Infant Feeding
Feeding is the process of eating or drinking. It includes what your baby’s mouth and tongue are doing before and when they swallow. Any difficulty with this process can be stressful in those first few months and affect not only feeding, but sleep patterns as well.
What are some possible red flags for Baby?
- Difficulty with latching onto the breast or the bottle
- Leaking milk while drinking from the breast or the bottle
- Preference for the bottle over the breast
- Excessive sleepiness
- Chronic open mouth breathing
- Fast or noisy breathing
- Poor weight gain
- Less than expected wet and/or soiled diapers
- Ongoing feeding difficulties even after support from a lactation consultant
- Signs of distress while feeding such as:
- Coughing
- Choking
- Spitting up
- Hiccuping
- Refusing
- Falling asleep
- Crying
- Back arching
What are some possible red flags for Mom?
- Pain while breastfeeding
- Creased, flattened, blanched (i.e., white in color), blistered, or bleeding nipples
- Still feeling full of milk in breasts after feedings
- Plugged milk ducts
- Infected nipples or breasts
- Mastitis (i.e., inflammation and/or infection of the breast tissue)
Why consider treatment?
Because it doesn’t have to be this hard! Ongoing feeding difficulties can be very stressful not only for mom and baby but for the entire family unit.
Treatment from a trained professional can impact all aspects of infant feeding. Successful feeding in infancy leads to typical development of the face and oral structures necessary to safely and easily transition to solid foods in the future. It also results in efficient breathing patterns, development of a typical swallowing pattern, and age-appropriate speech sound acquisition.
Pediatric Pelvic Floor Dysfunction
Pelvic Floor Dysfunction is a broad term to describe many conditions that might occur when the pelvic floor muscles (PFM) are not working with the bladder and typical voiding reflexes are disrupted. While having a formal diagnosis (i.e. constipation, enuresis, bowel and bladder dysfunction, dysfunctional voiding) does not change a child's plan of care, it may better guide our treatment approach. Therefore, we may recommend testing or imaging from a primary care doctor.
What are some possible red flags for a child?
- Incontinent episodes during the day and/or night
- Constipation: small, hard stools with straining and/or a bowel movement less than every other day
- Frequent urinary tract infections
- Leakage (urinary or fecal)
- Frequent voiding (i.e. having to go to the bathroom more than normal)
- Incomplete bladder emptying or difficulty sensing if his/her bladder is full
- Pain or straining with bowel movements and/or urination
- Postponing or avoiding bowel movements/urinating by "holding it"; either on purpose or subconsciously
Why consider treatment?
Success can lead to better quality of life, as well as improved self-esteem and confidence!
Incontinent episodes are often due to underlying causes and are not the child’s fault, and nighttime incontinence that lasts more than 10 months after being potty trained is considered atypical. Treatment for Pediatric Pelvic Floor Dysfunction can help reduce a child’s anxiety about spending the night away from home due to incontinent episodes. Treatment can be successful: pelvic floor muscles can be trained.
Food Group Approach to Feeding
Food group allows a child to interact with food in a playful, non-stressful way, beginning with the ability to tolerate the food in the room and on their plate, manage the smell of the foods, learn about how foods feel on the body and in their mouth, and then enjoying tasting and eating new food.
Food Group is a group of children and therapists working together to increase a child’s comfort level with mealtimes by exploration and exposure to new and/or less preferred foods. The goal is not volume of foods; the ultimate goal is to help children learn how to feel comfortable exploring new/different foods. Our approach focuses on developing/improving oral-motor skills, positioning, and sensory needs.
What are some possible red flags?
- Eats a restricted range/variety of foods
- less than 30 different foods (10 fruits/vegetables, 10 proteins, 10 grains)
- Cries or “falls apart” when presented with new or disliked foods
- Difficulty trying or touching new foods
- Ongoing problems with vomiting or more than one incident of nasal reflux
- Refuses entire categories of food textures or groups
- Eats the same foods for every meal/snack
- Prefers snacking/grazing vs sitting down for mealtimes
- Requires different foods at meals than the rest of the family
- No longer likes/eats favorite foods
- Frequently pushes food away on plate/table
- Refuses entire categories of food textures or groups
- Minimal chewing or swallowing
- Frequent gagging/choking/coughing
- Covers face with hands or turns entire body away from plate
- Inconsistent eating patterns
- (i.e. may like a food one day and then not eat it the next)
Why consider treatment?
The earlier you can begin working with a child who is struggling to eat, the faster you will see changes.
Feeding difficulties can impact a child’s ability to engage across a variety of environments (i.e. mealtimes, holidays, social gatherings, school/daycare). Decreased food/nutritional intake can also impact a child’s mood, participation, attention/arousal level, quality rest/sleep, etc. Teaching a child how to explore and interact with foods will help them learn how to successfully and safely eat foods. This will also increase their ability to cope and participate throughout mealtimes. For healthy eating habits throughout life, it is important that children learn to eat a variety of foods at an early age. The sooner they are able to learn these skills and build a positive relationship with foods, the sooner mealtimes and daily activities will become more enjoyable for everyone involved!
Tongue Thrust Therapy & Orofacial Myofunctional Therapy
An Orofacial Myofunctional Disorder can impact many aspects of daily life including posture, breathing, drinking, eating, and talking.
OMD includes behaviors and patterns created by inappropriate muscle function and incorrect habits involving the tongue, lips, jaw, and face (IAOM, 2014).
What are some possible red flags?
- Chronic mouth breathing and/or forward tongue position while breathing
- Abnormal dental alignment (e.g., anterior open bite ~ when molars make contact and incisors to not)
- Tongue thrust/inverted swallowing patterns
- Picky eating and/or food texture avoidance
- Difficulty forming a food bolus (i.e., messy eating)
- Persistent speech sound errors and/or recurring speech sound errors following speech therapy
- Prolonged use of pacifier, bottle, and/or sippy cup
- Prolonged oral habits (e.g., thumb sucking)
- Limited tongue range of motion
- (i.e., difficulty clearing food from cheeks/molars or sticking tongue out to lick an ice cream cone)
- Difficulty with feeding/swallowing at birth
- Sleeping problems or snoring
- Facial pain (i.e., jaw or neck pain)
- Clenching or grinding teeth
- Headaches
Why should I consider treatment?
If not addressed, Orofacial Myofunctional Disorders can have a lifelong impact on facial symmetry/appearance, dental alignment, speech articulation, sleep health, focus/attention, and overall quality of life.
Improvements from treatment can be seen in a matter of weeks and can reduce the potential for relapse following orthodontic intervention. Consider the following before and after pictures. This patient was referred by her orthodontist and presented with the following symptoms: forward tongue position while breathing, difficulty forming a food bolus, tongue thrust/inverted swallowing pattern, mouth breathing, and speech sound errors. Upon completion of our program, all of her symptoms were resolved.
Dyslexia Evaluation Services
What are some possible red flags?
- Confuses letters that look similar (e.g., b/d, u/m, m/n)
- Confuses letters that sound the same (e.g., v/f/th)
- Reverses or transposes words when reading or writing (e.g., was/saw)
- Confuses small words (e.g., a, an, of, the, on, for, from)
- Difficulty learning sight words
- Decreased fluency when reading
- Difficulty tracking with finger or keeping correct place, frequently loses his/her place
- Difficulty with reading comprehension
- Difficulty with spelling
- Illegible and/or grammatically incorrect writing
- Difficulty following directional phrases such as: (e.g., left/right, over/under, up/down, east/west)
- Difficulty telling time
- Difficulty with sequencing daily tasks (e.g., shoe tying, getting dressed)
- Confuses mathematical symbols
- Discrepancy between verbal and written proficiency
- Difficulty organizing time or materials
- Inconsistency with classwork and subjects
- Family history of dyslexia or similar difficulties/learning problems
- Currently receiving reading support in school
Why consider treatment?
Treatment is crucial to facilitate life-long skills related to reading, writing, spelling, and math.
Intervention is necessary to provide the appropriate kind of tutoring, at the necessary frequency, at the right time in development (i.e., early elementary years). A diagnosis followed by one-on-one tutoring will also likely reduce the risk of future negative impacts on self-concept and emotional health.
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Social Communication Therapy
A Social Communication Disorder refers to a child’s difficulty with interpreting and using language (both verbal and nonverbal) in functional and expected ways.
It impacts the ability to participate successfully in groups, build/maintain relationships, and adapt to others effectively across contexts. It encompasses problems with social interaction, social understanding, and pragmatics (i.e., using language in the proper context). While all individuals with autism spectrum disorder have pragmatic problems, children without autism can also have a Social Communication Disorder.
What are some possible red flags?
Difficulty initiating language (i.e., self advocacy);
tendency to withdraw or avoid instead of using language skills to seek assistance and/or information; these children may have difficulty asking for help, asking questions to gain information, seeking clarification, and initiating appropriate social entrance and exit with people
Difficulty conceptualizing to a larger whole (i.e., getting the “big picture,”);
tendency to think in parts instead of fully relate pieces of information back to a larger pattern of behavior or thought; difficulty with reading comprehension, determining main idea, and following subplots; these children may have difficulty with reading comprehension, summarizing, understanding social and academic information, and organization
Difficulty understanding perspective (i.e., theory of mind);
tendency to think about their own thoughts and feelings even when in a group setting; difficulty understanding the needs, emotions, thoughts, beliefs, experiences, motives, intentions, expectations, and personality of others in order to respond appropriately; difficulty participating groups; difficulty with obligatory tasks not of their choosing; limited knowledge of what it means to participate in a relationship
Difficulty solving problems (i.e., executive function);
difficulty creating organizational structures that allow for flexibility and prioritization.; these individuals crave structure but have difficulty creating it; difficulty managing homework and predicting time to complete tasks
Difficulty interpreting abstract and inferential language (i.e., reading between the lines);
tendency to be black and white/rigid/literal in thinking; tendency to miss information communicated nonverbally (e.g., eye gaze, gesture, facial expression, and posture) resulting in difficulty understanding the total communicative messages and making sense of one’s surroundings (especially when in a group); difficulty understanding humor; difficulty knowing if they are being laughed at versus being laughed with and/or may produce inappropriate humor (Winner, 2007)
Why seek treatment?
Treatment is valuable as children with pure social communication needs are unlikely to qualify for services at school.
They generally have good grades, good test scores, average to above average IQs, and are not seen as having “educational problems.” At Red Door Pediatric Therapy, we understand that education not only includes academic knowledge but also includes preparing children to be effective communicators, critical thinkers, and problem solvers (i.e., social communication).