Thursday, September 7, 2017

Therapy Tip: Spoons for Feeding Issues

Welcome to Therapy Thursday! This is the day I share a tip based upon my experiences as a pediatric speech-language pathologist and a mother of a child with special needs. Today's tip is:

Spoons for Toddler Feeding Issues

Working with toddlers, I run into a variety of feeding related issues that require intervention. Most of my feeding clients need help moving through textures. These kids may be orally defensive, gag easily, and even vomit with dietary changes. I also see kids who have a very restrictive diet. These children generally eat from one or two food groups (grains), and their problems are much more serious than just "picky eating." These kids too may have gagging or some other response when a new food is introduced. Other children I see may have low muscle tone or lack a chewing response that requires intervention as well.

Every child in feeding therapy is unique. Each has their own preferred foods, reactions to new foods, and physical responses to changes. Feeding therapy is very individualized and requires lots of brainstorming and trial-and-error. There are many, many things that go into feeding therapy, but today I'll address just one aspect-spoons.

The utensils that are used with a child may have a role in feeding intervention. Utensils are never THE fix to a solution, but they CAN be one tool or factor in helping a toddler. Today, I'm going to share a few of the types of spoons I commonly use in feeding therapy.
-The Maroon Spoons
Maroon spoons look simple, but they are unique. They have a very flat bowl. This flatness does a couple of things. First, there is no edge on the spoon, which benefits some children. Some toddler spoons are very deep and require strong lip movements to remove the food. The design of this spoon makes this much easier for children who have poor lip closure to eat successfully. The smaller maroon spoon, which is what I typically use with toddlers, limits the bite size that a feeder can give, which may be important for those who gag easily.

I personally used this spoon when my daughter with Down syndrome was eating baby foods. The difference between standard baby spoons and the maroon spoons was remarkable. With her low muscle tone, poor lip closure, and tongue protrusion, these spoons made meal times easier for her.  

If a flat bowled spoon is what you are seeking, there are some cheaper options that can be found in stores. I have found that the Kroger and Wal-Mart "take and toss" spoons have very flat bowls that meet the needs for some of my clients. The quality isn't as good because you get what you pay for, but it is another option. 
I love, love, love textured spoons! There are a few different options for textured spoons, but the ones pictured above are my favorite. Like the maroon spoon, they have a very flat bowl. Therefore, they are useful for the same types of children as the maroon spoon, but offer one additional feature. On the bottom of the spoon, there are small ridges or bumps that provide the tongue with a new feeling during feedings.

The texture on the spoon does a couple of things. First, it provides more feedback for the tongue giving more intra-oral awareness. Secondly, it provides a way to work on texture transitions. This is the reason I use textured spoons in therapy most often. If I have a child who eats Stage 2 baby food without incident but has a major negative response (gagging, vomiting) to the next stage, then I like to use textured spoons to fill in the gap. By keeping the child on Stage 2 foods but changing to a textured spoon, the child can get accustomed to a new texture via the utensil while their known food does not change. Generally, the toddlers will notice the change and sometimes gag with the change in spoon, but I can use this spoon to desensitize them. Sometimes, I can only use the textured spoon for a few bites because the reaction is so severe, but I can keep working to build up to a full feed using these spoons. 

Like maroon spoons, the manufacturer cautions using these spoons on children who will clamp down and bite on these spoons because they could potentially break them. I have never had a problem with this, but it is something I warn parents about. I never allow a toddler to use a textured spoon without adult supervision. 

If you have a DnZ vibe, then the spoon tip option is another handy tool to have in feeding therapy. Again, these tips have a flat bowl. (See a pattern in what I like?) By attaching these tips to a DnZ vibe, you can then use vibration as another way to provide a different input for the child who is struggling with oral aversions or texture changes. I have had some children who had no problems with the textured spoon but did exhibit a negative response when this tip was added with the vibration from the DnZ vibe. Therefore, the vibration gave me a transitional method when bridging the gap between two different texture phases. The vibration also gives the inside of the mouth more input, increasing the oral awareness on the tongue, lips, and cheeks during feeding. This oral awareness is important to achieve for those with low muscle tone. 

-Angled Spoons
Sometimes in feeding therapy, things progress to the point where a child needs to work on self-feeding. Spoons and forks that are angled do sometimes help a child be more successful with scooping food and placing it inside their mouth. The toddler's wrist does not have to make as many movements when a spoon is already angled, which can be helpful for children that have delays in fine motor skills. There are many angled spoons on the market and some options are available in common stores like Babies-R-Us. However, the spoons may all be slightly different.

Besides the angle, you need to look at the spoon bowl depth and handle thickness. Here a deeper bowl may be more beneficial as things won't spill off of the spoon before getting it to the child's mouth. If you are working on sticky, easy to scoop foods like pudding or mashed potatoes, then a flat bowl will still be appropriate. A thick handle may be easier for some children to hold but possibly too large for those with small hands or fingers. Trial-and-error may be necessary to find the perfect angled spoon, but these can be helpful for aiding in self-feeding.

In short, spoons are just ONE aspect of feeding therapy I consider in my practice, but sometimes they can be a very crucial piece that leads to success. I hope that you have some new things to consider when choosing a spoon for your toddler who has a feeding issue.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. Please consult your child's therapist before trying these spoons, and always follow the manufacturers' instructions on use.

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