Occupational Therapy Update

John's occupational feeding therapy is going well. John is excited on Wednesday mornings when I say, "We're going to have breakfast with Miss A----!" Then he recounts to me which toys of hers he is going to play with. Although for the last two sessions, he has not needed any bribing with toys to sit and work with her and food for the half hour. That's wonderful!

Each week, Miss A---- gives me one or two more tips to incorporate at home. I keep them on a list on the refrigerator to remind myself. I know this is dull for many people but a couple of my friends who have children with these issues might be interested:

* First: Relax. Stop forcing, punishing, cajoling, bribing about food. Calm down so John stops seeing food as a battleground. Don't take away his familiar foods (according to our OT: "no matter how junky!"). Don't try to starve him out. This atmosphere allows "food-chaining" therapy room to work.

* Use straws, not sippy cups. (Apparently sippy cups can cause trouble, especially for children who have as-yet undetected oral-motor issues. I replaced all our sippy cups with straw cups except for cups when traveling and at the bedside. Target sells a neat straw cup for $1.50 in which the straw folds down and locks shut, so it works for traveling too.)

* Place straw at the middle of his mouth, don't clamp down with teeth. (Whether using a sippy cup or straw, John drinks by placing it in the side of his mouth and clamping down hard with his molar for stability. When practicing not clamping his teeth, it helps if I gently cup John's jaw with my hand and that gives him a feeling of jaw stability.)

* Talk about textures of food with John. (Giving him a vocabulary for how things feel will reduce anxiety when trying new foods. Now John tells me all the time whether something is crunchy, etc.)

* Offer John a "spit cup." (Having a place he knows he can spit out food safely will reduce anxiety about trying something new. We haven't done this yet with John.)

* Let John play with food at mealtimes (but not throw it on the ground). (Receiving sensory information through his fingers is an important first step before willingness to receive sensory information through his mouth.)

* Experiment with squishy things (like whipped creme, shaving creme).

* Encourage John to cook, mix, bake with Mama.

* Encourage John to wipe his own hands and face. Encourage him to clean up (throw away) foods he thinks are yucky. (The other day we were working with carrots. He was so resistant that he hid behind a chair. After half an hour, the progress we made was that John was willing to touch the carrot in order to throw it away. That might seem ridiculously small progress, but lately I've seen several instances when John has grabbed a apple, a lime, or a tomato and said, "I want to eat it!" Then he has licked it before refusing to go further. That is a big deal for him!)

* Put out more than one acceptable food at mealtimes. (Because John will eat only one food at a sitting, I stopped wasting food and just give him one food at a mealtime. But that creates a cycle of his not being exposed to any different foods. So, now we are back to wasting food and putting out several things at each food sitting. I have seen progress. I put out peas for dinner every night for a week and by the end of the week John was willing to touch them with his fingers and even touch the peas to various parts of his body, like his cheek or forehead. And I've begun giving him different crackers with his cream cheese at one sitting: one graham cracker with cream, one multigrain cracker with cheese, one Wheat Thin with cream. Then this morning I really challenged him by mixing them: a sandwich of one graham cracker and one multigrain cracker with cream in the middle. Of course, he picks it apart, but that he eats all of those "different" things at once is improvement.)

* Offer different brands and flavors of foods he already likes. (Children who have strong texture aversions and neophobia need changes so changes even as small as varying peanut butter brands are a big deal.)

I'm currently reading "Just Take One Bite," which is an absolutely fascinating book. It's amazing to read about John on every page and discover that I wasn't crazy!

Meanwhile, I have fed Mary porridge two more mornings and she is doing just fine. She sees the spoon coming and usually opens her mouth like a little bird! Then she closes her mouth on the spoon (not locking it out, but bringing the food into her mouth). Then, usually, she gives me a smile!