Hot Topic Blog - Feeding, Eating, & Drinking
THE VALUE OF COORDINATING EARLY INTERVENTION, PEDIATRIC GASTROENTEROLOGY, AND PARENT FOLLOW-THROUGH IN THE TREATMENT OF FEEDINGStephanie LaPedis, MS, CCC-SLP of Los Angeles, California
Sometimes a feeding problem is the result of small issues gone unnoticed or untreated in the hopes that things will get better or a child will outgrow feeding challenges. Before parents know it, they are tied to limited choices of liquids, foods, utensils, and feeding environments. Non-food rituals (e.g., making certain toys or distractions available) may also become part of mealtime in a well-meaning attempt to help a child accept food and eat enough for continued growth and development. While such strategies may work temporarily, they are usually ineffective long term. Therefore, small feeding issues can grow into significant feeding problems, beginning a cycle that seems endless and is very stressful for both children and their parents.
I would like to share the case of 12-month-old Ella (name changed for confidentiality). With early intervention and parent-professional collaboration, we broke the cycle of potential ongoing and worsening feeding problems by getting Ella “back on track” with her feeding skills. This saved both Ella and her parents from a possible life-long struggle with eating and drinking.
ELLA’S MEDICAL PROBLEMS
Ella’s mom had been referred to me by her daughter’s pediatric gastroenterologist, who was concerned about the child’s history of significant projectile vomiting, constipation, inability to manage developmentally appropriate foods, and an increase in the duration of mealtime. Ella had been diagnosed with gastroesophageal reflux disease (GERD) and food allergies.
Ella’s medical issues had the potential of resulting in very negative and long lasting feeding, growth, and development problems. Luckily for Ella, her parents were proactive and consulted with a pediatric gastroenterologist who managed her symptoms and was knowledgeable and open to feeding therapy. Because Ella began projectile vomiting at just 2-weeks of age, she began taking Zantac and eventually, Prevacid. Her mom was diligent in administering these medications, and currently Ella only requires Prevacid to manage her GERD.
ELLA’S FEEDING PROBLEMS
My role was to determine if 12-month-old Ella was an appropriate candidate for feeding therapy. After collecting background information and conducting a feeding evaluation, Ella was diagnosed with delayed oral preparatory phase and delayed oral phase deglutition skills. This meant that Ella could not manage the placement and collection of age-appropriate foods within her mouth.
When I evaluated Ella’s oral skills for feeding, she preferred pureed foods that could be easily managed and swallowed. She was pocketing solid foods behind her upper front teeth and spitting food out. Her mother reported that when Ella was given a pureed food with lumps, she would swallow the puree and spit out the lumps. No lateral tongue movement was observed during the meal. Ella had also recently decreased the amount of solid foods she would attempt to eat and increased the amount of formula she was taking from her bottle.
Without intervention, Ella’s delayed oral skills could have had negative and long lasting effects on her ability to eat developmentally appropriate foods, maintain adequate nutrition needed to grow, and ultimately participate in mealtime social situations with peers. At one-year of age, Ella should have been eating soft, cut-up cooked and raw foods and soft, chopped meats (Bahr, 2010, p. 183). But, therapy could not begin here as Ella needed to develop some prerequisite feeding skills (i.e., appropriate oral awareness, chewing, tongue lateralization, etc).
ELLA’S FEEDING TREATMENT
Therapy began by addressing Ella’s immature oral skills for feeding, while at the same time educating her parents on the careful progression of foods that could be offered to ensure Ella’s success. A systematic oral massage program (Bahr, 2010, p. 125-136) was used to normalize her hyperresponsive gag reflex and improve her overall oral awareness. Oral awareness usually matures with typical feeding experiences which Ella had not had. A systematic chewing program was implemented using Chewy Tubes and a safe feeder to help Ella learn how to lateralize her tongue for the placement and collection food and chew. These and other feeding techniques can be found in Diane Bahr’s book Nobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development (2010).
Ella’s mom presented her with pureed foods with added texture over time. Both mom and I regularly checked in with Ella’s gastroenterologist. This collaborative relationship was important. As Ella began increasing the amount of solid foods she ate, her medication for GERD and the quantity of formula she received were monitored and regulated as recommended by her gastroenterologist and pediatrician.
For Ella, early intervention and collaboration were the keys to her success. The systematic approach to therapy and the collaborative approach to addressing her medical and sensory-motor feeding issues made a significant difference in Ella’s feeding progress. At her recent check-up with her pediatrician, her weight and height were proportional and appropriate for her age.
If Ella’s parents had waited in the hopes that she would figure out how to manage more challenging foods, she could have become so fearful of not knowing what to do with the food in her mouth (due to her oral awareness issues, poor tongue lateralization, and poor chewing skills) that food aversions and negative behaviors could have started and persisted.
Thankfully, Ella’s parents and gastroenterologist noticed the early warning signs of a feeding problem and took the necessary steps to help her. I was so excited when her mom shared with me Ella’s pediatrician’s reaction to her steady growth! It was truly an honor and so rewarding to be part of nourishing this little girl.
If you have any questions, please feel free to contact me at (818) 600-1757 or Stephanie@lapedisslp.com. Stephanie is a speech-language pathologist in private practice in the Los Angeles area, San Fernando Valley.
Bahr, D. (2010). Nobody ever told me (or my mother) that! Everything from bottles and breathing to healthy speech development. Arlington, TX: Sensory World.