The Critical Role of Nutrition in Therapy

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This guest blog was written by Betsy Hjelmgren, MS, RDN, CSP, LDN, owner and founder of Feed to Succeed.

Essential to every person, especially a growing child, is healthy nutrition. This is especially true for children who require therapy for health issues. As a registered dietitian, not a day goes by that I Blog-Nutrition-Main-Landscapeam not reminded that proper nutrition underlies the health and well being of every child.

I recently worked with an early intervention (EI) patient with developmental delays. When we first met, he wasn’t meeting the expected milestones for his age, such as walking and talking. His parents and therapists complained that he lacked energy whenever they tried to work with him, and yet, when they encouraged him to eat, he was too tired and weak for this seemingly simple task. I recommended a feeding tube for the short term, and in one month, the child gained three pounds and began to walk and talk.

Of course, not every child who would benefit from working with a registered dietitian requires such intensive therapy. Many children, however, do benefit from an adjustment in their diets so that they have the energy and strength to meet milestones in therapy and can improve outcomes.

A child who doesn’t have the proper building blocks in his muscle and nerve endings needs proper nutrition in order to thrive in occupational or physical therapy, for example. Similarly to a garden, where a plant needs soil, nutrition and water to grow, a child needs proper food, nutrition and care to ensure the best outcome in his development.

While all children who don’t receive proper nutrition cannot function to their highest potential, in some cases, it is not obvious that they are lacking nutrition. It’s once a child responds to a new diet that it is obvious how effective nutrition is. For example, a child who is allergic to cow milk may not be getting enough protein to build muscle and may not be growing as tall as she could. Nutrition guidance, education and support can provide a more well-rounded diet.

Following is a screening tool for parents to use in order to determine when a child would benefit from receiving nutrition therapy:

  • A child who has not gained weight over 2-3 consecutive months or has not grown in height over 3-6 months
  • A child who frequently has a poor appetitive or is extremely picky
  • A child who seems thin, tired or pale
  • A child who has frequent chronic constipation or vomits
  • A child who completely avoids certain food groups
  • A child on a modified or restricted diet.
  • A child who receives supplemental feedings, such as a feeding tube or Pediasure

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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BetsyBetsy Hjelmgren, is the owner and founder Feed to Succeed in Glenview, Ill. She has been a registered dietitian, licensed in the State of Illinois, for over a decade. Registered dietitians are the only nutrition experts regulated by the Academy of Nutrition and Dietetics, and licensed to provide professional nutrition advice. Betsy is credentialed with Early Intervention for qualifying children aged 0-3 years old and is also the mother of two children. Follow her on Twitter @feedtosucceed and on Facebook.

What Parents Need to Know About Feeding Therapy

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There are a variety of reasons why a child may need feeding therapy. To many of us, it would seem like Feeding Therapyeating should be a basic instinct. However, eating is one of the most complex activities we do, especially for the developing, young child. Eating involves several processes in the body, including sensory, oral-motor, muscular, neurological, digestive, and behavioral systems. Feeding problems can arise involving any one of these systems, and often more than one of these is implicated.

The following are reasons why a child may have feeding difficulties:

  • Sensory processing issues
  • Picky eating
  • Food allergies or severe reflux
  • Autism
  • Developmental delays
  • Complex post-op recovery course
  • Transition from feeding tube to oral nutrition

Feeding therapy is usually done with one or more clinicians. Depending on the type of feeding problem, therapy may involve a speech-language pathologist, an occupational therapist, a registered dietitian, a social worker or behavior therapist, and/or a physician.

A speech-language pathologist will approach feeding in a comprehensive manner, looking at the actual physical swallow mechanism as well as the sensory aspect of feeding. Before beginning a more structured feeding treatment approach, it is key to rule out any medical reasons that a child is not safe to be taking food or drink orally. If there are concerns regarding vomiting, choking, gagging, etc. then the family should seek further guidance from their pediatrician who may recommend a modified barium swallow study. This test looks at the actual swallow mechanism in real time using x-ray to determine whether or not food or liquids are being aspirated (i.e., food items may slip into the lungs rather than where it is supposed to go). If a child is aspirating, physical symptoms may or may not include choking, wet/gurgly voice, and refusal to eat. Feeding therapy can move forward once it has been determined that a child is safe to take food by the mouth.

In addition to safety concerns, therapists will also look at the various chewing and swallowing stages to see if there is a breakdown in this complex process, once food is in the mouth. There is a developmental sequence of chewing for a child as well as development of independent feeding, first using hands and then moving to use of utensils. Each child will have different needs and a feeding therapy plan should be developed that is unique to your child. One approach to feeding therapy that has high success and is evidenced based is the Sequential Oral Sensory Approach to Feeding.

The Sequential Oral Sensory Approach to Feeding is a therapeutic intervention developed by Dr. Kay Toomey. Certification by Dr. Toomey and her associates through a training course is required for therapists to utilize this technique. Once certified, occupational therapists, speech language pathologists, dieticians, social workers and other health care professionals can intervene using the SOS approach. Under this approach, children are exposed to a variety of foods to increase their comfortability with a range of foods, focusing on exploration of the foods using all the senses: sight, sound, touch, smell, and taste.

Each week, the therapist will send the family a list of 8-14 foods based on sensory characteristics that will help the child experience foods that he/she might never have tried before. The family then brings these foods to the therapy session that week. During the session, the child and therapist (and often the caregiver) engage with the food in a playful manner to move up the “Steps to Eating” with each food, a 32-step process involved in eating developed by Dr. Toomey.  The ultimate goal is for the child to explore a variety of foods and expand the range of foods that he/she tolerates. The goal initially is not for the child to eat the food, rather discover and interact with a variety of foods and develop the skills needed to do so. Parents receive feedback after each session and are given recommendations to continue practicing these techniques at home during the week for ultimate success and generalization across environments. Using this approach, children become more comfortable with and generalize the skills needed to eat a wide variety of foods.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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This blog was co-written with Julie Paskar.

J-PaskarJulie Paskar is a speech-language pathologist, and the Branch Director at the Lincolnwood clinic. She joined North Shore Pediatric Therapy in August of 2012. Julie obtained both her Bachelor of Arts in speech and hearing sciences and her Master of Arts in speech-language pathology at Indiana University in Bloomington, Indiana. She has lived and worked in the Chicago area for the past eleven years. During that time, Julie worked for a pediatric clinic providing Early Intervention services as well as speech-language therapy services to children ages 3-12. She has her Early Intervention credential in speech pathology as both a provider and an evaluator. Julie’s areas of interest include: phonological disorders, motor speech disorders: specifically childhood apraxia of speech, feeding disorders, and expressive language disorders/delays. Julie is a Hanen certified therapist, has also attended both the Introduction to PROMPT and Bridging PROMPT trainings, has attended Picture Exchange Communication System (PECS) Level 1 and Level 2 trainings as well as the Kaufman Speech to Language training. She has been trained in the Orton-Gillingham program which is a treatment program for dyslexia. Julie is a member of the American Speech-Language Hearing Association and is licensed to practice in the state of Illinois. Julie is dedicated to working with children and their families to make communication both fun and functional.

Food Milestones: From Mashin’ to Munchin’

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Mealtime and achieving food milestones can be a stressful time for many families, especially for those whose kids demonstrate Food Milestonesdifficulty consuming a variety of flavors and textures. Instead of stressing over consuming those calories and pumping on the weight, take time to relax and enjoy a meal. Take away the stressors from your day and use mealtimes as an opportunity to bond with your little one. There is great variety in the development of infants and toddlers due to differences in the rate of physical and mental development as well as how often these skills are promoted by caregivers. As children develop their preferences for different foods (tastes & textures), they learn to accept or reject specific foods, which is OKAY!

The old mother’s tale “you can’t get up until you finish your peas” has proven to be an ineffective way to have children smoothly go through the realm of trying different foods. Instead of “forcing” your child to eat different foods, give them options…”you can eat 5 or 6 peas…you pick!” Give great verbal praise despite how big of a gain the child has made that meal.

Please see the developmental chart below that guides you through a variety of food milestones while providing ideas on how to keep mealtime positive!

Age Strategies and foods that should be introduced Tips and Tricks
Birth-2 months
  • Nipple feeding by breast or bottle
  • Semi-reclined position during feeding

Foods:

  • Breast milk or formula (approx. 18-28 ounces)
  • Sing songs or tell stories while you feed your infant, build a rapport
2-3 months
  • Start forming a consistent schedule

Foods:

  • Breast milk or formula (approx. 25-32 ounces)
  • Make silly faces with your infant, make meal time a reciprocal relationship
3-4 months
  • Infant starts to put hands on bottle during feedings

Foods:

  • Breast milk or formula (approx. 28-39 ounces)
  • ˷4 mo, rice cereal trials
  • Always avoid television or electronics during meal time, practice songs or rhymes
  • Have your infant sitting at the table during adult meal times

 
5-6 months
  • Start to introduce pureed spoon feeds
  • Tongue will continue to “mash” the food to consume

Foods:

  • Breast milk or formula (approx. 27-45 ounces)
  • Overly ripe fruits/vegetables
  • Oatmeal
  • Rice or wheat cereal
  • Puree a food that you are having for dinner to make it easier with food preparation

 
6-9 months
  • Moves to a more upright position during feeds
  • Helps caregiver with moving spoon to mouth

Foods:

  • Breast milk or formula (approx. 24-32 ounces)
  • Sweet potato mash
  • Cottage cheeses
  • Puff cereal bites
  • Encourage infant to hold bottle independently
  • Think of a variety of different flavors to introduce, even mix flavors based off babies preference
  • Take small trials of foods from your plate to give baby to try
9-12 months
  • Progresses from pureed to more textured food
  • Increases finger feeding
  • Introduction of straw based cup or open cup
  • Moves to a more “munching” formation with jaw and tongue

Foods:

  • Breast milk or formula (approx. 24 ounces)
  • Egg-free noodles
  • Variety of fruit/vegetables
  • Mild cheese slices
  • Offer new foods without the expectation of eating the food (he/she can poke, smell, lick, etc)
  • Always offer small portions on a child sized bowl or plate (don’t overwhelm)

 
12-18 months
  • Grasps utensils and self-feeds
  • Complete transfer from bottle to straw based cup or open cup

Foods:

  • White potato mash
  • Chicken
  • Beef
  • Beets
  • Offer foods of different textures: pudding, soup, crackers, mashed sweet potatoes, etc
  • Have child come with you to the store to pick out their “special cup” to encourage discontinued use of nipple based bottle
18-24 months
  • Primarily self-feeding
  • Able to chew different textures and flavors

Foods:

  • Eggs
  • Lentils
  • Beans
  • Cantaloupe
  • Never ask a child “Do you want ____” because you will have to respect if they say “no”
24-36 months
  • Holds open cup independently
  • Eats a wide variety of solid foods

Foods:

  • Cleared to try any food
  • Have your toddler “get messy” with their food, spread the different textures on their hands, face, or even nose
Continuum into childhood
  • Continue to use choices to give your child the “control” during mealtimes
  • Have your child participate in mealtime prep as much as possible

 

Remember, mealtime goals shouldn’t be about consumption, but about a positive experience for the child. Always consult your pediatrician about diet concerns or questions.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

References:

Developmental Stages in infant and Toddler Feeding., Infant & Toddler Forum., 2014.

McCarthy, Jessica., Feeding Infants & Toddlers: Strategies for Safe, Stress-Free Mealtimes. Mosaic Childhood Project, Inc., 2006.

1998, The American Dietetic Association. “Pediatric Manual of Clinical Dietetics”. 1998.

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Autism and a Gluten Free Diet

Should Your Child with Autism Avoid Gluten?

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The Atkins Diet. Weight Watchers. Paleo. Coconut oil. Gluten Free. Casein Free. You may be familiar with some of these diet trends. People are constantly on a quest for the perfect diet that will shed the pounds and keep them off. Others are looking for diets that regulate their digestive systems and keep their stomach calm. And if you are a parent of a child with autism, you may have heard people maintain that a gluten-free or casein-free diet can be used to help manage behaviors associated with autism.

With the idea of placing a child on a diet for management of symptoms, many questions arise. Does aShould Your Child With Autism Eat a Gluten Free Diet? gluten-free diet make a difference for children with autism? What does the research say? How do you know if it’s working?

Let’s back up a little bit and look at why specific diets for children with autism are being considered. Gastrointestinal problems are often described in children with autism, however the prevalence of these issues has not been consistently proven to be higher than in the general population.

Unfortunately for the sake of determining benefits of a gluten free diet, every child with autism presents differently and will likely have different responses to dieting. Also, unfortunately, the literature is extremely limited and providing conclusive evidence that a specific diet improves behaviors associated with autism has yet to be done. Some studies have yielded positive results (improvements in symptoms), while others have yielded negative results (no improvements noted). It is important to note that none of these studies have provided conclusive evidence; studies reporting positive results were merely suggestive (the lowest level of certainty).

Now you may be thinking, what will it hurt to place my child on a gluten-free or casein-free diet? According to Mulloy et. al, these diets may put children at risk for nutritional deficiencies. Further, this population of children often encounters challenges to ingesting a typical diet to begin with, such as sensory processing difficulties that lead to limited food intake and restricted diets. This can make feeding your child difficult if they are already only accepting chicken nuggets and string cheese. Additionally, implementing a diet of this type is costly and time-consuming.

Should you decide to try a gluten-free diet for your child with autism, here are some important things to remember:

  • Keep objective measures: It will likely be hard for your child to accurately report how they feel given commonly associated language deficits in children with autism. Ask yourself, “How do I know that my child’s sleep is improved?”, or “How do I know that attention is improved?” Find a way to measure data for these questions, such as counting naps taken each day or minutes spent engaged in a task.
  • Involve others: Ask for help from people that spend a lot of time with your child. Ask them to objectively measure behaviors as best they can, and seek their results.
  • Keep a food diary: Track what your child eats for every meal, and any notable behaviors or improvements for each day. This ensures accurate implementation of the diet and gives you the ability to reflect on the weeks and months.
  • Be committed: In a systematic review, more positive results were yielded with longer implementation of the diet.  For example, studies yielding negative results were implemented for an average of 5 weeks while studies yielding positive results were implemented for an average of 18 months.
  • Keep other factors in mind: It is challenging to prove that improvement is due to one factor vs another. For example: If your child experiences improved sleeping patterns, perhaps eliminating sugary foods in general is the cause  as opposed to the removal of gluten. Always think twice before determining cause, and consider all potential variables at play.

If you are exploring diet options for your child, seek the guidance of a dietitian or nutritionist to ensure healthy implementation.

What to Expect When You Suspect Autism Download our free, 17-Page eBook

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

References:

  • Mulloy, A, et al. Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders (2009), doi: 10.1016/j.rasd.2009.10.008
  • Buie, T. (2013). The relationship of autism and gluten. Clinical Therapeutics, 35, 578-583.
Picky Eater

Picking Apart the Picky Eater: 5 Tips to Address Your Child’s Problem Feeding

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In an era with Whole Foods, Paleo diets, and organic produce at our fingertips, how do we improve a child that is a picky eater? Modern day life can be hectic and as the result feeding may reflect fast, convenient options that taste good but are not always the most nutrient-dense. So, how does one correct picky eating to support a more balanced diet?

5 Tips to Address a Picky Eater

  1. Re-create expectations around feeding. Eating does not just have to be about pleasure, it can be about sustenance, nutrition, and a time for social interaction/community. To frame feeding in terms of just for pleasure, we overemphasize the role of taste in our feeding practices; if it doesn’t taste goodPicky Eater or initiate our pleasure receptors, we shouldn’t eat it. Really, we eat for a variety of reasons and taste can be one of them. If we re-create our expectations to encompass eating for nutrition, sustenance, as well as taste it can become easier for your child to engage with non-preferred, more healthful foods.
  2. Motivate compliant behaviors through incentives. Feeding is a behavior just like any other so if you want to target increased compliance with eating certain foods, provide incentives to encourage the desired behavior. For example, if your child refuses to eat vegetables with dinner, create a log that tracks compliance with trying at least 3 bites of the non-preferred food. Upon completion of the bites, the child can get a sticker, equating with a long-term prize at the end of the week for compliant behaviors or result in shorter-term gratification which can look like being served dessert. Identify what may motivate your child the most to get through challenging tasks and work with this to create investment towards a new mode of eating. The 3-bite rule can help the child also determine if this is truly a food they like or not as they engage with it more.
  3. Debunk negative thinking. Chances are your child’s refusal of food is due to negative thoughts around how they perceive the food to taste or impact them. For example, if a child fears that a food will make them gag, taste disgusting, or make them sick, it would make sense that they would want nothing to do with these foods. The fact of the matter is, there may be limited to no evidence supporting these interpretations so it is important to challenge or debunk this negative thinking. If the child asserts that they don’t like broccoli, inquire about what they believe will happen to them if they eat it. Will they gag? Will they dislike the taste? Will it make them sick? Likely, they will report they just won’t like the taste. If that is the reality, this is a small problem that they can overcome with practice, perseverance, and supplemental positive thinking. Thinking that broccoli is just “ok” but nothing bad will come as the result can facilitate easier engagement and consumption with the non-preferred food item.
  4. Pair foods together. No one says that a meal will only consist of just preferred or just non-preferred foods so it is important to teach balance This can look like pairing favored foods with non-favored foods to emphasize this point; incorporating chicken nuggets with vegetables or fruit instead of French fries or dipping peanut butter and apples together can make unpleasant foods more pleasurable.
  5. Model. Model. If you want your children to get healthy foods and interact with a balanced plate so do you! Align with your child and demonstrate for them that these foods are good and good for you.




NSPT offers Sensory Processing Disorder (SPD)  and Nutrition services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

tongue tie

Tongue-tie (Ankyloglossia): Symptoms and Treatments

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Tongue-tie, or ankyloglossia, is a condition that restricts the tongue’s range of motion. When a child is born with tongue-tie they have an unusually short thick or tight band of tissue (lingual frenulum) tethering the bottom of the tongue to the floor of their mouth.

Symptoms of tongue-tie (ankyloglossia):tongue tie

  • The child may have difficulty sticking out his or her tongue
  • The child may have difficulty lifting their tongue to their upper teeth or moving it from side to side
  • The tongue may look heart shaped when stuck out
  • The child may have difficulty producing t, d, z, s, th, l, and r
  • The child pay have difficulty swallowing
  • The child may have difficulty breast feeding
  • The child may have difficulty eating solid or semi-soft foods

Here are some signs that your baby’s tongue-tie may be causing feeding problems:

  • She repeatedly breaks suction while feeding.
  • She makes clicking noises while feeding.
  • She’s gaining weight too slowly.
  • You experience nipple pain when she nurses. (She may be chewing rather than sucking in her effort to access the milk.)
  • Your milk supply is dwindling.

What your doctor may ask you about your baby:

  • Are you having trouble breast-feeding?
  • Is your child having trouble with their speech?
  • Is a gap developing between your child’s two bottom front teeth?
  • Are you concerned about activities your child is not able to do because of limited tongue movement?

Treatment options for tongue-tie:

  • The lingual frenulum may loosen over time and it may resolve on its own.
  • If tongue tie persists, a simple surgical procedure called a frenotomy may be warranted.
  • In this procedure the doctor numbs the membrane with a topical anesthetic, then snips the frenulum. It takes only a few minutes and doctors say it is less traumatic than ear piercing. Discomfort to your child is minimal during this procedure.

As always, consult with your pediatrician if you have concerns that your child may have a tongue-tie and consult with them for your best treatment options. A speech-language pathologist can help with feeding issues.


amazing after school snacks

Amazing After School Snacks

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After a long day at school, children will certainly be hungry for a snack! Here are some recipes to try. They are simple and do not require a lot of time; your children can even help!

Red, White, and Blue Sandwich

Ingredients:

  • 2 large whole wheat pita
  • 2 cups sliced strawberries
  • 1 cup blueberries
  • 6 tablespoons whipped cream cheese

Preparation:

  1. Cut the pita in half or into quarters
  2. Spread a layer of cream cheese
  3. Add strawberries and blueberries
  4. Enjoy!

Chocolate Granola Apple Wedges (perfect since we are in “apple picking season”!)

Ingredients:

  • 2 ounces semisweet chocolate chips
  • 1/3 cup low-fat granola without raisins
  • 1-2 medium apples (some favorite kinds are: Honeycrisp, Fuji, Gala, & Braeburn)
  • Shallow dish or bowl
  • Microwave safe bowl

Preparation:

  1. Cut apple into wedges
  2. Place chocolate chips in microwave safe bowl—microwave for 15 seconds, stir chocolate…repeat until chips are melted
  3. Pour granola into shallow dish/bowl
  4. Dip the apple wedge in chocolate, let excess drip back into bowl
  5. Dip the chocolate wedge in the granola
  6. Refrigerate for about 5 minutes and enjoy!

Homemade Fruity Roll-Ups

Ingredients:

  • 1 (3 oz.) pkg. INSTANT Jello—choose your favorite flavor!
  • 1/2 cup water
  • 1 1/2 cups miniature marshmallows (or 12 large marshmallows)
  • Non-stick cooking spray
  • 8” or 9” square pan
  • Whisk
  • Large microwave safe bowl
  • Dental floss

Preparation:

  1. Boil water in microwave (about 1 minute)
  2. Add gelatin and stir well
  3. Place back in microwave for 1 minute and stir again
  4. Add marshmallows and microwave for about 45 seconds (marshmallows should be puffed and slightly melted)
  5. Whisk together the melted marshmallows and gelatin (a creamy layer will float on the top)
  6. Lightly spray the square pan with cooking spray—make sure it is spread well!
  7. Pour mixture into pan and refrigerate for about 45 min until set and firm
  8. Loosen edges with a knife
  9. Start with one end and roll entire square up tightly
  10. Use dental floss to cut into slices (seam side down)
  11. Enjoy!

Tortilla Pizzas

Ingredients:

  • Small corn or wheat tortillas
  • Salsa
  • Shredded cheese (cheddar and mozzarella are favorites!)
  • Foil

Preparation:

  1. Place foil on tray
  2. Cover tortilla with salsa
  3. Sprinkle cheese on top
  4. Cook in either a toaster oven or conventional oven until cheese melts
  5. You can try other variations by adding refried beans, chicken, beef, veggies.

Cheesy Cracker Sticks

Ingredients:

  1. 1 ½ cups (about 4 oz.) grated cheddar cheese
  2. 4 Tbsp unsalted butter, softened and cut into 4 pieces
  3. 3/4 cup all-purpose flour
  4. 1/2 tsp coarse salt
  5. Dash of pepper
  6. 1 Tbsp milk
  7. Cutting board
  8. Rolling pin (optional)
  9. Pizza cutter
  10. Mini cookie cutters (optional)
  11. Large cookie sheet
  12. Foil

Preparation:

  1. Preheat oven to 350 degrees
  2. Combine cheese, butter, flour, salt, and pepper—use your hands to mix so the mixture looks like dime-size crumbs
  3. Add milk and again use your hands to form the dough into a ball
  4. Lightly flour a cutting board and roll out the dough to about 1/8-inch thickness
  5. Use the pizza cutter to cut the dough into “sticks” use cookie cutters to form shapes. Place on a foil-lined cookie sheet
  6. Bake the sticks/shapes for 10-12 minutes (or until edges are turning brown)
  7. Remove from oven and let cool
  8. Enjoy warm or at room temperature!

IBS Versus IBD: What Is The Difference And How Can Diet Help?

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Does your child suffer from gastrointestinal pain, bloating, diarrhea, or even vomiting episodes? Have you researched the symptoms or spoken with your pediatrician? You may have come across the terms IBS (Irritable Bowel Syndrome) and IBD (Irritable Bowel Disorder). These two gastrointestinal disorders can present with similar symptoms, so it may be confusing to decipher what’s really going on at first. However, there are distinct causes and ways of diagnosing them that determine whether a patient has IBS or IBD.

Irritable Bowel Disorder (IBD)

IBD is a term used for two specific gastrointestinal diseases.  One form of IBD is Crohn’s disease.

Symptoms– Painful “flare-up” episodes. The pain can occur anywhere in the gastrointestinal tract. The flare-ups cause diarrhea and sometimes vomiting, either of which may contain blood. These episodes may be accompanied by fever and/or fatigue. Weight loss can also occur.

Causes– A variety of factors that trigger an autoimmune, inflammatory response.

How it is diagnosed– A gastrointestinal doctor will perform a “scope” (endoscopy and colonoscopy) of the suspected areas affected in the gastrointestinal tract. This involves being sedated, having a tiny camera inserted into the gastrointestinal tract, and biopsies taken. The doctor can diagnose Crohn’s based on what he or she observes from these tests. If the inflammatory sites are located in patches or varying locations along the gastrointestinal tract anywhere from esophagus to anus, it is indicative of Crohn’s.

Treatment– During flare-ups, doctors will evaluate and may prescribe steroids, antibiotics, pain killers, and a modified diet that is low in fiber and other foods that may trigger inflammation such as lactose. In severe flare-ups, patients may be hospitalized and required to be on bowel rest, which means consuming nothing by mouth. When not having a flare-up, patients with Crohn’s are encouraged to eat a healthy diet with good sources of fiber. “Trigger foods” should also be avoided in general, which may include high fat or fried foods, excessive amounts of dairy, caffeine, and others.

The other form of IBD is Ulcerative Colitis.

Symptoms– Pain and cramping focused in the lower intestines. Diarrhea, sometimes with blood. Weight loss and fever can occur as a result of severe inflammation and diarrhea.

Causes– Inflammation that can be caused by a variety of factors and becomes chronic. Inflammation is in the colon and may progress continuously up the lower intestine.

How it is diagnosed– A gastrointestinal doctor will perform a colonoscopy with biopsies.

Treatment– Similar to treatment of Crohn’s.

Irritable Bowel Syndrome

IBS is a bit more of an ambiguous condition than IBD, and can be difficult to identify and treat.

Symptoms– Abdominal pain, bloating, gas, diarrhea and/or constipation, general maldigestion and discomfort which may or may not be associated with eating any particular foods.

Causes– Definite causes of IBS are still unknown, but are currently being researched.

How it is diagnosed– IBS is diagnosed by closely tracking symptoms and ruling out all other diagnoses.

Treatment– Individualized modifications in diet and lifestyle which differ from person to person and may change over time. Some IBS sufferers trial “elimination diets” where common problematic foods are eliminated (such as wheat, dairy, corn, eggs, soy, etc.) to see if symptoms improve. Another recent diet therapy for IBS is the FODMAP diet, which eliminates high fructose corn syrup, some legumes, wheat, and various fruits and vegetables, among other things.

If your child suffers from IBS or IBD and you would like more guidance on diet therapies, schedule an appointment with a registered dietitian at NSPT. 877-486-4140.

Recipe of the Month: Nutrition Powerhouse Smoothies for Parents and Kids

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Smoothies are a great way to pack a lot of nutrition into something that tastes like a treat. They can be part of a meal or a post-workout snack. These recipes include four of the five components of The Healthy Plate Model:  protein (yogurt), calcium (yogurt), fruits, and vegetables. All of these smoothies promote healthy digestion since they contain fiber (fruits and spinach) and probiotics (yogurt). Kids love drinking something that is colorful and comes with a straw. Plus these are so tasty, they won’t believe how healthy they are! Smoothies are also a healthy option to eat while on the go. Hope you enjoy these!

Berry Blast

1 cup frozen mixed berries
½ banana
¾ cup plain, organic, whole milk yogurt
1 cup loose baby spinach leaves

Put all ingredients in a blender and blend until smooth. If desired, allow berries to sit at room temperature for 20 minutes for easier blending.

Recipe makes 1 serving. Provides approx 245 calories, 8 grams protein, 6 grams fiber, 277 mg calcium.

Green Monster

1 cup frozen mangoes
½ banana
¾ cup plain, organic, whole milk yogurt
1 cup loose baby spinach leaves

Put all ingredients in a blender and blend until smooth. If desired, allow mangoes to sit at room temperature for 20 minutes for easier blending. This smoothie will be green, and giving it a fun name like “Green Monster Smoothie” makes kids more likely to want to try it (it worked with my kid!).

Recipe makes 1 serving. Provides approx 285 calories, 8 grams protein, 4.7 grams fiber, 277 mg calcium.

Immune Booster Digestive Aid

1 cup frozen pineapple chunks
1 clementine orange, broken into individual pieces
¾ cup plain, organic, whole milk yogurt
1 cup loose baby spinach leaves

Put all ingredients in a blender and blend until smooth. If desired, allow pineapple chunks to sit at room temperature for 20 minutes for easier blending. Pineapples and oranges both provide vitamin C. Pineapple also contains a natural enzyme called bromelain that aids in digestion.

Recipe makes 1 serving. Provides approx 242 calories, 9 grams protein, 4.7 grams fiber, 274 mg calcium, 116 mg vitamin C.

Click here for healthy twists on your child’s favorite foods.

What is Co-Treating?

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You may have heard your therapist say, “I think a co-treat would be a great option for your child!” But what does that really entail? Will your child still be getting a full treatment session? Will his current and most important goals be worked on? Will he benefit as much as a one-on-one session? When a co-treatment session is appropriate, the answer to all of those questions is…YES!

What is a co-treatment session?

Co-treatment sessions are when two therapists from different disciplines (Speech Therapy (SLP), Occupational Therapy (OT), Physical Therapy (PT), etc.) work together with your child to maximize therapeutic goals and progress.

When is a co-treatment session appropriate?

When the two disciplines share complimentary or similar goals.

EXAMPLE: Maintaining attention to task, executive functioning, pragmatics, etc. Playing a game where the child needs to interact with and attend to multiple people while sitting on a stability ball for balance. [all disciplines]
*When children have difficulty sustaining attention and arousal needed to participate in back-to-back therapy sessions.
EXAMPLE: Working on endurance/strength/coordination while simultaneously addressing language skills. Obstacle courses through the gym while working on verbal sequencing and following directions. [SLP + PT or OT]
*When activities within the co-treatment session can address goals of both disciplines.
EXAMPLE: Art projects can address fine motor functioning as well as language tasks like sequencing, verbal reasoning, and categorizing.
*When a child needs motivations or distractions. [OT + SLP]
EXAMPLE: Research has shown that physical activity increases expressive output. Playing catch while naming items in category or earning “tickets” for the swing by practicing speech sounds.  [PT or OT + SLP]
EXAMPLE: PT’s need distraction for some of their little clients who are working on standing or walking and working on language through play during these activities works well. [PT + SLP]

Why co-treat?

  • Allows therapists to create cohesive treatment plans that work towards both discipline’s goal in a shorter amount of time.
  • Allows for therapists to use similar strategies to encourage participation and good behavior in their one-on-one sessions with the child.
  • Allows for therapists to collaborate and discuss the child’s goals, treatment, and progress throughout the therapy process. Together, they can consistently update and generate plans and goals as the child succeeds.
  • Aids in generalization of skills to different environments, contexts, and communication partners.
  • Allows for problem-solving to take place in the moment. For example, an extra set of hands to teach or demonstrate a skill or utilizing a strategy to address a negative behavior.

Co-treatments sessions can be extremely beneficial for a child. There are endless ways therapists can work together to promote progress and success towards a child’s therapeutic goals.. However, co-treatments may not always be appropriate and are only done when the decision to do so is made collaboratively with the therapists and the parents.

Contact us for more information on the benefits of co-treating in therapy sessions.