Tag Archives: self-feeding skills

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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Teaching Children To Use Utensils to Eat: Use Good Tools, Good Food, and Good Timing

 

ksenia-makagonova-274699I gave a crash course in utensil instruction to an interested dad recently.  Speaking with him, answering his questions, made me realize that I had spent years refining my approach to teaching young children how to use spoons and forks.  I had never written it all down.

Select your tools carefully.  Many parents and nannies are handing over the narrow, long-handled infant spoons to their toddler.  That would be like me providing you with my spatula.  Take a look at  Which Spoon Is Best To Teach Grown-Up Grasp?  for the best design choices for older kids.  The blue spoon in the photo line-up is a great toddler/beginner spoon.  This Gerber spoon has a non-slip handle with dots on the surface where a young child should place their palm.  Yes, toddlers use a fisted grasp.  The bowl of the spoon is not too shallow and not too large.  The handle is thick and just long enough for a toddler palm.  Why shouldn’t they use a plastic disposable spoon?  All of the above features are missing, plus the light weight doesn’t provide the sensory input that helps children feel what their hand and arm are doing while they scoop and place the spoon into their mouth. Those plastic spoons say they are disposable, and that is what you should do when you are done with them.  Take a look at OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues for more ideas on great tableware.  If bowls and cups tend to tip too easily, try a silicone baking mat for a non-slip surface, or go pro and get some Dycem The Not-So-Secret Solution for Your Child With Motor And Sensory Issues: Dycem.

Where you hold their spoon determines where they hold their spoon.  Guiding their beginning attempts at scooping and their attempts to bring a loaded spoon to their lips usually involves your physical assistance.  Some parents opt for what teachers would call “hand-over-hand” assistance.  I use that type of assist sparingly, since most young children resist it.  In my opinion, they resist it because they do not understand why you are gripping their hand.  I opt for holding the spoon, not the child.  If they aren’t actively bringing the spoon to their mouth, neither am I.  No fights.  If you hold the handle in the middle, a child will grasp the part of the handle that is available:  the tip.   Children naturally reach for the tip, they often pick up a utensil at that spot when the spoon is resting on the table. That is, however, not a functional grasp, and even an adult wouldn’t be able to successfully load a spoon with food and eat with that grasp.

Place your hand so that it covers the tip of the handle, at the end.  If your child is old enough to try to feel herself, she will reach for the shaft of the handle, not the food in the bowl part of the spoon.  Her hand is now in the right spot start eating!

Choose food that sticks to the spoon.  The dad that I mentioned in the beginning had given his son some thick ricotta-like cheese for breakfast.  Perfect.  Even when the child tipped the spoon upside down, the cheese stuck to the spoon.  There are other choices that make learning successful and less frustrating.  I am thinking of mashed avocado, mashed potatoes, especially sweet potato or yams, very thick Greek yogurt, and the old favorite, oatmeal.  The worst choices?  Peas, unless mashed, rice, and pasta.  Having your food roll away is just so discouraging.

Use a plate or a bowl?  Suction cup base or not?  I prefer a shallow bowl, so that scooping can be done against the sides of the bowl and the angle of the spoon is small.  The hardest set-up?  Scooping out of a deep cup like a yogurt cup.  Some parents buy bowls with a suction cup base.  For super-curious children, this is catnip.  They have to figure out why the bowl isn’t moving.  Inevitably it does, right to the floor.  My favorite hack is a damp paper towel under the bowl.  Grips the bowl, but not fully, is familiar enough to prevent at least some exploration, and you can use it to clean up when the meal is done.  Take a look at OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues for an attractive line of dinnerware and utensils that don’t break and don’t look like “equipment” but function as well as therapeutic tools.

The first 3-7 bites are key.  I suggest to parents that they prompt for spoon use when a child is eager to eat, but the first bites are provided.  Some children are so hungry that having to work to get a bit of food makes them angry.  If they have a little taste, they are willing to work on scooping to get more.  After about 7 bites, a lot of children aren’t that hungry any longer.  The ones with small appetites will stop making an effort.  The ones who are resistant to using a spoon will wait for you to feed them.  That isn’t a terrible solution for very young children, as long as you got some cooperation and practice in while they were still hungry.  After all, there are more meals coming. 

Consistency between all caregivers.  If parents, the nanny and the other caregivers know the plan, simple as it is, learning comes faster.  Make the effort to explain and even demonstrate.  Children do not appreciate different strategies.  They default to “no”.

Make it fun.  My post on fun ways to practice utensil use, Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child, gets a lot of hits because everyone wants to have fun, no one wants to “work”.  Me too, which is why OTs generally use toys and play to build skills.  Here is a new post for those children that are read to try knife use: How to Teach Your Child to Cut Food With a Knife…Safely!

Good luck, and have some fun at the table today!

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