Tag Archives: low tone and sitting still for meals

Hypermobility Or Low Tone? Three Solutions to Mealtime Problems

 

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Many young hypermobile kids, with and without low muscle tone, struggle at mealtimes. Even after they have received skilled feeding therapy and can chew and swallow safely, they may continue to slide off their chair, spill food on the table (and on their body!) and refuse to use utensils.

It doesn’t have to be such a challenge.  In my new e-book coming out this year, I will address mealtime struggles.  But before the book is out there, I want to share three general solutions that can make self-feeding a lot easier for everyone:

  1. Teach self-feeding skills early and with optimism.  Even the youngest child can be taught that their hands must be near the bottle or cup, even when an adult is doing most of the work of holding it.  Allowing your infant to look around, play with your hair, etc. is telling them “This isn’t something you need to pay attention to.  This is my job, not yours.”  If your child has developmental delays for any reason, then I can assure you that they need to be more involved, not less.  It is going to take more effort for them to learn feeding skills, and they need your help to become interested and involved.  Right now.  That doesn’t mean you expect too much from them.  It means that you expect them to be part of the experience.  With a lot of positivity and good training from your OT or SLP, you will feel confident that you are asking for the right amount of involvement. Read Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child and Teach Utensil Grasp and Control…Without the Food! for some good strategies to get things going.
  2. Use excellent positioning.  Your child needs a balance of stability and mobility.  Too much restriction means not enough movement for reach and grasp.  Too much movement would be like eating a steak while sitting in the back seat of your car doing 90 mph.  This may mean that they need a special booster seat, but more likely it means that they need to be sitting better in whatever seat they are in.  Read Kids With Low Muscle Tone Can Sit For Dinner: A Multi-Course Strategy for more ideas on this subject.  Chairs with footplates are a big fave with therapists, but only if a child has enough stability to sit in one without sliding about and can actively use their lower legs and hips for stabilization.  Again, ask your therapist so that you know that you have the right seat for the right stage of development.
  3. Use good tableware and utensils.  If your child is well trained and well supported, but their plates are sliding and their cups and utensils slide out of their hands, you still have a problem.  Picking out the best table tools is important and can be easier than you think.  Items that increase surface texture and fill the child’s grasping hand well are easiest to hold.  Read The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem and OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues for some good sources.  Getting branded tableware can be appealing to young children, and even picking out their favorite color will improve their cooperation.  Finally, using these tools for food preparation can be very motivating.  Children over 18 months of age can get excited about tearing lettuce leaves and pouring cereal from a small plastic pitcher.  Be creative and have fun!

 

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Kids With Low Muscle Tone Can Sit For Dinner: A Multi-Course Strategy

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Low muscle tone can create so many different issues during mealtime.  Staying still and safe in a chair can be a real issue for these kids, and yet many are seen to be just “behaving badly”.  Here is a roadmap to navigate mealtimes when your child has issues with wriggling, sliding, falling or leaping up every few minutes.

First, understanding how low muscle tone influences behavior can help defuse some of the criticism and arguments.  Low tone creates too much information, as instability creates movement that distracts even the child who is moving.   Inadequate muscle and joint receptor stimulation doesn’t produce enough information in the form of position and movement sense for the brain to process (proprioception and kinesthesia for all you therapists out there). Add in loose ligaments around major joints (it is common to see these two issues together), and your child can really struggle to stay in her chair even with the best intentions.  Imagine yourself in this situation:  you cannot feel that your hips are sliding off the seat until you are just about on the floor, and when you do move, it seems like that is the best way to get more information about where your body is vis-a-vis the chair.  No one wants you to move, and no one wants you to fall.  If your child with low muscle tone decides that she dislikes sitting for meals but happily eats everything standing up or on the run, this could be the reason.

Parents need to start teaching self-feeding skills early and well.  Read Hypermobility Or Low Tone? Three Solutions to Mealtime Problems and Teach Utensil Grasp and Control…Without the Food! for some additional strategies that work.

Kids can start out looking pretty good on a chair, especially if they have a supportive chair that is the right height, seat depth, and provides solid foot placement on the floor or on a footplate. Booster seats that aren’t buckled securely onto a chair are a huge hazard for these children.  Don’t go there.   The Tripp Trapp chair has been the go-to chair for a lot of children with muscle tone issues for years.  There are others that provide similar support without the serious sticker shock.  Look around and ask your therapist what features are important.  For an easy way to keep those feet stable, read A Simple Strategy To Improve Your Child’s Posture In A Stokke Tripp Trapp or Special Tomato Chair.

One adaptation I like for these chairs or booster seats with a smooth surface is using non-skid shelf liner as a seat mat.  It can be cut to your exact seat dimensions and cleaned easily.  I don’t recommend adhering it to the seat.  The mat gives a little bit of grip on clothing that limits the sliding on a smooth wooden seat.  Some children like the matting glued to the footplate as well for tactile feedback, but that makes it harder to clean, a tripping hazard at times, and it can bunch up when the adhesive loosens in spots.  If you need more grip. try Dycem.  This rehab staple is available from therapy supply stores and online retailers.  Read about what it can do for your child here; The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem.

I also like to make custom placemats for younger children that encourage them to place their non-dominant hand on the mat unless it is needed for bowl stabilization. I trace that hand in a location on the mat that is slightly in front of them, next to the traced line for the bowl/plate.   A great resource for dinnerware that doesn’t fly off the table is OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues.  Hand-on-the-table is not as polite as “hand in your lap” positioning, but these children often need to use that hand in this position to shift their weight forward through their trunk and use it actively to stabilize their body  during the meal.  The usual result if their hand is left in their lap?  They slump toward one side, or that non-dominant hand will start to twist the tablecloth, bang on the table or make another action to energize or stabilize their nervous system.

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Utensil use is often rejected because it can be so frustrating for kids.  Avoid the temptation to allow a finger-feeding diet by teaching good utensil use and giving them good utensils.  i covered this in Which Spoon Is Best To Teach Grown-Up Grasp? and Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child.

Kids with low tone often try to rock while sitting or try to rock the chair to get more proprioception and some vestibular input.  Placing any chair near a wall is often the difference between a child flipping the chair backwards or not.  Banging the chair into the wall once or twice requires a conversation; flipping backward head first may require an E.R. visit!

Being involved in the family meal is always desirable for social skills and developing family togetherness.  For kids with low muscle tone, conversation can help them stay more alert at a time of day when they may be fatigued.  Their desire for movement might be satisfied by socially acceptable actions:  help setting the table, getting up to retrieve things from the kitchen for family members during the meal, and cleaning up.  If you were looking for reward chart items or just assigning household tasks to all family members, this can help everyone.

There are many more individual strategies to improve mealtime sitting.  I invite you to share your most successful ideas!

Looking for more help with positioning and ADL’s?

I wrote an e-book just for you!

The JointSmart Child;  Living and Thriving With Hypermobility Volume One:  The Early Years is now available on Amazon.com!  This book gives parents solid information to help navigate positioning, utensil selection, how to motivate and teach skills to kids ages 0-5.  But it also offers information on improving communication with family members, babysitters, teachers and even doctors!  There are forms to help parents think through their questions and feel confident in every situation!

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