Category Archives: tools for parents

Helping Baby with Gastroesophageal Reflux Disorder (GERD)

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One problem that impacts a large number of young children in Gastroesophageal Reflux Disorder (GERD).  Statistically, babies who have GERD are at risk for feeding issues during childhood.  It is important that parents be given tools to recognize GERD, address GERD, and promote future eating habits.

When the lower esophageal sphincter has poor closure, stomach content can regurgitate back up into the esophagus.

When the lower esophageal sphincter has poor closure, stomach content can regurgitate back up into the esophagus.

The best indicator of GERD is the infant’s symptoms, which may include reoccurring vomiting, fussiness during feedings, inconsistency with intake of milk or formula volume, gagging, swallowing with effort, arching the back or refusing to eat despite appearing hungry.  Many caregivers  of children with GERD report that they have been feeding baby while they are sleeping, since baby is refusing feedings while awake.  Medical tests cannot rule out GERD.

As an occupational therapist, my expertise is education on positioning, during and after feedings:

  • Use the log roll technique while changing babies diaper or clothes.  Many caregivers lie babies on their back and lift their bottom by their legs in order to change diapers or clothing.  This position puts a great deal of pressure of baby’s stomach and promotes stomach contents to reflux into baby’s esophagus.  Instead, roll baby from side to side like a “log”.  Avoid twisting baby’s trunk by keeping shoulders and hips aligned.
  • Feed baby on their side with head up above feet, versus flat on their back.  Place a pillow under your shoulder, ensuring that baby is on their side and with an upright incline.
  • For babies 6 months or older, feed baby on their left side.  Stomachs are positioned on your left side.  Infants have a vertical stomach, with very little curvature.  If your baby is 6 months or older (around the time most babies learn to sit upright), their stomach is beginning to be compressed  into the shape of a kidney bean.  Due to the position of the stomach, many babies who are 6 months are older, will reflux less when feed lying on their left side.  If your baby is breast feed, you can use the football hold technique in order to nurse from the left breast and keep baby on their left side.
Football Hold

The “football hold” is a great breastfeeding position to nurse from the left breast and positioning baby on his left side.

  • After baby eats, keep baby upright or on their tummy for 20 minutes.  My personal favorite was using a baby carrier after feedings.

Caregiver’s should also be aware of common feeding patterns of infants or children with GERD.  The symptoms of GERD can cause children to cycle back and forth from being in pain and refusing food, and being very hungry and overeating.  After regurgitating stomach content up into the esophagus, the area becomes inflamed, irritated and painful, and many children will avoid eating.  Then, after sometime, the physical, painful symptoms subside and the child is again ready to eat.  Since the child has been avoiding food, they are very hungry.  At this stage, many children will overeat and overfill their stomach.  This causes the stomach content to regurgitate again, which cycles back to avoiding food again.

If a caregiver suspects that a child has GERD, they should track the child’s feeding time (time of day and duration) or bottle intake.  Look for patterns of poor feedings and overeating.  The caregiver should also track the time of any observable symptoms, and look for patterns of discomfort after feedings with a larger volume.

In order to prevent this cycle, caregivers should consult with the child’s pediatrician to discuss strategies to prevent overeating.  The plan needs to be specialized for that child.

Finally, it is important to discuss strategies for promoting future healthy eating habits.  It is understandable that a child would be at risk for eating problems when their first experience with food is pain and discomfort.  While baby is nursing or bottle feeding, the caregiver should be aware of their own body language and tone of voice.  Are your shoulders tight?  Is your voice strained?  Take a deep breath.  Sing a sweet song to baby.  Coo and giggle with them.  Your calmness will carry them through a difficult time.

As the caregiver introduces solids (which is less likely to regurgitate because of their thicker texture), they should make a point to emphasize the joy of eating.  Play with food! Get messy, squeeze, paint, draw, lick, splat, make “animals”, make car noises, and most importantly SMILE while eating together.  Little ones are designed to learn and change.  Together, caregivers and children can build new, fun experiences with food.

Sensory Retreat: Ikea Ekkore Swing

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Pod Swing

Ikea Ekkore Swing

The Ikea Ekorre Swing is a great, affordable tool for creating a sensory retreat for your child.  During most of the day, I prefer to have the swing touching the floor, so that it doesn’t wobble and twist while your child is taking a break.  I’ve also tied a piece of fabric to cover the opening while allowing your child to easily get in and out.

Ikea Ekorre Swing

Ikea Efforre Swing with fabric square tied at the top to cover opening.

I suggest that an adult facilitates while the child is swinging on the Ekkore Swing.  If your goal is to help your child calm down, push them back and forth, in a rhythmical manner, without twisting or jerking the swing.  Very few kids are calmed by spinning in this passive swing.

For increased deep tactile and proprioceptive input, stuff the swing with the child’s favorite stuffed animals, bean bags, or blankets.

Kids in the Kitchen

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Children learn about food qualities through their eyes, hands, nose and tongue. Interacting with food before the demand of eating promotes success.

Children develop their perceptions towards various foods differently than adults.  We perceive food with a cognitive lens, in which we recall past experiences, categorize foods and reason our way through choosing which foods we are going to eat.

Children perceive food with a sensory-motor lens, in which they decide which foods they are going to eat through there eyes, hands, nose, in addition to their tongue.  Many children are highly aware of changes in food’s shape, size, color, smell, temperature and texture.  In some cases, children will refuse foods that appear slightly different than their preferred choices.

There are many reasons why a child may have a limited food repertoire and prefer to eat the same few foods again and again.  All children benefit from interacting with food in more ways that just eating.

My suggestion: Invite your children into the kitchen.  Scoop, pour, shake, stir, open, close and mix.  As a bonus, you’ll be engaging in activities great for sequencing, imitation, attention, planning and fine motor development.  Most young children are thrilled at the chance to join their parents in the kitchen.  Also, it’s a better use of time than the parent occupying or distracting the child away from the kitchen so that the parent can hurry up and get the cooking done.

With son #1, before he could walk, every morning we would make smoothies and my coffee together.  I helped him scoop the protein powder, pour the milk and kefir, peel the banana and scoop the ice.  Next I helped him scoop the coffee grounds (“one, two, three”) and pour the water. Then we washed the dishes together, in which he played in the water with his hands while I loaded the dishwasher.  And yes it was always a mess.  And yes it took three times longer than if I just did it myself.  You need to rethink your kitchen time as more than just preparing food.  It’s a place to develop your child’s lifelong relationship with food.

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For a little parenting humor, check this out this diagram from the “Honest Toddler”:
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Breath Activities

BUBBLE MOUNTAIN:

My favorite go-to activity to help our little ones with regulation is Bubble Mountain. All you need is water, a straw, a container and a few pumps of dish washing soap.

I suggest placing the container on the floor and having children lie on their stomachs, resting on their elbow and forearms. This position stabilizes the upper trunk, which discourages upper trunk breathing. Movement in the belly is desired. Movement at the shoulder and collarbone is inefficient and fatiguing.

Just a few minutes of blowing can reset a child’s arousal state. Children of all ages love this activity.

Breath Activities

Breath Activities

Bubble Mountain

Bubble Mountain

SOUNDLESS WHISTLE:

Another great tool are soundless pipe whistles. Most whistles are loud, shrill and alerting. The soundless whistles are fun and calming.

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http://www.therapro.com/Magic-Corn-Cob-Pipe-P6310C6305.aspx

DIAPHRAGMATIC BREATHING:

Below is a fun Elmo video song called “Belly Breathe”.  Watch it with your little one and try modelling diaphragmatic (aka “belly breathing”) breathing next time your child has a high arousal state.

 

Starting Solids: Hard Munchables

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Baby is improving his oral motor skills in preparation for eating.  His tongue reflexively moves towards the carrot during a munching chew pattern.

As babies transition from milk to solids, hard munchables are a great food to introduce around 8 months old, after purees and before crackers. Baby won’t actually swallow this beginner food, but will engage in oral motor play to prepare for chewing.

Hard munchables are firm foods, appropriately shaped into a stick form.  They are long enough so that baby can easily grasp the food and reach the back of the gums.  It’s important that the food be firm enough so that it won’t break, and thin enough so that it will fit between the gums.  Also, it is crucial that the food is at least 5 inches long and that baby is supervised, in order to prevent choking. My favorites are carrots, celery, jicama, fruit leather, bell pepper strips and bagel strips.  My sons always preferred their hard munchables cold from the refrigerator (probably felt good on their gums).

Placing objects in the mouth (in a safe manner of course) is a crucial preparatory activity for eating.  Hard munchables encourage the gag reflex (which is present at the front of the tongue in newborns) to move to the back of the tongue and throat.  They also inhibit tongue protrusion (movement pattern used for sucking at the nipple), promote tongue tracking (needed for managing solids) and support the emerging munching pattern.

Coordinating lip, tongue, jaw and throat muscles for eating is hard work for little ones.  Providing hard muchables while introducing solids will help give your baby a good start.

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BrainBeat: an in-home program developed from the Interactive Metronome

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The Interactive Metronome is a research-based tool that has been used by professionals during treatment to improve many skills including focus, sequencing, timing, and fluidity of movement.  I became a certified Interactive Metronome provider in 2008 and have successfully used this program with many children.

http://www.interactivemetronome.com/

Brain Beat has been developed from the Interactive Metronome to improve access and affordability.  The child completes the program in their own home, on a personal computer, on their own time.  Also, Brain Beat is a dynamic game with levels and various themes, which helps keep kids motivated and engaged.

In order for rhythm based tools to be the most effective, the child should perform the activities with good form, use fluid movements and appropriate force.  Some children, who have difficulties with sensory processing, body awareness or coordination, may need assistance from a trained professional so that the activities are the “just-right challenge”.  I suggest consulting with a pediatric occupational therapist to determine which program is best for your child.

http://brainbeat.com/pages/about

 

Five Activities for Crossing the Midline (and why it’s important)

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http://teachmama.com/five-activities-crossing-midline-important/

The post written by Devany LeDrew, a former kindergarten teacher, includes a few great activities for crossing the midline that include easy to follow pictures.  Pediatric occupational therapists often include some of these activities during their therapy sessions.

Engaging in activities that cross the midline can be beneficial during a homework break, in the morning before school or incorporated during playtime.