Adaptive Eating Utensils for Kids

I am enjoying that my 19 month old son likes to feed himself applesauce with a spoon. If I try to feed it to him, he clamps his mouth shut and turns his head. I love that! He may be messy, but oh well! How else can he learn if he doesn't practice? Toddlers should want to use a spoon on their own! But some toddlers aren't physically able, even if they are emotionally and cognitively ready to not be fed by an adult anymore. This is where adaptive utensils come into play!

The particular adapted spoon, fork, or spork that is needed depends upon the child's strength of upper body muscles, coordination, muscle tone, and range of motion. Some of the adapted utensils may have a: built-up (larger round) handle- foam or plastic, angled metal portion, curved handle, swivel metal, or weighted handle. So why are some of these utensils needed?

A built up handle is for someone with limited range of motion, abnormal muscle tone, or strength.

A weighted handle is for someone with ataxia or tremors as well as for someone with decreased sensation- the added weight lets them feel the utensil better.

Curved handles and angled or swivel metal utensils may be for someone with limited forearm, wrist, or finger active range of motion or limited control of muscles such as with tremors or spasticity.

Common diagnoses that use adaptive utensils include: Cerebral Palsy, Stroke, Muscular Dystrophy, Arthrogyposis, Brachial Plexus Injury, and many others.

Catalogs for therapy equipment such as www.sammonspreston.com sell numerous adaptive eating utensils. But I have found that sometimes you can use your own utensils and adapt them for a lower cost, depending upon the child's need. For example, if you just need a fatter handle, then try using rubber/plastic bicycle handle bars that can be found 2 for $1.00 at dollar stores; slip the spoon in the slot that would go around the bicycle handles. I've also used foam craft supplies along with electrical tape to creat a built-up handle; just wrap and tape. One that is real easy to use is Crayola (R) Model Magic (R) and shape exactly where you need the fingers to get support, and within a day the products dries. Only problem with this idea is it shouldn't get that wet or it can alter its shape. So you may not want a child who excessively sweats, drools alot, or is super messy to use this product.

I've learned as an occupational therapist to be creative with adapting feeding supplies and "Think outside of the box". Sometimes there just isn't a product already out on the market that can help a particular child. And sometimes, it's the parents who "Think outside of the box" and rig something up that works perfectly!

Ambidextrous Versus No Hand Preference

Most children begin to prefer using one hand over the other for skilled activities (e.g. eating meal with a spoon, throwing a ball at a target) by the time they are in preschool (age 3-5 years). Technically, they aren't considered "behind" if they haven't done this even up until the age of 7 years when their brain becomes fully myelinated. Yet, some developmental standardized tests show that it's a skill that should be present at 2 years of age. It helps if the child has chosen a hand dominance by preschool and kindergarten when they are learning to write letters and draw pictures. Since 96% of people are right-handed, chances are you can put the crayon in the child's right hand and be correct about your choice. But definately, don't fight with the child if they start using the left hand, just let them do it. Maybe they can perform an activity such as cutting out shapes by taking turns with each hand. And eventually, one hand will feel "just right" to them, and they will choose a preference.

Not having chosen a hand preference yet should not be confused with being ambidextrous, which is being highly skilled in each hand such as writing just as neatly with either hand, manipulating chop sticks with either hand, or hitting the baseball with the bat in either hand. Often, it may not be known if a child is ambidextrous until middle elementary school years, since preschoolers are just learning to perform fine-motor activities.

So what is dominance confusion? Well, this is when the child isn't that skilled in either hand, and may only use the side of the body that is convenient for that moment. For example, if you placed a spoon to the left side of the child's plate, then he would eat with his left hand...and would probably be messy with it. If you had placed the spoon on the right side of the plate, he would have used the right hand to feed himself. He may not cross over the middle of his body as noted by not transferring items from one hand to the other and only reaching with the hand closest to the item he is about to grasp. This might also accompany other problems since crossing the midline of the body requires that the two sides of the motor hemispheres of the brain "talk" to one another. Often, I see global muscle weakness in these kids and a poor ability to perform 2-handed activities such as holding the paper with one hand while the other writes on/cuts paper or one hand holding Mr. Potato Head's (R) body while the other hand inserts body parts . This is known as poor bilateral (two sides of the body) coordination which is often seen with certain syndromes (e.g. Down), cerebral palsy, sensory processing disorder (AKA sensory integration dysfunction), prematurity, and developmental delay. Anytime you see poor bilateral body coordination, there is a tendency for the child to have a speech and language delay, since the mouth is on both sides of the body. These children might also be clumsy such as with climbing, falling when running, not jumping well, and delayed with learning to ride a bicycle.

If you are wondering if your child is ambidextrous, get a checklist of fine-motor skills a child his/her age should be able to do. Then, have the child perform all of the skills with the right hand, then later do the same with the left hand. If he could do good with both sides, then he may truly be ambidextrous.

Also, remember that a person with a right hand preference could be good at using the left hand for certain things, especially when taught a certain skill with the left hand. For example, I was taught to tie my shoelaces by my left-handed sister, so I do that skill like a left-handed person would do. I have tried to change how I tie shoes, shoot pool, and perform the other numerous skills she helped to teach me, but my brain has already learned those things using the left hand. Now, if I were ambidextrous (which I'm not), I would have been able to generalize those skills to the right hand and make the switch easily. So are you a lefty, righty, or amby?

Head Banging

When a young child bangs his head repeatedly, it can be scary to us parents. My 15 month old son recently went through a stage in which he wanted to bang his head on the stroller and high-chair. I don't think he was doing it for any particular reason; he did it once and seemed to like it, so he kept doing it. I nipped this behavior in the bud by completely reclining the back of the stroller and the high-chair. This meant if he was to throw himself back, nothing was immediately there to bang his head on. He tried it once, and realized it made him lay down. So, he quit trying it.

It is not considered abnormal to head bang, however, many children with special needs bang their head and do so excessively. Some kids do it to the point that you are left wondering how they aren't in excruciating pain. More than one book on raising infants and toddlers reports that up to 10% of typically developing young children head bang in order to fall asleep. This statistic sounds a bit high to me, but maybe it included children in the statistics who were similar to my son where they just tried it for a month or so. Yet, many of the kids I work with are chronic head bangers. I try to put my thinking cap on and help the parents come up with solutions to diminish the head banging. Often, we are successful, but sometimes not. Many of those kids eventually outgrow the behavior when they were ready. Listed below are some tips that have worked for some kids that I have worked with over the years. Consider why the child is head banging:

• Is the child frustrated with a toy or person? If so, help him come up with other ways to appropriately release anger. One idea includes a place to retreat to when he is upset such as a tent. Within this tent provide toys or music that are typically calming and/or fun for him. For some kids, don't place anything in the tent other than a pillow or bean bag because they may need only minimal input.
• Is he upset that you don't understand his wants and needs? If he is completely non-verbal, then PECS, sign-language, augmentative communication devices, or other strategies taught by a speech-language pathologist, ABA therapist, or other special educ. staff may need to be implemented. If he is verbal, but just can't express himself when upset, then give a couple of choices. This makes him feel validated as well as helping him express his wants and needs. The choices can be with words, sign language, gestures, or pictures.
• Is the child just bored? Many kids, especially those with sensory processing disorder (SPD) or an autism spectrum disorder (ASD), need lots of movement opportunities or they get bored. Indoor activities may include: trampoline, tunnel, rocking horse, help clean and do chores, and obstacle course. Outdoor activities include: playground equipment with swings, slides, and climbing structures; swimming, walking/running, bikeriding, wagon rides, and yard work. Even a toddler can "help" dig weeds or water the flowers. Maybe the child is bored because he doesn't know how to play with toys or by himself. Get suggestions from your special education staff (OT, PT, SLP, ABA, developmental teacher, EIS, etc.) on toys and activities that may be easier for the child to learn to play.
• Is the child a sensory seeker and needs that deep input head banging provides? Try lots of "rough housing" (supervised), jumping, and the other activities listed in the previous question-answer. Head massage or vibration may be helpful too.
• Does he have seizures or migraines on a regular basis? Even if he is on medications that doesn't mean these problems are under control. I have had numerous kids over the years head bang, eye poke, & nose poke during, before, or after a seizure. Some kids have mixed types and although they may usually stare off, that may not always be the case.
• Does the child have a visual impairment or functional visual deficit? For children with some vision (low vision) or who see double (diplopia), they may get eye aches and think it feels good to bang their head. In this case, darken the room and minimize the work the eyes must do. If the child is head banging as you are having them work on puzzles or other fine-motor activities, then give frequent breaks or cut the session short. If the child should be wearing glasses, then insist they do. Build up to all day starting with 30 minute increments; but don't skip a whole day or play with toys up close without the child wearing the prescription glasses.
• Is he dependent upon head banging to rock himself to sleep because he has no other strategies? If so, help teach self-reglation and self-calming activities. Some kids suck their thumbs until they fall asleep whereas others hum, sing, or hold a soft toy. For this child, provide lots of motion activities throughout the day which may shorten the length of time the child head bangs in the evening. Some kids do well with compression such as tightly tucked in sheets, large heavy pillows placed around their bed, and tight pajamas.
• If the head banging is so severe that the walls or furniture are getting damaged, then this is excessive force. Consider having the child wear a soft helmet to protect his own head as well as the surfaces he hits. Try using lots of pillows too.
• Is the child head banging for attention or avoidance? If so, behavioral strategies may be needed to stop this behavior. If it is for attention, then quit being the audience and try your best to ignore it. Now, everyone in the family and at school (preschool) must be on board, or the child thinks he just has to head bang harder or longer in order to gain your attention. Try to give attention to him when he is not head banging...save the computer, TV, and phone talking that you do for another time, and give the child lots of positive attention during his waking hours.
• Does the child have a reason to have an itchy head? Lice, eczema, dandruff, scabbs, etc. should be considered. If you do not know what lice or their eggs look like, then search the Web and I'm sure you can find loads of information. Discuss treatment for lice with your child's physician. If eczema is a possibility, then discuss this with your child's physician; the child may need prescription shampoo and lotion for his head.