Tagged "Lori Overland"


Ask a Therapist: Down syndrome Feeding Question

Posted by Deborah Grauzam on

Hello, my daughter is almost 2 years old and has Down Syndrome. We had the opportunity to meet Lori Overland when my daughter was about 9 months old. I feel so fortunate to have found TalkTools while my daughter was very young, although we still have some struggles. Our OT is familiar with TalkTools and is also a feeding expert. We have an issue with tongue thrust/protrusion. My daughter drinks from a straw but she sticks her tongue out. I think she may still be using the suckling action. (We have never used sippy cups.) She eats a lot of foods and we have always tried to introduce solids on the sides. She does chew and bite on things and we are slowly progressing to more challenging chewing foods. We have your straw program but have only used the first straw due to tongue issues. I believe she has what is called a reverse swallow – she sticks her tongue out to move food back before swallowing.

My daughter sticks her tongue out when playing and puts everything in her mouth. Sometimes I feel like  it's a game to her to stick her tongue out. We also have some chewy tubes and a z-vibe. My daughter will sometimes bite down on the z-vibe but doesn't care for the chewy tubes. She loves to have her teeth brushed now and bites down on the toothbrush all the time. I am sad and discouraged and not sure what to do. I feel like we have worked so hard but she still has this problem. I know it can be corrected, I just don't know what our next step should be. Any guidance you could share would be wonderful. Thank you so much.

Hi, children with the diagnosis of Down Syndrome often have this issue. The first thing you need to do is see an Otolaryngologist (ENT) and have him/her look at the adenoids, tonsils and Eustachian tubes to ensure that there is no airway obstruction causing the tongue to be displaced forward for breathing. Sara Rosenfeld-Johnson explains these issues in this article.

Once there is medical clearance, you will need to do a series of feeding and oral placement activities to provoke three main goals:

1. Jaw Stability

2. Lip Closure

3. Tongue Retraction

While I cannot diagnose or create a program plan without seeing your child, a few general suggestions can be given.

A. I suggest you take Lori's course on the Down Syndrome Population and/or her Sensory-Motor Feeding course. You have a great start with slow feed for solids and the straw, however it seems you need to add a few more pre-feeding tasks to the repertoire. Maintaining tongue lateralization and Lori's tongue hugs would be helpful. Cheek toning and the upper lip stretch will be useful as well.

B. I suggest using the Honey Bear Straw Cup mid line, supporting the jaw and superimposing the correct oral motor skills for swallowing by supporting the jaw, and squirting small amounts of liquid into her mouth in sequences. This breaks the suckling habit. The straw should be no longer than 3/4 of an inch.

C. A combination of Oral Placement activities such as: Bite Blocks, TalkTools Horns and Bite Tubes would be great for her, but this type of plan really needs to be created by an experienced TalkTools Therapist. Please visit the "Find a Therapist" page. We also offer traveling clinics -- perhaps you can catch up with one of us when we are local!

Hope this helps :) Thanks for your interest in TalkTools!

Robyn Merkel-Walsh

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Ask a Therapist: Nutritive Feeding for Charge Syndrome

Posted by Deborah Grauzam on

I have a 4 year old student with CHARGE SYNDROME. He has minimal intake and could be looking at a feeding tube if this declines any more. Mom is totally fighting with him (holding one hand with her mouth, the other with her non-feeding hand and then spoon feeding with the other!). Feedings take at least an hour to get adequate intake. Would love to pick your brain!

Hi Lisa, I would be happy to talk to you about your little one with CHARGE. I often see parents who are frantic to get their child to take adequate nutrition. In therapy, your goals should be to assess this child's sensory motor skills to support feeding and to work on the underlying motor skills to support safe nutritive feeding. I would also recommend consulting with a nutritionist to make sure this child is getting adequate nutrition. Perhaps you can look at a complete nutritional shake (something like Complete), so he does not need to be force fed, while you are working on sensory motor skill development. If this child is unable to get adequate nutrition by mouth, tube feeding may be a the best option. It often allows parents to relax, work on developing the motor skills for oral feeding and to enjoy mealtime with their child.

Hope this helps!

Lori Overland

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Ask a Therapist: Beckwith-Wiedemann Syndrome and Tongue Protrusion

Posted by Deborah Grauzam on

A 6 month old baby with Beckwith-Wiedemann Syndrome was referred to me. This syndrome is new to me, and I have had a hard time finding good information. I know that macroglossia is present in most children with BWS. This baby's tongue protrudes significantly. Most of what I have read says many require tongue reduction surgery. I am trying to figure out what to do for this child in terms of oral placement therapy (which is also newer to me). Would I need to wait until after the surgery (if done) has been completed? Do you have any suggestions?

Sincerely,

Gabrielle

Hello Gabrielle, I have worked with a few children with BWS over the years. Unfortunately surgery often creates as many problems as it solves. It does reduce the size of the tongue and improve a child's appearance; however, with the cut through muscles, I have observed notably reduced sensation in the tongue. I do think both oral motor/feeding and oral placement/speech will help this child. I would specifically work on the lateral borders of the tongue...trying to get some lateral tongue, and tongue tip movement. Many of these children have reduced muscle tone and you will observe issues with the jaw, cheeks, lips etc. What are you observing in this child? Have you taken any of the TalkTools classes? Given the age of this child you would want to take the 2 Day “Feeding Therapy: A Sensory Motor Approach” first. It will definitely help you to evaluate this child's motor skills for safe, effective nutritive feeding, and help you to plan a program. Then I would recommend taking “A Three-Part Treatment for Oral Placement Therapy.” I hope that will be a good start for you!

Good luck.

Lori Overland

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Ask a Therapist: Feeding Therapy with Bite Straws

Posted by Deborah Grauzam on

Hi Lori. Without seeing the student, can you tell me if this sounds like accurate application of the Feeding Therapies we learned in your workshop? When using the bite straws with a one year old girl with Down's, she moves her head to the side to which the straw is presented to instantly suck the applesauce out of the straw. I believe this is due to the rooting reflex not being totally integrated and also her ability to suck vs bite is much delayed. Mom notes she seems to be moving her tongue around a little better since she started with the bite straws. Mom continues to give facial massage to the outside of face, using tapping when wiping her face. She is doing some cup drinking and tolerating it just a bit. She can drink from a straw and mom has been instructed in straw drinking. We are working on reducing tongue protrusion and mom is providing a lip block when drinking. I know I need to try tongue lateralization and tongue hugs with her. Thanks, Lisa

Hi Lisa. You probably need to address cheek mobility, and upper lip mobility, given her age and diagnosis. As for the lack of dissociation, try positioning yourself behind her, using the "v" support and then doing the ice straws with chewing hierarchy level #1, as explained in my book A Sensory-Motor Approach to Feeding.

Lori Overland

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Ask a Therapist: Complicated Premie with Feeding Issues

Posted by Deborah Grauzam on

I am treating a beautiful, 4 month old baby born at 29 weeks gestation. Meyer was immediately intubated and sent to NICU where he experienced bouts of apnea. Meyer was given feeds on 2/3 for 5 days with good suck and intake, but subsequently required surgery for Necrotizing Enterocolitis (NEC - a gastrointestinal disease, that involves infection, inflammation and destruction of some/all of the bowel). Successful surgery was completed. While on PO feeds at hospital Meyer had uncoordinated swallow/suck with sputtering and bradycardia (i.e. bradys). An oral pharyngeal motility study (OPMS) demonstrated aspiration on both thin and thickened liquids. Discharge report indicated NPO status. Meyer's discharge recommendation: 5CCs of thin liquid each day orally and remainder of nutrition via naso-gastric tube. He currently receives 85% daily feeds via an NG tube, but when we attempt to increase his oral feeds he shows bradycardia. After trials with a medium flow Playtex nurser, he was very successful with the Haberman feeder using thickened breast milk for a couple of weeks with no Bradys, mom paced him from fast to medium flow as he got organized with the feed. We are thickening the breast milk with rice cereal (pediatrician and I felt giving a preemie rice cereal early was the lesser evil to aspirating on thin liquids). He saw a renowned, pediatric ENT at Emory University due to stridor and was diagnosed with fairly benign laryngomalacia – she feels it will disappear and is not impacting his swallow -- she scoped him, looked at his swallow without liquid and said it looked "fine.”

In the past week it has changed – he has increased Bradys. Pediatrician and mom think it is due to increased GERD. Last week, he went from 40 CCs via the Haberman (we limited amounts to work him up to accept it without Bradys) 3 times per day, to less than 20CCs at each feeding and he "falls asleep" during feeds. I think he is becoming cognitively aware of the GERD and refusing to suck. His mom did a trial feeding on the breast yesterday and he sucked well. I'm thinking maybe he has not learned that the breast causes pain from GERD. He does have some decreased oral motor skills with his jaw and cheek, but he is able to suck a pacifier well. We are doing O-M exercises daily. My thought is to maintain the O-M exercises and treat the GERD in the hopes we can get it under control and get him to eat more. Would love any thoughts you might have – poor baby has lots going on.

Thanks, Jennifer

Hello Jennifer. He does sound like a complicated little guy, and you have done a good job with him. I understand that sometimes you have to make a decision about using rice cereal as the lesser of two evils...but I am always concerned about motility (and allergies) when thickening premies' feeds. Have they explored possible allergies? Is the baby being bottle fed with the NG tube in? This MAY account for increased reflux. Is mom working with a lactation consultant? There MAY be less reflux with breast feeding than bottle feeding. Have they tried a lactaid? If the baby is sucking well on the breast...this may be an idea. In what position are you recommending feeding him? Feel free to run the pre-feeding exercises by me if you want another set of "eyes.”

Lori Overland

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