Café Cole: Therapy Strategies
by Elias Malespin Marketing Coordinator
(We conclude our interview series with Courtney Hescht, M.S. CCC-SLP and Cole’s feeding expert)
For our last entry in this Feeding Therapy series we will go over a couple of scenarios to give you an idea of what Cole does and what we could do for your child.
First up, how would we tackle a feeding tube?
A lot of times with continuous feed (meaning food/nutrition is always being administered to their system, directly to the stomach through a port), babies don’t feel hunger because their bellies are constantly being fed, so they’re not as motivated to want to eat. So that may be where we start. Let’s build a curiosity for food. This is all part of the evaluation too; when you cook at home and everyone gathers around to eat, or however meal time happens in your family, is he/she smelling/looking/touching the food? What’s happening there? And then we try to build that curiosity and we try to bring them down to a Bolus feed (feeding on a cycle, like every 3 hours or whatever is appropriate) if the doctor ok’s it. We maybe add a little bit more time in between the Bolus feed to build a little bit more hunger.
Peanut butter, some people say introduce it to the child whenever, others say wait a certain amount of time so they don’t become allergic to it. Where do we stand on that?
Well, it’s more fluid, but if I have a two year old or three year old that is not gaining weight then I’ll start using peanut butter. I would not use it in an infant. I would not use it with a one year old. I would probably wait until they’re two and that’s just my preference. I don’t feel comfortable using it any younger, because our culture’s list of allergens is growing exponentially. If we are building a certain patient’s repertoire of food, I would stress starting with baby food that is organic because you are isolating and minimizing some of those allergen variables.
How do we build the repertoire of food?
I teach the parents to work on dietary things. Sometimes we’ll get families whose culture is heavy on starch and very little on vegetables, so I actually have little cooking classes to teach them to build some of those other food groups into the food at the CONSISTENCY that I need. If I’m starting at Stage 1 baby food and then I move to Stage 2 and then I go to Stage 3 because I’m building in that texture then I tell them this is how you’re going to cook the food and this is the consistency I’m looking for. So I want you to bring me the potato and I will get it to that consistency so that you can match that at home. There’s a little bit of a cooking class mixed in there as well.
Sometimes we get children that have allergies to seemingly everything and that makes it really hard for the parent to feed them because they’re also on a budget and they can’t afford gluten-free and organic everything. So how do we do this? We work with their dietician and with the gastroenterologist to make sure they have a safe feeding experience.
What if the issue is a 4 year old who can feed themselves, but refuses to do so?
We can certainly help with that. A lot of our cases are head games. You can have a kid who may be functioning lower with adaptive behavior, so perhaps intellectually it may be harder to reason through some of this stuff and they choke on a piece of bread and now they don’t want to try any solid foods! Now it’s working through some of that fear to get them to where they can continuously feed appropriately.
Just for example’s sake, how would you get a child back to eating bread/solids again?
You would work in things they really like to eat, depending on where they are on the aversion scale. We have some patients that can’t even stand for you to open a container with green beans in the same room as them. So you could start off as simply as having mom bring some green beans and some other food they really like and we have it on the table near them. They’re getting a little hungry/being motivated by the food they like and you have them eat it, while you then open the container with green beans so they smell it.
They might be very aversive to that, so you put the lid back on, but now they’ve smelled it. We’re talking slow, incremental changes. From being completely aversive to it, to maybe having it on the table, in eyesight, to playing with it, so they get the feel of it to even, we like to tease and say “give it a kiss” so that at least the green bean or whatever food, is touching their mouth and they incrementally become accustomed to the food. We slowly condition them to accept the food.
Thank you for taking the time to share all this information with us. It’s so helpful, I know people have questions and that we have answers.
Watch the video below to see a quick clip from one of our feeding therapy sessions. Please feel free to comment any questions you have and we’ll do our best to answer them.
If you have any feeding concerns please see your pediatrician, stop by one of our 7 Houston area Cole Pediatric Therapy locations or even message us on Facebook @ColeHealth!