When to transition to baby cereal and/or pureeds Stage one baby foods

This question seems to come up a lot in the feeding world....

Why? Well, my personal thought on this topic... is that back in the 1980's and before...... it was believed that babies should start getting baby cereals as early as possible because doing this would help them to sleep through the night. Thats why today in 2009...when we are asked..."How is he sleeping"...we cringe...because we know when we say..."oh...pretty good, some nights are better than others though"...that we are going to hear..."well, he is up because he is hungry...you need to start giving him baby cereal".

Soooo...whats the answer? When should you start? Were they right in the 80's? Does giving to them earlier help them sleep better?

Most pediatricians recommend the following as a standard of when to introduce baby cereals and pureeds:

* Start rice cereal between 4-6 months of age
NOTE: we say rice cereal because it is the least likely out of oat, wheat, mixed and rice to have an allergic reaction.
NOTE: if your family has food allergies, intolerhances, or seasonal allergies try to wait to introduce the cereal until as close to 6 months as possible.
NOTE: After you introduce the the rice cereal...monitor your baby for any reactions...constipation, diarrhea, vomiting, increase in spitting up, skin rashes, irritability, etc..these could be signs of an allergy or a sign that your baby's tummy isn't ready for solid foods yet...wait two weeks then try again.

So...start rice cereal between 4-6 months of age...CHECK...got it...but...uh...why?

Well...for several reasons. God designed little ones to start taking cereals at this age...how cool is that! Between 4-6 months of age, the infant's "fat pads" (aka their chubby cheeks) start to get less chubby inside their mouths...which gives them more room in their mouth...

Aha! Isn't that awesome! When infants are drinking liquids they need less room in their mouths...but in order to introduce pureeds...they need a little bit more room...so what does God do...he makes that possible by decreasing the fat pads in their cheeks and giving the babies that extra room that they need!

Another reason is that between the ages of 4-6 months babies start being able to sit up more..they are gaining more external stability..they are a little less "floppy" :) Their heads need less support. This gain in stability allows all of their energy to be focused on their mouths..and the fine motor movements needed to eat cereals and/or pureeds... their tongues transition from an "in/out" movement needed in sucking from a bottle to a more complex oral motor movement needed to eat cereals. At the beginning of trialing with the cereal your baby may push the cereal out of their mouths with their tongue (because they are used to doing this movement when they sucked on the bottle)...but as they gain experience in eating the cereal their tongue will stop pushing the food out...and will begin to remain quiet in the oral cavity (aka mouth)...and will wait for the spoon to approach...

NOTE: in order to decrease the forward tongue motion...as you put the spoon in their mouth...put some firm downward pressure on their tongue...this does 2 things...it helps to train their oral muscles to change to the new motion...and it helps increase their upper lip to close over the spoon and help to get the bolus (aka food) off the spoon instead of needing you to scrape it on their gums as you remove the spoon.

Another reason for waiting is that....research has found that delaying introduction of cereals and pureeds until 4-6 months (closer to 6 months is better)...helps to prevent future allergies and intolerhances to foods. Before 4-6 months babies do not have a mature enough digestive system to handle anything but formula or breastmilk...they just aren't ready yet...they need more time. Giving the food too early can hurt the digestive system in your baby.

So thats it...

When should you introduce baby cereal? 4-6 months...but try to wait as close as possible to 6 months...they just aren't ready before that...their tummy isn't ready, their mouth isn't ready and their muscles aren't ready...

NOTE: if your little one was pre-mature..you will need to use their adjusted age in order to determine when to introduce cereals...meaning if they were born 8 weeks early and they are 4 months chronological age...and 2 months adjusted age...then they are too young to start cereals!! Actually, it is recommended that infants that were born premature should wait until their adjusted age is 6 months before they start cereals...because their little systems are even more sensitive....meaning that the above mentioned child would need to be 8 months chronological age and 6 months adjusted before starting cereals!!

** As allows it is recommended that you always check with your pediatrician...if he/she says to wait longer...then wait longer...I just wouldn't introduce them ANY EARLIER THAN 4-6 MONTHS IF AT ALL POSSIBLE!!!!

Toys/Materials a speech therapist recommends

Toys that a Speech Therapist would buy…..

**Any of the Sandra Boynton books-they have repetitive lines that the kids can repeat (moo, baa, lalala- is my favorite)

**Books that have pictures-not story books

**Books that have animals-to get kids to imitate animal sounds and label pictures

**Toys that don't make noise-so kids have to use imagination and make the animal sounds themselves instead of the toy doing it for them

**Ring Stackers- Good for problem solving skills as well as playing "peek-a-boo" through the rings...etc..

**First words card- Scholastic has a ton of different cards that kids can touch and feel as they learn...Amazon.com has them for great deals...at Toys R Us they are about 10-15 dollars...

**Baby Signs are great for the little ones to start using to communicate (easy signs like "more", "all-done", "please", etc...)
Amazon.com has great deals on these as well

**Musical Instruments facilitate speech...through imitating sounds while playing and imiaginative play

**Toy Telephones-to practice pretend conversations and role play (i.e., hi mama..uh-huh...okay..bye-bye, etc...)

**Toy babies..with bottles, spoons, bowls, blankets, etc... helps to facilatate language through imaginative play

**Toy foods and kitchens set the stage for imaginative play

**Toy picnic-same idea..give the props to help
set the stage for imaginative play...
don't provide toys that do all the work for kid
(meaning-don't get noisy, light-up toys)

**Toy house, or people-so kids can make up
conversations and scenarios with toys

**Toy tools-where child has to make up scene
and imagine what to build

**Get tupper-ware container, put in sand or rice and hide bugs,
or objects and have kids dig to find objects...talk about what
they find....etc...

hope that helps :)

Learning to feed in the NICU

This little one is 5 days old....the speech therapist is illiciting a sucking reflex with his finger which has a little bit of milk on it. This helps to ease the infant into oral feeds (aka bottle feeds)...each time the infant does this the therapist tries to make sure the suck is rhythmical and tries to make the infant last longer with their suck before the tire. Pretty soon this little one will have a suck that is strong enough to feed using a syringe...and then hopefully move to a bottle. This infant is probably getting all of its nutrients through a feeding tube right now...eventually that will be taken out as the infant becomes more efficient on the bottle :)
http://www.youtube.com/watch?v=9TSfWiGYwfM


This little one has graduated from the video above to syringe feeding with a finger...the finger is there for a couple reasons...1.) it slows down the flow of the liquid 2.) if the baby stops sucking the finger can move inside the mouth triggering a reflux that makes the baby suck again 3.) The finger can move rhythmical giving the baby a tactile cue so that they can regulate their suck into a rhythm
http://www.youtube.com/watch?v=5tfIVmKtcv0&feature=related

Barium Swallow Studies..aka...Xray of children swallowing

Below is a video of a little girl taking a bottle. What the speech therapist is looking for...is that she has a rhythmical swallow, that she is clearing the liquid (meaning that it isn't getting stuck in her pharynx...the tube leading the the tummy and the lungs), that there is no aspiration (aka the liquid goes down the esophagus to the stomach..not into the trachea and into the lungs), and they are checking general anatomical structures to make sure they are functioning correctly. The speech therapist may also be checking to make sure the child isn't refluxing (aka the liquid isn't coming back up once it is in her tummy..or in the pharynx). Watch closely..this child will aspirate towards the end of the video.
http://www.youtube.com/watch?v=tcjEyDtJYYY&feature=related


This little guy is having difficulty triggering his swallow (meaning the liquid is getting stuck in his mouth...or it is going into his pharynx without the swallow triggering which is causing the liquid to come back up and out his mouth)...he is continually holding the liquid and spitting it out.
http://www.youtube.com/watch?v=K7MV2C-MVZE&feature=related

This is just a video of a cute little baby getting a swallow study. I think they are trying to determine if he is safe for oral feeds (feeding through the mouth via bottle)...He is also trying towards the end to intitiate a suck...he is holding the nipple in his mouth but isn't sucking...this may be due to him needing more stimulation to get the suck going...and/or he is having trouble breathing..so he is choosing to breathe instead of swallow (which I would choose that too)...or he is having trouble establishing a rhythimical suck..he isn't getting into a groove of swallow, then breathe, then swallow, then breathe...
http://www.youtube.com/watch?v=JHlrKHg6awU&feature=related

If your child is going in for one of these evaluations. Expect the speech therapist to probably take you back with them...and give your child a liquid, a pureed, a solid...all covered in barium...the white stuff that helps the food to show up on the xray. Kids are actually usually okay with this procedure...it doesn't hurt....and the barium although it tastes "chalky" isn;'t really too bad :)

Ask your speech therapist before going to the evaluation if she would like you to bring the spoon you use at home, the sippy cup and/or bottle, the bowls you use, etc...sometimes speech therapists have you bring familiar tools...so that the child is more comfortable and so that they get a more accurate picture of what exactly is going on when the child is swallowing at home.

An Inspiring song...

I can almost see it
That dream I am dreaming
But there's a voice inside my head saying"You'll never reach it"
Every step I'm taking
Every move I make feels
Lost with no direction
My faith is shaking
But I gotta keep trying
Gotta keep my head held high
There's always gonna be another mountain
I'm always gonna wanna make it move
Always gonna be a uphill battle
Sometimes I'm gonna have to lose
Ain't about how fast I get there
Ain't about what's waiting on the other side
It's the climb
The struggles I'm facing
The chances I'm taking
Sometimes might knock me down
But no, I'm not breaking
I may not know it
But these are the moments thatI'm gonna remember most, yeah
Just gotta keep going
And I, I got to be strong
Just keep pushing on'
Cause there's always gonna be another mountain
I'm always gonna wanna make it move
Always gonna be a uphill battle
Sometimes I'm gonna have to lose
Ain't about how fast I get there
Ain't about what's waiting on the other side
It's the climb, yeah!
There's always gonna be another mountain
I'm always gonna wanna make it move
Always gonna be an uphill battle
Somebody's gonna have to lose
Ain't about how fast I get there
Ain't about what's waiting on the other side
It's the climb, yeah!
Keep on moving, keep climbing
Keep the faith, babyIt's all about, it's all about the climb
Keep the faith, keep your faith!
By Miley Cyrus

I just think this song is a good reminder to keep our focus on God...and focus on "climbing" because its an "uphill battle" to continue to grow closer in relationship with Christ...we just have to keep going and keep the faith..God has a purpose for each one of us...We aren't always going to get what we think we want...but we will always get what God wants us to get...Sometimes life is full of struggles but we need to remember that God is a loving God and he never changes...he is the one thing in our lives that we can count on...

So keep climbing...keep focusing on God...keep praying that God be in charge of your life...lifes about "the climb"...its about keeping our focus on our ultimate goal...serving & loving God...our end goal should be eternity spent with him...

What a speech evaluation looks like.....

First let me say...
If your child needs a speech-language evaluation...don't worry! It really should be a pretty laid-back experience.

When you arrive at the clinic you and your child will be taken to a therapy room. Therapy rooms typically look "happier" than doctor offices...so no worries your little one won't be scared they are visiting the doctor and getting shots :(

Once inside the room the clinician (aka the speech therapist) will either jump right into the evaluation or begin with some medical history questions.

What type of questions???

Here is a list of some of the questions that might be asked...keep in mind its not all of the questions, just some:

1.) Why are you here today? (meaning...who referred you...your pediatrician, a family member, a teacher, or yourself)

2.) What is your main concern? (are you having trouble understanding what your child is saying, do they not have enough spoken words, are they not following directions, etc...) Basically, whats going on???

3.) Was he/she full-term?
- if premature how many weeks?
- what was the birth weight?
-Any complications during the pregnancy or at birth?
-Was the birth c-section, vaginal? Was he/she breech, were forceps needed, etc...
-What were his/her apgar scores?

4.) Did he/she pass their newborn hearing screening at birth?
-do you have any current concerns with their hearing?
- Have they had their hearing tested recently?

5.) Any diagnosis for cerebral palsy? Hypotonia? Cleft lip/Cleft Palate? Down Syndrome? Autism?

6.) Any hospitalizations since birth?

7.) Any ear infections? How many? Did they clear up with antibiotics? Were they in both ears or just one? Do they have tubes in their ears? When were they placed?

8.) Did your child babble much as an infant?

9.) At what age did your child crawl & walk?

10.) Is there a family history of developmental delays, medical conditions, speech therapy, learning disabilities, siezures, etc...

11.) How does your child make clear their wants & needs? (gesturing, grunting, pointing, etc..)

12.) What words does your child say?

13.) Does your child imitate your words or sounds or phrasing (rising intonation for questions)?

14.) Does your child understand your speech? What you are telling them?

15.) Does your child play "people games" (peek-a-boo, I'm gonna get you) etc..

16.) Do you or your child become frustrated with their communication skills?

17.) What are your expectations for speech/language therapy?

18.) Was your child breast or bottle fed?
- How did that go?
-How did they do and when did they transition to pureed (baby foods)?
-Do they currently eat different types and textures of foods?
-Do they drink from an open cup or sippy?
- Do they use a spoon independently?
-Do they use a straw?


Whew! Lots of questions I know... After the questions..the speech therapist will probably "play" with your child for a while. They are primarily during this time going to try to illicit some communication and see what they can get your child to do spontaneously...

After that...the speech therapist will begin her formal assessment. Typically, a speech therapist will look at 7 domains...

Auditory comprehension (the ability to understand spoken language)
Expressive communication (the ability to use a variety of gestures &/or words, phrases and sentences to communicate a message)
Pragmatics/Functional communication (communicative intentions and ability to follow social rules governing use of language in context)
Phonology/Speech Sound Development: (Sound development and clarity of speech)
Voice: ( vocal volume, pitch, quality and resonance)
Fluency/Prosody(ability to use smooth, flowing and effortless speech with appropriate rhythm and rate)
Oral-motor/feeding: (ability to use facial/oral structures appropriately for facial expressions, speaking and chewing/swallowing)

She will complete the evaluation of these areas through various pictures, observing behaviors, asking you additional questions, and illiciting responses from your child.

At the end of the evaluation...the therapist will typically score the evaluation and let you know the results...and based upon those results therapy will be recommended or not recommended. The frequency of therapy is recommended based on those scores too...Every other week, weekly, monthly, monitoring, etc...

Following the eval and recommendations...you will recieve a full typed report within a couple of weeks detailing what was seen during the eval, the full scores of the assessments, and the recommendations.

I would encourage you that if therapy was recommended and it has been a couple of weeks since the completion of the eval that you keep tabs on scheduling their first speech appointment. Call and ask what you can do to help to speed things along and get your child scheduled. Sometimes we are tied up waiting for the pediatricians to sign a prescription for speech therapy...sometimes its insurance companies, and sometimes WE as an agency need to be reminded to hurry ourselves along too :)

Book review of "From Eternity to Here" by Frank

I was contacted by a publishing company and asked to do a review on a recently published christian novel....welp...here is that review...enjoy the break from Speech & Feeding :)

This book was an in-depth, thought provoking journey through God's word intrepreted for the "every day reader". Frank began with God's beginning...the story of "adam & Eve" and then walked the reader through the bible all the way until the story of revelations. It was very insightful, intriguing, personal account of the greatest love story the world has ever known, the story of Jesus Christ.

"From Eternity to here" is a book that makes a comparison, one that Christ himself makes thoughout the bible, of Jesus being the "groom" and the "Bride" being his church. As I read the pages in the first portion of this book I was captured by how Frank described in detail the love that Jesus has for us....his bride...his church. I couldn't wait to get to the next chapter to learn more and understand more fully what exactly "God's purpose" is...I felt like a child who was caught in awa as she realized just how truly awesome our father in heaven is....and how much he loves us!!

At the end of the book Frank ties everything together and then energizes the church to rise to the standards that Christ set forth for us. He speaks of how when Jesus came that he taught of "his body" aka the "church" being united. It made sense to me..how if we (i.e., christians) are the arms, hands, legs, and feet of Christ...that we must be united...because anything less than a "whole" form does not allow Christ to have all the "parts of his body" working fluidly...and without fluidity..his body (i.e., the church) is not fulfilling God's purpose to the standard that he gave us...we are not giving it 100%. In the book of John in the bible...Jesus talks of uniting..that there should be no division amount the churches..and Frank breaks down that passage and helps his readers to fully understand the weight and urgency of that message. This book also gave me a re-newed passion to dig further into the word of God (aka the bible) to learn more about my heavenly father.

I caution though that I am not a "biblical scholar" nor do I claim to be "well versed" in everything that God says in the bible...so...although I truly enjoyed the book...I have to wonder if it was actually based on the true word of God or Frank's interpretation of the word of God. We recently talked about, in our small group bible study how to discern if something is "from God" or if it is not...like that guy who wrote "your best life now"...sometimes things sound convincing and sound "peachy" but they don't line up with God's word. Sooo...what I am saying is...sadly I don't know enough about the bible to say if Frank's book is true or not...but I can say that the book is good...very good and...when more people read the book that are "Well-versed" in the bible...please share :)