Therapy Explained - Eating

Here is the last part (for now) of my explanation of Asher's therapy. Eating is predominantly the focus of our occupational therapist (the rest are mostly led by our physio therapist). As Asher gets older, OT will become more involved in things like self care, dressing himself, etc, but for now, eating is the main thing we are working on.

Eating

Thankfully, Asher's eating has never been a concern. (I bet you couldn't have guessed that by looking at his physique could you?!!). Some kids with CP have difficulty controlling the muscles required to chew and swallow, can't hold their heads up, or even have issues with their metabolism, so we are blessed that Asher is fine in all of those areas. Asher (and Nolan) now eats the same foods we do (texture and spice)  but he does, however, struggle with self feeding.

So far, it seems as though his fine motor skills are really good (which, given his gross motor issues, is strange). He can open his hands and fingers well, and is even beginning to use his pincer grasp (thumb and forefinger) yet has issues picking up small food because his arm won't cooperate and bring it to his mouth. Often times he will pick up something small in his hand and then immediately drop it, as if he doesn't know what to do with it.

We noted to our OT that he does best with baby mum mum crackers - they are long and wide and he can easily grasp them - so she suggested that whenever possible we feed him "long" food (such as toast cut in soldier fashion). That has really helped him and we have seen major improvements. A few weeks ago he would pick up a piece of food, take a bite and then drop it, unable to pick it up himself. So we'd have to put it in his hand for him so he could take another bite and then drop it. Over and over until the food was finished. Now we leave the piece of food on the tray and he picks it up himself, takes a bite, and then intentionally puts it down. When he is done chewing he picks up that same piece and does it again. Over and over. It is very impressive to see how he has learned this and how much more confidence he has. Of course it isn't pretty, it's incredibly slow, and he often needs parental intervention to get him through the meal, but that's a huge improvement. 

In addition to the way we prepare his food, we also have a few tricks to make things easier. One is a curved spoon, as shown below. He isn't very interested in spoon feeding himself yet (nor is Nolan), preferring to use his spoon as a teether, but when he is willing to give it a try (mostly with our hand over his to guide him), it makes the trip to his mouth a bit shorter for his arm to bend.

Another item we use for both boys are the little sacs with a handle shown below. You fill them with hard or small food you wouldn't want your baby to eat on their own, but they can safely eat through a mesh bag. It is a good alternative for Asher to bring to and from his mouth. As you can see below, he likes to let it hang out of his mouth, hands free, while he chomps on it. Kind of defeats the purpose, but what can you do?! He's been cutting teeth like a champ, so we'll give him this one.

The other part of feeding we are working on is drinking from a sippy cup. Neither boy has any interest. We have tried several different makes and both of them just like to play with them or use the handles as a teether. (Or in Nolan's case he likes to hold it upside down and watch the water pour out). We will continue to work on this for both boys.

The last thing we are working on is adding a higher footrest to his high chair (currently there is a foot rest on both high chairs but the boys' legs are too short and their feet just dangle). The theory is that if he has his legs bent at 90 degrees with his feet planted flat on the footrest, he may feel more in control and be better able to stabilize his core, therefore making his arms more effective for eating. It's really all a trickle down effect for him, and takes a whole lot of trial and error. We'll see how that goes.

Ok peeps, I think that's it. There's Asher's therapy in a nutshell! (a rather large nutshell if you consider it's 4 posts worth). If you have any questions or suggestions, please feel free to share!

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For more on Asher's thereapy, see posts on gear, positioning, and stretching.