Sunday, March 20, 2011

Feeding drama and a magic solution (that you can make, too)

For the past month, meals have been really hit or miss with Maya.  Her feeding issues have gotten more complex as she's gotten older, because the behavior challenges of toddlerhood (asserting herself, being dramatic*, etc) are coming into play.  When she first started feeding therapy, everyone agreed 100%--she wants to eat, she loves food and flavors, she just can't do it. 

But now, sometimes she's difficult because her mouth is tired or disorganized, and sometimes she's difficult because she's 2. 

And 2-year-olds are sometimes just difficult.

The basic background on Maya's eating stuff:  Progressing to purees/baby food was challenging.  Once she had a handle on purees, progressing to real stuff (yogurt, applesauce) was challenging, too.  (That started to really happen around 15 mos old).  Then, progressing to real food was a lot of work, because things just get lost in her mouth---her tongue had to learn to move the food to her teeth, her jaw had to learn to make her teeth chew.  (She still has to work a lot on the chewing, because her jaw muscles are weak.  And her mouth is still disorganized.)  We were on all "real" foods around 27 months.   Now, her diet is pretty limited to things that you don't have to chew too much:  milk, yogurt, applesauce, chicken nuggets, grilled cheese, waffles, pancakes, french fries/potatoes, cheese, meatballs/meatloaf, fish sticks, spinach pancakes, soft fruits, and vegetables that are steamed and mashable, etc. 

She is fully capable of eating everything that I just listed, but suddenly she was refusing to eat for me.  She would sign that she was hungry, get in the highchair, and have a meltdown.  She would clamp her lips, throw herself to the side of the highchair, cry, take food out of her mouth after I had put it in, cover her face with her arms, etc.  Misery.  It is not fun to have to fight through every meal and snack everyday.  More than once I would have to hold her arms down, pry her mouth open, and put food in. 

A few times I thought "She must not be hungry", tossed the food, and took her out of the high chair . . . but no sooner did her feet hit the floor than she would smile and sign "Eat!"


I realized that we weren't tapping into her logic skills at all, so I tried to tell her "One bite, and then ________  (stickers, barn, whatever)."  It worked, but only for one bite.  Doing an entire meal one bite at a time takes a longggg time.

And then came the magic solution (care of our speech therapist).  It's so simple (especially if you have any knowledge of preschool stuff, the land-of-labeling-things-with-pictures) and yet so effective:


That's our new meal chart (chart?  I'm not sure if that's the right word.  But you get the idea).  The little pictures of the guy with the spoon say "eat" at the top.   The star is a "surprise".  

How we use it

Me: Maya, do you want to have some stickers?

Maya: (smiles and nods emphatically)

Me: Ok, then you need to take 3 bites of waffle (pointing to the 'eat' cards) 1-2-3, and then you get stickers! (pointing to the star)

Maya: (nods and opens her mouth to take a bite)

As she bites, I take the 'eat' pictures down and say "Great job!  That bite is done, so you have 2 more, 1-2, and then stickers!"

When the bites are done, she plays with the toy.  I keep feeding her, and sometimes she doesn't notice.  If she starts refusing food, I take that toy away, reload the 'eat' pictures, and start again.  If the toy loses its motivational factor, I get a new one.

No more drama. 

No more fighting.

The chart is 2 sided, so she's looking at the side she's working on, we're looking at the back.

In action-here she's taken 1 bite of waffle and has 2 left before she gets the school bus with the zebra and polar bear.  Obviously, school busses carry zebras and polar bears.

Do It Yourself
There are endless variations to this, but here's how ours is made:

-The standing-up part is the bottom cut off of a manilla file folder (which makes it easy to stand up).  There's a sentence strip glued onto it, and 5 velcro dots stuck on in a row. 

-The squares are color printed and laminated, with Velcro dots stuck on the back. (If you don't have a laminator, it's worth getting.  Like I said, I didn't make this, but I do laminate everything.  Maya's been carrying around a laminated picture of her with Santa since December.)  The icons are from Boardmaker, I think, but you can use any picture you want.  Just do a google image search, copy the picture to a word document, and print it up.

And you're done.   So easy.

Oh, and it's perfect to travel with, too.

At the diner, with one bite left until she gets her Santa picture.

The same idea of simple velcro visuals is often used to create schedules for the day (first you make your bed, then you take off pajamas, then you put on clothes, etc, etc), but I can see it working for other obnoxious challenging behaviors, too. 

For example, is tooth brushing a problem?  (It sometimes is for us)  Maybe one parent could brush while the other parent methodically removes numbers from a countdown, or a row of toothbrush pictures to show that time is almost up.  The possibilities are endless.

I'm sure this is a been-there-done-that post for a lot of folks with older kids, but I hope it helps someone else out there.  I think it's a great model to present ideas/routines to all kids---special needs or no special needs.

*Speaking of drama, did you see my story on FB from earlier this week about having a cry alone in the crib?  Yikes.


Nancy Cavillones said...

My stepmother is a speech pathologist (plus, being deaf, I have worked with my share of speech therapists!) so I might be biased when I say that speech teachers are magicians. But they totally are!
Does Maya drink out of a straw cup? Has her speech therapist suggested it? Both of my kids used straw cups from the beginning because my stepmother said it helps to strengthen the jaw muscles and develop speech.

Dana said...

Hey N--yes, our current therapist is fantastic! (We had a couple of misses before this one, but she was worth the wait)

Maya went straight from bottle to straw cup for the reasons that you recommended---but she still tries to suckle the straw. We use a honey bear to try to get her lips to work separately from her mouth, but it's low going.

Melinda said...

You definitely are getting PECS down pretty well! My son only got used to a straw when he was about 3 1/2. Even at almost 5 1/2, he still bites the straw occasionally. Great work with Maya though!

Geggie said...

Awesome idea! I may use that for our morning *routine*.

Cortney said...

You are a teachers dream parent! You are using a token economy (that's the official name for it) and it's excellent that Maya caught on so quick. All my students use token economies except instead on taking down the picture icons we actually put them up. Good for you two!

I guess I've never introduced myself before...I'm Cortney, I teach students with severe Autism. I can't remember how I found your blog, but I've been reading it for a few weeks now and enjoy all your stories, they are inspiring.

Cheryl (in Buffalo) said...

Just an FYI for those out there interested in Boardmaker but unable to afford it.....They frequently have a one month free trial of Boardmaker encourage you to buy it for your computer....but you could take the free month.....print any picture you think you might want (There are literally thousands!) and then cancel...if you find it doesn't meet your needs financially. I have Boardmaker at school, and use it all the time (as well as having used it for my daughter before she started talking again) and it truly is an amazing program. Overall, Boardmaker is much more than pictures...(charts, games, open ended anythings..)..but the pictures are wonderful!!!

Liz said...

Thanks for sharing the steps to the chart! I've been meaning to get around to something like that for a few months -- now I have the inspiration and the directions :)

Post Tenebras Lux said...

*really* awesome idea. I love it!

Nancy Cavillones said...

I've been thinking about the straw thing all week. Do you ever buy those applesauce pouches from Trader Joe's? There's one that is just applesauce and another that is carrot and applesauce. It has a built-in spout and you have to suck a little to get the sauce out. I taught Stella to use it, and she caught on pretty quickly. Anyway, I was thinking that it might be a neat thing for Maya to try because you can't suckle the spout--it's a hard plastic. (I know that Stop and Shop sells a different brand of these pouches, with berry flavors and so does Whole Foods.) At Trader Joe's, they are called Crushers and they are on the same shelf as the regular applesauce.

Beth @ Snaps Of Our Life said...

This is an awesome idea! I wonder if there's a way to use this for keeping glasses on her face. That is our biggest issue at the moment (and tanrtums).