This three hour course will focus on techniques to transition babies, at risk for feeding disorders, to solid food feedings. This novel approach integrates a sensory motor approach to feeding with modified baby-led weaning (Overland, L. & Rabin, J., 2019).
Feeding disorders are often present at birth and can be the first red flag for developmental disabilities (Overland & Merkel-Walsh, 2013). Feeding and swallowing disorders affect between 25 to 45 percent of the typically developing children and closer to 80 percent of children diagnosed medical or behavioral disorders (chw.org). The following, recently published, definition is based upon the World Health Organization (WHO) guidelines: “Pediatric feeding disorder” (PFD) defined as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill and/or psychosocial dysfunction(Goday, P. Huh, S., Silverman, A., Lukens, C., Dodrill, P ., Cohen, S., Delaney, A., Feuling, M., Noel, R., Gisel, E., Kenzer, A., Kessler, D., Camargo, O., Browne, J. & Phalen, J., 2019).
Factors which may be associated with feeding issues include, but are not limited to prematurity (ie: extended NICU stays), medical issues (ie: cardiac, respiratory, gastrointestinal issues, allergies), tone/postural issues, syndromes (ie: Down syndrome, Velocardiofacial syndromes, Pierre Robin syndrome), structural issues (TOTs, cleft lip/palate), and less obvious factors such as epigenetics, assisted reproductive technology, advanced maternal/paternal age, and autism.
Baby-Led Weaning (BLW) is a child-directed feeding approach that has gained popularity as an alternative way of transitioning babies to solid food feedings. With this method, babies are taught to self-feed table foods from the time they begin eating solids, versus the primarily adult-directed method of being spoon-fed purees. Gill Rapley and Tracey Murkett, authors and pioneers of the baby-led weaning approach, state in their book that: “BLW is best with typically developing children and may not work with children with developmental challenges; however, if a BLW approach was utilized with babies with special needs, skills acquired with this method could be quite beneficial as well as therapeutic.” (Rapley, G. & Murkett, T. 2011). This presentation will demonstrate how the baby-led weaning method combined with a sensory–motor feeding approach can contribute to developing oral sensory motor skills as a foundation to ensure a smoother transition to breast, bottle and solid-food feedings.
The benefits of BLW, for babies who are at risk for feeding disorders, are far-reaching. The way a baby learns to eat can impact oral structural anatomy. This begins with breastfeeding which is the natural child-directed feeding precursor to BLW. Breastfeeding shapes the oral cavity by creating a “U” shaped palate (Palmer, B. 1998) This can generate an important structural change that not only helps with dental development but also can positively impact the baby’s airway by creating more space in the oral cavity and potentially help with nasal breathing, health and sleep issues.
BLW also impacts motor skills and transforms eating into a therapeutic activity. It allows babies to be active participants in their feeding, learning to self-feed with constant hand-to-mouth movement, engaging the baby’s core every time he leans forward to pick up a food item, developing eye-hand coordination and refining fine motor skills. Many babies with feeding challenges have or develop sensory-based feeding issues which can result in an aversion to feeding, problems adapting to texture and prolonged feedings of smooth purees. Baby-led weaning gives babies tactile and sensory experiences as they are frequently touching their food, and learning to move solid food pieces around in their mouths. Recent literature also stresses the importance of not missing a crucial window in exposing babies to textured foods by nine months of age as it may result in resistance and avoidance of those food textures. (Coulthard, Helen, et al. 2009).
In looking at the multitude of benefits that BLW could offer, it seems like an ideal approach, however with all the potential medical, feeding and swallowing issues, in this at risk population, this approach could be viewed as daunting as well as dangerous. While self- feeding may be effortless for typically developing babies, children with feeding issues may struggle and as a result use compensatory motor skills strategies such as tongue mashing or tongue thrusting in order to manipulate their food. This is why appropriate assessment, taught in this webinar with didactic lecture and videos, will provide a foundation for the SLP to develop a prefeeding program, followed by a therapeutic feeding program and then use these programs in conjunction with modifications of baby-led weaning.
The SLP will be instructed on an oral phase feeding assessment which may include observations of: tone, posture and alignment, sensory processing in the mouth, oral structures and oral sensory motor skill development using a task analysis of the skills for breast feeding, bottle feeding, spoon feeding, chewing, cup drinking and straw drinking. The initial goal of a pre-feeding program is to develop the underlying motor skills to support safe effective, nutritive feeding. This is then followed up with a therapeutic feeding program that includes a set of techniques that support safe feeding and maximize a client’s postural stability, sensory processing and oral sensory motor skill development (Overland & Merkel-Walsh, 2013).
In conjunction with the above mentioned prefeeding and therapeutic feeding programs, the SLP will then learn about how to modify the baby-led weaning approach for babies with feeding challenges. The SLP will initially teach the caregiver how to facilitate hand to mouth using alternative means such as food popsicles, flat bowled spoons preloaded with purées and silicone feeders. These devices allow babies to bring food to their own mouths. The modification of this approach continues to be child-directed and caregivers use responsive feeding techniques always making sure the child ¨gives permission” for them to put food in their mouth with positive acceptance demonstrated as leaning forward and/or opening their mouth in anticipation of the food. The goal of this novel approach is fading the facilitation and encouraging babies to self-feed like their typical peers. Case studies will be used to illustrate the benefits of this combined approach.
- Participants will be able identify factors which place an infant at risk for feeding disorders.
- Participants will be able to list at least four benefits of modified baby-led weaning.
- Participants will be able to list at least four benefits of a pre-feeding and therapeutic feeding program.
10 minutes: Welcome and Introduction
5 minutes: Defining feeding disorders
5 minutes: Infants at risk for long term feeding disorders
10 minutes: Long term nutritional, health, dental, sleep, developmental, and structural implications of feeding issues
10 minutes: What is Baby-led weaning?
10 minutes: Potential implications for babies at risk of feeding disorders
15 minutes: A Sensory-Motor Approach to Pre-Feeding and Therapeutic Feeding
15 minutes: Modified Baby-led weaning
30 minutes: Integrating two approaches: A sensory motor approach to supporting baby-led weaning (video case studies)
10 minutes: Q & A