, water, etc) their body will not signal their brain that they are hungry. It is important to encourage a toddler to have 2-3 8oz servings of milk a day and 3-5 8oz servings of water a day if thirsty (the higher end during the warmer months to stay hydrated), and 1 6-8oz serving of 100% juice. These recommendations can be found in a 2006 article written in The American Family Physician. Milk/liquids should always be offered after they have had a chance to eat. If a child drinks first their belly will begin to feel full with the liquid first and they will eat less or not at all.
The third thing I will look at is how is the child eating now. Are they being fed by the parents or are they feeding themselves? More often than not a picky eater is usually fed by their parents and it is often not a pleasant experience. The parent is stressed because they know the child needs to eat. The child is stressed because their parent is. The harder the parent tries to feed them the more upset and jaw locked the child becomes. One thing I will suggest is to offer the toddler two foods you know they like. Let them point at or look at the one they want and offer that to them. Try and make it as successful as you can for them when it comes to being able to feed themselves. Toddlers go through an independent stage and more often than not, if they can feed themselves, if they feel safe putting the food into their mouths themselves, they will eat it.
I also tend to be an advocate of "distraction" when eating if the child is picky. A favorite TV show or video being played can go along way to having the child eat more than they would if they are sitting upset in their highchair. As the child gets more comfortable eating and is less picky the TV show or video can be slowly removed (show only a portion of the show/Video during the beginning or end of the meal - depending when the child is more picky - until it is removed completely.) I know I can hear therapists and mothers groaning everywhere right now but I'm sharing this because it does help the picky eater "forget" how much they don't like eating and can get them started on a healthier eating habit than if they are left to fuss and complain. Often a distraction they enjoy can help them begin to enjoy eating when it's combined with encouragement. Then mealtime turns into a pleasant and enjoyable experience and no longer a stressful one for the child or the parent.
These are a few things to watch for and strategies to try when it comes to picky eaters. Please join me next week when I share some thoughts on what NOT to do when helping a picky eater become a better eater. For instance the old "you'll stay there until you finish what's on your plate!" - NOT a good strategy.