Doughnuts with Di Training “Snippets” for Ohio’s Part C Assessors

A little bit about go-to-webinar CHAT BOX-COMMUNICATE TO THE TRAINERS INTRODUCE YOURSELF: TYPE YOUR NAME/ROLE/COUNTY IN THE CHAT TYPE QUESTIONS IN THE QUESTION BOX TROUBLE-SHOOTING OBTAINING YOUR CERTIFICATE FOR PROFESSIONAL DEVELOPMENT UNITS

Objectives: Support Ohio Part C Assessors with: CONDUCTING AN AUTHENTIC ASSESSMENT ACROSS DEVELOPMENTAL DOMAINS USING A VARIETY OF ASSESSMENT METHODS IDENTIFYING AND RESPONDING TO PARENT’S CONCERNS DISCUSS TYPICAL AND ATYPICAL DEVELOPMENT IN THE CONTENT AREA IDENTIFY “RED-FLAGS” IDENTIFY TOOLS AND RESOURCES conducting an authentic assessment Using a variety of assessment methods to Identify the child’s strengths and needs Identify and respond to parent’s concerns Discuss typical and atypical development in the content area Identify “red-flags” to look for during observations, parent interview, and reviewing medical and other records that will assist the team with determining need for services and or identifying need for specialist in this area. Identify tools and resources to help determine NFS and/or further assessment needs

Content Area: Nutrition and Feeding

What are Some Long Term Goals? A CHILD THAT KNOWS TO EAT WHEN HUNGRY AND STOP WHEN FULL A CHILD THAT EATS A VARIETY OF FOODS A CHILD THAT ENJOYS EATING AND IS GOOD COMPANY DURING MEALS A CHILD THAT CAN BE EXPOSED TO NEW FOODS AT A FRIEND OR FAMILY MEMBERS HOUSE OR RESTAURANT AND REMAIN COMFORTABLE

Typical development: BETWEEN 0 AND 3 YEARS: TRANSITION FROM A FULLY MILK-BASED DIET TO A DIET BASED ON VARIETY OF REGULAR FOODS OF VARYING TASTES AND TEXTURES

Typical Development: Birth-3 months SKILLS FOODS COORDINATION OF SUCK-SWALLOW-BREATHE ABILITY TO REMAIN AWAKE AND CALM WHILE FEEDING BREASTMILK INFANT FORMULA

Typical Development: 4-6 months SKILLS FOODS SIT WITH SUPPORT BEGINNING HAND TO MOUTH PLAY ORAL EXPLORATION OF OBJECTS REACH FOR BOTTLE OR SPOON BREASTMILK INFANT FORMULA BABY FOOD PUREES MELTABLES (EX: GERBER PUFFS) POSSIBLE PEANUT INTRODUCTION

Peanut Introduction Guidelines PEANUT INTRODUCTION GUIDELINES HAVE CHANGED LEAP STUDY (LEARNING EARLY ABOUT PEANUT ALLERGY) TAUGHT US THAT EARLY INTRODUCTION OF PEANUTS BASED ON INDIVIDUAL RISK STRATIFICATION CAN PREVENT THE DEVELOPMENT OF PEANUT ALLERGY DELAYED ALLERGEN INTRODUCTION HAS NOT BEEN RECOMMENDED SINCE 2010

Typical Development: 6-12 months SKILLS FOODS TRUNK / HEAD CONTROL FOR INDEPENDENT SITTING TRANSFERS TOYS FROM ONE HAND TO ANOTHER PUT FINGERS IN MOUTH TO MOVE FOOD EMERGING TONGUE LATERALIZATION PINCER GRASP DEVELOPING USE FINGERS TO SELF FEED BREASTMILK INFANT FORMULA PUREES MELTABLES HARD MUNCHABLE SOFT CUBES

Typical Development: 12-18 months SKILLS FOODS HOLD SPOON (BUT NOT EFFICIENT) HOLD CUP WITH 2 HANDS FINGER FEEDS WELL MOST SOFT TABLE FOODS (CONSIDER CHOKING) BREASTMILK AS DESIRED MILK

Typical Development: 18-24 months SKILLS FOODS PICK UP FOODS AND BRING TO MOUTH IMPROVEMENT IN USING FORK OR SPOON IMPROVEMENT IN DRINKING FROM AN OPEN CUP MOST REGULAR FOODS (CONSIDER CHOKING) BREASTMILK AS DESIRED MILK

Atypical Development: Infancy INABILITY TO FEED FROM A BOTTLE (MILK DRIBBLES OUT OF CORNERS OF MOUTH) EXCESSIVE CHOKING WHILE EATING PAST 4-6 WEEKS OF AGE INABILITY TO CONSUME AT LEAST 2-4 OUNCES PER FEEDING

Atypical Development—6-12 months LIMITED INTEREST IN PUREES OR FINGER FOODS BREAST OR BOTTLE FEEDINGS THAT TAKE MORE THAN 20 MINUTES INABILITY TO KEEP PUREE FOOD IN MOUTH EXCESSIVE GAGGING

Red Flags PARENT OR CAREGIVER EXPRESSES CONCERN/ EATING IS A SOURCE OF STRESS OR ANXIETY FOR FAMILY EXCESSIVE PROJECTILE VOMITING INFANT OR CHILD REFUSES TO EAT LACK OF EXPECTED WEIGHT GAIN, FALLING OFF THE GROWTH CURVE CHOKING, GAGGING, OR COUGHING WHEN EATING

Red Flags, Continued RELIANCE ON MILK OR FORMULA FOR MAJORITY OF CALORIES AFTER AGE 1 RELIANCE ON BABY FOODS AFTER ~16 MONTHS EXTREMELY LIMITED DIET (FEWER THAN 20 FOODS AFTER 18-24 MONTHS OF AGE) AVOIDANCE OF FOOD GROUPS OR TEXTURES CHILD’S RANGE OF ACCEPTED FOODS DECREASES INSTEAD OF INCREASES

How Can We Support Feeding? TALK ABOUT GOOD FEEDING BEHAVIORS MORE THAN NUTRITION DEMONSTRATE AND PRACTICE WHAT POSITIVE FEEDING LOOKS LIKE MODIFY FOOD TO MEET SKILL LEVEL OF CHILD

Division of Responsibility in Feeding PARENTS HAVE JOBS IN FEEDING WHAT, WHEN, AND WHERE CHILDREN HAVE JOBS IN FEEDING WHETHER AND HOW MUCH

Division of Responsibility in Feeding FOR THIS TO SUCCEED REQUIRES STRUCTURE INCLUDING: PREDICTABLE SIT DOWN MEALS AND SNACKS PARENTS STAYING IN THEIR “LANE” GOOD ROLE MODELS EATING ENVIRONMENTS FREE FROM PRESSURE (2 MORE BITES, EAT THIS BEFORE THAT) SPOILER ALERT: THIS IS REALLY HARD!

Practical Help for Family Meals BEHAVIORS FIRST, THEN FOODS A FAMILY MEAL IS A MEAL OR SNACK EATEN WITH FAMILY/CAREGIVER CAREGIVERS ARE ROLE MODELS AN OPPORTUNITY FOR POSITIVE INTERACTION MANY CAREGIVERS DO NOT HAVE PRACTICAL FOOD SKILLS FAMILY MEALS DO NOT NEED TO BE FANCY OR 100% NUTRITIOUS CONVENIENCE FOODS ARE OK, BASIC FOODS ARE OK

Implementing Meals and Snacks HELPING FAMILIES IMPLEMENT STRUCTURED MEALS AND SNACKS CAN BE ONE OF THE MOST IMPORTANT INTERVENTIONS FAMILIES NEED GUIDANCE AND SUPPORT FOR IMPLEMENTING STRUCTURE (SIT DOWN TO EAT, NO WALKING AROUND WITH SIPPY CUP OR BOTTLE) FAMILIES WITH CHILDREN WITH FEEDING DIFFICULTIES WILL NEED EXTRA SUPPORT TO IMPLEMENT THIS STRUCTURE AS THEY MAY BE FEEDING PERMISSIVELY OUT OF FEAR

Providing choice and Control TASTING BOWL FAMILY STYLE MEALS CHOOSE PLATES/UTENSILS CHOOSE BETWEEN LIMITED OPTIONS

Skills before Manners ALLOW CHILDREN TO REMOVE FOOD FROM THEIR MOUTHS (POLITELY) CHILDREN THAT CAN REMOVE FOOD FROM THEIR MOUTH WILL BE MORE LIKELY TO TRY NEW FOODS CHILDREN ARE MESSY WHEN LEARNING TO USE OPEN CUPS AND UTENSILS PLACE 1-2 OUNCES IN AN OPEN CUP USE STIFFER PUREES THAT ARE LESS LIKELY TO FALL OFF OF A SPOON PROVIDE SMALL AMOUNTS OF FOOD AT A TIME-1-3 BITES

How can we support kids with Feeding Tubes? TREAT TUBE FEEDINGS AS MEALTIMES ENCOURAGE CAREGIVERS TO HOLD INFANTS WHEN RECEIVING FEEDINGS (JUST AS BREAST OR BOTTLE FED INFANTS ARE HELD) SIT OLDER CHILDREN IN A HIGH CHAIR DURING TUBE FEEDING TIME PROVIDE TASTE FOODS ON HIGH CHAIR TRAY (EX: SMEAR OF PUDDING) IF ALLOWED ADVANCED SKILL: PARENTS CAN SUB CALORIES IN TUBE FEEDING FOR AMOUNT EATEN ORALLY WITH EDUCATION

How can we support kids with delayed Feeding Skills MODIFY THE FOOD SHAPE/SIZE MODIFICATION TEXTURE MODIFICATIONS SUPPORT INDEPENDENCE SPECIALIZED CUPS, BOTTLES, UTENSILS AVOID “FEAR LANGUAGE” WITH PARENTS IF JOHNNY DOESN’T START GAINING WEIGHT HE WILL NEED TO GET A FEEDING TUBE!

Addressing Parent Concerns Listening and Responding A CHILD THAT DOES NOT EAT CAUSES FEAR IN PARENTS OUR CULTURE HAS MANY FEAR MESSAGES AROUND FOOD LISTEN AND REDIRECT FROM NUTRITION TO FEEDING BEHAVIORS REFER OUT AS NEEDED (REGISTERED DIETITIAN, FEEDING TEAM, ETC.)

Addressing Parent Concerns Listening and Responding OPEN ENDED QUESTIONS WHAT KIND OF ADVICE ARE YOU GETTING ABOUT FEEDING YOUR BABY? PRACTICAL ASSISTANCE WITH MEALS ENCOURAGE EATING TOGETHER HELP IDENTIFY A PHYSICAL SPACE FOR EATING PRACTICAL HELP WITH FAMILY MEALS

Resources—Peanut Allergy Prevention ADDENDUM GUIDELINES FOR THE PREVENTION OF PEANUT ALLERGY IN THE UNITED STATES: REPORT OF THE NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES–SPONSORED EXPERT PANEL HTTPS://WWW.JACIONLINE.ORG/ARTICLE/S0091-6749(16)31222-2/FULLTEXT

Resources--Feeding HTTPS://WWW.ELLYNSATTERINSTITUTE.ORG/ HTTPS://WWW.ELLYNSATTERINSTITUTE.ORG/WP-CONTENT/UPLOADS/2016/11/HANDOUT-DOR-TASKS- CAP-2016.PDF

Resources—Feeding Issues  CHILD OF MINE: FEEDING WITH LOVE AND GOOD SENSE ELLYN SATTER LOVE ME, FEED ME: THE ADOPTIVE PARENT’S GUIDE TO ENDING THE WORRY ABOUT WEIGHT, PICKY EATING, POWER STRUGGLES, AND MORE DR. KATJA ROWELL HTTP://WWW.MEALTIMENOTIONS.COM/

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