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  • Eating with a Cleft

    “A cleft lip and/or palate is one of the most common craniofacial malformations, occurring worldwide” (de Vares et al., 2023). Clefting of the mouth interferes with the success of a child's eating, impacting the ability to seal the nipple during breastfeeding or not having the strength to suck enough milk for nutrition (Robin et al., 2006). A cleft is when there is a separation of the mouth that is usually joined (Morris & Klein, 2000). A separation can be anywhere in the mouth, running from the lips to the nasal cavity. The most common clefts that are seen are one-sided clefts where one side is separated, or if both sides are affected, the left side is usually more affected. Additionally, clefts are more common in males than females. Children with a cleft palate or cleft lip tend to demonstrate a slower growth rate due to the increase difficulty to efficiently eat. Both the lips and palate are important for successful eating, as the lips create a seal for incoming liquids or foods from spilling, and the palate creates a boundary and directs the food and liquid to the throat down to the stomach. Since clefts can interfere with a child’s success in eating, surgery is an option in the first months after birth. If surgery is not done, there are several alternatives to help create a pleasant experience when it comes to eating and feeding. Challenges: Lengthy feeding times Frequent feeds Nasal regurgitation Vomiting from excessive air intake Colic Insufficient nutritional intake Weight gain Coughing and choking during feedings Maintaining oral hygiene Helping Children With a Cleft: Use your fingers to close off where the cleft is Position baby sideways like holding a football for a secured breastfeeding position Slowly introduce small amounts of foods Allow the baby to initiate incoming food to their mouth Modify seating position Implement a teeth brushing routine Using the right bottle Cleft Lip/Palate Nurser by Mead Johnson Provide a squeeze to the bottle when your baby is sucking When your baby pauses, you pause SpecialNeeds Feeder Keeps milk in the nipple of the bottle where suction is not required Dr. Brown’s Specialty Feeding System with One-Way Valve Keeps milk in the nipple of the bottle where suction is not required The baby controls the flow of liquid Pigeon feeder Fits on any standard bottle Keeps milk in the nipple of the bottle where suction is not required The baby controls the flow of liquid Has a soft and hard side, the soft side hitting the baby’s tongue A small notch on the nipple acts as an air vent. This notch should go under the baby’s nose. Tightening the nipple, slows the flow of liquid References Coffee, G. (2021, October). Cleft lip and cleft palate feeding. Cincinnati Childrens. https://www.cincinnatichildrens.org/health/c/cleft-feeding de Vries, I. A. C., Guillaume, C. H. A. L., Penris, W. M., Eligh, A. M., Eijkemans, R. M. J. C., Kon, M., Breugem, C. C., & van Dijk, M. W. G. (2023). The relation between clinically diagnosed and parent-reported feeding difficulties in children with and without clefts. European Journal of Pediatrics, 182(5), 2197–2204. https://doi.org/10.1007 /s00431-023-04852-1 Helping Hand. (2019, August). Cleft palate: Feeding your baby. Nationwide Children’s Hospital. https://www.nationwidechildrens.org/family-resources-education/health- wellness-and-safety-resources/helping-hands/cleft-palate-feeding-your-baby Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive resource for mealtime development. Pro-ed International Publisher. Patient and family education: Cleft feeding instructions. Seattle Children’s Hospital. (n.d.). https://www.seattlechildrens.org/clinics/craniofacial/patient-family-resources/cleft- feeding-instructions/ Penny, C., McGuire, C., & Bezuhly, M. (2022). A systematic review of feeding interventions for infants with cleft palate. The Cleft Palate-Craniofacial Journal: Official Publication of the American Cleft Palate-Craniofacial Association, 59(12), 1527–1536. https://doi.org /10.1177/10556656211051216 Robin, N. H., Baty, H., Franklin, J., Guyton, F. C., Mann, J., Woolley, A. L., Waite, P. D., & Grant, J. (2006). The multidisciplinary evaluation and management of cleft lip and palate. Southern Medical Journal, 99(10), 1111–1120. https://doi.org/10.1097 01.smj.0000209093.78617.3a

  • How to Become a Feeding Therapist

    There is no one path to becoming a feeding therapist. Every feeding therapist has had a different story of how they specialized in feeding. A therapist that is interested in feeding can either become skilled or certified. Becoming skilled includes no credentials, and learning is all self-taught or from a current feeding therapist. Becoming a certified feeding therapist includes credentials by taking a series of classes that allow the therapist to acquire advanced knowledge of feeding therapy practices. In order to become a confident feeding therapist, it is recommended that both occupational therapists and occupational therapy assistants search for feeding therapy mentors, observe feeding therapy sessions, actively treat a feeding therapy session with supervision/feedback, read books, and take as many CEU/webinars as possible. The following resources are recommended courses, readings, and steps to becoming certified! Recommended Self-Education Pediatric Feeding Disorders on Summit Professional Education Food Chaining Book by Fraker, C., Fishbein, M., Cox, S., & Walbert, L. Infant and Child Feeding and Swallowing: Occupational Therapy Assessment and Intervention by Sherna Marcus & Suzanna Breton Anxious eaters, anxious mealtimes: Practical and compassionate strategies for mealtime peace by Marsha Dunn Klein Pre-Feeding Skills: A Comprehensive Resource For Mealtime (Second-Edition) by Suzanne Evans Morris & Marsha Dunn Klein Feeding Matters How to become a certified feeding therapist? When an occupational therapist becomes certified, they will have the credentials SCFES, which stands for Specialty Certification in Feeding, Eating, and Swallowing (SCFES) (Feeding Matters, n.d.) Steps: https://www.feedthepeds.com/ OR https://sosapproachtofeeding.com/sos-certification/ References Basco, K. K. (n.d.). Pediatric feeding disorders - summit professional education. Summit Education. https://summit-education.com/course/CFEEKB.1/pediatric-feeding- disorders#VIDEO/ONDEMAND.CFEEKB.1 Feeding matters. (n.d.). Feeding skill. https://www.feedingmatters.org/what-is-pfd/feeding- skill/ Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet. Hachette Books. Klein, M. D. (2019, November 8). Anxious eaters, anxious mealtimes: Practical and compassionate strategies for mealtime peace. Archway Publishing. Marcus, S., & Breton, S. (Eds.). (2022). Infant and child feeding and swallowing: Occupational therapy assessment and intervention (2nd ed.) AOTA Press. Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive resource for mealtime development. Pro-ed International Publisher.

  • Benefits of Feeding Therapy

    Feeding therapy helps any child develop healthy and typical habits with food. Feeding therapy teaches a child the basics of “how to eat” by addressing the barriers, fears, or difficulties with food. The goal is to change the perspective of eating as being an unsafe alerting experience to a safe and enjoyable experience. Feeding, eating, and swallowing is addressed by multiple disciplines depending on the child or patient's needs. When the disciplines collaborate as a team to help the child, the route can lead the child on a happy and successful road with food. Check out the "Interdisciplinary Roles in Feeding & Eating" post for detailed information on what each discipline addresses.

  • Breastfeeding

    Breastfeeding is known to be the best source of nutrition to help decrease the risk of the infant developing undesirable health conditions. Undesirable conditions may be: allergies, eczema, asthma, obesity, type 1 diabetes, severe lower respiratory disease, acute otitis media (ear infections), sudden infant death syndrome (SIDS), and/or gastrointestinal infections (diarrhea/vomiting) (Centers for Disease Control and Prevention, 2023). In addition, breastfeeding provides benefits such as taste bud development leading to an increased success when the baby starts to explore foods this world has to offer (Darby, n.d.). The mother's breast milk reflects the mother’s diet and will likely make the child more accepting of flavors of table foods (formula feeding can affect the child’s willingness to try table foods) (Toomey et al., 2017). It is important to be able to identify an infant's hunger cues as it is their way of saying "I want food/breastmilk!" A responsive mother leads to positive feeding experiences (Satter, 2000). One good tip, when to wean off of breastmilk to introduce solids; the answer ranges but when the child’s first tooth breaks through the gums! When a tooth appears, that is the body saying I am ready to explore foods! Some mothers have also brought up the concern of not having enough breastmilk. The breastmilk production will reflect on how much the mother eats (Satter, 2000). It is important that the mother listens to her internal cues on when her body is signaling hunger, breastmilk production should not be an issue. The only reason a mother would not listen to her internal cues is if she is overtired, nervous, or sick where one's appetite is suppressed (it is still important to eat for breastmilk production!). The first few months is the only time in feeding therapy when the therapist will ask not to have a feeding schedule, as breastmilk supply and demand are important for the infant's growth. Therefore, it is important that the mother's maternity leave is long enough (six weeks or more) in order to get a well-established breastmilk supply (Satter, 2000). However, if six weeks is not achievable, a lactation specialist can provide tips on milk production depending on your specific limitations. What Breastfeeding Looks Like, Symptoms of Ineffective Breastfeeding, & Solutions: YouTube Video (Fauquier ENT, 2014) How to identify hunger cues in an infant: Early cues: stirring, mouth opening, turning head seeking/rooting Mid cues: stretching, increasing physical movement, hand to mouth Late cues: crying, agitated body movements, color turning red, must calm down before attempting to eat What successful breastfeeding looks like: It does not hurt! This means your baby has the proper nipple latch. You are often nursing. In the 24 hours of the day, feeds typically range from 8-12 times a day! You can hear your baby swallowing. This means he/she is intaking your milk! Your baby's weight is increasing slowly Your baby's mouth fits around the breast, not just the nipple The feeding time averages 20-30 minutes and decreases as the baby get older Your baby is urinating often, such as 6-8 times or more throughout the day References Centers for Disease Control and Prevention. (2023, April 4). About breastfeeding. Centers for Disease Control and Prevention. https://www.cdc.gov/breastfeeding/about- breastfeeding/index.html Darby, J. (n.d.). Picky Eaters - Summit professional education. Summit Education. https://summit-education.com/online-course/2309428 Fauquier ENT. (2014, August 14). Breastfeeding problems[Video]. Youtube. https://www.youtube.com/watch?v=XZae0tz8RPE Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet. Hachette Books. Sanghui, N. S. (n.d.). Sensory, cognitive, and motor planning interventions to support successful mealtime. Summit Education. https://summit-education.com/online-course /2309430 Satter, E. (2000). Child of mine: Feeding with love and good sense. Bull Publishing Company. Toomey, K. A., Ross, E. S., Kortsha, B. C., Beckerman, L., Fitzpatrick, K., & Lagerborg, D. (2017, November). When Children Won’t Eat: Picky Eaters vs. Problem Feeders. Assessment and Treatment Using The SOS Approach to Feeding.

  • The Battle with Toddlers & Food

    It is known that toddlers have an increased desire to be independent within the environment they live in. Toddlers want independence and control because they are experiencing many changes, learning to walk, move, talk, and interact with peers. Toddlers also learn how to say NO, and saying no is their job. Toddlers go through a lot of changes in their early developmental stages; however, one thing they do not want to change is the food they eat every day. For them, eating the same thing every day is what they desire. Eating the same foods every day can lead a toddler to develop food neophobia: the fear of trying new foods (Klein, 2019). Toddlers that are typically developing will grow out of this phase when they have repeated positive exposures with mealtime and food! If the phase is still lasting out of toddlerhood, try the solutions listed below on "How to Address the Battle" or address concerns with the pediatrician to see if therapy may be beneficial. If your child is not a toddler yet, start creating change now! Familiarity with change can decrease the chances of toddlers having worry or anxiousness when it comes to change. Change can include changing an ingredient in their smoothie recipe, offering a grape with all their strawberries, or adding a small amount of meat to the spaghetti sauce. If your child does not work well with change in general, make sure they are very small changes! Toddlers & Food: They are skeptical - if it is different from their typical routine, they will need time to explore the food and see how others interact with it They are inconsistent - what they like one day, may be different another day They are opinionated - they like to feel like they know what is best for them and what is not best (They like being in control!) How to Address the Battle: Have a routine for example: 3 meals a day with snacks in between Plan a family menu to pick from (do not make it too large or too small) Once at the table, let them eat how they want to eat it Allow them to play and get messy with their food Do not allow grazing ("snacking") throughout the day Praise for good eating habits, ignore bad eating/behavior Remove all distractions during mealtime (e.g., television, tablet, phone) Only offer what the family is eating, do not cater special foods just for your toddler Always has a preferred food on the table References Klein, M. D. (2019, November 8). Anxious eaters, anxious mealtimes: Practical and compassionate strategies for mealtime peace. Archway Publishing. Satter, E. (2000). Child of mine: Feeding with love and good sense. Bull Publishing Company.

  • Signs and Causes of Inadequate Eating and Feeding

    Physical RED FLAGS to look out for: Ranked below the 10th percentile for growth Dark circles under the eyes Loss of skin color Dizziness Fainting Dry skin Cracking lips Hair loss Poor wound healing Fatigue Irritability Sleep disruption Underweight Painful joints Brittle nails Shortness of stature for age Mealtime WARNING SIGNS Gagging Coughing Back arching Disengagement - turns head away from the food source Watering eyes Difficulty initiating a swallow The child changes in color “Wet” or “gurgly” sounds after eating Excessive drooling and unaware of it Overstuffing Strong preferences for the type of nipple or pacifier Aspiration Vomiting Food refusal Lengthy mealtime Delay in texture advancement Mouth breathing Loss of appetite Spitting out food Throwing food Causes of Feeding Disorders Nervous system disorders (e.g., cerebral palsy or meningitis) Stomach problems Being born prematurely Heart disease Having a cleft lip or palate Having breathing problems Autism Poor postural control Poor muscle strength Medicines that decrease appetite Sensory aversions Having a tube insertion Signs of Food Allergies Hives Rash Eczema Itching Swelling of lips, face, tongue, or throat Stomach pain Diarrhea Vomiting Anaphylaxis reaction (obstruction of the airways) Signs of Silent Aspiration Frequent colds Coughing Frequent congestion Choking Wet breathing sounds Watery eyes during food consumption Limits their liquid intake from "not feeling right" *Silent aspiration is very hard to observe; the Modified Barium Swallow Study is the only thing that can determine if your child is aspirating their foods. Keep a log of concerns and symptoms as they occur to share with your pediatrician* Note: Ensuring that the child’s weight, length, and head circumference correlates with a good growth curve is important (look at CDC.gov for growth curves for specific disorders) References American Speech-Language-Hearing Association. (n.d.a). Feeding and swallowing disorders in children. American Speech-Language-Hearing Association. https://www.asha.org /public/speech/swallowing/feeding-and-swallowing-disorders-in-children /#:~:text=An%20SLP%20trained%20in%20feeding,moves%20their%20mouth%20and%20ton gue Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet. Hachette Books. Marcus, S., & Breton, S. (Eds.). (2022). Infant and child feeding and swallowing: Occupational therapy assessment and intervention (2nd ed.) AOTA Press. Taylor, T., & Taylor, S. A. (2021). Let’s not wait and see: The substantial risks of paediatric feeding problems. International Journal of Child & Adolescent Health, 14(1), 17–29. Toomey, K. A., Ross, E. S., Kortsha, B. C., Beckerman, L., Fitzpatrick, K., & Lagerborg, D. (2017, November). When Children Won’t Eat: Picky Eaters vs. Problem Feeders. Assessment and Treatment Using The SOS Approach to Feeding. Typical development of feeding skills - San Diego occupational therapy. San Diego Occupational Therapy. (n.d.). https://sandiegooccupationaltherapy.com/wp-content /uploads/2012/01/TypicalDevelFeeding.pdf

  • The Controversy of Obesity & Eating

    “The risk of childhood obesity increased with increased parental concern about obesity and with increased incidence of early childhood feeding problems” (Satter, 1983). Additionally, Satter (1983) has found population studies to be presenting a major theme where the more television children watch, the heavier they tend to be. When watching television throughout the day, during a meal or not, the child is focused on what is on television rather than their internal cues on whether they are hungry, starving, or full. ALkhalik et al. (2022) studied children that ate fruits and vegetables once a week rather than daily were at a higher risk for obesity. Fruits and vegetables are good foods to implement in your child's daily food intake as they are low in calories, high in fiber, and tend to have a satisfactory impact. It is important to allow children to rely on their internal regulation when it comes to eating; when they feel hungry, allow them to use their inner tunes (feelings) to eat (Satter, 1983). In addition, provide ample learning opportunities with food by introducing foods from each food group, such as fiber, vegetables, fruit, dairy, and protein. If children are forced to eat, children will start to rely on outside sources of regulation instead, such as eating when stressed, refusing to eat when forced to sir, or only eating with the television on. Tips to Reduce the Risk of Childhood Obesity: Develop a positive feeding environment (no forcing of foods, no negative comments) Implement exercise or movement activities daily (can be as simple as walking) Include a variety of vegetables, fruits, whole grains, lean protein foods, and dairy in your child's meals daily Encourage drinking lots of water Set a consistent sleep schedule Reduce screen time References Abd AL-khalik, A., Al-Hafidh, A. H., & Kadhum, S. A. (2022). Relationship of eating habits and obesity among children under 5 years in primary health care centers at Hilla City, Iraq. HIV Nursing, 22(2), 1751–1757. https://doi.org/10.31838/hiv22.02.336 Satter, E. (2000). Child of mine: Feeding with love and good sense. Bull Publishing Company. U.S. Department of Health & Human Services. (2022, August 29). Preventing childhood obesity: 4 things families can do. Centers for Disease Control and Prevention. https://www.cdc.gov/nccdphp/dnpao/features/childhood-obesity/index.html

  • Eating with ADHD

    Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders. Symptoms of ADHD include: difficulty staying focused, difficulty paying attention, difficulty controlling behavior, and over-reactivity. The prevalence in the U.S. is 86% of children have ADHD. Parents of children with ADHD tend to have a diminished quality of life, increased economic costs, and increased risk for developing long-term academic underachievement. If ADHD goes untreated, it increases the risk of conduct, violence, alcohol dependence, antisocial behavior, and criminality. In children with ADHD, there is a chemical imbalance in the brain where the body is not functioning properly, such as digesting and detoxifying certain foods. The inability to digest and detoxify certain foods balancing the body's homeostasis tends to increase ADHD symptoms. In addition, if the body is nutritionally deficient, everything tastes bad and bland, leading to more picky eating tendencies (decreased appetite). What can Feeding Therapy do for clients with ADHD? Develop strategies to increase attention span during mealtimes (at school, dinner table) Refer to other specialists that may be able to provide internal health solutions A gastrointestinal (GI) specialist can help determine the client’s current gut health, as gut health correlates with full body function, such as attention span. Changing the child’s diet can… Relieve GI problems Lessen constipation Improve language skills and learning Increase focus and attention Reduce hyperactivity Increase better sleep Ease toilet training Reference Darby, J. (n.d.). Nutrition management for patients with ADHD - Summit professional education. Summit Education. from https://summit-education.com/online-course /2304877

  • Food Allergies vs. Food Intolerance

    First, let's start with what a food allergy is. A food allergy is an immune response to the protein found in the food (Fraker et al., 2007). The protein in the food causes an allergic reaction to occur because large protein molecules have entered the child's immature GI tract. Once the large molecule hits the immune system, the immune system now recognizes it as a threat creating antibodies for that protein. This is why it is important to not introduce common allergy-causing food early or before it is recommended by your pediatrician. Most pediatricians recommend not introducing the allergy-causing foods until the child is one year old. Once introducing the most common allergy-causing foods after one year, slowly try one new food at a time and document symptoms you observe in your child. After the symptoms are documented and observed, eliminate that certain food for two weeks to see if any symptoms resolve. If you are uncertain if your child is experiencing a food allergy, document them and report them to your pediatrician. Symptoms may include vomiting, diarrhea, gastritis, growth failure, colic-like crying, or repeated regurgitation. Second, food intolerance is where the digestive system comes into play. Food intolerance indicates the food is so irritating, that the child's stomach cannot digest or break down the food. Food intolerance symptoms "include nausea, stomach pain, diarrhea, gas, cramps, bloating, vomiting, headaches, heartburn, and irritability" (Fraker et al., 2007). Tips for Building a Healthy Relationship with Food (after having bad experiences): Allow the child to determine how much and whether they are eating the food or not Offer a variety of food Be matter-of-fact about food limits Respect your child's preferences Refer to my "Signs and Causes of Inadequate Eating and Feeding" post for SIGNS of food allergies. References Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet. Hachette Books. Marcus, S., & Breton, S. (Eds.). (2022). Infant and child feeding and swallowing: Occupational therapy assessment and intervention (2nd ed.) AOTA Press. Satter, E. (2000). Child of mine: Feeding with love and good sense. Bull Publishing Company.

  • Types of Tube Feedings

    "A tube is given to support life and make it easier for the child to grow without the risk of malnutrition, excessive fatigue, or aspiration" (Morris & Klein, 2000). The first years of life is a critical time period for development and can cause major setbacks if the child is malnourished. A tube is used for children that have one of the following: prematurity, anatomical abnormalities, neurological issues, aspiration, fatigue, pending surgeries, Failure-to-Thrive diagnosis, or decreased appetite (Fraker et al., 2007; & Morris & Klein, 2000). It is important to consider and know what tube your child will use. The doctor will examine and determine what is best for your child's needs. The non-permanent tubes that may be considered include the orogastric, nasogastric, nasojejunal, and gastronomy tubes. Orogastric Tube: Tiny premature infants receive this due to their small nasal passageway A thin and flexible tube that is inserted through the mouth to the stomach It is put in temporarily for feeding and taken out when feeding is not occurring Feedings typically take 15-20 minutes Nasogastric Tube: Plastic or silicone tube inserted through the nose into the stomach Often used for a short time Most "normal" feeling of feeding since the food is entering stomach like any other food would Often invasive and uncomfortable for children since the tubing is taped on the face Surgery is not required Can interfere with normal swallowing mechanisms Nasojejunal Tube: Inserted through the nose passing the stomach to the jejunum of the small intestine Used when physicians feel the stomach is functioning poorly Special predigested formula is used due to bypassing the stomach Slow delivery of food via feeding pump Gastronomy Tube: Surgically inserted into the stomach through the abdominal wall Often used for a long time Food directly goes to the stomach without having to go through the mouth and throat Does not conflict with oral motor development of the mouth Types of Tube Feeding: Bolus: Delivered several times a day Lasts up to 10-30 minutes Requires less equipment Often less expensive More convenient to administer More mobility and normality in everyday activities as the tube is not connected to a pump all the time Continuous: Provided by a feeding pump Formula is put in a feeding bag that connects to the feeding tube Is administered for several hours Feedings are up to 8-12 hours (usually at night) Tips for Children on Tube Feedings: Provide positive touch around the mouth and face Encourage object/toy mouth play or chewing Offer teething or chewy toys Offer soft spoons to explore Offer a soother for sucking development During tube feedings, provide positive interactions Encourage the child to participate in family mealtimes (e.g., sit in a high chair or booster seat with the family at the table during meals even though they are not eating) Introduce toothbrushing During tube feedings, have food present or cooking to associate the two *Once your child can prove they can meet their growth and nutritional needs, the tube can be removed. References Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet. Hachette Books. Gillette Children's Speciality Healthcare. (2021). Using a nasogastric Tube. Retrieved June 15, 2023, from https://www.gillettechildrens.org/your-visit/patient-education/using-a-nasogastric-tube Marcus, S., & Breton, S. (Eds.). (2022). Infant and child feeding and swallowing: Occupational therapy assessment and intervention (2nd ed.) AOTA Press. Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive resource for mealtime development. Pro-ed International Publisher.

  • Eating with Autism

    Feeding and mealtime challenges are one of the most common characteristics of children with autism spectrum disorder (ASD) with prevalences estimates of as much as 84%-89%" (Marcus & Breton, 2022). Children with ASD tend to show problems with feeding as early as 6 months. Children with autism refuse more foods and have more problems with eating than neurotypical children. At 6 months, children with ASD are described as slow feeders, then 15-24 months they are described as difficult to feed leading to a later introduction to solids. 67-90% of children with autism have difficulty sitting at the table, trying new foods, and overall are considered “picky eaters.” Picky eaters tend to prefer certain textures, have a narrow food diet, eat with certain utensils, and have preferences on food groups and their presentation. Sometimes, children with autism do not always associate food with hunger, and as adults they often forget to eat. With the decreased interest in eating certain textured or smelling foods, the oral muscles will be weak, increasing the risk of gagging, aspiration, and choking. Children with autism tend to struggle with transitioning, socializing, communicating, and interacting with others (Klein, 2019). Imagine having these challenges. Would you want to sit at the table with your entire family where transitioning, socializing, and communicating are expected? This fear of not knowing what to communicate, how to interact with others, and being in a room with new people can lead to negative associations with mealtime. Children with autism like control, routine, and feeling safe; if they can make their mealtimes the same, they will (Morris & Klein, 2000). Mealtimes are usually their biggest challenge sensory-wise, transition-wise, and social-wise. Therefore it is important to start small and make gradual changes to make each experience positive. What can Feeding Therapy do for clients with ASD? Create sensory food experiences Build a garden Go on a field trip to the grocery store or farmer’s market Messy play Create a supportive eating environment Create expectations that come with eating, manners, and sitting at the table Provide sensory regulation strategies Address oral-motor challenges Decrease overstuffing tendencies Teach the components of food without the pressure of eating the food Resources to try at Home: Bite-Sized Visual Charts First, Then Printable Food Bingo Food Exploration Place Mat Visual Food Rating Scale Learning To Eat Visual Chart References Emond, A., Emmett, P., Steer, C., & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 126(2), e337-342 Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet. Hachette Books. Friedman, J. (n.d.). Autism food rules: Practical solutions for expanding your child’s diet. Jenny Friedman Nutrition. Hunt, M. A. (2020). Occupational therapy for the treatment of selective eating. In R. Bédard & L. Hecker (Eds.), A spectrum of solutions for clients with autism: Treatment for adolescents and adults. (pp. 185–192). Routledge/Taylor & Francis Group. https://doi.org/10.4324/9780429299391-24 Klein, M. D. (2019, November 8). Anxious eaters, anxious mealtimes: Practical and compassionate strategies for mealtime peace. Archway Publishing. Marcus, S., & Breton, S. (Eds.). (2022). Infant and child feeding and swallowing: Occupational therapy assessment and intervention (2nd ed.) AOTA Press. Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive resource for mealtime development. Pro-ed International Publisher. Toomey, K. A. (2008a). Family meals [PDF]. Denver, Colorado: Toomey & Associates, Inc. Toomey, K. A. (2008b). Therapy meals [PDF]. Denver, Colorado: Toomey & Associates, Inc.

  • Drinking Liquids

    Being able to drink liquids is an important skill for a child to have (Peterson et al., 2015). Whether it’s from a bottle or a cup, it helps promote independence and continued nutritional growth. A tip for positive bottle feeding, includes cuddling opportunities and having a consistent liquid temperature during feedings (Satter, 2000). When the infant is feeling a sense of comfort, the infant will eat until she/he is full rather than eating too much or too little for comfort. Ensure the comfort and feeds are occurring during mealtime, as bottle feedings should be avoided as a comfort mechanism such as to put the baby to sleep. When it comes to the number of ounces an infant should intake for each feed, it is different for everyone. A good suggestion is to contact your pediatrician for specific measures. As long as your infant or baby is growing consistently, the intake should not be a concern. When it comes to introducing solids along with liquids, drinking liquids for a child is different than for an adult. As adults, we can drink liquids throughout the day without it ruining our appetite, hunger, and mealtimes. This is not the case for children, for a child it can interfere with their mealtime routine. For children, drinking liquids before a meal dampens their appetite (Fraker et al., 2007). If a child consumes liquids throughout the day, it is equivalent to snacking throughout the day, therefore the child will not be hungry by the time mealtime comes. If the child consumes too many liquids throughout the day, sitting at the table can become difficult. A good tip to follow to have successful eating, is to only offer liquids during mealtimes. If your child is thirsty between mealtimes, offer water! Want to make sure your child is hydrated on water? Here is a water tracker for kids from ages 1 to 9+ years old: Kid's Water Tracker Reference Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet. Hachette Books. Peterson, K. M., Volkert, V. M., & Zeleny, J. R. (2015). Increasing self‐drinking for children with feeding disorders. Journal of Applied Behavior Analysis, 48(2), 436–441. https://doi.org /10.1002/jaba.210 Satter, E. (2000). Child of mine: Feeding with love and good sense. Bull Publishing Company.

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