Thursday, July 19, 2012

Therapy Meals

If you've never had a child with a feeding issue (lucky!), then you probably have never heard of "therapy meals." I know I never had! It's a meal or snack that follows a strict set of guidelines and a firm schedule of events, designed to desensitize your child from certain foods, textures, smells, etc. It is supposed to look like a snack, albeit a militant one, but actually function as a small feeding therapy session.

Geri has just started them, and it's sort of strange. We've been going to feeding therapy for months now, but bringing it home is different. During feeding therapy, I'm mom and I watch and assist as therapists work with Geri. During the meal I feel less like mom and more like a therapist. It's so structured, which is not even remotely my style, and I'm having to analyze everything during the meal. It's a real shift of mindset, and I'm still adjusting.

Here's how it works. First, I had to develop what's called a "food contiuum." That's a list of 6-8 foods to be served at the snack in a specific order. Various levels of food (easy for my child through hard for my child) need to be presented, each food group should be involved, and each food needs to link to the food before and after it in some way. Drinks are served at the end, because they can be easy and filling and ruin the rest of the snack if given too early, and we finish with a lollipop because it's such a hard food. Each food is served in order, one at a time, but the next food is served while there is still a little of the previous food on the plate, that way they can interact.

Second, there's the schedule. Each meal follows a fairly strict schedule, as follows:
- Sensory "Warmup", to get child in the right frame of mind for the meal
- March to the table and sit down
- Blowing bubbles (releases calming biochemicals and works on oral and breathing strength)
- Wash hands with a washcloth, play "tug of war" with the washcloth in the child's teeth
- Hand out plates and napkins
- Hand out and progress through each food, focusing on skills
- Announce "all done" and clean up the snack
- Wash hands again

Third, there's the eating skills we are trying to work on. The doctor who developed this system has identified 32 individual steps to eating, and the idea is to move up the steps. It begins with simply tolerating the food in the room all the way to taking biting, chewing and swallowing the food. Every interaction with the food is positively reinforced. If a child refuses, you back it down to a lower level and praise that before moving on. Different, silly activities are used to get the child to interact with the food. Kissing a food is a good way to encourage putting the food to their lips. Bouncing the food can encourage touching. Crunching to make a loud noise and wake mommy, drawing with the food, making duckbills out of potato chips... lots of silliness to encourage the kiddo to interact positively. The whole meal avoids punishment or chastising and the mood of the whole thing is fun, lively and upbeat.

This whole thing is done once per day. Ideally you do it every day, but that's a lot so our feeding group only asks us to do it twice a week outside of therapy.

We're doing at-home therapy meals Wednesday and Thursday and using Friday as either an extra or a make-up day. Monday is out because that's the day she has her group feeding therapy, and it would be overwhelming to do this twice in one day. Tuesday is out because she gets something similar at the Anchor Center. Weekends are sort of "catch as catch can. " We like to go and do things together on the weekend, so I don't plan anything therapeutic. I just try to make what we do as therapeutic as possible, if that makes sense.

The food continuum stays the same for the first three days, then I start changing 25% to 50% of the items each day. Right now our continuum is:
1) Plain Pringles
2) Tapioca
3) Apple Slices
4) Veggie Straws
5) Pedia-milk (Pediasure and milk mixed about 50/50)
6) Lollipop

Is your head spinning yet? Mine sure is! It's actually pretty straightforward, I suppose, but it's a lot to keep in mind. The prep is a bit of a pain, too. I have to get everything set up in advance, each item in it's own bowl, all the bowls covered with a cloth so she can't see what's coming, all the plates and napkins and washcloths and bubbles on the table. It feels like an ungodly amount of effort for a snack.

But it's for her good, and the kids who fare best in feeding therapy are the ones who practice at home. So, practice at home we will. Hopefully, like all other things, it will start to just feel like part of the routine pretty soon. Amazing how quickly that happens, huh?

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