Expert Advice On Feeding Your Children

Keep Food Safe at School

2/1/2020

Feeding Littles | Feeding professional moms give their tips for keeping food cold and safe at school and daycare based on USDA information, including their favorite lunch boxes for kids.

One big question we always get is, “How do you keep lunches cold?” (Shown here are Bentgo boxes that we love! You can find them in our Amazon shop under Lunch.)

Here are some tips from USDA:

Perishable food must be refrigerated or stored with 2 ice packs. A frozen water bottle or other frozen drink can count as one of the ice packs, but it is recommended to do an ice source on the bottom and the top of the Bentgo itself. Store the lunch in an insulated bag to help keep it cold. (We have some of our favorite insulated bags in our Amazon shop too.)
Perishable foods include meat, poultry, fish, eggs and most dairy. Cut up veggies and fruits should also be kept cold.
According to USDA, foods that do not need refrigeration include: whole (uncut) veggies and fruits, hard cheese, canned meat or fish, chips, breads, crackers, PBJ, mustard and pickles. We do ice packs in our lunches no matter what just to be safe.
Food should be kept out of the “temperature danger zone” (40-140F) as much as possible. It is not recommended to leave any perishable food out longer than 2 hours.
If you pack lunch the night before, keep it in the fridge overnight and pack it with ice right before you leave for school the next day.
It is not recommended to eat uneaten perishable foods that come home unless you can guarantee that it has been kept cold.

Don't forget that these safety guidelines apply to any food out of the fridge, even snacks you send with your preschooler or diaper bag snacks.

Teach your Child How to Swallow a Pill

2/1/2020

Feeding Littles | Starting at the age of 4, children can learn how to swallow pills. Swallowing pills can be a very helpful skill, especially if they need a medication or supplement that it's available in another form. These steps are written by a feeding therapist.

Foodie Judy here! Yesterday a member of our Feeding Littles Clients Only Facebook group asked how to teach a child how to swallow a pill, so we thought we’d give you a tutorial here!

Why do some kids need to swallow pills? Some medications only come in pill form or kids may not like/tolerate the liquid or chewable version. Sometimes important medications cannot be crushed or cut. Teaching your child (age 4+) to swallow a pill can be a very helpful skill, especially if they are dealing with a temporary or chronic illness or if they need to take a supplement and it doesn’t come in a palatable liquid, powder, gummy or chewable. (See our blog post for more on supplements.)

Here are our steps for helping to teach your child how to swallow a pill:

Make sure your child is willing and motivated (and at least 4 years old) - see more below.
Have your child sit with good posture and feet supported on the floor or a foot rest.
Start with something very small like a cake sprinkle. Fill two straw cups with 4 oz of water.
Demonstrate by taking a sip of water from the straw, then place the sprinkle on the front to middle of your tongue. Drink the rest of the 4 oz of water.
Now it's your kiddo's turn! Practice a few times and keep it positive. Next, try 2 or 3 sprinkles. Do this for a few days or a few weeks until you're confident your child can try a small pill.
Have applesauce nearby to help facilitate a swallow in case the sprinkle feels stuck - the applesauce acts as a "magnet".

Remember that we all develop differently. Some kids are not ready for this at age 4.

A few additional points that we want to add:

First off, if your child has oral-motor or swallow issues, consult with your pediatrician or feeding team first.
Make sure your child is willing to do this - forcing them will result in an unpleasant experience. Sometimes recruiting an older sibling, family member or friend can motivate them to try it.
Cake sprinkles are small and can be chewed in case your child defaults to chewing. Some families also use tic tacs, but we like sprinkles because they’re so small and soft to start with.
Use a straw cup so that your child doesn’t tip their head back really far, as it can actually prevent a successful swallow.
Keep the experience positive - praise them when they do it successfully, but also encourage them if it doesn’t go right. Some children have anxiety about swallowing pills, so we want to make this a positive, productive process.
Applesauce or another fruit purée can help with the swallow process - keep it nearby when practicing with sprinkles and with the actual pill.
Make sure the pills you offer are relatively small and easy to swallow - large tablets may not work for your child.
Work with your pharmacist about the best medication delivery method for your kiddo.

Choking Hazards to Avoid or Modify for Kids

12/2/2019

Feeding Littles | We want to help you keep your child safe by either avoiding or modifying these choking hazards. We've including a list of both common and uncommon choking hazards to watch out for.

Many parents don't realize that It is recommended to avoid or modify choking hazards until your child is 4 - that’s about the age when most kids have adequate oral-motor strength to properly handle these foods. Choking hazard foods are either very hard so difficult to chew, or they're round and juicy like grapes, cherries and cherry tomatoes, which more easily slide to the back of the mouth.

Even if your baby is eating anything and everything well, it's still need to avoid choking hazards. Of course, you as the parent have to decide which foods are best for your child - we just share the info so you are aware of the potential risks.

The most uncommonly known choking hazards are raw carrots and raw apples. We recommend cooking or shredding them with a cheese grater to make them safer.

A short list of choking hazards is below. A complete list with thorough safety explanations and precautions can be found in both of our online courses in a handy dandy printable.

Modify:

Raw apples and hard pears - soften, shred
Grapes, cherries and cherry tomatoes - quarter lengthwise
Hot dogs or sausages - dice into small pieces
Whole nuts - serve as nut butters or ground nuts

Avoid:

Chips or tortilla chips
Hard candy
Gum
Popcorn
Hard gummy candy

Why Gagging is Good*

6/5/2017

* Gagging is good as long as it improves with time!

Your baby should - and needs to - gag in order to learn how to eat safely.

Let's talk about the biggest source of stress for parents when they start Baby-led Weaning (BLW): the gag reflex. Babies who self feed starting at 6 months have to have larger pieces of food (around the size of an adult finger) that they have the ability to pick up, which inherently leads to a fear that baby will choke.

Major governing bodies and health associations have always recommended offering finger foods around 6-7 months of age, and a recent study suggested that BLW does not increase risk of choking over spoon feeding as long as choking hazard foods like whole grapes and whole nuts aren't offered. However, it doesn't stop parents from being concerned about safety, since most of us are not comfortable with watching a baby gag.

Gagging is not the same as choking. In fact, gagging is good because it means that your baby's body is automatically protecting her airway. You will know baby is gagging and not choking if you can hear sound and if baby is working the food out quickly. Choking does not involve sound (no air = no sound).

Most babies gag frequently for 1-2 weeks when starting BLW. Fortunately, as they get more proficient at lateralizing the food to the side of their mouths to chew it before swallowing, gagging greatly reduces. Essentially, as your baby practices and learns that she can not just swallow whole food, she will gag less as and lateralize/chew more. The more gagging and practicing she does, the less she will gag in the long run.

Instead of fearing the gag reflex, we want to teach you more about what it is, how it protects your child, and how to help your baby learn to chew safely. Our online course Infant Feeding: the Baby-led Way goes into even more detail about gagging and shows you multiple videos of what it looks like!

Coughing and gagging are similar.

Did you know that gagging is considered one of two oral protective mechanisms? The other such mechanism is coughing. So, your baby protects her airway by coughing or by gagging.

Your baby will cough reflexively after the following things occur:

Foreign material enters the upper airway. This stimulates the laryngeal receptors, which triggers a cough to expel the foreign material and protect the airway. This happens with most infants daily as they learn to coordinate their breast or bottle skills.
The bronchial receptors are stimulated by excessive secretions, such as mucous. This is obvious when an infant catches a cold or swallows water during bath time.

Gagging is a good thing.

We are very comfortable seeing our baby cough, since most of us cough at some point during the day. Gagging, on the other hand, seems much scarier because we assume that it means the baby is choking on food.

Remember, gagging is not the same as choking. Furthermore, gagging is simply a protective oral reflex, just like a cough!

The purpose of the gag reflex is to protect the baby from ingesting items too large to be handled by the esophagus. Think of it like a gate keeper - NONE SHALL PASS!

The gag reflex works by touch-pressure receptors located on the tongue or on the pharyngeal wall. These receptors perceive food that is too large to pass to the esophagus and cause a reverse peristaltic movement in the pharynx. This can also cause a cough. Remember, since it's a reflex, it does it automatically without your baby doing it on purpose.

The site for the elicitation of the gag reflex changes with increasing age, but our gag reflex never goes away - it is there to protect you. You may have gagged as an adult when your throat was swabbed for a strep culture or if you took too big a bite of food.

In a newborn, the gag reflex at the mid-tongue area. As the baby matures, the site gradually moves back to the pharyngeal wall or the posterior portion of the tongue.

As a feeding therapist, if I see a gag reflex that is too easily stimulated, it indicates a hyper-responsive reflex that may interfere with feeding. Conversely, if a gag reflex is not present, the baby may be neurologically depressed and feeding may not be indicated for safety reasons. These children may need to receive nutrition through a feeding tube.

That is why encouraging a child to play in their mouth with toys such as a Fluxy is so important - it familiarizes baby with her gag reflex.

We want to encourage babies to put their hands in their own mouth. (Yes, it seems gross, but it's actually an important developmental step!) Biting down hard on a toy like the Fluxy or another long, safe teether on the area where the molars will eventually arrive is essential. This allows for great oral awareness, developing jaw grading and strength, and desensitization of the gag reflex in a way that most babies allow (because many don't want us in their mouths)!

So, gagging is good, and the more your allow your baby to gag on long teething toys before feeding begins and in the early stages of introducing food, the faster she will understand where her gag reflex is and will learn that food needs to be routed to the back of her gums, not straight down her throat. What's most important is that gagging improves with more exposure to real food.

Furthermore, the more you see gagging, the easier it will be on you. Most parents get really nervous by it when they see it at first, but by a few days in it's much more commonplace...and then baby does it less as she gets more skilled.

How can you help your baby right now?

Let your baby explore her gag reflex as much as possible, and don't be afraid to gently go in baby's mouth (with clean hands, of course!) and feel along the back gum line (where the molars will eventually be). Here's what you can do right now to help your baby with safe eating:

Encourage your baby to put her hands and safe teething toys like the Fluxy and Como Tomo in her mouth. Try to avoid pulling a baby's hands out of her mouth when she's a drooling, teething mess - remember, she needs to have her hands in her mouth to familiarize herself with the gag reflex!
Help gently guide the Fluxy or other longer toy to the back corner of her mouth - biting with the front of her gums may feel good for teething, but it doesn't help with safe eating skills.
Watch your baby closely as she eats, and let her gag while staying calm. See if she spits out the food or tries to chew it again within a few seconds. Also watch that she's not struggling and is not turning blue or lacking oxygen. Remember, a baby can choke on anything - it is imperative that you are prepared at all times. We recommend taking an infant CPR class if you haven't already.
Gagging should improve with time - usually within the first few weeks. If you don't notice an improvement, speak with your pediatrician.