ARE YOUR CHILD'S SELECTIVE FOOD HABITS MORE THAN NORMAL PICKINESS?
By Laura Austin, Ph.D.
Our Children's House at Baylor
All children evidence periods of picky eating. Toddlers in particular are notorious for loving a food one day and refusing it on their plate the next. How then are parents to know when pickiness becomes a problem?
In general, food selectivity becomes a problem when it impacts growth or nutritional status or if it causes disruption at home, school or with socialization.
If a child is not growing well or medical testing has identified nutritional deficits, then action should be taken to improve the volume and/or variety of foods accepted. However, physical status is not the only consideration when evaluating food selectivity. Food preferences can be disruptive at home or school. This may be more evident as children get older and show difficulty participating in social events such as birthday parties and sleepovers.
If your child exhibits food selectivity that interferes with physical or social development, the next step is to attempt to determine the source of the resistance. One of the first questions to ask is whether or not certain classes of foods are avoided. For example, does your child eat only pureed or smooth foods but rejects anything solid that must be chewed? Or, in contrast, does your child prefer chewing foods, but resists any smooth or pureed texture? Perhaps your child will only eat carbohydrates or food of only one color? Patterns in the types of foods accepted or avoided can provide clues as to whether or not a true problem exists.
There are a variety of factors that can lead to food selectivity. Medical issues such as reflux or food allergies can lead to irritation in the esophagus and/or stomach which can make kids reluctant to eat. Oral motor weaknesses such as difficulties with strength or coordination in the mouth can make eating certain types of foods difficult or scary for kids. Oral sensitivities lead children to avoid certain types of foods because of the way the food feels inside of the mouth. These children often have global sensory processing problems as evidenced by resistance to activities such as getting their hands or face messy, resistance to having their hair washed or fingernails cut, and reluctance to walk barefoot in grass or sand. Finally, when children refuse foods parents often resort to the “Whatever they’ll eat. Whenever they’ll eat. However, they’ll eat” approach. As such, refusal behaviors can become ingrained making forward progress with eating difficult.
Fortunately there are a variety of professionals who can help provide insight into the sources of food refusal and treatment for kids. North Texas is fortunate to have one of the nation’s few multidisciplinary feeding programs- Our Children’s House at Baylor. This facility provides multidisciplinary assessment and treatment for children ages birth to 18 with food selectivity or food refusal. Parents should also seek medical advice from the child’s pediatrician or from a pediatric gastroenterologist to rule out any underlying medical factors that could be impacting oral intake.
IS MY CHILD ON TARGET FOR HIS AGE?
By: Jane Wagner, MSPT, PCS
Clinic Manager, Our Children’s House at Baylor in Grapevine
“My child walked at 6 months.” “My child didn’t talk until he was 4-years-old and then started talking in complete sentences.” “My child never crawled.” “My child is so cute, she walks on her toes like a ballerina all the time, and has been doing this since she started walking at 15 months of age; she is 3 years old now.” “My child didn’t roll over until she was 7 months old, but I think it was because she never liked being on her tummy.”
Parents hear other parents, family members, friends and teachers tell them about children and how they are supposed to develop normally and when they should achieve normal milestones. There is an abundance of information on the Internet and plenty of books to read, but your child will probably have graduated from high school before you get through the myriad of sources available to parents.
Let’s look at some practical advice. Making sure your child has the underlying skills to help him progress with gross motor, fine motor and speech activities can be an important key in helping your child be “on target” for his age.
For the child to roll, push up on his arms, rock in hands and knees and get into sitting, he needs to be able to work against gravity and develop good core muscles as well as good stability around the shoulders and hips. The child learns these movements and develops the strength in these areas by spending time on his tummy during waking hours. Reaching while on his tummy and crawling activities help further develop the strength and stability around the shoulder girdle that will help the child have a good base for them to develop manipulative skills in their hands so that they can perform handwriting, buttoning, tying shoes and a variety of ball skills. A good core as well as strength in the upper trunk and neck muscles helps support good breathing, sucking, swallowing and feeding skills.
But it’s not just about a good “core” and being on the tummy every waking hour. It’s also about spending time with your child playing “peek a boo”, clapping your hands, reading to him, singing songs and giving him a variety of play activities. These activities help your gurgling, cooing infant learn to identify 1-2 body parts, follow simple one step directions and have an expressive vocabulary of 3 to 20 words by 12-18 months of age.
So, you say, “What if I’m doing all this and my child seems to really struggle to perform similar skills to his peers?” Talk to your pediatrician. Simple hearing and vision screens can help rule out some problems. Your pediatrician can also lead you to good resources like pediatric occupational, physical and speech therapists.
Being a parent is one of the most important jobs you can have. Be your child’s advocate. Your one-on-one time with your child will help him develop “on target” and help you know early if he is having problems.
WHAT YOU NEED TO KNOW ABOUT AUTISM
by Jennifer Morrison, Ph.D.
Pediatric Neuropsychologist-Our Children’s House at Baylor
Over the past decade, awareness of autism has reached a fever pitch. Although this awareness is needed, it can bring with it much confusion—especially for the parents of young children who are constantly exposed to media coverage and new research studies about the condition. So how can parents process this information without becoming alarmed or overly concerned? Or more importantly, if their child is diagnosed with Autism, where can they turn for help?
First, it’s important to know that when a child displays signs and symptoms of autism, it is possible for them to have one of several potential diagnoses including Autism, Asperger’s Disorder, and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS). There has been speculation in the media about the different signs of Autism and the age at which they can present, but it should be noted that while a child can display behavior commonly associated with these conditions, it doesn’t necessarily mean they have it.
The early signs of Autism Spectrum Disorders (ASD) include various severity levels of:
- impaired language,
- behaviorial tendancies such as limited eye contact,
- repetitive actions including hand flapping or hyper focused visual attention,
- social skills deficits such as inappropriate behavior, poor relationships, inability to deal with transitions and environmental changes,
- and marked impairments in daily functioning at home, school, and in the community.
Given that that any of these deficits are possible without meeting criteria for an ASD, it is important that trained professionals guide the process of diagnosis. Careful consideration and thorough evaluation are needed prior to making the statement that a child meets criteria for an ASD, as this is a lifelong disability that will impact all areas of daily functioning.
In order to be diagnosed with an ASD, a child must undergo a comprehensive assessment including evaluation of intellectual, language, social/behavioral, and adaptive skills. Additionally, evaluations explore other criteria like assessment of sensory processing, fine motor and visual perceptual skills, gross motor abilities, and neurocognitive profiles and learning styles.
In order to fully assess all of these areas, multiple professionals are needed. Fortunately, families here in North Texas have access to specialized clinics made up of highly-trained specialists at Our Children’s House at Baylor (OCH). With nine outpatient clinics located throughout the Metroplex, OCH staffs professionals in every discipline needed to manage the diagnosis and treatment of ASD: Neuropsychology, speech-language pathology, occupational therapy, and physical therapy.
Although it is possible for a neuropsychologist/psychologist to assess for and diagnose ASD’s alone, it is always best to have insight from experts in other therapy disciplines. The multidisciplinary teams at OCH not only handle the diagnosis process, but provide ongoing support for children and families in treatment.
Finally, parents should know that simply stating that a child has a diagnosis on the autism spectrum is not nearly descriptive enough to allow parents, teachers, therapists, family, and friends to conceptualize the child’s abilities and needs. Each child is different. Assessments should be driven by a focus on interventions, access to appropriate therapy techniques, social support and family training resources, educational planning, and vocational and career placement. That’s why facilities like OCH seek to provide the highest quality of care to the child regardless of the diagnosis. This includes addressing the direct needs of the child and areas of concern for the family, school, and community agencies serving the family. Those who work with children diagnosed with an ASD should seek to educate doctors, parents, and school staff that it is never too early to intervene, that there is no such thing as too thorough of an assessment, and that each child with an ASD is special and should be treated as such.