Self Help Skills | Encouraging Kids To Eat Using Spoon

It’s always an exciting moment to watch our kids hit developmental milestones.

Even for parents raising regular kids, every new learning is a proud moment. But many of us take for granted the simple things we need to perform everyday to live with the desired level of independence. These simple skills are called self-care or self-help skills like:

• brushing teeth 
• sitting up 
• eating 
• taking a bath
• dressing up 
• combing hair
• putting things in place

Some kids with developmental delays like Eira pay a high price to learn the most basic skills like eating without assistance. Her physical limitations mostly due to hypotonia slows down her progress in performing critical self-care.

A common course of action would be to seek help from occupational therapists (OT). But it’s always best for parents to be actively involved in the development of your child. Outside professional OT help, parents can encourage progress and you might be surprised how your kid achieves milestones at a faster pace than you expect.

Most may not understand that for parents raising a child with special needs, there is an extra special shout for joy with every little victory. When Eira recently started to initiate feeding by herself using a spoon, the excitement was as real as our struggles for the last seven years trying to encourage her to feed independently -- all emotions condensed in one single moment, celebrating a small triumph.

Yes, there is real struggle in trying to achieve one small milestone; and so, with even the smallest progress brings a rush of euphoria. We can tell you that all roads leading to one glorious moment of progress had been an uphill climb. But we'd do it all over again because our child is worth it - every drop of sweat and tear, ever pain, every sleepless night, and every aching joint in our bodies.

How to Encourage your Child to Eat?

Our honest answer would be: there is no single method that fits all. Every child is unique and as parents, we should be able to take cues from them. But there are some strategies you can explore to make it fun and interesting for your child, suggested Sahana Charan, Parent Circle. We picked some fun activities you might want to try out:

• Take the creative route for visual appeal. Explore food art and arrange food to create shapes and fun characters like creating a heart shape with peas or a house with carrots and breadsticks. Usually, what appeals to their eyes, may appeal to their taste, too. You can also involve your kid and teach them to create shapes with noodles or pasta. Fun learning games can get kids excited to explore the texture of a variety of food items with their hands and eventually, will feel ready to taste and put the food in their mouth.

• Go bright and colorful with finger foods. Most kids love food they can touch with their hands and finger foods are the best way to get them started exploring textures. As they get familiar with texture, it will soon come naturally to try out for the taste.

• Allow playtime. Most parents are petrified watching kids play with food. But remember that learning an important skill outweighs a little mess that can be cleaned up. Kids feel the need to trust the food they will put in their mouth. Imagine it was you, blindfolded and made to eat something you don’t recognize. It’s a scary feeling not to know what you put in your mouth and it’s the same for kids. Playing with food helps ease that fear because they get to touch and feel the texture of their food.

• Schedule a family meal time. More and more modern families are eating-on-the-go and spending less and less time sharing a meal together on a dining table. But family mealtime is an important activity that can help your child learn at best because they see first-hand how members of the family eat using hands or spoon that encourages them to mimic. Kids are great imitators and family mealtime is a great opportunity for kids to mimic actions and get them to eat by themselves.

Our method: what we did to encourage eating independently

Getting Eira to eat by herself was a slow and long process. Every mealtime was a struggle. We spent a lot of time and attention encouraging her to feed independently. The biggest help for encouragement was her little sister who makes every mealtime a fun and happy experience for both of them.

• Flying kiss: the useful hand on mouth exercise. A daily practice of flying kiss proved to be a useful exercise in preparing Eira with the movement of hand on mouth. We’d take every opportunity and ask her to execute a flying kiss until it became a habit.

• Pretend play. One of the fun activities we explored that encouraged Eira to eat by herself is using play. During our first visit with Eira's physiatrist, we discussed about various playsets that can help prepare Eira to start eating by herself. We shopped for multiple food playsets such as fruit and veggie sets, kitchen tool sets, tea party sets and other. Having siblings or friends to play with makes learning for kids easy and fun. Pretend play is one fun way to encourage kids to eat by themselves but you must be careful selecting your toys. Always check that the toys you pick are non-toxic, safe toys before you give them to your kids. Here are some toys we picked for you:

Melissa & Doug Food Groups - 21 Hand-Painted Wooden Set | Buy This!

Casdon Morphy Richards Kitchen Set | Buy This!

Baby Kitchen Toys Pretend Playset Cutting Food with Shopping Basket | Buy This!

• Water bottles. She loves water and we’d always carry a water bottle for her. We would let her hold her bottle to familiarize her hand with the texture and we’d also give her sister the same water bottle. She used to just watch her sister drink by herself. Repeating the process at every opportunity was a strategic approach to encourage her to finally lift the bottle up and pour into her mouth. Her early attempts did not have control over the flow of water and she’d get wet. But daily practice paid off. 

• Introducing ice cream treats. Twice a week, we visit the mall and we started introducing ice cream treats to the girls. Eira would enjoy watching her sister eat while just holding her cone of ice cream until it melts in her hand. We had to deal with sticky hands every time and of course, cries… perhaps, out of frustration. We had to buy another round, on a cup this time and assist her feeding. But we continued the process and repeated week after week; then month after month went by without attempts to initiate eating by herself. When she was finally ready, it was a celebrated moment of total joy and we captured all her giggles. It was a glorious moment.

• Encouraging play during mealtime with rice. During mealtimes, she is allowed to play with her rice. It’s a great way encouraging her to touch and feel the texture of the food. Small, fun activities like this all led to the moment that made her feel ready to eat by herself.

• Milk + bite size bread squares. Eating ice cream by herself was a huge step. We followed that up by encouraging play during mealtime and then, leaving breakfast meals on her table daily. We usually prepare milk + bite size bread squares and leave her to eat by herself. We use Gardenia bread products because it comes in different flavors and colors.

• Visual Cues. After our December 2017 visit with Eira's SPED teacher, Teacher Goya, we started introducing visual cues. Visual cues is the retro approach to help kids (especially those with developmental delays) identify words and images to communicate easier, especially if you are caring for non verbal kid like Eira. Let's talk more about this at greater lengths in the next blogs.

Self help Milestones 

The journey that leads us to achieve every milestone is what we must embrace. It's a wonderful adventure, even for parents raising regular kids. The key is to keep going, without deadlines.


By far, we've achieved some monumental milestones using play, mimic, and repeating the process—

• Eating breakfast by herself
• Eating snacks by herself
• Eating rice meals using spoon
• Eating ice cream by herself
• Drinking from water bottle
• Drinking milk from glass
• Brushing teeth - work in progress
• Combing hair - work in progress
• Dressing up - work in progress
• Undressing - work in progress

Final Thoughts

Learning happens one step at a time. There is no contest; parents do not have to rush kids to process learning on a deadline. Raising a child with special needs is a journey worth embracing. While milestones are exciting achievements, what really matters are moments that lead us to every milestone. Enjoy that. It’s priceless. In the end, life is not about milestones… it’s about moments we spend with our kids and family.

How do you encourage your kids to eat by themselves? We'd love to learn from your stories... you can leave a comment below.

If you have questions related to teaching self help skills at home, just keep scrolling until you find the 'Ask A Question' box and send us your quick questions. We will publish the answers coming from professionals in our network.

Insights on Recurrent Pneumonia: Risks in Kids with Developmental Delays

It’s a deadly disease. While pneumonia can be treated, the risks are higher for a child with developmental challenges.

Here's why:

There are communication difficulties with a developmentally challenged child that can possibly lead to two problems¹:

1. delay in the recognition of respiratory problems; and 
2. difficulty in establishing the precise diagnosis.

If you are parenting a child with global developmental delay, you probably understand the challenges we encounter when it comes to accurately identifying medical concerns.

When you’re dealing with a case of recurrent pneumonia in a child with developmental delays having multiple episodes in a year, it becomes more important than ever to learn about prevention and control.

Here in the Philippines, pneumonia takes the lives of many children each year. The Department of Health reported that pneumonia is the number one leading cause of child mortality². Data from the DOH 2010 records is presented below.

Before we keep going, you should know that Eira was vaccinated with pneumoccocal vaccine, Prevnar. 

She received the vaccine when she was a little over one year old. Unfortunately, for whatever reason, she was admitted for pneumonia soon after the vaccination. It’s not the first time she had pneumonia and we’re not saying the vaccination was the culprit for her hospitalization.

December 2011 | Eira spent the holidays @ San Pedro Hospital, Davao City | Diagnosis: Pneumonia

But she continues to suffer from recurrent pneumonia despite the vaccination.

Eira’s recurrent pneumonia could be caused by many other factors. For one, she is diagnosed with asthma. Asthma triggers could lead to viral infection and progress to pneumonia. But I guess, that is something we may never find out for certain.

September 2017: At 7, Eira still suffers from recurrent pneumonia | Shot in SPH Davao before going in for X-ray

A parent's perspective: Understanding pneumonia

From a parent dealing with pneumonia several episodes in a year, here's what I understand.

When infection reaches one or both lungs, the airways swell resulting to a buildup of mucus or fluid in the air sacs making it difficult to breathe because the airways are blocked and oxygen could hardly reach the blood. That’s why, we cringe at the first sign of colds or cough.

Pneumonia is a bacterial or viral infection of the lungs... it causes inflammation of the air sacs in one or both lungs.³

In Eira’s case, as soon as she catches colds or starts to cough, the mucus build-up takes just overnight and her body goes into relapse. Her temperature quickly heats up, breathing gets faster and labored with wheezing sound, her appetite reduced (if not completely gone), and in some episodes she throws up any food or fluid intake and begins to dehydrate. 

Timely and proper management is crucial.

In most episodes we experienced, she acquires viral infection when exposed to a human carrier, or in some cases triggered by asthma attacks; and that progresses into bacterial infection requiring treatment with antibiotics.


We have to constantly watch out for anyone carrying viral infection that could quickly spread simply by coughing or sneezing and transmitted to her. Pneumonia could also be caused by fungal infection, a rare case.

Thankfully, Eira never had pneumonia caused by fungal infection.

Image Source: tabletsmanual.com

The above image shows you the anatomy of the lungs to have a better understanding of what pneumonia looks like. It usually begins after an infection in the upper respiratory tract moving to the lungs.

Fluid, white blood cells, and debris start to gather in the air spaces of the lungs and block the smooth passage of air, making it harder for the lungs to work well.⁴

Breathing gets difficult the moment infection sets in and fluid fills the air sacs in one lung or in some cases, both.

In our series of ER rush, emergency responders who knew us would quickly check for Eira’s SO₂ (blood oxygen saturation) level. They use a handy pulse-oximeter. It measures how much oxygen the blood is carrying and indicates the health functions of the lungs.

More often than not, Eira’s dropping SO₂ levels require additional oxygen support.

Prevention and control: Responding on time with proper management

I should stress that medical management may be different for every child. 

Eira’s condition may not be the same with your child’s. It’s important that you consult with your pediatrician specializing in pulmonology and discuss what you can do from home as first responders to care that may help prevent or control the progress of your child’s recurrent pneumonia.

For us, at the first sign of viral infection, our pulmonologist stresses the importance of keeping the airways open.

Before we started her on Seretide, she was given Meptin. It’s a bronchodilator that helps keep the airways open for 24 hours. It helps ease her breathing.

But recently, it seems that her asthma attacks cannot be sufficiently controlled with a regular steroid inhaler with salbutamol neb (reliever med).

So, we shifted to Seretide per doctor’s order.

That means we’re skipping on Meptin. And that’s because seretide contains a combined active ingredients: salmeterol and fluticasone propionate that already helps reduce the inflammation in the lungs and keeps the airways open.

The device above is called a babyhaler. If your pediatrician recommended the use of a babyhaler on your child, make sure you learn the proper technique of using the device. The video below is a helpful demo with Ann Toother, a Clinical Nurse Specialist (Respiratory) on how you should properly use the babyhaler when delivering medication.

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What we do from home controlling pneumonia

As parents, we should be equip with proper education on how to properly respond on time during emergencies to control and prevent the progress of pneumonia.

• Treating acute breathing emergencies… 

The nebulizer kit has always been our good friend during emergencies at home. When breathing gets troubled, tight or difficult, treatment with Salbutamol Nebule Solution using a portable nebulizer provides quick relief to the lungs as it quickly delivers the medication directly to the respiratory tract and helps prevent respiratory problems from developing.

Tip: Use the baby mask from the neb kit for optimized treatment effect.

Recommended for you:

OMRON MicroAIR U100 Portable, Pocked-Sized, Silent Mesh Nebuliser 

• Medication container capacity: 10ml maximum. 

• Easy to assemble, simple preparation 

• Wide medication compliance  

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• Keeping fever down… 

Fever is the body’s natural response to threats such as viral or bacterial infections. While it is a good sign that shows your body is putting up a good fight against infection, it’s important to keep it down when the body temperature rises. Eira usually hits 38 to 39 degrees and at one point her fever reached over 40 degrees despite the antibiotics and paracetamol.

Risk for convulsion is high during peak points of fever.

So we don’t simply rest our faith on paracetamol alone in keeping fever down. Applying cold compress on the whole body has been an effective method in breaking a fever. With Eira, it’s only a matter of minutes after applying cold compress then her temperature goes back up again. That makes it more important to monitor and continuously apply cold compress to keep her body temperature low.

• Hydrating… 

The risk for dehydration when your child loses appetite or when there is fluid losses is common.

This is important: Our pulmonologist cautions against giving children Gatorade for purposes of hydrating. It contains high level of sugar that can make diarrhea worse, according to pediatrician Jo Ann Ryhans.

We give Eira pedialyte. This is recommended by her pediatricians. It helps prevent dehydration and replace losses of nutrients and electrolytes when vomiting or sometimes suffering from diarrhea. It contains balanced levels of salt and sugar made-to-measure for the needs of children.

Special Note: Consume Pedialyte within 24 hours after opening.

Do you want to try Pedialyte?

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Shipping anywhere in the Philippines!

But we keep a sharp eye in observing her condition. There are cases when dehydration is severe and she needs IV insertion at fast drip. Be quick to know if your child is severely dehydrated and call 911 if you observe these signs--

• lethargic, or sleepy
• dry lips
• does not urinate in over 12 hours
• weak, or nauseated
• labored or tight breathing
• vomiting
• pale skin

Notes: Eira is also partially diagnosed with RSS, so when she begins to lose appetite and refuses to take in any food or fluid within four hours, it’s our cue to ER rush because she could be at risk for hypoglycemia. 

I’m sure you know your child better. If you feel that something is not right, don’t think twice and take your child to the nearest emergency clinic.

• Controlling fluid losses… 

A bad episode of recurrent lung infection has Eira on lots of fluid losses. Stomach disorder causes her to throw up at every attempt to intake fluid or food. We’re always ready with Domperidone. It’s an oral medication to prevent reflux and relieve symptoms of vomiting and possible nausea and loss of appetite. In episodes of viral infection, this usually works and she recovers her appetite soon after a full rest.

But with bacterial infection, it’s always necessary for antibiotics before she recovers back to health with restored energy and appetite.

Some helpful tips for prevention

• Serve healthy foods
• Encourage active play
• Identify and avoid allergic triggers
• Create a habit to wash hands before handling food and eating
• Upon arriving home, instruct to wash up after a few minutes of rest
• Avoid allergic triggers such as powder, pollens, fabric conditioners, scents, etc.
• Seek advice from pediatrician if your child have trouble swallowing
• Make sure your child gets enough rest
• Avoid contact with sick people
• Don't use alcohol heavily

Final Insights

I get it. I cannot bubble-wrap my kid from all pathogens. But the thought of losing my daughter to pneumonia scares the crap out of me. Every time.

So, prevention and control are what we recognize as the two strong shields against pneumonia. And it starts with proper education.

• Recognize the early signs of infection
• Consult with your pediatrician about how you can prevent and control the progress of pneumonia in your child
• Be quick to take note of details you observe and be completely open in sharing the information with your pediatrician during consult for a more precise diagnosis.
• Call it paranoia, but I can recognize the first sign of asthma attack and / or viral infection in my child. Early recognition is one of the keys to preventing and controlling the progress of pneumonia.

I choose to prepare for this battle and win. So, I throw a lot of questions at our pulmonologist that helps me provide better care for my child with developmental delays at home.

Do you have questions, too?

We can ask our doctors and get you answers direct from relevant medical professionals and specialists. Simply fill up the box below for your questions.

If you learned something from this article, please share with your families and friends. Join us again in the next blog!

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References:

¹Seddon PC, Khan Y. “Respiratory problems in children with neurological impairment.” Archives of Disease in Childhood 2003;88:75-78.

²Department of Health. Retrieved on November 24, 2017 from http://www.doh.gov.ph/Statistics/Leading-Causes-of-Child-Mortality

³Asthma Respiratory Foundation, NZ. “Living with Childhood Pneumonia.” Retrieved on November 24, 2017 from https://www.asthmafoundation.org.nz/your-health/living-with-childhood-pneumonia

⁴The Nemours Foundation. “Infections: Pneumonia.” Retrieved on November 24, 2017 from http://kidshealth.org/en/parents/pneumonia.html

⁵Schochet, Peter N. and Lie, Hauw S. “Recurrent Pneumonia in Children.” Pedilung. Retrieved on November 24, 2017 from http://pedilung.com/pediatric-lung-diseases-disorders/recurrent-pneumonia-in-children/

Will Seizure Slow Down My Seven Year Old Daughter’s Development?

I asked my daughter’s neurologist this question when we went for a consult soon after experiencing her first seizure attack.

What I learned after our neuro consult last week (Wednesday, November 8) is that seizure is typical among children with developmental delay.

The risk of a child with a developmental disability experiencing an unprovoked seizure by age 5 is about 4 times greater than in the general population1.

An overview on pediatric first seizure, published in Medscape, suggests that a recurrence may not be experienced by most children2. That's a relief...

But a seizure attack could mean two things:

1. an initial presentation of a more serious medical condition; or
2. subsequent epilepsy.

Like every parent, I have questions about how I can help my child from a life-threatening seizure? Then, I also have these questions in mind—

• what does this seizure episode mean for my daughter in the long term? 
• will it further slow down her development?

If you are a parent seeking answers for the same questions we have, I hope this post helps you gain some insights.

What research tells me so far…

According to a neurologist in the Epilepsy Center at Boston Children’s Hospital, Tobias Loddenkemper, MD, he suspects seizure-like activity in the brain at night among some children with developmental delay3.

These spikes of electrical activity in the brain gets easily undetected because “very few physicians have been looking to see what’s happening at night,” says Loddenkemper3.

Excess brain electrical activity at night can disrupt development  — but if found, may be treatable3.

The above image shows Eira’s EEG result. Notice the electrical brain activity in different regions with every wavy horizontal line. See the spiky triangular waves appearing continuously during sleep. This reflects constant seizure-like activities that is not seen in her daytime EEG.

Final Thoughts...

Let’s go back to our initial questions:

• what does this seizure episode mean for my daughter in the long term? 
• will it further slow down her development?

It is good that we consulted with a neurologist earlier than later. 

It means we get the opportunity to manage and control episodes with proper medical treatment. Treatment for seizure usually takes three up to five years. 

From a neuro perspective, if seizure recurs especially at frequent intervals, there could be developmental milestones that may be slower to achieve.

If you suspect your child having seizure attacks, consult with your pediatrician right away, especially if your child has developmental delays.

I’m committed to learn more and understand seizure. 

You can email me for questions related to seizure or any other neuro-related query and join me again in the next blog for answers from our neurologist.

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References:

1Epilepsy Foundation Metropolitan New York. "FAQ Epilepsy and Developmental Disabilities." Retrieved on November 13, 2017 from http://www.efmny.org/faq/epilepsy-and-developmental-disabilities/ 

2Waite, Shelley R. November 29, 2016. "Pediatric First Seizure." Medscape. Retrieved on November 13, 2017 from https://emedicine.medscape.com/article/1179097-overview 

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Recommended Books:

Seizures and Epilepsy in Childhood: A Guide

Description: An award-winning book used as the standard resource for parents in need of comprehensive medical information about their child with epilepsy.

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Epilepsy in Children: What Every Parent Needs to Know

Description: From a leading neurologist, experienced nurse practitioner, and registered dietician comes the complete guide to help your child achieve and maintain a high quality of life.

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Treating Epilepsy Naturally: A Guide to Alternative and Adjunct Therapies

Description: Drugs commonly used to treat epilepsy have some extremely harmful side effects. This book is an empathetic, practical, empowering look at treatment options, lifestyle choices, and ways of living well.

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Children with Seizures: A Guide for Parents, Teachers, and Other Professionals

Description: This concise, accessible handbook for families, friends and carers of children with seizures provides all the information they need to approach seizures from a position of strength.

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