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#1 of 20 Old 04-25-2005, 11:34 AM - Thread Starter
 
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My 20 month old is developmentally delayed in gross motor skills and oral sensory skills.

He does not eat solid foods. Will barely tolerate bringing them to his mouth.

My problem: He is now refusing to eat the pureed/mashed food he's been eating for so long but he also will not/can not eat the solid foods I'm giving him.

So he's basically not eating. I can tell he is frustrated with his jarred baby food and doesn't want to eat it. His favorite food, yogurt, is also getting dumped on the floor. He used to guzzle a fruit smoothie and now will drink maybe an ounce before dumping that on the floor too.

So I give him small finger foods like pieces of cooked waffle, crackers, banana, etc. but he just dumps those on the floor. Meanwhile he's hungry but he's not eating.

I don't know what to do. What would you ladies do in this situation? He is so low on the growth charts that skipping meals is just not a good idea for him. We have enough trouble getting him to eat enough calories per day as it is.

I'll take any and all ideas. Thanks!
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#2 of 20 Old 04-25-2005, 11:44 AM
 
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With his oral adversion have you tried "brushing" his mouth? Nuk, I think it is makes nubbie type toothbrushes. My son would chew on them for the longest time. They did seem to make his adversion a bit more tolerable. Also try speaking with his OT if he has one. She/He may be able to offer you some more suggestions.
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#3 of 20 Old 04-25-2005, 11:50 AM
 
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Erin,

Is he still nursing? Could he be teething or have an ear infection?

My ds went from the 95th percentile to the 4th percentile in the growth charts. I did some research and realized that the information on the growth charts is not specific enough. I needed a growth chart for a child who was breastfed extendedly and ate whole foods. Plus, I am only 5'1", so how large should my child be? I don't know if that gives you any comfort...

The types of things I would do, is make mealtime playful. Think of his stomach as the size of his fist and keep low expectations as to the amount of food he will eat. The food I would offer would be packed with fat and nutrients... avocado, nut butters etc... And remember, he is not going to starve himself. I know this is stressful and it's hard when others are putting pressure on you.

BTW - is he receiving therapies?

~Laura
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#4 of 20 Old 04-25-2005, 11:51 AM - Thread Starter
 
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He does have an OT but she mainly just gives us advice and things to try, which we are doing. He's just in a weird transition phase where he doesn't want to eat what he's been eating and refuses to eat the new stuff offered to him.

I will try brushing his teeth/mouth with the NUK thingie. He will chew on other things pretty often now like toys and rubbery toys. But he really hates putting food in his mouth. And once it's in there, he won't chew, he will just suck the food.
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#5 of 20 Old 04-25-2005, 12:29 PM - Thread Starter
 
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He is seeing a physical therapist and an OT. He is making great strides (pun intended) with his physical development. He is cruising now and I expect him to be walking within 4 months. Although he is delayed, he is progressing on his own time table.

But his eating is not progressing well. He is at the 3rd percentile, but the nutritionist is not that concerned since he has been there for 7 months and is growing steadily relative to his own curve.

He is not nursing anymore. Stopped at 16 months.
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#6 of 20 Old 04-25-2005, 01:00 PM
 
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Our OT also suggested using a cold washcloth and/or a battery-operated toothbrush prior to mealtimes to "wake up" the facial/mouth muscles. My youngest is 2 1/2 and had gone through about 3 episodes of eating regression (refusing favorite foods, spitting out foods for no obvious reason, etc).

Is your son sitting in a high chair? One of the problems my son had was an inappropriate chair. We got rid of our high chair when it became a dangerous climbing toy at around 18 months. But we never replaced it until I read in a book (Just Take a Bite by Lori Ernsperger) that children without adequate leg/trunk/arm support often have a hard time eating because they are trying to keep their body stable. Once we got a chair sized for him (Kinderzeat), eating improved.
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#7 of 20 Old 04-25-2005, 01:07 PM - Thread Starter
 
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He is in a high chair, maybe that IS a problem. What is this Kinderzeat you have? He doesn't climb on the high chair at all.

I've been thinking that maybe I need to sit him in a booster seat at the main table.
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#8 of 20 Old 04-25-2005, 01:54 PM
 
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Quote:
Originally Posted by Erin Pavlina
He is in a high chair, maybe that IS a problem. What is this Kinderzeat you have? He doesn't climb on the high chair at all.

I've been thinking that maybe I need to sit him in a booster seat at the main table.
This is the one that we have: http://www.stokkeusa.com/ and we've been very happy with it. But I know that I've seen threads here at MDC (maybe in the childhood or toddler forum) discussing the difference between this one and a similar one that costs less. I'm sure an archive search would turn it up.
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#9 of 20 Old 04-25-2005, 04:30 PM
 
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I don't want to scare you at all, but someone mentioned that he will not starve himself. Children can do this so just keep an eye on him and go with your instincts when it comes to his health.

I can't offer much help because my 8 month old will not eat anything! NOTHING! She nurses and that's it. Thank God for that at least.
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#10 of 20 Old 04-25-2005, 04:44 PM
 
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Are you trying new foods that are mashed? Maybe he is bored with the food but not ready to deal with the solids. Is there anyway to present the food in a new way, like by sprinkling cinnamon?

I have no experience with a special needs kid so ignore if that doesn't seem applicable or if you've already tried that . My ds is picky but wants variety so I get real tired of trying to feed him.

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#11 of 20 Old 04-25-2005, 04:54 PM
 
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we were/are in similar situation and soups work well for us.
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#12 of 20 Old 04-25-2005, 05:00 PM
 
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I have not read through this all yet. I am typing on the run. :LOL

My dd has eating problems and feeding therapy has been wonderful for her. Does he get any? I'm sure he would qualify through your state services if he has delays in other areas, too. Nitara doesn't eat much by mouth yet (g-tube fed) but she's over her fear of eating. Now it's just up to her to do it.

Does he gag? Has he been evaluated by a speech therapist to make sure he is able to swallow okay?

Has he been checked for reflux yet? Kids with dd often suffer from silent reflux. Some of the first signs is lack of appetite, gag reflex, and trouble with solids. These things often get better once the reflux is treated with meds.

Has he been sick lately, or maybe does he have allergies? Both of these things can make a child whose eating is already iffy, go to nothing.

I hope he gets back to eating soon. I know how hard it is to have a child with eating problems.

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#13 of 20 Old 04-25-2005, 06:18 PM
 
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DD#2 had many of the same eating issues as a toddler. It was a rough time. She still has some major food aversions, but she is surprising me daily with what she will at least try, and what she will REQUEST to try. So there is a light at the end of the long tunnel.

That said, when she was that age, she only ever wanted to eat food that were 'big kid' food, but yet required little to NO chewing on her part. Crackers were a favorite, because she loved the first crunch, and then she didn't have to do much other than let it sit for 2 seconds and melt, then swallow the bite. Just looking at foods with certain textures made her gag. Like pasta. It was sticky to touch and required way too much chewing for her. Your ds may love it, though. And funny thing is, now DD#2 craves it all the time! We also went through a phase where she only wanted the bland, whitish foods... nothing with color. LOL! So vanilla yogurt was ok, crackers were ok, cheerios were ok (though we started those soo much later than other people due to the fact she wouldn't/couldn't chew some foods)

So it may be a matter of trying to figure out what is triggering the reactive response in him... it could be the smell of one food, the texture of another, the visual of another...

Another thought about the 'big kid' food. She so desperately wanted to do everything herslef, like toddlers do, but she didn't have the coordination for it. Mealtime was hard because she wouldn't let me do it for her (especially with mashed food or yogurt), but she couldn't quite do it herself. The Nuk toothbrush someone recommended is actually fabulous for feeding practice with mashed foods. our little ones can just stick the end into the food, and because the nuk is textured, the food stays on instead of falling off quickly (like with a spoon). So then the kids have more success getting the food to their mouth. So if he's wanting to be more independant, that would be something else you could try - he's still be getting the mashed food that his mouth is used to and can handle, but he can feel that he's feeding it to himself.

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#14 of 20 Old 04-25-2005, 06:45 PM - Thread Starter
 
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The OT has said that he just doesn't know what to do with the food once it is in his mouth, won't use his tongue to move it around and doesn't try to chew it.

We've gotten him to the point where he can use his front teeth to bite something like a piece of apple or banana, but then he sucks the apple a bit and spits it out.

The OT wants us to try to teach him to use his tongue to move things around in his mouth instead of just suck/swallowing like he does now.

But how do you teach a baby to use their tongue to move foods around?
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#15 of 20 Old 04-25-2005, 07:00 PM
 
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Quote:
Originally Posted by Erin Pavlina
We've gotten him to the point where he can use his front teeth to bite something like a piece of apple or banana, but then he sucks the apple a bit and spits it out.
That's what DD would do when she had something in her mouth whose texture called for chewing (the feel of it in the mouth told her brain to chew), but then she couldn't chew, so she'd spit it.

Quote:
The OT wants us to try to teach him to use his tongue to move things around in his mouth instead of just suck/swallowing like he does now.
We started by playing tongue games without food. Funny faces, etc, to work on tongue muscles and coordination. Then we worked up slowly through... Putting a little dab of yogurt or peanut butter on her lips to encourage her to try and lick it. We put some directly on her tongue, so she'd have to 'lap' it up in her mouth to swallow it. We put a bit on our finger to put a little on the inside of her cheek so her tongue would need to get it. There was more, but it's not coming right to mind. I'll post when I remember!

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#16 of 20 Old 04-25-2005, 07:12 PM
 
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I have totally been there with my oldest dd. She had the same problems and ended up eating at 3 1/2 after realizing not eating may have triggered a health crisis & put her in the hospital.

We had problems with her gagging and vomiting breakfast almost every morning in kindergarten (ages 4-5). She is seven now and in 2nd grade in a regular classroom (she is on the autistic spectrum very very mildly, mostly w/ the typical mannerisms/tics). And she eats sometimes but a lot but she is so skinny she can handle it. That is a bad thing sometimes because she doesn't always have a shut off. MIL let her eat a whole bag of flaming hot cheetos and dd puked all night!

When she was tested at 20m she had mouth paralysis on one side. Apparently mouth paralysis can develop with severe anemia (which she had). She didn't put things in her mouth as a baby and didn't like to touch anything, she held her arms out to the side to keep from touching things.

The OT had her paint in pudding and applesauce messy but she would taste it sometimes after a few sessions. Edible clay.

Some other things: bubble blowers, music makers to strengthen oral skills
Nuk brush rubbed on her gums for several minutes every day, battery toothbrush.

Have you tried a mesh feeder? It is like a little bag thing you can put foods in to get your sensory challenged child used to the taste of things w/o danger of choking.
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#17 of 20 Old 04-26-2005, 10:55 AM - Thread Starter
 
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We do have the baby safe feeder and I use it for fruit a lot. He likes that.

Last night at dinner I gave him some mashed potatoes but he wouldn't even try to eat them, just played with it on his spoon. I was frustrated but tried not to show it. I know that playign with food is important, but I want him to eat some too.
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#18 of 20 Old 05-01-2005, 04:54 PM
 
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The OT has said that he just doesn't know what to do with the food once it is in his mouth, won't use his tongue to move it around and doesn't try to chew it.
HI Erin, I chatted with ya months ago.. How come he is still unable to receive Speech? I agree Ots can help with oral motor however speech therapists ( some ) are highly trained in this area. I dont understand why the OT is not referring for speech and possibly even cotreating.. I cotreated many times with speech therapists so we were incoorportating sensory orally and the exercises together... the feeding issue could be the motor aspect of it however the underlying could be sensory or visa versa...

Speech also does great with physical therapy. I have seen them cotreat and it does wonders. Crawling helps the brain to utilize both sides and crawling also helps speech patterns....

im not sure of the exact site right now however GOOGlE the Debra Beckman Oral Motor protocol and possibly see if their is a speech therapist with knowledge of this.......

I personally say Speech ASAP


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#19 of 20 Old 05-01-2005, 10:42 PM
 
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I agree with the above poster - it sounds like your ds needs more intensive therapy than he's getting. You need someone who will spend a good, solid hour actually working with him on feeding rather than offering vague suggestions. Telling you that you need "to teach him to use his tongue to move things around in his mouth instead of just suck/swallowing" isn't really very helpful when you don't know the techniques and tools necessary to accomplish this.

If for some reason your son is unable to get speech/feeding therapy (and it sounds like he would qualify, especially if he's lost weight), then I think it would be worth it to look into finding a different OT with more experience in feeding therapy. Feeding therapy is an odd area where there is some overlap between ST and OT - you can find OTs with lots of experience in feeding and some STs with very little. If you ask around you should be able to find the right therapist to help your son. Good luck!
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#20 of 20 Old 05-01-2005, 10:50 PM
 
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This is quoted from debra beckman-oral motor therapist....
check out her site www.beckmanoralmotor.com


For an infant with normal muscle tone, development occurs without any major interventions by the caregivers. Skills which begin at the front and center of the mouth gradually change to include movement at the lateral and posterior areas of the mouth. For the infant with abnormal muscle tone, development of oral motor skills becomes more problematic, often with abnormal patterns of movement used to complete every day activities such as swallowing secretions, drinking, eating, vocalizing, chewing, and speaking in words or phrases. Because the muscles do not work together and do not give consistent pressures within the mouth, the individual may seek such input from external sources, such as clothing, toys, or other items. Many of these individuals have not progressed from pureed or soft foods, and so, are not receiving input on the jaw through chewing. The posterior area of the mouth may be receiving little or no input. Gagging (with or without vomiting) may result.

The sensory input for the mouth is important, and the craving of such input does not decline for individuals on pureed diets or for those individuals with non-oral intake. It may be increased, resulting in pica - the eating of non-edible objects. Some individuals attempt to increase sensory input at the mouth by biting themselves, or others within their reach. Telling someone to stop putting everything into his or her mouth, or punishing him or her for doing so, does not address the underlying sensory motor needs. If the individual is hypersensitive, telling that person to stop gagging, or becoming angry when the individual refuses to do certain oral activities, does not address the underling sensory motor needs. By completing the Beckman Oral Motor protocol, the right kind of input can be provided in a safe way to enhance the muscle balance and internal muscle pressures the person should have, thereby reducing the constant craving for additional external input (mouthing of non edible items). Providing the right kind of input also normalizes oral sensitivity, so that the individual's response to pressure and movement is a functional movement, such as swallowing or moving the lips or tongue, instead of gagging, crying and screaming.


Hope this explains it better......


As a therapist and an aunt of a niece with cerebral palsy i have learned sometimes you need to make it clear what you want for your child!

Remember you know your child best and see your child skills more then a therapist does in a 1/2hr-1hr time....


michele
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