Feeding

So, today our SLP and OT came to observe Kinnick and Carver's feeding routines. After observing, they came up with some new things to try.

The following is what our SLP and OT observed, and what they would like to try as far as swallowing goes:

Kinnick:
1) Breathing. Kinnick has limited respiratory intake and output. Therefore, she needs time to catch her breath after she swallows. Sometimes she needs to swallow a couple of times before she is ready for another bite. I (SLP) think she gets stressed out, then her breathing quickens, then she has to swallow, then catch her breath, and be ready for the next bite. This could cause her to stress out even more, choke, and then refuse, and she's back to square one. During lunch, Nurse Marci did a great job making Kinnick feel safe and comfortable. We (SLP and OT) allowed Kinnick to "wait" for a little bit before the next bite. I (SLP) also cued her to say "wait", which she is still learning to do. At one point, she asked for "more"! :) We (SLP and OT) also let her know when the bite was coming ("Here comes a bite, Kinnick). Kinnick typically closes her lips when she swallows.

2) Limiting oral intake to 30 minutes. Mom and Marci already do this, but I (SLP) wanted to be sure you knew why the limit is 30 minutes, especially for Kinnick. Eating takes lots of energy, b/c of coordinating chewing (or movement of the food to the back of the mouth), swallowing and breathing. Kinnick's breathing is still effortful. If oral intake goes over 30 minutes, the food Kinnick is eating will be used up as energy for eating only.

3) We (SLP and OT) noticed she is not drinking her milk. It could be the flavor. Nurse Marci said Kinnick is drinking or learning to drink from a sippy cup and that Kinnick also likes juice. Kelly (OT) and I (SLP) are excited for her to learn to drink from the sippy cup on her own, then move on to a cup. Go, Kinnick!

4)We (SLP and OT) worked on appropriate refusal ("no, thanks"), rather than screaming.

5) At the feeding conference Kelly (OT) and I (SLP) went to, we learned that kiddos with texture/flavor aversions are given a variety of flavors through their g-tube. The logic is that when gas is burped from the stomach, it can be tasted. Sounds gross, I (SLPL) know, but this is a way for Kinnick and Carver to try something new without it being too offensive. Of course, Kelly (OT) and I (SLP) would NEVER try this without your explicit permission. This was just an idea we were tossing around. We (SLP and OT) will also continue to orally introduce new flavors and textures.

6) We (SLP and OT) are going to work on more oral stim with Kinnick to help with toothbrushing.

I (SLP) am very pleased that she did not demonstrate great discomfort/aversion during mealtime, and was very willing to continue with therapy. Way to go, Kinnick!

Carver:
1) What an awesome little man! You have done a fabulous job of teaching him how to use a spoon! Kelly (OT) and I (SLP) are excited for him to learn to feed himself!

2)We (SLP and OT) are looking at helping Carver close his lips around the spoon, rather than the spoon scraping the food off of the roof of his mouth.

3)He is enjoying lumpier textures which is great. We are still encouraging oral stim with a nuk brush and z-vibe (basically, a rubber tipped vibrating stick) to help with tooth brushing and chewing. Because of his tonic bite, he may need support for chewing and I (SLP) am currently looking into this. Kelly (OT) and I (SLP) would also like to vary his flavors orally.

4) I (SLP) would like oral stim with a nuk brush to take place at home. This could only take about 2 minutes out of his day, if Mom and the rest of the team are ok with that. If Mom would like, I (SLP) would be happy to demonstrate or show you, Nurse Marci and anyone else, how we (SLP and OT) do this.

5)Just like you all encouraged "pretend eating" with the spoon, I (SLP) would like to encourage "pretend drinking" with a cup (for both Carver and Kinnick). This will help them be aware of the corners of their mouth, the tip of their tongue, etc.