FEEDING AND SPEECH DEVELOPMENT

Working in the field of Early Intervention for almost 19 years, I have the pleasure of working closely with parents and caregivers. While we are able to get some information from the child’s initial or re-evaluation, some assessments don’t capture all of the crucial information in regards to early developmental milestones. This occurs especially in the area of feeding. Unless the child presents with clear cut reasons for a feeding delay or difficulty(specific diagnosis, tube fed, etc), the Speech Language Pathologist(SLP) may be the first person that identifies early issues with feeding development contributing to the speech delay. The child may still have difficulties or delays with feeding that go unaddressed even at 18 months- 2 years of age! Why are feeding delays or difficulties contributing factors to speech delays? When babies do not get opportunities to learn oral movements for drinking, chewing, and swallowing, these same movements will be more challenging to use for the combination of movements required for speech. Also, take into consideration the coordination required to use voice or not, respiratory functions, and rapid motor movements all at the same time. Wouldn’t it be better for children to have practice with oral motor movements before combining multiple systems? Of course, there are reasons that babies can not have opportunities to practice oral skills while feeding, but the focus for this article will be children who are not physically unable to eat. Here are some things to monitor and have conversations with your pediatrician regularly about:

  1. Difficulty latching to breast or bottle.
  2. Slow feeding from breast or bottle and/or inconsistent sucking.
  3. Choking while feeding frequently and/or excessive spit up/vomiting after feeding.
  4. Resistance or difficulty transitioning to baby foods-look for excessive spitting out of foods(this is a tongue thrust that should decrease with practice).
  5. Baby not mouthing objects.
  6. Baby not beginning to vocalize or babble on time.

*Refer to the tabs on the home page for developmental milestones.

If you have concerns at any time with your baby’s feeding milestones, please speak to your pediatrician about your local Early Intervention program or email me:

tina@eattalkplays.com

WHY ARE ROUTINES IMPORTANT IN EARLY INTERVENTION?

First, let’s start with the question, “What is Early Intervention?”. Early Intervention(EI) is a multi-disciplinary service and support system provided to families and caregivers for children found eligible, presenting with a developmental delay or disability. It may include: Physical Therapy(PT), Occupational Therapy(OT), Speech and Language Therapy, or Specialized Instruction(SI). Additional services may include, Vision, Hearing, or Nutritional supports. Why is it important? It provides families and caregivers resources, information, and support to assist their child with developmental skills so they can participate in their family’s routines and activities. EI can help families and caregivers embed learning opportunities throughout the day. By doing so, their child grows in their abilities to engage and become independent within their family, as well as the community. Why are the family routines and activities critical for children to learn and participate in?

  1. Children learn best in their natural environments. Whether they are at home, in a child care setting, or at a family member’s house, learning opportunities happen almost every moment of the day when they are awake!
  2. When a child become eligible for EI, this means there is an area of development that is delayed. EI is designed to assist and support families to practice strategies that improve/enhance the skills that are or are not already occurring. They teach families and caregivers how to provide multiple opportunities to practice.
  3. Practicing a certain strategy or skill becomes a naturally occurring process through out the day instead of, setting aside only a specific amount of time to practice. This can lead to the child not generalizing the skill. For example, if you only practice the word “more” with your child to ask for more blocks, they may not use that same word to meet their need of more to eat or drink. Imagine the frustration that may occur!

Whether you think we you are a person who is a “free spirit”(not routine oriented) or a person who lives and breaths structure/schedule(routine oriented), “routines” do occur every day for every one of us! Think about it this way: We all wake up, get dressed, eat, go to bed. What else do we ALL need to do during the day? There is so much opportunity to practice a LARGE variety of skills every day. Also, this gives us as parents and caregivers, the ability to help our children learn the skills they need for every day life.

BABY FOOD POUCHES

The debate and the struggle is real. Pouch or no pouch? Among therapists in the field of providing early intervention services, we are split in our opinions. While most therapists agree that pouches offer the convenience of nutrition in our very busy lives, especially for those “picky eaters”, they should not be used 100% of the time as a way for our children to eat. Why? There are a few reasons.

#1. Sucking puree foods through a pouch decreases opportunities for your baby to learn to feed themselves with utensils-which is a life skill. You can always squeeze it out into a bowl or on the highchair tray to use a spoon!

#2. This will also decrease time babies have to explore their foods with their hands(tactile sense or sense of touch) which will eventually go to their mouth innately(hand to mouth connection important for self-feeding). Babies need to get messy so they can more easily accept different textures as they grow, without(or at least with less) anxiety.

#3. Sucking through an opening(like a straw) is important for oral motor awareness, however, babies also need to learn to chew. This chewing pattern needs to be practiced and mature so they can begin to accept solid foods.

#4. Babies and toddlers are visual eaters. When children don’t see colors of foods early on, this can lead to “picky eating” due to visual aversiveness. For example, they won’t eat anything green(fruits and veggies). Their diets may become bland. Meaning, the foods they eat are only shades of beige(crackers, dry cereal, cheese, plain noodles, etc).

All of these milestones need to occur so their mouths are ready for speech as well! Babies need to explore different objects(including their own fingers)orally to develop awareness and range of motion to produce a variety of speech sounds. They are also teething during this time. Sometimes a spoon can also be a good object to chew on to relieve some pain!

Again, there are absolutely some circumstances that using a pouch is a great solution. However, if you find that your baby is beginning to refuse to eat unless it’s from a pouch, it’s time to decrease that option and/or consult a professional feeding therapist.

*A side note: Pouches can easily become punctured in a purse or diaper bag without you even knowing. This creates an opportunity for bacteria to get in or mold to develop.

FEEDING BABY

Around the same time babies begin to teethe, they begin to their first foods. Also, they begin to make more sounds. Feeding and speech development are closely related! They compliment each other and each milestone your baby meets in one area, s/he should meet another milestone in the other area. Once your baby shows interest in putting objects in their mouths, you can present them opportunities to explore tastes and textures of the foods you eat. You can do this safely with the use of baby food feeders(mesh or silicone)that are found in the baby section of many stores, or on line by searching for “baby safe feeders”. Starting with vegetables and fruits that your baby has already shown no allergy or sensitivity to can give them new tastes and textures to explore, while helping them learn to move their tongue, lips, and jaw in a variety of directions to develop the coordination needed for emerging speech sounds.  You will begin to hear them makes sounds while they are exploring that you can imitate back to them, creating a socially enjoyable experience and connection with you as their feeder. Imitation of the actions occurring in their mouths while feeding is as important as the imitation of sounds that naturally occur as they move their mouths.  Your baby will learn the difference of the sounds they can make while their lips are closed(mmmmm) or when their mouths are open with their tongues down(gagaga). Giving your baby early experiences with a variety of tastes and textures could lead to decreased protest of new tastes and textures as they grow. In addition to these feeders giving your baby opportunities to explore new foods, it can be useful for those painful teeth coming in! Place fruits or veggies in the freezer and place them in the feeder for some tasty relief😉. You will also be teaching your child about different temperatures of foods this way! Always consult with your pediatrician or early interventionist when moving from purees to solids, even if presented in a safe way with the use of these feeders.

WHY DOES EVERYTHING GO IN THEIR MOUTHS?

As parents, we want what is best for our babies. We want to make sure they are safe, they are healthy, and what goes in their mouths is clean.  As soon as they are able to pick up, grasp, and move their hands to their mouths, they will put things in there😊. Inevitably, we then have to make sure it’s not something they will potentially choke on or get sick from.  Babies can begin teething as early as 4 months!  Although we don’t want them to put EVERYTHING in their mouths, this is a developmental stage and important for both feeding and speech development.  As you begin to notice their hands going in their mouths more often, they will begin to try other objects as well, sometimes even your fingers or hands!  This is when we as parents, can provide them objects that are appropriate.  In this day and age, we can easily look for objects to provide them at a click of a button.  Many toys you may already have for them could have different textures on parts of them just for teething so definitely check it out.  Let them explore(safely)!  As they put things in their mouths, they are learning a hand to mouth connection, important for feeding development.  In addition, this gives them the opportunity to build awareness of the structures in their mouths, how they can move them, and different sounds they can produce with these movements.  It also helps with the pain of teething and break those teeth through the gums.  So, before you take that toy they just put in their mouth out, assess if it’s safe, clean, and appropriate.  If it is, let them keep exploring!

*If your baby isn’t going through this stage, struggling with feeding, and not beginning to make more sounds, contact your pediatrician to inquire about you local Early Intervention program.

**Nobody Evert Told Me(or My Mother) That! By: Diane Bahr

PLAYING WITH FOOD!

Does your child love to play in the kitchen?  Most small children go through the stage of wanting to be and do everything just like a parent/caregiver.  One of the ways they show us this is imitating adults preparing food. They love the “real” kitchen stuff, even if they have the pretend kitchen and all the accessories that go along with that.  Using play food and/or a pretend kitchen is a great way to expand both receptive and expressive language skills. It may even help expand the variety of foods they will eat!  As they pretend to eat or drink while playing, you can model sounds like you are takes bites, munching/chewing, take a drink(sipping sound, then ahhhh).  Definitely model “Yum!” or “Mmmmm” when you like something or even “ooooo, yuck!” when you don’t like it(or if they are pretending to eat something that is not actually edible).  To build receptive language, you can ask your child to get a particular food or kitchen object for you, provide simple directions, such as “Stir!”, “Pour”, “Put in”, etc.  Expressively, name the foods or kitchen objects you are using or your child is playing with, narrate what you are doing(Make cookies, Blow on the pizza, it’s hot, Stir the soup, Pour the milk, etc) or ask them to name the objects  independently.  This is also a good opportunity to provide choices for them to imitate words(Do you want milk or juice?) or to give them cues to ask for “more” of something(More cookies).  As they build their vocabulary and are spontaneously requesting certain foods, drinks, or objects, expand to modeling phrases for them to ask.  For example, “Do you want more juice?” “You tell me, more juice!” so they imitate the word combination.  Sometimes, children respond to the adult over exaggerating the phrase(More juice) by slowing down the word(s) or saying it in a sing song like pattern, imitating more easily. Even if you don’t have the play food or pretend kitchen, you can use these same strategies with the items you have in your kitchen to pretend.  Not only is this a good way to build pretend play skills, it provides opportunities to learn and express many concepts while communicating with you!  Also, “playing” with food and tools used to prepare it can help if your child experiences any anxiety related to trying new tastes/textures.

Words/sounds to include: Names of foods, drinks, kitchen objects, action wordsàeat, drink, pour, stir/mix, dump, scoop, wash, blow, cut, Mmmmm, yum, yuck, oooo/ewwww, more, all done, clean up, hot, cold, wet, dry, on, off, in, out, open, close, pot, pan, fork, spoon, knife, cup, plate, etc.

GROCERY SHOPPING

For some of us, grocery shopping is fun!  For others, one of those tasks we dread. Having a baby or young child with us can make it even more challenging!  What if sometimes, we turn it into a fun adventure and learning experience for our children?  From a young age, babies can begin to learn about the foods and drinks we can get at the grocery store, as well as, the process we go through.  These days, we can get so much more than food there!  Here’s an example of how grocery shopping can be a teachable moment.  “Up we go, in the cart!”  “Let’s see what we need.”  “We need more bananas.”  “Where are they?” “Here’s the bananas!”  When they are old enough, see if they can find them, or hold up the bananas and another fruit and ask them to find them(“Get the bananas” or “Where’s the bananas?”).  They are building receptive language this way by identifying them.  Whether they choose correctly or not, hold the bananas close to your face so they can see you pronounce the word.  Then you can ask them, “Can you say it?” or tell them, “You say banana”.  Over exaggerate the word in an almost sing song voice, “ba-NA-na” emphasizing the second syllable or both the second and third. They are learning expressive language this way.  Many young children will say “nana” first and that’s o.k. when they are little.  Talk to your baby as you shop and label what you are buying.  Tell them “In the cart” to describe where the items go.  If they are old enough to walk on their own, they can help put the items in and you can ask them each time, “Where does it go?” so they begin to answer “In the cart”, or at least an approximation of the phrase.  As you take everything out to put it on the conveyer belt, you can tell them “Out!”, “There it goes, wheee!”.  Describe to your baby or young child the items go “In the bag”.  If they are older, ask them to help put some “In the bag!”.  When you’re done, talk about what you bought and how much fun the adventure was.  You can also complete the activity saying “All done!”, “Let’s go home!”.  In addition to teaching your child language, grocery shopping can be a good way to introduce or teach them to try new foods.  Maybe while putting the groceries away, you can talk about something you can make, or they can help make.  One example might be a smoothie-something sweet you can also hide veggies in😉.  For more suggestions and information on smoothies, please visit the “EAT” tab. Remember, it is important to do these activities when there is enough time to take your time…..learning is more difficult for everyone if it is rushed!

Words/sounds to include:  Names of foods, drinks, or household items, in, out, eat, drink, yum/yummy, cart, beep, more, all done, go, stop, look, etc.

SUMMER SMOOTHIES

It’s summer and it’s HOT! What better way to cool down than ice cream…..or a smoothie!  With technology at our fingertips at any given moment, you can find many recipes for smoothies. It’s a great way to incorporate fruits and veggies into our children’s(sometimes picky children’s)diet.  What you probably didn’t know is that this is a great way for your kiddos mouth to work a little harder and differently to drink.  Make it fun by giving them a silly straw to drink it from.  This will provide awareness to their lips and tongue, as well as extra work while they are sucking through the straw.  It could be an easier way for children to learn to drink from an open cup since the liquid is thicker and won’t go so fast as they learn to tip the cup to gauge the amount of liquid to swallow.  You can easily play around with the consistency, whether you want it more like a milkshake or a smoothie.  When they are old enough, have them help add the ingredients and teach them the names of what is going into the smoothie, and the actions that go along with it(cut, mix, pour, etc).  Then enjoy a cool treat during the dog days of summer!  For more information about picky eaters, see the resources tab for a helpful and informative website!

LET’S EAT BABY!

When is it time to begin to feed your baby first foods? Most experts say around 4-6 months your baby will be ready for baby cereals and purees. This is an important step not only for them to reach feeding milestones and continue to grow, but will give baby more awareness and movement of oral structures they use for successful eating and speech.  When you first spoon feed your baby, beginning with rice cereal or oatmeal, it is important to place the spoon so that the tongue and roof of the mouth can work together to move the food back in order for baby to swallow. Also, baby’s lips should have the opportunity to clear the bowl of the spoon. The first few bites, or even the first few times your baby eats, you will most likely see them push the food out instead of a complete and/or successful swallow(tongue thrust). This is completely typical, however, if your baby doesn’t begin to successfully swallow more quantity each time they practice, you may want to seek additional advice or help.  Having good communication with your pediatrician who can refer you to your local early intervention program is important if you begin to have concerns. In addition, I have included an additional resource in the resources tab for information from an occupational therapist who specializes in feeding. Once your baby is more proficient with a variety of purees and is beginning to teeth(chewing on everything, excessive drooling, more irritability, etc)you can begin trying some teething biscuits so baby will learn a more mature chew, then bite action. You can also begin transitioning them through the next stages of baby foods so they can be efficient and successful with table foods.  Whether you are using store bought or homemade baby foods, let your baby explore the foods they eat.  Let them get messy and learn how to become confident with self-feeding while progressing through the stages.  Remember, all of the exploration and movement they are learning through feeding, also helps baby learn awareness and movement to begin speech. Talk to your baby during feeding times to teach them names of all the foods they are trying and what they need to eat them. Most importantly, be patient and have fun watching your baby learn and grow!

Words/sounds to include: eat, yum/yummy, mmmm-mmmm, names of foods, spoon, bowl, bite, chew, scoop, dip, mouth, tongue, teeth, lips, more, all done, etc.

*Please refer to the resources tab for additional information regarding feeding milestones.

TRANSITIONING YOUR BABY TO CUP DRINKING

Transitioning your baby from a bottle to cup can be a rewarding accomplishment as a parent and scary at the same time!  Around the time babies are ready to be introduced to cereals and other purees, you should begin to explore cups.  Somewhere between 9-12 months, it is typically safe to begin introducing an open cup. Not only does this help progress them through the stages of feeding, it aids in speech development as well!  Small cups with small amounts of liquid is best to start with.  Look for some disposable ones that have a thicker rim. This helps when you are positioning it to fit to the corners of their tiny mouths and teaches them to keep their tongues in and down to rest on the bottom jaw.  Starting this process early on will help with difficulty transitioning when they are older, more aware and potentially anxious, and attachment to the bottle is stronger.  If your child is over a year old and you haven’t yet taken this leap, not to worry! Make it a fun activity while they are in the bathtub, having fun outside(in the warmer months of course), or playing with favorite dolls/stuffed animals having a picnic or tea party. When they are in the tub, you won’t have to worry about them spilling! Nesting cups are a great way to practice during bath time. The rim around the top is large and this way they also practice motor skills of dumping, filling, and pouring.  Remember, as they are learning, they will tip it too much and sometimes cough, just like we do when we take too big of a drink.  Coughing is good, that means the liquid has not reached the lungs. Always monitor when they are first learning and practicing.  Also available now at most stores and online are 360 cups that are closed like a sippy cup and will help them learn to tip it up while controlling the liquids(saves parents/caregivers from cleaning up spills). If you suspect your child is having more difficulty using an open cup than you expected and something doesn’t feel or look right, contact your pediatrician.  You may want to ask them about further evaluations or your local Early Intervention program.

Words/sounds to include: cup, drink, water, milk, juice, wet, cold, pour, yum, ahhhh(after taking a sip).