Oral Motor Tools for Feeding

 Try these tools for at-home feeding therapy:

Tool:	Use for:	How to use:
Chewy tube	Chewing skills Jaw gradation	1)    Place chewy tube on molars.  Have the child chew in sets of 5-10 reps on each side.        2)      Start with smallest chewy tube and build up to large chewy tube.
Nuk brush	Tongue lateralization	Dip in puree and have child reach the target. Place at corners of the mouth and inside of cheeks.
Toothette	Tongue strength Tongue range of motion	Dip in liquid and place on side of tongue. Have child push against the target.
Lollipop	Tongue lateralization	1)      Place on center of tongue and have child move it to molars 2)      Place on molars and have child move it to center of mouth   3)      Place on inside of cheek and have child move it to center of mouth
Popsicle	Tongue strength Tongue range of movement	Place popsicle in front of or on sides of mouth and have child lick the popsicle.
Frosting	Tongue strength Tongue range of movement	1)      Have child lick off frosting placed on upper lip, lower lip, and corners of the mouth. 2)      Have child lick frosting off of the back of a spoon.
Dissolvable solids (Cheese puffs, ice cream, graham crackers, etc.)	Chewing skills Jaw gradation Tongue lateralization	Place dissolvable solids on molars and have the child chew.

Child Nutrition

Nutrition is critical in children's early years of development. In these years, children are learning a growing a great deal, and they require adequate nutrition in order to do so. It can be a distressing experience when your child is not receiving proper nutrition due to delay in feeding skills or persistent food refusal. Strategies for improving your child's nutrition include:

· Try to expose your child to a variety of food types, textures, and flavors to facilitate comfort level with a variety of healthy foods.

· Aim to offer your child the most nutrient rich, natural foods. Consider buying organic foods, which contain less harmful chemicals and pesticides.

· Read product labels before buying foods. Don't just read through the calorie and fat content. Rather, study the list of ingredients to be sure that you are offering healthy choices for your child. Try avoiding foods that contain artificial colors or flavors. 

· Offer foods that will provide rich sensory experiences. These include foods with stronger and/or distinct tastes. It is preferable to use adult foods (e.g., graham crackers, bananas, avocados) rather than baby/toddler food products.

· Try to offer a well-balanced meal that includes the following three components: a whole grain, a protein, and a fruit/vegetable.

· If your child is not getting adequate nutrition from foods in his diet, consider adding a nutritional supplement, such as Pediasure, or a multivitamin. 

· Be sure to make nutrition the number one goal for your child. In a feeding therapy program, nutrition should be prioritized over other goals such as use of utensils or advancement to solids.  

· If your child is not getting adequate nutrition and has a dangerously low weight for height, short or long term implementation of a feeding tube may be indicated. Most children who have a tube in place, unless medically contraindicated, are able to continue with an oral feeding therapy program.

DIR®/Floortime

Chatterboxes’ speech-language pathologists are trained to provide DIR®/Floortime™ to their patients when appropriate.

DIR®/Floortime™ is a framework which helps parents, clinicians and educators complete comprehensive evaluations and develop treatment programs customized to the unique strengths and weaknesses of children with developmental challenges, including Autism Spectrum Disorders (ASD), among others. The DIR®/Floortime™ model aims to build the underpinnings for social, emotional, and intellectual capabilities, rather than focusing on individual skills and behaviors.

D = Developmental: Functional developmental capacities that integrate the most essential cognitive and affective processes

I = Individual Differences: Biologically-based differences in sensory processing, modulation, muscle tone, and motor planning and sequencing

R = Relationship: Affective interactions build social and emotional development, intelligence, and morality

Basic Principles of Floor Time:

1) Follow the child’s lead
2) Join in at the child’s developmental level and build upon his/her natural interests
3) Open and close circles of communication
4) Create a play environment
5) Extend the circles of communication
6) Broaden the child’s range of interactive experience
7) Tailor the interaction to the child’s individual differences
8) Simultaneously attempt to mobilize the six functional developmental level

For more information on the DIR^®/Floortime™ Model, please visit: www.icdl.com.

The Language of a Meal

The language you use in reference to foods can influence your child's perceptions about

foods. You can improve your child's eating attitudes and behaviors by teaching your

child about foods and being thoughtful about how you talk about foods.

• Avoid categorizing foods as healthy and not healthy. Many people associate healthy foods as not tasting good or as not being as fun as non-healthy foods. Instead, consider calling healthy foods "strong foods" or "growing foods" to create positive associations with these foods.
• Modify the language allowed to be used with reference to food. Don't allow your child to say, "I don't like it!" Instead encourage phrases such as "It's a new food," or "It's not my favorite."
• Use first-then language. Let your child know that he may have a preferred food after eating/interacting with a novel/non-preferred food.
• Use positive directives. For instance, instead of telling your child, "Stop banging your spoon," instruct your child, "Put your spoon on the table."
• Offer task specific praise. For instance, say, "Nice bite!" or "Good chewing!" rather than more general phrases such as "Good job!" so that your child knows exactly why he is being rewarded.
• Children have a natural desire to be in control. Offer your child choices when appropriate. These may include choosing which plate or cup to use and may also include choosing which vegetable to eat. When offering children choices, be sure that you will be happy with either choice.
• Talk about the foods you are eating. You can teach your children about where foods comes from (e.g., Apples grow on trees). You can also discuss what the foods look, taste, or feel like (e.g., Frozen yogurt is cold! Chicken soup is hot!).
• Read books about foods to increase your child's understanding and familiarity with foods. For younger children, look for board books with colorful pictures of foods or even search out books that are scented like the foods. For older children, seek books that teach about where foods come from or how foods are cooked. There are also lots of silly books about food available at any book store!

Links:
Parent's guide to feeding strategies & positive mealtime behavior
Chatterboxes feeding therapy
Feeding therapy FAQ

Strategies for Conversation with Children who have Childhood Apraxia of Speech

Children with Childhood Apraxia of Speech (CAS) tend to communicate more easily when there is less communication pressure. To reduce this pressure, try to:

• Make more comments in conversation than questions.  When you ask a question, it is demanding that the child responds right away and with particular information. Only ask questions when necessary.

• Reduce the frequency of asking the child to repeat something he has said, as this can lead to increased frustration and communication breakdown.  When you do not understand what your child has said, it’s OK to “go with the flow” and make a general comment (e.g., That’s cool!) to keep the interaction going.

• Make comments that are related to the activity you are engaging in with the child instead of aspects of the child’s speech.  For instance, while playing with dolls, you might say, “Oh no the baby’s crying,” or “She’s sleepy” rather than “Nice job talking,” or “You had a hard time saying that.”

• Avoid putting your child on the spot when greeting other people. For example, telling your child to say “Hi” or “Good morning” to someone can be a very demanding task with which your child may have difficulty, resulting in communication breakdown.

• Avoid putting your child on the spot in front of an audience by asking him to tell other people about something (e.g., Tell Sarah about your birthday party, Tell James what you did at school). 

• Try not to focus on “getting your child to talk” and rather focus and having fun with your child in conversation and play.

• Talk about things your child is interested in. When you do so, your child may be more likely to make a comment.  Just as adults enjoy talking about particular subjects, oftentimes so do children.

• Make conversation fun and light-hearted and maybe even silly, as this can reduce tension and create a more relaxed atmosphere, thereby increasing the likelihood of your child participating in conversation.

10-Step Plan for Improving Nutrition and Feeding for Children with Autism

1) Transition to a healthy diet: Avoid food additives, pesticides, refined sugars, processed foods, and trans fats

2) Get enough basic nutrients: Water, Macronutrients (protein, carbohydrates, and fat), Micronutrients (fat soluble vitamins and water soluble vitamins)

3) Take a multivitamin and mineral supplement: Containing 100-300% RDA of fat soluble vitamins (A, D, E, K), vitamin B complex (B1, B2, B3, B5, B6, B12, folic acid, biotin), vitamin C, minerals (calcium, magnesium, zinc, selenium, manganese, chromium, molybdenum); Avoid multivitamins that have artificial colors and flavors, potential allergens and herbs

4) Increase Omega-3 fatty acid: Eat fish and other foods that contain Omega-3 and/or with a supplement.

5) Improve feeding problems: Enroll in the feeding therapy program if: Restricted repertoire of foods (less than 20 foods), Foods lost from diet due to burnout, and foods not regained into the diet, Persistent refusal of novel foods, Refusal of entire food texture groups.

6) Heal the gut: Signs of gastrointestinal (GI) disorder include abdominal pain, bloating, gaseousness, diarrhea, constipation, reflux, vomiting, food refusal, limited variety of foods, mealtime tantrums, irritability, self abuse, sleep disturbances. Treat by modifying the diet, eliminating problematic foods, and/or taking supplements, including probiotics, antifungals, digestive enzymes, therapeutic levels of Omega-3 fatty acids, and glutamine

7) Identify food allergies and implement treatment: Foods responsible for 90% of allergic reactions include milk, wheat, soy, egg, peanuts, tree nuts, fish, and shellfish

8) Try an elimination diet: Most popular is the Gluten Casein Free Diet (GFCF)

9) Try high dose vitamin B6 with magnesium

10) Consider additional supplements: To enhance immune system: dimethylglycine (DMG), iron, magnesium, selenium, zinc, vitamins A, C, D, and E. To enhance cognitive function: carnitine, choline, coenzyme Q10, iron, zinc, ginkgo biloba. To enhance detoxification system: alpha-lipoic acid, glutathione, N-acetylcysteine, selenium, trimethylglycine (TMG), vitamin C, milk thistle

-Courtesy of Elizabeth Strickland