I have a lot of therapy strategies up my sleeve when it comes to pediatric feeding disorders. Some of them include fancy positioning equipment, oral-motor devices, stretches, and textured teething toys. Some of my strategies even require that I become "certified" just to use them. Yet, the most effective strategy that I have found so far is to show up during family meal or snack time for children and during a scheduled bottle feeding for infants. It sounds SO simple, but it works!
For many of the children I work with they can perform a certain skill such as munching a soft diced vegetable if I was to give them just a couple of pieces in between some mouth exercises at a time in which they were not even hungry. They might even be able to hold a spoon if we practiced scooping up toys out of a sand box while we are playing in their room. But that doesn't mean they have the muscular endurance and sensory processing abilities to chew three different foods on the plate while using utensils to feed themselves. It is hard for many children with feeding disorders to handle more than one food due to the various flavors, temperatures, resistances, and textures. Additionally, they may be able to chew the food, swallow the drink, and manipulate the cup and utensils when sitting alone, but can't handle it when there are more people present. Why is that? Well, every child may have a different reason, and I am not going to know "why" unless I directly observe the meal within the natural setting: family meal time. If that isn't possible, then I observe snack time.
What does family meal time look like? It is different for everyone. I tell the families to set everything up as if I wasn't there. The meal may occur in front of the TV on the couch with one of the three siblings next to the child I am working with or it may occur at the dining room table with every household member present. I just want to see what naturally occurs during the meal time routine...there is no right or wrong. For some children they may not be able to participate in family meal time because of the noise level. For others it might be that they are sitting too close to a sibling that keeps inadvertently touching them. Even after I observe family meal time, I may still not know why the child is having difficulty with eating. That is when I watch the child eat a variety of foods while he is alone. If I figure it out, then we may work on specific skills separate from meal time, but even then the intention is to include the child in family meal time. Some children may need some 1:1 work with oral motor exercises, fine motor play, a "sensory diet", and other strategies immediately prior to family meal.
For those kids who can't handle eating with their family, maybe they could at least sit and socialize or just "be" there, even if they have to eat before or after everyone else. Just "being" with everyone else at the table might be the only way a medically-involved or tube-fed child can participate, and that is okay.
It breaks my heart when I find out that the child with the feeding disorder is not included in any form or fashion just because he has a feeding disorder. If the child's sensory processing abilities don't allow him to be with the rest of the family, then maybe he could help with meal preparation or setting the table.
For babies with feeding disorders, I show up for occupational therapy at one of their scheduled feedings and watch the parent (or caregiver) feed the child. I offer suggestions if needed. I may follow up with stretches and ideas for pacing, positioning, burping, and nipple/bottle changes. If the child is having alot of problems, then I may feed the child. But the problem with that is that babies that are oral feeders get usually 6-8 bottles a day and I am not going to be present for all of those feedings! So, the natural routine of the meal is going to be the adult holding the baby (or placing them in a device) while feeding him. Sometimes I do the first half of the feeding process for training purposes, and then after the baby has burped I will have the parent try to do the same things I did. After all, feeding your baby is the most basic thing that every parent wants to do successfully!
I guess my biggest "take home point" from this blog entry today is try to work with the child within the natural routines. If the strategies given to the family aren't meaningful to them and feel like extra work, then they will not work on them between the therapy visits. On the other hand, if the strategies are purposeful and occur within routines they already have, then the family is more likely to use the therapist's ideas.
Showing posts with label natural environments. Show all posts
Showing posts with label natural environments. Show all posts
Friday, October 1, 2010
Friday, September 10, 2010
Changing the Environment & Interaction Style to Help Kids with Developmental & Sensory Processing Delays
I have worked in a variety of settings: school system, hospital, outpatient clinics (more than one), early intervention, and home health. I have been working in early intervention and home health over the past 6 years, because I have found it to be my "niche". Why is that you ask? Well, I believe that helping children in their natural environments such as the home, daycare, and other community settings is where the biggest changes will be made. Now I am not saying therapy clinics are a bad place; I have worked in those settings and thoroughly enjoyed it and know that most of the kids had fun there. But the main focus of working with a child in a clinic, is the child and his deficits. Yet, in their natural environments the focus is not only the child but all of the people that come into contact with him on a regular basis and how every one and thing can help. Isolating the child in a clinic to work on fine-motor, feeding, language, behavior or whatever other skills doesn't necessarily carryover to how the child will function in another environment in which all of those "therapy toys" are not present; it may carryover for somethings and it may not. In home health settings, a therapist helps the family utilize what they already have in the places the child will be at on a regular basis.
A recent example of what a difference I was able to make in a child's life was through teaching the daycare staff how to work with a particular young boy. He is almost 2 years old and has significant developmental delays as well as mild spasticity due to some complications with being born at 27 weeks gestation- "a preemie". He has limited range of motion in his upper body in which it is hard for him to raise his arms over his head. He also has difficulty with tight hamstrings- the muscles in the back of the legs. So, when I observed "music and movement" time at the daycare, I was able to help the teacher incorporate some stretches and movements that would benefit this child as well as his peers, including touching toes while sitting in the floor. Now, he will get to do these stretches 5 times a week since he goes to daycare 5 days a week and they follow the same schedule each day. In addition, we altered the chair that he sits in at lunch time to a shorter chair so that he can now independently climb in and out of the chair. Other areas that were helped were naptime, outdoor play on the playground, and "centers" for fine-motor play. By teaching the teachers how to adapt the activities, alter their interactions such as by saying particular phrases, and by altering things within the environment, this child became more independent. If I had seen this child in a clinic, my focus would have been to teach some of these skills but without meeting the daycare staff and watching the sequence of the routines, I would not have been able to help this child as much.
Another example includes a child I see at his home who has significant behavior problems, sensory processing problems, and a short attention span. By teaching his mom to set up activities that he can be independent with at a small table within her line of vision, she can now cook dinner without him "getting in trouble". In the past, this child only acted well when given immediate 1:1 attention by an adult. So, I taught Mom to help him with an activity, and initially be on the other side of the room from him. Then, she progressed to leaving for 1-2 minutes, which then led to her being away from his side for 5-10 minutes. Within no time, she was able to do this in the kitchen and successfully cook supper without any (or at least only at times) "meltdowns". If I had not been in the home to teach his mom this activity, and only told her how to do it, he would probably not have been successful with this. The first time we tried to leave his side as he played alone even briefly, she wasn't thinking "it was going to work". So often, the parents and other caregivers just need us (therapists and other professionals) to show them how to do something and then they can do it on their own.
In the past, I thought that when I worked in a clinic and typed up a home program full of suggestions that that would help; that may be the case for some families, but most need to be shown! Also, I was giving general suggestions even if I thought I was individualizing it, because I had never walked into that child's daycare or home, so how could I have been completely individualizing it! Really, I was giving exercises and strategies aimed at decreasing the child's deficits such as poor balance, hand weakness, etc. I now realize I was only helping such a small portion of that child's daily routines.
If your child receives private OT, PT, SLP or other services at a clinic or other place than the home or daycare, ask the therapist to come do one or more home visits. If that is not possible, make video recordings of the different routines that don't work well.
A recent example of what a difference I was able to make in a child's life was through teaching the daycare staff how to work with a particular young boy. He is almost 2 years old and has significant developmental delays as well as mild spasticity due to some complications with being born at 27 weeks gestation- "a preemie". He has limited range of motion in his upper body in which it is hard for him to raise his arms over his head. He also has difficulty with tight hamstrings- the muscles in the back of the legs. So, when I observed "music and movement" time at the daycare, I was able to help the teacher incorporate some stretches and movements that would benefit this child as well as his peers, including touching toes while sitting in the floor. Now, he will get to do these stretches 5 times a week since he goes to daycare 5 days a week and they follow the same schedule each day. In addition, we altered the chair that he sits in at lunch time to a shorter chair so that he can now independently climb in and out of the chair. Other areas that were helped were naptime, outdoor play on the playground, and "centers" for fine-motor play. By teaching the teachers how to adapt the activities, alter their interactions such as by saying particular phrases, and by altering things within the environment, this child became more independent. If I had seen this child in a clinic, my focus would have been to teach some of these skills but without meeting the daycare staff and watching the sequence of the routines, I would not have been able to help this child as much.
Another example includes a child I see at his home who has significant behavior problems, sensory processing problems, and a short attention span. By teaching his mom to set up activities that he can be independent with at a small table within her line of vision, she can now cook dinner without him "getting in trouble". In the past, this child only acted well when given immediate 1:1 attention by an adult. So, I taught Mom to help him with an activity, and initially be on the other side of the room from him. Then, she progressed to leaving for 1-2 minutes, which then led to her being away from his side for 5-10 minutes. Within no time, she was able to do this in the kitchen and successfully cook supper without any (or at least only at times) "meltdowns". If I had not been in the home to teach his mom this activity, and only told her how to do it, he would probably not have been successful with this. The first time we tried to leave his side as he played alone even briefly, she wasn't thinking "it was going to work". So often, the parents and other caregivers just need us (therapists and other professionals) to show them how to do something and then they can do it on their own.
In the past, I thought that when I worked in a clinic and typed up a home program full of suggestions that that would help; that may be the case for some families, but most need to be shown! Also, I was giving general suggestions even if I thought I was individualizing it, because I had never walked into that child's daycare or home, so how could I have been completely individualizing it! Really, I was giving exercises and strategies aimed at decreasing the child's deficits such as poor balance, hand weakness, etc. I now realize I was only helping such a small portion of that child's daily routines.
If your child receives private OT, PT, SLP or other services at a clinic or other place than the home or daycare, ask the therapist to come do one or more home visits. If that is not possible, make video recordings of the different routines that don't work well.
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