Friday, January 20, 2012

Feeding Therapy session #2

The high chair has been packed away and replaced by the booster seat. my son has been sitting at the table with the rest of us for the past week. He loves the electric toothbrush I got - Thomas, of course. I started by lightly rubbing it on his hand, then cheeks, and around his face, then lips and finally inside his mouth. First on his teeth but also gums, tongue and inside of cheeks. He had no problem with any of it, and pretty quickly asked to do it himself. In fact, I had to take it away as he was walking all over with it, and I'm always afraid that he'll trip while it's in his mouth and get hurt.

Yesterday, I set him and his sisters up to play with food. I gave each of them a plate with some Cheerios on it. First I had them line them up to make a road, then train tracks. Once I saw he was fine with touching the dry ones, I had them each smush a couple of Cheerios. We pretended it was sand and then I added a little of his left over baby food to be the water at the beach. We took some of the whole Cheerios and used them as people and had them "dive" in to the water by pushing them in. The idea being to start with just touching something dry, then smushing it to change the texture, play with the texture, and then combine the dry with the wet to get comfortable with the wet texture. He did pretty well with all of it and played along. My daughters of course want to speed things along and asked if we could use cheese or bananas instead. I tried to explain that even though those are soft, that's not the direction we are going in yet. Lots of baby steps before we actually get to the real food.

This morning after his drop off class and a quick lunch the therapist came back. She started in our family room, first using the same brush as last time rubbing it all over his body to get him used to different sensations. He giggled through most of it. Then aw did the monster faces and wiggling his lips. Then she does a thing where she rubs her fingers all around the inside of his mouth pretending she's looking for an animal. She never does find it as the sneaky thing goes down his throat to his belly :)

Then she got a kind of hard rubbery toothbrush and dipped it in Pixy Stick powder and rubbed it around his lips, mouth and his tongue, and had him bite on it. She does everything 5 times, and he was fine with it the first couple of times and seemed to like the flavor, but by the 3rd time he was getting tired of it. But again she did a total of 5 times. Then she let him play with a puzzle - he chose one of the fishing puzzles with the little fishing pole. Then it was time to get in the kitchen and play.

He climbed up in his chair and we got out Ritz crackers, Cheerios, apple sauce, and vanilla yogurt. We started with the Ritz, first rolling it around on the plate, then smushing them with our fingers and then crushing them with a palm or fist. She had him take one of the whole ones and put it on his cheeks, head, nose to get used to the feel. Then she had him balance it on his nose and then pretend to sneeze and look down real fast to try and get it to land on the plate. He did fine with that.

Then she had him try and hold the Ritz in his mouth. It took a little encouragement to get him to do it, but he finally did and then spit it out. The second time he tried, he used his teeth instead of his lips and accidentally but off a small piece. He started to get scared and cry and she told him it was ok to spit it out, which he did. After calming down a little she had him do it again and he was fine. Then we held the Ritz in our mouths and then balanced some Cheerios on it, before dropping them down on the plate the next time again he bit off s little and got more scared and stared to cry. She had him look up and that got him to spit it out.  While he did rub off what was on his face, he never picked out the piece of cracker that had gotten in his mouth, so he must have swallowed it. She had him do it one more time, so that his final memory of the exercise wasn't a negative one.  She also explained to me that if he starts to gag on something it's best to startle him a little to for him to spit it out. It's a fine line though cause as my daughter said when I told her that later, sometimes if you get rally startled you inhale really fast and that would maybe make him swallow hard/choke.

As a little reward for his efforts, she let him play with a puzzle while we set up some more stuff.  Time to play with wet things too.  She put some vanilla yogurt and apple sauce on her plate, and had him scoop some on his. She drew a circle in hers with a spoon and asked him to do the same. She picked up some of the smushed crackers and sprinkled them on top.  Still he played along. Finally she asked him to mix up the crackers into the yogurt or applesauce. He hesitated quite a bit but finally agreed to do it together with her. Once he does something wet that he doesn't like, she quickly wipes it off and says, "No big deal". The idea being you don't want to torment the poor kid by forcing them to keep it on their fingers if they don't like the sensation, and teaching them that they can just wipe it off if they feel like.

At that point her had pretty much had enough, and our hour was up any. The Early Intervention group is also sending a Occupational Therapist to our house on Tuesday to evaluate him, and I asked her about that.  I feel like he's fine when it comes to motor skills, it's just the sensation he doesn't like and I guess it's more of a behavioral problem than a developmental. She said that most times, she works hand in hand with an occupational therapist as they work with him to get comfortable with different textures of non- food items, as a parallel therapy. They both follow something called Sequential Oral Sensory (SOS) Feeding therapy. More on that after she comes on Tuesday.

She asked me to do more of the same activities with him before she comes back next week, and was pretty happy with his progress so far. The dry foods no longer freak him out. It's now the wet stuff he needs encouragement on. She recommended sneaking a little hard stuff in his food (ground up Cheerios in yobaby for example), and increasing the amount as he tolerates it. The first time, so little that he can't see it, but maybe tastes it, and then increase it.

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