Brooke feeding me yogurt using jaw support.
Allison blowing bubbles in preparation for starting the feeding session. You can go around and blow bubbles first, and then introduce foam soap to wash hands at the table, then start with the feeding.
Food art, probably by Virginia if I had to guess (my camera was hijacked).
The orange/brown foods we ate!
Marla's trying hard, but Patchez doesn't look too happy with how things are going! She hates pudding!
This morning we had a three-hour feeding lab, with two visiting therapists in Memphis as well as one in Chattanooga (distance learning). We were following the SOS feeding protocol, which recognizes there are 32 steps to feeding and that children with feeding problems should be treated with understanding and compassion using the rules of the program. It is important to realize that for children with severe eating problems (not just being picky), the children won't just eat when they get hungry enough - they can literally starve themselves to death. It's also not true that eating is our number one priority! Different pediatric diagnoses will have different problems. It can range from swallowing problems in babies who had G-tubes to tongue thrust reflexes in children with cerebral palsy. The first hour was lecture on the different textures of foods, food crises and how to solve them (like if the child is gagging or coughing), and how to solve common food problems. (Food too dry? Add butter. Etc).
The second hour we focused on handling techniques that help with chin support, lip support, jaw support, or a combination. Some children may have such low tone they can't keep their mouth closed while eating, for example, so you may help them support their face in a way that allows them to eat their food without it spurting out. The therapists also pointed out that Stage 3 Baby foods (combination foods of puree/chunks), are dangerous and should not be eaten. The reasoning is that little babies who learn to eat puree do so with a sucking motion. To introduce a combination food before introducing the small chunks previously can cause choking or gagging since the baby doesn't have the oral motor skills necessary to deal with these chunks. Therefore, babies should be introduced to purees, then little chunks, BEFORE combining the two. Also, Cheerios are dangerous for younger children because they don't melt in the mouth. There is a new line of Gerber graduates that have cereals that are meltables, and that is essentially because one of the SOS creators is a consultant for Gerber now.
The coolest thing we learned in this hour is how to deal with a bite reflex of a child with hypertonicity. Let's say you stick a spoon in a child's mouth with a bite reflex and they clamp down and won't let go. You might be tempted to go OH NO and start trying to tug open the child's mouth. This will make it even worse. Instead, there is a technique to rub your fingers down the nasolabial folds (smile lines) of the child in such a way that it helps remove the spoon. It's pretty cool.
Another thing I learned through previous experience, but I have no verification this is okay as this was NOT in the feeding lab, is that if you have a child who puts something inappropriate in their mouth (like say, a mound of silly putty), you can immediately tilt their head forward with the chin tucked in because that makes it very hard to swallow. Try it right now - tuck your chin in as far as it will go and try to swallow. Difficult, right? I was once working with Celia in one of my first sessions with her, and her mother was sitting with us. We were playing with some neat silly putty and she quickly put a big chunk of it in her mouth. Before I could even blink, her mother (ICU nurse to the rescue) grabbed her head and pushed the chin forward so she couldn't swallow as easily, and then fished it out from that position. I asked the therapist about that and she said she had never heard of that but she would ask her SLP about it. So I'm not recommending that since I don't know for sure this couldn't cause a problem. Still, a good thing to ponder.
During the third hour we did a typical feeding session. We were in circles of groups of six in Memphis, and went through the feeding protocol. Basically each person acts as a social modeler and the key is to play actively with the food and explore it, and there is no bribing or forcing of anything. It is a safe, playful environment. You do a progression of food that typically always has either color or shape in common. For example, we started with a line of chocolate pudding, then moved to a hard pretzel rod, then a cheese stick, then a carrot stick, then a Cheeto stick, and so on. You are definitely encouraged to mess around with your food - OH THIS ORANGE STICK FEELS SQUISHY ON MY FINGERS AND IT WIGGLES. CLOMP CLOMP IT IS JUMPING AROUND MY PLATE! Etc
Marla doing ice massage on Cheryl. All you do is stick a popsicle stick through a film canister, fill it with water, and freeze it!
Kerri doing ultrasound on Mary
A very makeupless me doing a shoulder ice pack on the one OT taking our Thermal Modalities course, "T".
