Wednesday, May 11, 2016

5 Feeding Tips for Kids With GI Disorders & Tubes


             
Children with disorders of the gastro-intestinal tract commonly experience pain during eating. As a result, the child may develop resistance or anxiety surrounding feeding. The placement of gastric tubes can further complicate the situation as children who require delivery of nutrition via a tube may not have the opportunity to explore the various tastes and textures of food. Typically, when a child does not have an impairment of the GI tract, feeding progresses naturally and is most likely a pleasurable experience. Babies are born with the innate ability to suck and as their gag reflex disappears, the child begins to accept solid foods with variances in texture and taste. Eating becomes social and pleasurable. As the child learns the skills of chewing, including moving food items with the tongue and muscles of the mouth, he develops key skills which will bring about successful eating habits for the future. It is also important to note that the ability to eat helps develop the oral structures necessary for speech production and vice versa. Often times, when children have a negative experience with eating, a bad memory will form. If this is repeated over time, a resistance to try new foods OR anxiety surrounding eating can result. It can be difficult for families to determine exactly when or why a feeding difficulty may have occurred. When a child is not able to eat a diet full of variety in texture and taste, sensory defensiveness may result. This means that the child may exhibit behaviors such as gagging, choking, or avoidance of certain foods based on their perception of the food's properties.
 

1)  Know the signs of trouble.

·         Gagging, spitting, or vomiting "safe" foods.

·         Refusal to use a fork or spoon.

·         Dislike of hands and mouth being messy.

·         Difficulty moving food from one side of the mouth to the other OR pocketing (holding    
                    food in the cheeks).

·         Negative reactions to the smell of food.

·         Gulping or swallowing food without chewing it.

·         Throwing food or refusing it altogether.

·         Increased negative "behaviors" or tantrums surrounding mealtime.

2)  Seek the right professionals.

It is commonly the job of Occupational Therapists (OTs) to help remediate feeding difficulties with children who may or may not have a medical diagnosis.  OTs are specifically trained to consider the child's unique situation as well as the importance of feeding to the family's daily life.  For example, many families with children who have known feeding disorders, may not focus on mealtimes to avoid anxiety and disappointment to the child.  There are, however, many ways to work with families on the skills that eating helps to develop in fun and non-threatening ways.


In my book, The Parent's Guide to OT for Autism and Special Needs, I give an entire chapter of feeding tips.  One of the biggest ways to help with feeding consider the meal-time environment. Try to alleviate as much stress from feeding times as possible. Placing pressure on a child to eat or force feeding him may have a negative effect.  Keep mealtime conversation light and fun. Encourage your family to listen to calm music or set the table with bright and fun place settings can change the atmosphere into a more positive one.

3) Introduce a vibrating oral motor tool, such as wiggly toothbrush or z-vibe to a child’s face, cheeks, lips, mouth, and tongue.  

The use of fun "tools" is a good way to allow the child to experience different textures and movements in the oral area.  Spinning toothbrushes are fun and give great sensory input. Massage your child's cheeks and around his mouth with a warm washcloth, or very soft bristle brush. Try sensory mouth massage brushes to provide vibration, which is known to 'wake-up' receptors. Use the vibratory input to the inside of the cheeks, teeth, tongue, and lips.  Allow your child to dip the tool into safe liquids with different tastes.  Experiment with sweet, sour, warm, and cold.  Try to introduce foods with the tool instead of a fork or spoon if your child is comfortable doing so.  (Of course, ask your OT or physician what's safe for your child.)  

4) Play tongue & face games.  

Try to place a dab of safe food onto his lips and encourage him to use his tongue to get it off.  This is excellent exercise for the mouth and tongue muscles!  Sing fun songs such as Old McDonald and encourage kids to exaggerate the sounds. Place a mirror in front of your child and make silly faces.

5) Encourage messy food play.
Remember that children learn through play.  Using food such as fruits or veggies cut to make designs is fun.  Also, try "finger painting" with foods of all different kinds.  Use pieces of food as a stamper onto paper and see what creative ideas your child comes up with!  It is especially wonderful if your child takes a lick or two of the food while playing.  This is fun way to encourage small bites.The most important thing is to make mealtime a fun and relaxing place for the entire family.  Never pressure or force feed your child.  Help him to have control of food choices and prepare meals with you as he is able.  Celebrate every success and work to build your child’s confidence. The bond you create will last a lifetime!


Cara Koscinski, MOT, OTR/L, is an occupational therapist and the author of The Parent's Guide To Occupational Therapy for Autism/Special Needs & My Mighty Mito. She has two sons with Eosinophilic Disorders and her younger son is fed via G-J Tube. Visit www.pocketot.com for more information.

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