D I A N N E T O W E R , M A , S - L P ( C )S P E E C H – L A N G U A G E P A T H O L O G I S T

&A M I - J O D U N N , M S C , ( O T )

O C C U P A T I O N A L T H E R A P I S T

A Transdisciplinary Approach to Promoting Optimal Feeding

Development

D I A N N E T O W E R A N D A M I - J O D U N N D O N O T H A V E A N A F F I L I A T I O N ( F I N A N C I A L O R

O T H E R W I S E ) W I T H A P H A R M A C E U T I C A L , M E D I C A L D E V I C E , O R C O M M U N I C A T I O N S

O R G A N I Z A T I O N .

Welcome

Agenda

Learning Objectives What impacts Feeding? Relationships Are KEY: COS model Typical Feeding Development Normal Kinesiology Abnormal Development Red flags Guiding principles Strategies

Learning Objectives

Understand the importance of the developmental progression of feeding skills in early childhood health and wellness.

Recognize the importance of the parent-child relationship in successful feeding and optimal growth and development

Be able to incorporate strategies that support regulation and successful feeding with infants and young children.

Factors that impact Feeding

Environment Parent – child interactions Health Regulation / State control Muscle balance and motor development Oral motor skills Sensory System

Parent – Child Interactions

Attachment is built through caregiving. (Rossetti)

Mealtimes provide consistent times where families can be together and build connection.

Feeding fulfills a child’s basic need – can have huge impact on attachment.

Protect me Comfort me Delight in me Organize my feelings

Circle of SecurityParent Attending to the Child’s Needs

I need you to

Support My Exploration

Welcome My Coming To You

I need you to

Watch over me Help me Enjoy with me Delight in me

I need you to

I need you to

© 2000 - Cooper, Hoffman, Marvin & Powell

VIDEO EXAMPLES

Feeding is Complex

Requires synchronization of 26 muscles Integration of 5 cranial nerves 3 spinal nerves

Breathe

Respiration = inhaling & exhaling air

The ability to increase capacity & grading of depth and rate of respiration contributes to biological rhythms

This develops stability in sleep-wake cycle, feeding cycles, patterns of arousal, attention, self-regulation strategies, styles of learning, memory & behavior

Stages of Arousal (Brazelton)

Inhibition

Activation

1. Asleep2. Drowsy3. Hypo alert4. Calmly Focused &

Alert5. Hyper alert6. Flooded

Eating SkillsEating Skills Appropriate Food TextureAppropriate Food Texture

Roots for nipple Develops graded jaw

opening Sucks Swallows Breathes

Nipple feeding from the breast or bottle

Development of Eating Skills: Birth-6 months

Eating SkillsEating Skills Appropriate Food TextureAppropriate Food Texture

Control of head movements develops

Rooting & bite reflex fade Begins sitting Follows food w/eyes Opens mouth for spoon Lips close over spoon Moves semi-solids to back of

tongue Swallows semi-solids Begins to grasp objects w/palm

and bring to mouth

Nipple feeding from the breast or bottle

Semi-solid food, which is made progressively thicker by using less breast milk or formula to thin

Development of Eating Skills: 6 months

Eating Skills Eating Skills Appropriate Food TextureAppropriate Food Texture

Tongue moves side to side Positions food in the mouth Delays swallow Chews up and down Palms food

Scrapes food into mouth

Development of Eating Skills: 6-8 Months

Nipple feeding Mushy food that is fed from a

spoon Water in a cup

Eating Skills Eating Skills Appropriate Food TextureAppropriate Food Texture

Bites off food Chews w/ rotary movement Moves food side to side Stops in the middle Curves lips around cup Uses thumb and forefinger to

grasp (pincer) Gags some but doesn’t choke

Nipple feeding Thicker lumpier food that is fed

from a spoon Small pieces of soft finger food Dissolvable food that baby can

bite or break off w/ gums Water in a cup

Development of Eating Skills: 7-12 Months

Eating SkillsEating Skills Appropriate Food TextureAppropriate Food Texture

More skillful w/ hands Finger feeds Chewing improves Cup drinking improves Interested in eating a variety of

foods Becomes social while eating

Nipple feeding &/or cup drinking: breast milk or whole milk

Easy to chew & easy to swallow table foods

Development of Eating Skills:12 Months

K I N E S I O L O G Y A N D I T S R O L E I N F U N C T I O N O F F E E D I N G A N D R E L A T I O N S H I P S

Normal Development

Muscle Balance & Development(Partners in Movement, Meade)

NormalNormal

Extension 1st @ head & neck Optimal dev @ neck: adds

flexion Capital flexion: chin tuck for

power suck 2 mo- full elongation of

flexors 3 mo – chin to chest -mouth

closed, head stability for tracking

NastyNasty

Over use of extension Capital extension = chin

jut Over use of the

sternocleidomastoid Mouth open/drooling Retracted tongue

Too much extension

Difficulties: Eye development Tongue development, feeding and speech development Impact on attention – sustained attn 7 mos as predictive to 2

yr. social/emotional, cog, fine motor (Lundqvist-Persson C., 2001) Impact on parenting & relationship building (Winnecott, 1987)

RED Flags

Poor weight gain Taking a long time to feed Choking or gagging on food or liquids Drooling Picky eating & refusals Chronic chest &/0r ear infections Motor delays

Guiding Principles

1. Relationships set the stage for feeding success2. Sensory–motor development impacts feeding

function3. Practice doesn’t make perfect, it makes permanent4. Easy, repeatable and repetitive practice is essential

for developmental change5. Make it fun and functional

Strategies

Confident presence of caregiver

Use your power wisely and with love

Parent role is to purchase, prepare and provide food (include children in preparation and cooking as appropriate)

Allow child to have and use power

(Slaughter, 2013)

Strategies

Be willing to try new foods yourself as this has an influence on your child

Use positive language related to food and new foods

“I haven’t learned to like it yet, but I plan to try it again and see if I like it then.”or

“This is interesting, but I don’t think I want any more of it today.”

Sit and be with your child at every mealtime and snack (creates opportunity to build connection)

Keep mealtimes emotionally safe

(Slaughter, 2013)

Strategies

Offer small, developmentally appropriate challenges WITH loving support

Offer new foods 10-15 times and encourage tasting (but do not need to swallow the food) (Birch et al., 1987)

Strategies

Paper napkin strategy – gives permission for child to stop unpleasant experience at anytime

Use Face Stickers so children can record their reactions to a target food over time (Wardle et al., 2003)

Tiny Tastes tasting game kit can be ordered from: www.weightconcernorg.uk/node/302

Strategies

Environmental modifications Positioning: stable, flexion & neutral head position Feeding routines Sensory experiences: bubbles, whistles, straws,

chewy toys, hands on texture experimenting Sound play and practice with books, toys and songs Tooth brushing routine

Thank You!

References

Cooper, G., Hoffman, K.,& Powell, B. (2009). COS-P© Facilitator Manual (DVD Manual 5.0): Circle of Security Parenting©: A Relationship Based Parenting Program.

Powell, B., Cooper, G., Hoffman, K., & Marvin, B. (2014). The Circle of Security Intervention: Enhancing Attachment in Parent-Child Relationships. New York: The Guilford Press.

Meade, V., (2008). Partners in Movement: A Family Centered Approach to Pediatric Kinesiology, Vickie Meade Therapy Services.

Oetter, P., E.W. Richter, (2004). M.O.R.E. Integrating the Mouth with Sensory and Postural Functions. PDP Press Inc.

Shonkoff,J.,& Meisels, S.J., (eds) (2000). Handbook of Early Childhood Intervention. New York: Cambridge University Press

Slaughter, C. (2013). Hungry for Love. North Charleston, South Carolina: CreateSpaceIndependent Publishing Press.

References

Wolf, L.S. and R.P. Glass, (1992). Feeding and Swallowing Disorders in Infancy: Assessment and Management.Austin,Tx: Hammill Institute on Disabilities. (512-451-3521)