Our journey through autism

Posts tagged ‘feeding’

Myofunctional Therapy

Myofunctional therapy is basically therapy of the facial and oral muscles, (tongue, lips, mouth, jaw, cheeks, etc…) A couple weeks ago Bilal’s OT therapist was traveling abroad and the owner of the facility took over for 4 sessions, she wasnt used to his speech patterns and asked whether he was getting any speech therapy and she suggested that I get him evaluated by her friend and colleague for this myofunctional therapy. We set an appointment, for the beginning of the month but he woke up with a slight fever that day so we rescheduled for the 15th of May. We go in and Dr. Sharon Wexler starts her evaluation, she checks his stance, posture and neck alignment, she explains to me with a mouth and tongue model what a normal swallow should look like and what a lot of children with autism look like. She says infants have a thrust swallow, as they nurse and deal only with liquids they move their tongues inwards and outwards as they swallow as they mature and start taking in solids they swallow by moving their tongues upwards and backwards. As with many of Bilal’s fine motor delays his tongue thrust never developed properly,  also while your mouth is shut and relaxed the tongue usually rests and touches the roof of your mouth but for Bilal its at the bottom, when asked to swallow with your teeth set closed your tongue goes up but for Bilal he had to push it out. She had him bite and chew an animal cracker, he bites with his side teeth and takes a lot of small bites, and swallows it as it is. A normal person will usually bite with his front teeth, chew, move the food around his mouth with his tongue and gather it towards the back and swallow, all this is done unconsciously and involuntary but that’s how it is done. She also had him chase a lollipop around with his tongue sticking out and it took him some effort to stick his tongue out at the correct side, he’s also unable to lift his tongue for the “LLL” position. His tongue weakness explains why he takes a lot of small continuous bites of food so that the new food will push the other food down as he cant manage to swallow it correctly, that’s why he overstuffed his mouth as well. She then measured the strength of his tongue and found it to be weak, and then finally she had him identify some pictures to see how he pronounced those words, he misses a lot of letters but not always indicating a weakness. The good news is that his mouth and lips are fine, no drooling or other issues. She says he’s at the perfect age for this therapy as he’s old enough to understand and follow directions, and to learn to be conscious of his swallow and learn the proper method of doing it. She says speech therapy is great and all, for vocabulary and grammar development but for pronunciation its all wrong trying to build on weak foundations, it will never build up correctly. She does half hour sessions with him once a week while we practice at home the rest of the week. Her testimonials say that parents noticed results within 6 months. It was a very interesting and beneficial evaluation explained a lot of his eating habits, why he only eats these particular foods because its what he can manage, chew and swallow on his own, he doesnt take any hard foods which are apples with the peel or meats, everything he eats either breaks down or melts easily and gets pushed back almost on its own, its also why he chews with his mouth open and why he’s a messy eater. She’s still in the research process of the relationship between reflux and tongue weakness, but it makes sense, she says that with this method of swallowing an air pocket gathers and when he burps it pushes up all the food again, Bilal had reflux until he was 18 months. I’m looking forward to this therapy and the results we’ll get, better prouounciation leading to better communication and better eating habits and hopefully a more varied diet.

The only drawback is that The Institute of Myofunctional Studies does not file insurance claims, I have to send in the receipts and wait for them to refund me, so its expensive and time consuming and there is the risk of the insurance company delaying refunds and making up stories of not receiving it, getting lost in the mail and so on, but its worth it inshaAllah.


Feeding Therapy

I apologize for not updating recently, just been busy with house stuff and also I’ve picked up some books from the library and when I start reading a good book I dont want to do anything else. Writing out this post here before I forgot the details of the visit.

I finally got Bilal an appointment for a feeding therapy evaluation, first sent the paperwork to Marcus and they transferred it to Children’s Healthcare of Atlanta, the same rehab center we go to for speech therapy. I was told to bring in a fruit cup, beef jerky, string cheese, vegetable chips, juice and milk, to make sure there were items he liked and items he didnt. I had no idea what the evaluation would entail really, and what a feeding program was. Bilal since he turned 3 has become a picky eater, he suddenly dropped certain foods and will no longer eat them and we’re down to a list of only 10 accepted foods, if I tried offereing him anything else he would either ignore it or spit or gag on it, not wanting to deal with vomit I just go with what he wants and not push it, I decided to leave that to a professional to deal with. I was told that he shouldnt eat too soon before the evaluation as he was required to eat in front of her, so he only got breakfast and snack at school, no lunch.

We get there and are introduced to the occupational therapist, we go over Bilal’s eating history, reflux, when he dropped foods, eating habits and what he eats. She discussed seating arrangements and says using a booster or a special chair  that provided sensory input for him to push his feet against, this was important so that he wouldnt move around too much while seated which is an issue at home and he can concentrate better on his meal. She explained that eating uses all the senses and for a child with autism that can be too much to handle, she suggested we use the sensory brush or bounce mat before meals. To blow bubbles, whistles, balloons for oral exercise, wash hands and sit down to eat. I am to place 3 food items on his plate 1 from each food group, with at least 1 of them a preferred food, and he has to show any kind of interaction with the non preferred ones, look at it, touch it, smell it, put against his lips, teeth or place it in his mouth, I should model for him and give him a lot of praise and positive reinforcement, meals should last no more than half an hour, and whatever he wouldn’t eat he can than “kiss bye bye” before throwing into another plate or the garbage, the idea being that he touches it with his lips, or he can put in into his mouth and spit it out in “shooting rockets” form again being he tasted the food. I should also change my language from “Can you eat this?” to “You can eat this” no questions or begging just stating it as a matter of fact that this is what we will eat. With time and practice and patience he will become less sensitive to new food, flavors, textures and will learn to eat a variety of food. She watched him eat a Mozzarella cheese stick and noted that he had some minor oral motor weakness, because he chewed with his mouth open and didn’t push the food around with his tongue just let it roll around under his teeth. So I was to follow this home program and see her once every other week with new tips and suggestions and guidelines to follow. She said I should continue only offereing a drink (juices like V8 Fusion or Fruitables) after he completes his meal, and use a lot of sneaky chef ideas by hiding pureed vegetables in foods he already eats.

I understand and agree with everything she says but some of it is a lot of work, change of habits, more cooking (I hate cooking) and I’m also teaching the baby to eat as well and going around his teething problems and bottle attachment issues and its just easier offering Bilal what he would eat with no special tactics and getting it over and done with, but it is therapy and I’ll find a way to stick to it, just as I am sticking to his schedules, taking him to therapy and discussing with his teacher and therapists ways to fight his autism whether that be social, speech, fine motor or oral motor delays.

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