Failure to Thrive – Feeding

Kristen Posts:

Dear ERI COMMUNITY: I am a pediatric nurse practitioner working with a child who struggles with severe oral aversion. At 18 months old she was diagnosed with sensory processing disorder and failure to thrive and enrolled her in the early intervention program. She was much delayed in her gross motor skills and not walking until 19 mos. Fast forwarding to age three, she was diagnosed with Celiacs disease and we thought that was the answer to her failure to thrive and her sensory issues. A year later she didn’t grow in height and only gained a pound weighing a mere 26lbs. After a long agonizing 3 month decision with the GI team we placed a gtube. All this time her family, doctors, and therapists seemed to miss her oral aversion focusing on her delayed grossed motor skills. So today at age 5 she maybe orally eats a select few foods and relies on gtube feeds to keep her alive. Everyday is a struggle to get her to eat and “just take one bite”. What are your experiences with these children in their teen and adult years? What percentage out grow this problem? What have you found to be the most successful treatments? Thanks for all your help.

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How to Wrap-up Your In-Service.

Leaving your colleagues inspired and wanting for more information can be a challenge.

In your final comments, repeat your main points.  Tell your colleagues how they can obtain further and more in-depth information.  If you are so inclined, invite them to observe you treating a patient using this new information or offer to consult on one of their challenging patients.

Don’t forget to share reference materials that colleagues may need to provide evidence and support for this clinical approach.

Good luck! 

Feel free to post any specific questions you may have as you pull together an effective in-service for your colleagues. 

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Therapy Tip: Autism and Feeding

Jennifer Posts:

DEAR ERI COMMUNITY: Tip for OT’s working on feeding:
I recently attended a conference on Autism and an amazing OT & DO, Paula Aquilla was one of the presenters. She shared many techniques she has tried, but one that has really worked for me is a feeding game. You begin by making a die with words such as lick, kiss, smell, touch, look, etc. We have a pile of cards with pictures of foods we are exploring that day; we used the PEC images with the word underneath. We take turns rolling the die and picking a card from the top of the pile. We both follow the directions on the die matched with our card and we maintain a very non threatening environment. This patient has begun trying food at home. I have my fingers crossed but so far this has worked for us!

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Evidence Based Approach to Feeding Fragile Infants

ERI Faculty, Erin Ross publishes Paper:

[caption id="attachment_449" align="alignright" width="150" caption="Erin Sundseth Ross"][/caption]

Erin Ross, a speech language pathologist and Education Resources, Inc. faculty recently co-authored a paper describing her successful oral feeding of preterm and other ill and fragile infants, based on the SOFFI (“Supporting Oral Feeding in Fragile Infants”) method. This method utilizes sensitive, ongoing assessment of an infant’s physiology and behavior, requires knowledgeable decisions that support immediate and long-term enjoyment of food, and competent skill in feeding. Therapists, nurses and parents can use the SOFFI method to increase the likelihood of feeding success in the population of infants at risk for feeding problems that emerge in infancy and extend into the preschool years. It stresses the quality of the feeding rather than the quantity, so that feeding skills develop pleasurably and at the infant’s own pace. Once physiologic organization and behavioral skills are established, an affinity for feeding and the ingestion of sufficient quantity occur naturally.

She teaches this highly successful method in her course: Feeding the Most Fragile: From NICU to Early Intervention

Clinicians: Please share your experiences using the SOFFI approach

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Help: Challenging EI Patient

Linda Posts:

DEAR ERI COMMUNITY:I am an experienced OT (37 years) working in Early Childhood Intervention working in the home. Our program really wants us to use what is in the home and in the child’s natural environment. I have a 23 month old child who is in Spanish speaking family (so I work through an interpreter). He is extremely shy (fearful of all change)and will not interact with me at all. The way I treat is giving the mother ideas and then she tries them with him. The interpreter is an ECI Early Intervention Specialist who can also interact with the child and get him to do some of the things I suggest. He did not walk until 19 months. He never tolerated tummy time and even after he crawled he would not get on the floor to look for a toy under the bed, etc. He is an over responsive sensory avoider, extremely posturally insecure, moderate hearing loss, balance and motor planning are very poor. We have made lots of improvements and he will now get on the floor and look for a toy that rolls under furniture, get on a jumping horse and bounce, sit on a donut gym ball and play with toys, runs in the house but not the yard or playground, climbs on and off furniture, allows Mom and Dad to bounce him on their knees as long as it is not too aggressive and kicks a ball. I have left a few things in the home to work with (Rody Jumping Horse and Donut Ball). I am needing some new ideas in the challenging case.

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