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The Lingual Hokey Pokey

(AKA the importance of lateral tongue movements in learning to eat solids)
Like many of the other structures in our bodies, we don't think very much about what our tongue does. It just quietly does its job, and we only notice if something goes wrong. But next time you speak to someone, or eat, or drink - pay attention to the movements of your tongue. It really is an amazing group of muscles. It can move in any direction, it is very strong for its size and it works really hard for us, tasting, cleaning our mouth and teeth, keeping our lips hydrated, and supporting speech, eating and drinking.
The last few weeks I've found myself talking to a few parents about the importance of lateral (sideways) tongue movements. A lot of the time when a child is gagging on lumps, or not chewing and swallowing foods whole, reduced lateral tongue movement is the culprit.
Think about it (and maybe get a cracker, because this works better when you actually do it as you think about it). Usually you place food front and centre in your mouth, because your front teeth are great for tearing and cutting pieces of food off. But once you've got a bit off, what do you need to do? Chew it, of course. And where do we chew? On our molars, which are towards the back at the sides of our mouth.
So once the food goes in, we need a way to transport it from the middle of the mouth to the side, and that is where lateral tongue movements come in. Our tongue picks up the food and deposits it on our molars so we can chew it. As bits escape, the tongue scoops them right back up and delivers them back to the molars. Once everything is chewed up, our tongue collects all the bits back into the middle of the tongue so it can send them cascading down into our throat (that's the first part of a swallow).
Very little babies really only know how to move their tongues forward and back (to suck), and in concert with their jaw. They can't move their tongue side-to-side independent of their jaw. That's a more sophisticated motor skill, and it will be a while before it starts to develop. Typically, it kicks off around the time when babies are establishing solids. How convenient! Sometimes, though, it takes a while longer to develop, or doesn't develop independently at all. So when the food goes into the baby's mouth, they have no way of mashing it up and it stays lumpy. They may then spit it out, or try to swallow it (sometimes triggering a gag), or just roll it around, hoping it will break down eventually.
Luckily there are ways we can support our babies to develop lateral tongue movements and so improve how they manage solids. There is a very handy reflex called the transverse (or lateral) tongue reflex which means that up until 6-9 months, many babies will move their tongue sideways when they feel touch to that side of their tongue. To support lateral tongue movements, we can tap into this reflex.
What I recommend is allowing and encouraging your baby to mouthe stick-shaped items, which will touch the side of their tongue and encourage those lateral movements. Stick shaped items like:
- Teethers and spoons - the Pigeon toothbrush trainer set (http://www.pigeonbaby.com.au/healthcare.php - available in many pharmacies) is a great example. I'm a big believer in learning to eat by eating, so level up by dipping these teethers/spoons in puree and allowing your baby to suck it off.
- 'Hard munchable' foods - whole raw carrots, spears of dried papaya or mango, beef jerky, lamb chop bones
- Dissolvables - potato stix (http://www.healtheries.com.au/product/kidscare-potato-stix/ - available in the baby or health food section of Coles and Woolies), veggie straws (http://www.amazon.com/Sensible-Portions-Garden.../.../B0093JX9RA - available from Costco), Baby Mum Mums and other rusks.
As always, with baby feeding therapy at Ready Step Grow, keep it child led. Place the items on their high chair tray or on the table in front of them, let them bring it to their mouth, and keep everything calm and low pressure. Inevitably with mouthing of stick shaped items, they will trigger a few gags. When that happens keep calm and remember, gagging is an important part of development (https://www.facebook.com/groups/423273087757162/permalink/865526766865123/). They'll figure out their limits eventually.
tl:dr? Here are the key points.
- Sideways tongue movements are important for managing lumps
- Lack of sideways tongue movements can lead to gagging and spitting out lumps
- You can support sideways tongue movements by encouraging your baby to mouthe stick shaped items and foods.
As always, if you have questions, email This email address is being protected from spambots. You need JavaScript enabled to view it., or speak to me in group. :)

Katherine Sanchez (RSG Speech Pathologist)

What a gag

So what is gagging? Gagging is a reflex - which means we can't consciously control it. It is usually present from birth, and we hold onto it our whole lives. Like most reflexes, it can be stronger or weaker, and more or less sensitive in different people. Some people (like sword swallowers) actively desensitise or suppress their gag reflex, and a few people are just born without it - but most of us have it. In adults, it is usually triggered by touch to the back 1/3 of the tongue, and sometimes the soft palate. The result is a quick spasm of the muscles at the back of the throat, designed to move food or drink forward and away from the airway. It is our body's first line of defense (second line is coughing!) against choking or aspirating (food or drink entering our windpipe and lungs). Sometimes a strong gag can lead to retching and vomiting. Gagging isn't painful or dangerous - but it doesn't feel hugely pleasant. 

In babies, gagging is a bit different. Because little babies are not ready to eat solid foods, they are born with a gag reflex that can be triggered by touch much further forward in the mouth. This is protective and very clever of evolution! But of course once they move to solid foods, it's really inconvenient - you don't want to be gagging every time food reaches the middle of your tongue. So what most babies do instinctively is seek opportunities to desensitise their gag reflexes. They do this by mouthing things - food, non-food, whatever - and triggering or almost triggering the gag reflex often enough that their system learns that it's really nothing to worry about. If they don't have many opportunities to mouth, they will struggle to desensitise their gag, and transitioning to solids or lumpy solids may be more challenging. So tip one is: allow and encourage lots of mouthing!

The other challenging thing about gagging is that many adults interpret it as choking. Gagging is very different from choking. Where gagging is a defense mechanism, choking is a sign that all our defense mechanisms have failed, and something has blocked our airway. Gagging is usually noisy, whereas choking is often silent and can be accompanied by a change in colour. Gagging is not dangerous - it's protective; it shows us that our children are able to protect their lungs. Choking is dangerous - it shows us that our child's airway is blocked. Learn what to do if your child chokes (see attached), and it might help you manage your worry when they gag!
The appropriate response to choking is first aid. The appropriate response to gagging is to remain calm and wait to see if your child can independently clear the food. You can say "Ooops! Bit of a gag!" or "went down the wrong way!" but keep it light and positive. If your child can't clear the food, you can retrieve it with your fingers, or give them a sip of water to wash it down. If you are clearly scared when your child gags, if you shout or cry or grab them immediately, they learn that gagging is really scary, and may become more reluctant to eat or participate in oral play. Tip two: learn the difference between gagging and choking, and try to stay calm when your baby gags (reframing might help: "don't I have a clever baby, protecting his/her lungs like that!")
For some children, gagging can become a 'conditioned response.' That means that the child has felt so terrible in a previous situation that caused them to gag or vomit that now even reminders of that situation can make them gag. Think about a food you ate before you got food poisoning or gastro, or a particular type of alcohol you can't drink because you were once sick after drinking it - that's the sort of response we're talking about. That sort of gagging may require some professional input from an OT, speechie or psychologist, to help your child learn to feel safe and protected in that situation again.
When gagging is continual or distressing to you or your baby, then it might indicate a problem with any of a number of areas (e.g. oral motor skills, oral sensory skills, sensory integration, anxiety). The solution can sometimes be as easy as providing 'easier' food textures for a while, or it might be more complicated, You can speak to your MCHN, Paediatrician or Speech Pathologist if you are concerned.
Your take away messages:
- Gagging is a NORMAL and important part of a child's development.
- Children will gag less in the long term if they are allowed and encouraged to mouth objects early on.
- Keep calm when your baby gags so they can learn to keep calm too.
- Gagging and choking are different. Learn the first aid required to deal with choking.
- If you are worried, seek professional help sooner rather than later.
Any questions? Let us know via This email address is being protected from spambots. You need JavaScript enabled to view it.

A leg-up for premature children

As seen November 1 2014 in The Age (Melbourne), Sydney Morning Herald & Essential Baby website.

"Thanks for your interest in the article, we would just like to clarify that comments regarding limited follow-up for late term prems was not in relation to patients of the Mercy Hospital for Women. The Mercy Hospital for Women does have follow-up for babies born 36 weeks and earlier."

 

Having a hands-on role in advancing the development of premature babies is a regularly fulfilling job, according to premature birth expert Simone Mossop.
She says one of her standout experiences to date has been with a premature baby she first treated right after the baby was discharged from hospital.
Doctors predicted the girl - who had had a bumpy medical ride - would never use the left side of her body again. Part of Mossop's ongoing treatment was having her participate in upper body exercises on vertical surfaces to encourage arm use. At one point, Mossop had a camera handy, she says, which proved fortuitous.
"The one moment I've got the camera on her in a program, she reached out to me with a ball with her left hand," Mossop says. "That was such a special moment because it captured this little girl who was told she wouldn't use the left side of her body." Mossop is the founder of ReadyStepGrow, a charity organisation that supplies education and support programs for parents with premature children. She delivers the programs, performs management/operational tasks and raises awareness about the challenges and learning and developmental risks associated with premature birth.
"The main goal of the program is the social and emotional development of these children," Mossop says.
"Most children that are born pre-term are discharged without further care. Parents are sort of left on their own with lots of questions, because they're Googling and they understand that their children are at risk." Mossop has a unique career background that informs her approach to her role. In addition to being a neonatal nurse who worked in hospitals in Australia and overseas (she still works in intensive care at the Mercy Hospital for Women), she has also been a primary school teacher.
As a teacher at St Joseph's Primary School in Malvern, she saw a string of premature children entering the education system with learning difficulties that were magnified in the school setting.
Mossop began ReadyStepGrow in 2012 to bridge the service gap affecting families with premature children.
"It's constantly evolving," she says. "For somebody who has had no business background, the hugest learning curve has been what it takes to develop an organisation." As the organisation continues to grow, Mossop says she finds herself refining her goals. In the next few years, she's aiming to expand her programs to have regional and interstate reach, which she hopes will further allay the problems premature baby families face.
"That was my frustration. There was so much research and it seemed so glaringly obvious that we needed to start putting some professional programs in."

What makes attending ReadyStepGrow different than going to another "therapy" session with your child???

1. RSG is not just facilitating the group to let you part with your money without a very good return.

2. RSG has expert therapists with different expertise (Neonatologist, Early years practitioner, Neuropsychology PhD, Speech Pathologist, Exercise Physiologist) as part of the team that develops well thought out programs to address the needs of your premmie's development at every stage.
3. You, as the parent, has direct access to these expert therapists in one place to ask questions, discuss concerns etc regarding your premmie's development.
4. RSG is also here to support you, as the parent, to help your premmie to prepare themselves for life and school. For some it's a life journey and for others a short one. 
5. RSG is a safe place for parents on the therapy roller coaster to get advice and support for themselves as the team at RSG knows firsthand the emotional trauma that may be experienced by having a premature baby.

To EXPERIENCE ReadyStepGrow and talk to facilitators and other families involved why not come along to our OPEN DAY this Thursday October 2nd?

Written and shared with kind permission by a ReadyStepGrow Mum - Charlotte Van der Poll

independent

Raising independent children

Is this a dying art form? For years (from my vantage point of teaching the early years in primary school) I have been bewildered by young children unable to tie laces, open lunch boxes and seemingly unable to carry even their own school bags into school!

Today, in the supermarket, I had my two little helpers as busy as I could possibly keep them. I've learned, like most of us (the hard way) this is the only way to come out of our larger supermarket trips a success.

But about today, I need to write. At the checkout the girls were busily unloading our trolley. With as little direction from me as possible, I allowed them to figure out how they could best do this. In actual fact, for a moment, there was a fleeting thought that went through my mind, that I was actually (wait for it) doing nothing!

Read more ...

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    support for premature children Paediatric Occupational Therapist "I found the work you are doing to support premature children and their families, so inspiring. From Read More
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    Sia born at 30 weeks Sia was born in her 30th week. The hospital did everything they could to stop her but she had a Read More
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Tue Jun 27, 2017 @10:00 - 11:30AM
Tuesday Toddlers (Term 2 2017)
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Tue Jul 18, 2017 @11:45 - 01:15PM
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Wed Jul 19, 2017 @10:00 - 11:30AM
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Wed Jul 19, 2017 @11:45 - 01:15PM
Tiny Premmies (Term 3 2017)

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