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

2. 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

3. 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

4. Content Area: Nutrition and Feeding

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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 MONTHS OF AGE)
AVOIDANCE OF FOOD GROUPS OR TEXTURES
CHILD’S RANGE OF ACCEPTED FOODS DECREASES INSTEAD OF INCREASES

17. 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

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

19. 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!

20. 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

21. 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

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

23. 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

24. 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

25. 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!

26. 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.)

27. 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

28. 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

29. Resources--Feeding
CAP-2016.PDF

30. 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

31. Questions
TYPE IN YOUR QUESTIONS IN THE QUESTION OR CHAT BOX

32. Next time:
TOPIC CONTENT EXPERT DATE/TIME