The Feeding Challenge

Cheryl - thank you for sending follow-up info....he definitely sounds like a complex little guy. I'm curious about the feeding and exactly what he can and can't do - I would suggest observing a feeding (as you stated) and clearly define what the families goals are for this little boy with regards to both feeding and communication. Keep us posted.....this is definitely an interesting case and one that we can learn from as therapists!

Stephanie, I did the eval. on Bradley.  He has a complex medical and social situation.  The information will help greatly.  He makes a throaty sound and some vowel sounds with inflection, "ee, oh", maybe a couple words "mama" "there"? He had some eye contact, desire to interact and manipulate toys and objects.  He wasn't using the G-tube while I was there.  He did drink from a sippy cup with a good suck and swallow.  I didn't observe feeding yet but Mom reports that he tolerates and handles most textures fairly well.  I question lung capacity for breath support and control-most of his receptive and expressive language skills ranged from 3-9 months. He has asthma as well and lives with smokers.  I was most encouraged with his interest in his environment inspite of everything.  I'll write again    and thank you for any input.  Cheryl

To Cheryl ~ Did you do the eval on the 2 yr old with the G-tube? Curious as to how it went and what you found....please share if you can....Thank you for writing in! I hope the most recent post from today regarding feeding may help with your treatment plan.

This is a valuable blog.  I refer to it often.  Thank you.  I will be doing an eval. of a 2 year old with Prune Belly syndrome with a GU.  What is that and how is it different from a G-tube?  I will first visit with a nurse at the home, hopefully to learn much about how he ambulates, attends, observe feeding and anything else that comes up in his daily routine at home.  I will have many questions I am sure.  I read that he eats different foods that his kidneys will tolerate-namely french fries, hamburgers and chicken?  Comment please.  He has failure to thrive, so anything taken orally along with supplemental is progress, I assume.  I appreciate anything you might suggest.  Thank you, Cheryl

I had a similar experience with an infant. She was 6 months old when I started working with her and she would ONLY eat while sleeping. She is now a year old a takes ALL bottle feedings awake. She still eats a minimal amount of solids but is making progress. The following web site offered additional tips to help a baby with reflux

http://www.infantrefluxdisease.com/help-infant-reflux.php

We also consulted with other team members (pediatrician, etc.) and added rice cereal to her bottle (it helped reduce reflux and increase caloric intake). We also tried several different formulas until we found one she seemed to like best. Most importantly, we focused on creating positive feeding experiences in a loving, nurturing environment and trained her parents to identify signals of hunger, satiation and respecting her cues. Good luck!

Thank you for your question....my first three thoughts are: 1. How is the reflux being treated? Is it under control or is the child in pain or discomfort during or after eating?, 2. How is the oral motor function? Even if it is reflux, is there also a sensory component? and 3. Is the child being seen privately for feeding? Is there anyone you can co-treat with?  *Please write in with other suggestions...                                          

What has recently become very challenging for me are young babies- 6 months and under who are refusing to eat more than 1 ounce at a time.  They eat better when sleeping.  These are babies who are being treated for reflux.  They are equally as miserable when taking more solld food.  Nutrition has become more the issue than quality of feeding interactions.  Any advice?  Thank you, Rebecca

One of the most important pieces of any feeding kid (but also may be the most challenging) is conducting a thorough oral-motor evaluation.  Determining whether a feeding disorder is sensory-based, motor-based, sensory-motor-based, or behavioral-based is imperative for creating an effective treatment plan.