Me, Dennis, and Sidney. . . .2 members of our feeding group :)
Bennet ready for therapy in all his gear to keep him from scratching himself. Many things such as a baby's fine motor skills, gross motor skills, language and of course feeding skills are assessed to qualify them for our swallowing/feeding therapy group. Of course not all the babies at the Havens have feeding difficulties so we try to target the ones who need it the most. Gross motor skills are tasks such as sitting on their own unassisted, pulling themselves up during "tummy time", and working on head support and stability. We also play attention to their fine motor skills such as if they can reach for objects, fisting (which shows if they are tense or relaxed), tracking (holding your finger up and seeing if they follow), if they bring objects to their mouth or not, etc. We then assess their language. We want to know if they are cooing, smiling, laughing, babbling, have eye contact or not, turn to sounds, respond to their name, etc. All of these things play a big role in how a baby is feeding. The feeding issues we have seen in some of the babies also qualify them for our group including: anterior liquid loss (milk coming out of the front of their mouths), weak- to no suck, shallow breathing, weak non-nutritive suck (i will explain later on), overactive gag, spitting up, tongue protrusion, aspiration and abnormal oral facial structures.
After learning about each babies histories, Caroline also went over what a typical therapy session will include and how to perform each task. (The order of the tasks depends on the baby and his or her needs) but usually the first thing we do when we get into therapy is change them and get them clean and happy. (This is a big deal and can really play a big role in a baby's feeding) Next, we have "tummy time" where we are trying to get the babies to pull their heads up and get their muscles working and stronger.
Tummy time with Miller and Lushomo! They did an AWESOME job! So proud!
Sometimes tummy time is really difficult for these little guys! :( but we try to encourage them and not give in to their sad little cries as much as possible. We want them to get better!
We then perform Beckman exercises, which are oral motor exercises that are used to stimulate the baby's muscles used for feeding. This was really new to me. She instructed us on how to massage their upper and lower lips, outer cheeks, and inner cheeks in a soothing pattern to stimulate their muscles. We also use a “z vibe”, which uses vibrations to stimulate their muscles as well. For some babies, it relaxes their muscles causing them to gain more control of their tongue for feeding. Some of the babies absolutely LOVE this, and some think it is the devil. I had the pleasure of working with Teagan this morning and she has a love hate relationship with the z vibe. She is okay with holding it on her own and putting it in her mouth when SHE wants it there, but if I tried to put it anywhere near her she cried and threw a fit! Towards the end of the session she got more used to it though. YAY.
angry Teagan
happy Teagan. haha :)
We also give the babies pacifiers to work on their non nutritive sucking. Non nutritive sucking is different in the fact that they are not actually feeding so this type of sucking is generally faster and has shorter pauses than normal nutritive sucking. Non nutritive sucking is really important because it can increase their oxygen levels in the blood, decrease heart rate, and increase weight gain. Which is a big deal! So we make sure to incorporate this into our sessions as well.
After all this is completed we sing to them, show encouragement, give them their bottles and document their progress and look for more things to work on…and if we notice any particular problems while feeding during the session. It is only day one of my week of feeding therapy and I can already see what a difference these exercises and the z vibe can make. Caroline said some SLPs don’t believe this type of therapy approach works, but I have seen it work already with the two babies I worked with today. After doing this on Sidney, (a child with TB and that is also HIV exposed) her tongue was way more relaxed and she was able to drink more controlled with less anterior liquid loss. I am so excited to be able to help these little guys!
After learning about each babies histories, Caroline also went over what a typical therapy session will include and how to perform each task. (The order of the tasks depends on the baby and his or her needs) but usually the first thing we do when we get into therapy is change them and get them clean and happy. (This is a big deal and can really play a big role in a baby's feeding) Next, we have "tummy time" where we are trying to get the babies to pull their heads up and get their muscles working and stronger.
Tummy time with Miller and Lushomo! They did an AWESOME job! So proud!
Sometimes tummy time is really difficult for these little guys! :( but we try to encourage them and not give in to their sad little cries as much as possible. We want them to get better!
We then perform Beckman exercises, which are oral motor exercises that are used to stimulate the baby's muscles used for feeding. This was really new to me. She instructed us on how to massage their upper and lower lips, outer cheeks, and inner cheeks in a soothing pattern to stimulate their muscles. We also use a “z vibe”, which uses vibrations to stimulate their muscles as well. For some babies, it relaxes their muscles causing them to gain more control of their tongue for feeding. Some of the babies absolutely LOVE this, and some think it is the devil. I had the pleasure of working with Teagan this morning and she has a love hate relationship with the z vibe. She is okay with holding it on her own and putting it in her mouth when SHE wants it there, but if I tried to put it anywhere near her she cried and threw a fit! Towards the end of the session she got more used to it though. YAY.
angry Teagan
happy Teagan. haha :)
We also give the babies pacifiers to work on their non nutritive sucking. Non nutritive sucking is different in the fact that they are not actually feeding so this type of sucking is generally faster and has shorter pauses than normal nutritive sucking. Non nutritive sucking is really important because it can increase their oxygen levels in the blood, decrease heart rate, and increase weight gain. Which is a big deal! So we make sure to incorporate this into our sessions as well.
After all this is completed we sing to them, show encouragement, give them their bottles and document their progress and look for more things to work on…and if we notice any particular problems while feeding during the session. It is only day one of my week of feeding therapy and I can already see what a difference these exercises and the z vibe can make. Caroline said some SLPs don’t believe this type of therapy approach works, but I have seen it work already with the two babies I worked with today. After doing this on Sidney, (a child with TB and that is also HIV exposed) her tongue was way more relaxed and she was able to drink more controlled with less anterior liquid loss. I am so excited to be able to help these little guys!
After a busy morning at Havens 1 and 3, we headed to lunch. I wasn’t feeling too good by this time and was having some stomach trouble. (slightly caused by being spit up on so much…but I’m getting more used to it) After lunch, Kaylee, Rachel and I walked back to the house together. When we got there Rachel went to unlock the door. After a long struggle Kaylee took a try at it, and then I followed..... NO LUCK! The lock was broken and we were locked out of the house! AHHH. After everyone else got there we each took a turn trying to wiggle the key into the door….. Still no luck. Catherine’s “bobby pin idea” was a FAIL as well. Haha. We ended up going to get Ian to climb through the bars of the window (since he is the smallest of course)…. SUCCESS! After about 30 minutes of struggle, we were finally inside, this time through the back door! WHEWWW. What a “situation!” haha. Props to Ian for being able to fit through this tiny spot!
The weather was still kind of blah today. It rained a good bit yesterday so everything was still a little wet and the sun didn’t show it’s face hardly, thus taking it longer for our laundry to dry! (still havent gotten that back...Ha) It was around 65 degrees with a breeze, but not chilly enough for a jacket. It is so crazy to see the natives around here. Since this is their “winter”, they think it is “SOOO COLD”. When we got to Haven 1 this morning we all laughed to see how some of the children were dressed. You would have thought it was below freezing outside in their “Eskimo gear”.
Little Lisa the Eskimo
Tomorrow we will continue our feeding/swallowing sessions at Havens 1 and 3. Please continue to pray for all the babies!
The weather was still kind of blah today. It rained a good bit yesterday so everything was still a little wet and the sun didn’t show it’s face hardly, thus taking it longer for our laundry to dry! (still havent gotten that back...Ha) It was around 65 degrees with a breeze, but not chilly enough for a jacket. It is so crazy to see the natives around here. Since this is their “winter”, they think it is “SOOO COLD”. When we got to Haven 1 this morning we all laughed to see how some of the children were dressed. You would have thought it was below freezing outside in their “Eskimo gear”.
Little Lisa the Eskimo Tomorrow we will continue our feeding/swallowing sessions at Havens 1 and 3. Please continue to pray for all the babies!
P.S. Matt says "THUMBS UP FOR FEEDING/SWALLOWING THERAPY!!" haha :)Nighty Night!
Lacey
Sounds like yall are really busy! How many kids are you all seeing? Are they all in a group or you seeing them individually? Or how many in one group and what kind of groups are there? Hope yall get more sun and at least it's cool there and it's not 90 degrees like it is here.
ReplyDeleteThanks so much for explaining the exercises for feeding and swallowing. I was wondering how all that worked. It is awesome that you have already seen an improvement with these kids in 1 day. I would love to research more about these exercises. We also use the z-vibe at the hospital with our dysphagia patients. I also love that you guys sing to them for encouragement. I can't say I have ever thought about doing it in any of my therapies. Would you say this is a cultural difference between Zambian and American children? What other types of reinforcement have you been using during therapy? Praying for you guys and the work you are doing there. So proud of you guys!
ReplyDeleteYa I was curious how many children you have in your group? I am learning Beckman oral motor techniques in my offsite as well. It's complicated. I had it done on me and it really makes your muscles feel different. It has been really rainy up in Chicago, so I can relate to your weather. Also, it is so cute to see the little ones in their eskimo outfits!
ReplyDeleteOMG those kids are so precious! Thank you for the photos and explaining the exercises and everything you do! We do oral motor, E-stem and upper body strengthening. We usually try to coordinate this with PT OT or restorative. It really sounds like you guys are very busy, but enjoying that. Keep it up!! Can't wait to see more pictures!
ReplyDeleteThose pictures are precious!! Thank you for explaining the exercises yall do with them, it gives us a little picture of what you girls are doing over there! That's good that yall modify each exercise and know which baby needs what! Exciting to see progress and improvements!! Is swallowing a scary thing to do? Love you girls!
ReplyDeleteWow!!! Great explanations on everything that is going on. I feel that what you all are doing is a great help to the infants. Again, those are great pictures!!!
ReplyDeleteLove the pictures!! Sorry
ReplyDeleteI'm just now commenting, I have been very sick! Thanks for explaining the exercises!! all of you girls are helping the littles ones in so many ways and learning a great deal I'm sure!!