Feeding your child – Tips and Techniques for Parents - Video

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A video for a New Parent

http://www.youtube.com/watch?v=yYc0kmtpxd8&feature=youtube_gdata_player

By Sarah Rosenfeld- Johnson,
A Speech Language Pathologist with more than 35 years of experianxce,a  Feeding Specialist, an Educator, a founder of Innovative Therapists International/TalkTools http://www.talktools.com/

Watch a video and share your opinion in a "Post a Comment" section at the end of the page. Thank you – Urszula

Feeding and Swallowing Disorders in Infants and Children

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Read an abstract and let me know if you found it useful by sharing your opinion in a "Post a Comment" section at the end of the page. Thank you - Urszula


Children with feeding and swallowing difficulties (also called dysphagia) are at risk for malnutrition, dehydration, and respiratory problems. Infants and children with feeding and swallowing problems are a diverse group, ranging from premature babies to teenagers. Parents are often the first to notice a feeding problem.

Causes of feeding and swallowing problems

• Prematurity
• Cerebral palsy
• Autism
• Head and neck abnormalities
• Muscle weakness in the face and neck
• Gastroesophageal reflux
• Multiple medical problems
• Respiratory difficulties
• Medications that may cause lethargy or decreased appetite
• Problems with parent-child interactions at mealtime

Symptoms

Children with feeding and swallowing problems present with a wide variety of symptoms, depending on the nature and cause of their disorder. Typical symptoms include:

• Poor feeding
• Difficulty chewing
• Difficulty drinking from a bottle or cup
• Difficulty breast feeding
• Refusing food or liquid
• Coughing or choking while eating or drinking
• Excessive drooling and food spilling from the mouth
• Liquid leaking out the nose
• Gagging
• Vomiting during meals
• Increased congestion during meals
• Increased fussiness or crying during meals
• Accepting only certain types of food (only pureed foods or only crunchy foods)
• Poor weight gain
• Frequent respiratory infections or pneumonia (may occur when food or liquid is aspirated into the airway, rather than swallowed effectively)

Evaluation and Diagnosis of Feeding and Swallowing Disorders

If you suspect that your child is having difficulty eating, contact your pediatrician right away. Your physician will examine your child and address any medical reasons for the feeding difficulties, including the presence of reflux or metabolic disorders. The pediatrician may refer you and your child to a feeding team or speech-language pathologist who specializes in treating children with feeding and swallowing disorders. The SLP will discuss your concerns and observe your child while they eat. The SLP may also conduct an instrumental assessment of your child's swallowing ability. This involves having your child eat and drink foods and liquids mixed with barium while watching them on an x-ray. This procedure is typically called a modified barium swallow (MBS) and is conducted in a radiology office. Sometimes a different instrumental assessment will be completed, which involves having a lighted scope inserted through the nose so your child's swallow can be observed.

If a feeding team is involved, which may include the speech language pathologist SLP, an occupational therapist OT, a physical therapist PT, a physician or nurse, and a dietitian, your child's posture, self-feeding abilities, medical status, and nutritional intake will also be examined. The team will then make recommendations on how to improve your child's feeding and swallowing.

You can watch normal swallow

Animation - 
http://www.youtube.com/watch?v=1YfO11Pry6Y

X-Ray swallow - 
http://www.youtube.com/watch?v=PwVreNrTKBw&feature=related

Compare it with abnormal swallow animation:

http://www.youtube.com/watch?v=d_tmhBhec70&feature=relmfu

http://www.youtube.com/watch?v=IyTyLJrEFgA&feature=relmfu

http://www.youtube.com/watch?v=OwlCKmIK8Sg&feature=relmfu

Learn about basic of videofluoroscopy of swallowing

http://www.youtube.com/watch?v=-wmt6HlLduY&feature=related

Treatment

Based on the results of the feeding evaluation, the SLP or feeding team may recommend any of the following:

• Medical intervention, as needed
• Direct feeding therapy designed to meet your child's individual needs
• Nutritional changes
• Postural or positioning changes (different seating, etc.)
• Behavior management techniques
• Desensitization to new foods or textures
• Food temperature and texture changes
• Referral to other disciplines, such as psychology or a dentist

If feeding therapy with an SLP is recommended, the focus of intervention may include:

• Strengthening the muscles of the mouth
• Increasing tongue movement
• Improving chewing patterns
• Increasing tolerance of different foods or liquids
• Improving sucking /drinking ability
• Coordinating the suck-swallow-breathe pattern (for infants)
• Altering food textures and liquid viscosity to ensure safe swallowing
• Other interventions depending on your child's specific needs

Swallowing strategies for dysphagia 

A. Compensatory Strategies
- Supraglottic Swallow
- Effortfull Swallow
- Mendelsohn Maneuver
- The Supra-Supraglottic Swallow

B. Postural Techniques
- Head Rotation To Weak Side
- Head Rotation To Strong Side
- Head Back/ Chin Up
- Chin Tuck

Watch video with the swallowing strategies presented by a clinician - 
http://www.youtube.com/watch?v=UgkRVD-LvjY&feature=endscreen&NR=1

  

Management hints of gastro-oesophageal reflux 

1. Keep your baby upright for at least 30 minutes after a feed. 
2. Use a baby sling, which allows you to keep your child upright, while keeping your hands free. Avoid baby slumping. 
3. Try elevating the head of the cot/bassinet. 
4.  Consider using a dumm. 
5. Avoid vigorous movements or bouncing the baby. 
6. The best time to lay your baby on the floor is when baby's tummy is empty, i.e. before a feed. 
7. Change nappy before a feed. Take care to elevate the baby's head and shoulders. Avoid lifting the legs too high, and turn to the side if possible. 
8. Avoid any tight clothing around the waist, such as tight nappies, elastic waistbands. 
9. Avoid overfeeding – if the baby vomits, wait until the next feeding rather than feeding them again. 
10. If the baby is bottle-fed, it may be worthwhile trying AR (anti-reflux) formula, or a hypoallergenic one. 
11.  Offer a spoonful of thickened milk (formula or breastmilk) following the feed. 
12. If breastfeeding, avoid foods that can aggravate reflux such as citrus, tomato, fatty foods, spicy foods, chocolate and carbonated drinks. 
13. Some reflux children may suffer from food sensitivities, and may need dietary restrictions (or the mother may consider an elimination diet). If you suspect foods may be responsible for your child's condition, it is essential to discuss this with your health care provider. Do not change your or your child's diet before seeking medical advice. 
14. Contact a reflux support organisation for further information and support. The support groups can offer the emotional support you may need.

Advice for Parents/Caregivers How to Develop and Improve Child’s Oral-Motor Strength and Sensitivity.

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Rules to follow for a success
Try to apply and look for a triumph. Good Luck!

Let me know if you found it useful by sharing your opinion in a "Post a Comment" section at the end of the page. Thank you - Urszula

Make exercises fun as much as possible!

Modify environment by minimizing distractions!

Sit behind a child, the way you both face a mirror!

Make sure your child is in comfortable, supported position!

Explain what you are doing in a simple, narrative way!

Provide exercises for short periods of time!

Don’t do all learned exercises at the same session!

Provide exercises before each meal not during a mealtime!

Pause to allow time to swallow any saliva that may have accumulated!

Don’t attempt swallowing if your child has a cold!

Stop if your child becomes distressed at any time!
Be patient!

 

Exercises to develop and improve oral sensitivity and muscle tone

1. First, before you approach the child’s face verbally explain what are you going to do and what for.
2. Use slow, firm strokes over the hands, arms, shoulders, neck with rough texture (e.g. towel, etc.)
3. Next start at the sides of the face, forehead, chin, gradually working towards the centre of the face.
4. Massage the cheeks using circular movements, particularly around the mouth.
5. Using thumb and index finger press the top and bottom lips firmly together. Hold for a while and release.
6. Stroke firmly downwards on the area between the nose and top lip while using your finger to push the bottom lip upwards.
7. Using 2 fingers pull the top lip down, starting under the nose and working towards the top of the lip (without touching the lip itself).
8. Do the same for the bottom lip, working from the chin to the lip. Support the jaw if necessary.
9. Gradually introduce stronger flavors at mealtimes:

a.       Using seasoning (curry, garlic, etc.)

b.      Introducing organic chips of different flavor (vinegar, pepper, etc.) and dips (mayonnaise, ketchup, etc.)

c.       Offering tangy, bitter flavored fruits or yoghurts (kiwi, lemon, grapefruit, cranberry, etc.)

10.  Introduce food of different temperature (ice-cream, popsicles, etc.)

11.  Gradually introduce sensory toys (textured teethers, etc.)

Exercises to develop and improve lip movements

 

1. Child will drink from a cup making very small sips.
2. Child will drink using straw (tight/round lip seal around the straw; straw has to be held just by lips, not deeply.)
3. Child will blow bubbles in the air, bubbles in the water using a straw, cotton wool balls across the table, whistles/party blowers, etc.
4. Child will make /oo/ sounds (imitating a ghost, owl, monkey, wind) and /ee/ sounds, like E-I-E-I-O in Old McDonald song, using exaggerated lip movements. You might need to gently push the lips from a tight stretched position (smile shape) to the round position (kiss shape).
5. Child will blow kisses. (You might need to gently push the lips from a tight stretched position  -smile shape to the round position - kiss shape. Put on some lip stick or face paint and make kiss marks on a mirror, tissue, paper etc.

Exercises to develop and improve jaw and tongue movements

1. When side-spoon-feeding your child, place spoon on the lower lip. Let the child to clean the spoon.
2. Over time place food at the sides of the mouth, between the teeth. This will encourage munching/sideward tongue movements.
3. To stimulate biting, munching and sideward tongue movements.

a.       Do exercises at times when your child is relaxed.

b.      Exercises should not be done at mealtimes.

c.       Place the item in the mouth, between the teeth, along the line of the jaw and ensure that it is not placed so as to stretch the lips. Do not place too far back in case your child gags.

d.      Place on the best side initially, than move to the other side.

e.       If the child is not munching, pull the item out slightly and gently or press down.

f.       When you feel your child is confident about biting skills, introduce food items. Initially use bite-and-dissolve foods (biscuits, snacks, etc.)

g.      If the child is not biting off the food, break it off for them while they are biting down on it. Do not force your child to take foods that their mouth is not ready.

h.      Over time, gradually introduce chewier foods in the same way.