Transition to Solids: Seeking Suggestions

Jaclyn Posts:

Client with Feeding Difficulties:
I am seeing a child who is now 15 months of age. She was born at 36 weeks gestation, with very low birth weight and a very weak suck – was never able to breast feed successfully. After transitioning from hospital to home, mom found that only one orthodontic nuk nipple would work for feeding her 50/50 mix of breast milk and formula. The child was very sensitive to different bottle nipples, many of which would make her gag and vomit. Since 1 month of age, the child has been vomiting almost daily (previously was after every feed). She was diagnosed with reflux (GERD) and put on medication (Prevacid), which was recently discontinued due to doctor’s belief that the reflux has improved now. The child was able to take in enough with the frequent liquid feeds, and she is still currently an age-appropriate weight. Mom has been trying several strategies and for over a few months to transition her to accepting anything solid (started with trying pablum, which child could not accept without having a gag and/or vomit response). Mom has applied all recommended sensory strategies (z-vibe introduction and exercises, tactile exploration, sensory play, introducing new smells/tastes in graded steps, and use of wilbarger oral protocol, etc.). The problem now is that the child’s transitioning to solid foods and thickened liquids is ongoing, but slow. As well, the child has been vomiting daily since 1 month of age. Now, when the child coughs too much, gets too upset, or has something stuck in her mouth that she can’t get out with her tongue, she uses vomiting as a default strategy for getting anything uncomfortable out of her system. The mom would like to know if there are any strategies/tools or approaches that can be used to 1) stop the vomiting from occurring once she can see early signs of that response in the child (i.e. if the reflux is just starting, the mom can sometimes stop it if she distracts child by putting her feet in water — she would like more strategies like this); and 2) prevent the child from developing a voluntary behavioural issue with vomiting, as she matures.
Any advice, recommendations, feedback from other health professionals familiar with these issues would be greatly appreciated!!!!! Thanks :)


4 Critical Questions to Ask Yourself When Preparing an In-Service for your Therapy Department.

Carol Loria, President ERI:

You want to share your learning and enthusiasm with your colleagues but you only have 1 ½  hours to present 2 days worth of material.

How do you pair down the material?  How do you decide which information will have the greatest impact on your colleagues? 

Questions to Consider:

  • Who is the audience for this in-service?
    • How well do they know the topic and what is their general level of expertise?  This will determine how much background/theoretical information to cover versus how much time you can spend focusing on clinical applications. 
    • What is the predominant patient population that they work with? What are their greatest challenges and priorities?  This can help tailor the focus of your presentation to their needs
  • How does the audience feel about the topic? 
    • If their attitude is supportive or better yet, excited about learning this new information, you needn’t spend much time presenting material to win them over and you can get down to clinical applications fairly quickly. 
    • If the group is not generally open to this new or alternative information, you may want to spend the majority of the time providing an evidence-based cogent argument and leave the clinical applications and treatment strategies for a follow-up with those that are apt to be open to them. 
  • How best to divide the time? 
    • For a one and one-half hour talk, plan on 5 minutes for an introduction to explain your goals and plan for the session
    • Offer one comment to let them know how “charged and excited you are about the material….do this in the first few minutes
    • Plan 75 minutes of content after your intro, and 10 minutes for questions at the end. 

Good luck! 

Share your thoughts and stay tuned; next time we’ll be talking about hints for deciding on content for your in-service.


Realistic Goals? Child with Rett Syndrome

Kat Posts:

DEAR ERI COMMUNITY: I currently have a client with Rett Syndrome and this is my first case in my career to treat the child. She presents with very high functioning skills, she is able to transition from the floor to stand via bear stance, she can walk over uneven surfaces with out falling over, she can gallop and increase her walking speed without falling. She has a #3 DAFO on one foot and a #4 DAFO on the other. Cognitively she does not follow verbal commands and requires hand over hand assist to stay on task. This child is 10 years old and the previous therapy place was seeing her on a weekly basis. I reached to them to ask their recommendations and opinion on realistic goals and if she requires continued therapy on a weekly basis. The therapist philosophy was to treat this child on a weekly basis due to her progressive neurological decline and that if she saw the child, that the child would not regress. I treat what I see, I also work in an outpatient clinic which insurances drives to see improvements. Is skilled services required at this time with her current presentation?


How to Overcome Nervousness When Presenting an In-Service to your Therapy Department

Carol Loria, President ERI:

You just finished a continuing education course and you can’t wait to impart your excitement and the new knowledge you learned BUT you are so nervous.
You are afraid that your hands and voice will be shaking.  No worries, you are not alone.  Studies have shown that people fear public speaking more than death. 

When I first started working with faculty at Education Resources, I was truly shocked to discover that many internationally renowned speakers got butterflies in their stomach (one even threw up her lunch) prior to taking to the stage and still looked so unbelievably calm and in control.  I started asking how they managed it and through the years research has borne out their “home remedies”.  You can train yourself to appear calm and most people can even overcome their nervousness completely

Here are just a few tricks I’ve learned over the years: 

  • Think of this in-service as an opportunity to develop your public speaking skills….NOT as a performance
  • Ask yourself if there were any “aha” moments for you when you learned the material.   This will conjure up your enthusiasm and we all know that if you can impart that enthusiasm, you will engage their interest.
  • Increase your confidence and ease by practicing at home, standing in front of a mirror (or a sympathetic roommate)
  • DO NOT read from your notes but rather use them as talking points
  • Speak with words and tone that is both comfortable and natural
  • Make eye contact with your audience intermittently looking at your papers
  • Always check out the space before you speak, even if it is a familiar room to you….make sure the lights; temperature and arrangement of the chairs are to your liking. 

What are your tips to overcome nervousness? 

Stay tuned; next time we’ll be talking about 4 critical questions to ask yourself when preparing a presentation.


Help: Stimming in Autism

Tonyia Posts:

DEAR ERI COMMUNITY: I’m looking for any advice regarding a current student I work with. He is a 9 y/o boy with severe Autism, hard of hearing, and cognitive delay. His stims have been increasing lately, approximately the last 6-8 weeks, we’ve seen new stims including drawing on himself and in the air, arm flapping, running in circles, can not stand still longer than 2 sec (I know these are “typical” stims). His normal stims are drawing on white board over and over, looking at his drawings with his peripheral vision, and rocking. The stimming is constant throughout his day and nights, compared to previously a handful of times throughout the day. We are a residential school, so he is here 5 days/nights a week. He has also started touching other boys in their genitals, repetitively. He has developed an unhealthy relationship with another classmate, who he needs to be next to at all times, is constantly touching him, if the other child leaves the room, he begins to cry and perseverates on that boy until he returns. The teacher and aides have them separated in the classroom so there is no touching that can happen, unless this boy runs over and grabs the other boy. The other boy does not encourage these behaviors. He is caring toward the other student, but often wants a lot of separation between the two of them.

I know that stims change, come and go, intensify at times, one needs to be replaced with another. We have always been able to redirct him in the past, we’ve worked with increasing his sensory diet and he communicates his needs most of the time now. He is never denyed sensory when we feel he needs it or when he requests it.

So, the real question is: does anyone have any ideas what can be causing the increase in stimming and behavior, plus treatment ideas please. Our behavior specialist is helping with the changes as well, but hasn’t come up with anything effective yet.

Thank you,