Is feeding and meal time a source of stress for your family? As parents and professionals, we want to see our children and the children we work with happy and healthy, but oftentimes children with autism also present with feeding issues that need to be solved. In this interview with SLP and Feeding Expert, Melanie Potock, we go over some great information and resources for pediatric feeding.
Autism and Picky Eaters
It has been my experience that almost all children with autism have some issues with feeding and drinking. Melanie Potock shares that every child with autism she has come to know, with the right therapy, has grown to take joy in meal time. Picky eating, which is very common in autism, can be the cause of an internal lack of safety, if kids don’t feel safe eating something they aren’t going to eat it. Children with autism are involved in so many therapies and interventions that their feeding issues can be seen as small or not the focus. Melanie sees many children later on that have long term feeding issues that, while it’s not too late to work on, could have been much easier to tackle if approached earlier on. Encouraging a gentle approach, Melanie works on issues related to feeding including anxiety and especially motor skills.
Straw vs. Sippy Cup
In this episode, we talk a lot about weaning from a bottle and pacifier. Be sure to check out the linked resources. But what happens when you do wean from the bottle? What cup is best? Traditionally, many parents move right on to a sippy cup, because they think it is the next step. Melanie shares the science behind oral feeding development and how hard spout sippy cups can hinder the natural development of your child’s oral motor skills. There are many things that can contribute to the delay or the natural progression of these skills but avoiding a sippy cup and moving to a cup with a short straw is a big one. Melanie emphasizes the importance of the straw or any cup to not block the movement of the tongue as a function of swallowing.
Melanie is the author of 5 books, her most recent and upcoming, Responsive Feeding: The Baby-First Guide, is geared to help families understand babies feeding cues from the start of solids at 6 months old all the way to toddler eating habits at 3. You can find more information about Melanie and all the resources she has to offer on her website and social media.
Melanie Potock on Turn Around Autism
Melanie Potock, MA, CCC-SLP, is an international speaker on the topic of feeding babies, toddlers and school age kids. She is the co-author of the award-winning Raising a Healthy Happy Eater: A Stage-by-Stage Guide to Setting Your Child on the Path to Adventurous Eating (2015) and the upcoming Responsive Feeding: The Baby-First Guide to Stress-Free Weaning, Healthy Eating, and Mealtime Bonding (Jan 2022). The tips in her activity cookbook for parents & kids, Adventures in Veggieland: Help Your Kids Learn to Love Vegetables with 100 Easy Activities and Recipes, are based on the latest research and Melanie’s 20 years of success as a pediatric feeding therapist. Melanie’s children’s book “You are Not an Otter” takes preschoolers on a food adventure, exploring all the ways that various animals eat! Melanie’s advice has been shared in a variety of television and print media, including The New York Times, The Wall Street Journal, Washington Post, CNN.com and Parents Magazine. Contact her at www.MelaniePotock.com and follow Mel on Instagram and Facebook too!
- When to wean off the pacifier?
- How to wean off the pacifier?
- When should you take away a pacifier?
- How to identify and treat a tongue and lip-tie in your baby?
- Do sippy cups cause speech problems?
- Why are straw cups good for oral development?
- Do children with autism have feeding issues?
- Sign-up For Mary Barbera’s Workshop
- Does My Toddler Have Autism or Is It a Speech Delay Due to Covid Isolation?
- Dr. Keith Williams: Tackling Selective Eating in Children with Autism
- Pacifier & Bottle Weaning for Children with Autism in 6 Easy Steps
- Should You Use Chew Toys for Kids with Autism?
- Melanie Potock
- Picky Eater Courses
- Picky Eater Free Toolbox
- Books | Melanie Potock
- Melanie Potock on Instragram
- My Munch Bug on Facebook
- Why Wean From the Bottle?
- Baby Footrest Hack
Melanie Potock – Turn Autism Around Podcast Transcript
Transcript for Podcast Episode:160
When To Tackle Weaning Off Pacifiers with Pediatric Feeding Specialist Melanie Potock
Hosted by:Dr. Mary Barbera
Guest: Melanie Potock
Mary: You're listening to the Turn Autism Around podcast episode number one hundred and sixty. I just had a great conversation with Melanie Potock, who is a speech and language pathologist who is an expert on feeding babies and toddlers and school-age kids. Her website is mymunchbug.com, and she's very active on Instagram and Facebook, where she provides a lot of good visual aids to help us know how to wean babies from pacifiers and bottles and what sippy cups are actually good for oral motor development and which ones are not. So in this episode, we talk all about the transition from bottles to cups and what type we talk about how to seat a child, when to transition from a high chair, and also what to do with kids who are older, who may not have developed that oral motor development that's so necessary for both breathing and speech. So it's a great episode. Hope you love it as much as I do. Let's get to Melanie Potock.
Welcome to the Turn Autism Around podcast for both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host autism mom, behavior analyst, and bestselling author Dr. Mary Barbera.
Mary: Melanie, thank you so much for your time. I'm looking forward to interviewing now.
Melanie: I'm just so happy to finally get a chance to chat. We've been trying to schedule this for a while.
Mary: Yes. Yes. Actually, a few months. So it's exciting. And your new book by the time this airs will have just come out. So we have a lot to cover. So first, let's start off with, you know, describe your fall into the world of helping kids with speech and then helping kids with feeding and including kids on the spectrum.
Melanie: Oh yeah. Be more than happy to. I actually became a speech pathologist when I was in my early 30s. It's a little late to the game and I worked in our local hospital and became a member of their autism team. And that's how my interest in children with autism really just began to grow. And then coincidentally, I was also very interested in feeding. So the two paths were parallel for a while. I still work with many children with autism, but my career as a pediatric feeding specialist has broadened to anywhere from your garden variety picky eater all the way up to very extreme picky eaters. Children diagnosed with avoidant restrictive food intake disorder, et cetera, et cetera. So I feel really fortunate and that my life is just all about finding the joy in food and helping children do that as well.
Mary: Wow. And you start with feeding right away, even for babies. So why don't you tell our audience the name of your new book and just kind of briefly say who it's for and who it helps?
Melanie: Well, thank you. I have five books. This will be the book that I said, I'm never gonna write another book. And then here we are. I have a brand new book coming out in January of 2022 that I've been working on for a few years, as you know, takes a lot of time, put a book together and it's called The Responsive Feeding. And I'm so glad that you mentioned babies because when I first learned about responsive feeding, I was a young therapist working in the neonatal intensive care unit as a feeding specialist. And that's where I first learned about reading a baby's cues and really helping parents to understand that feeding is based on communication, which of course, is such a big part of being a speech pathologist as well. So what this book does is it focuses on that communication dance that we all do as parents with our babies, but it specifically starts right when we start solids. And then I take parents of children that at about that six month age all the way up to age three and walk them through every aspect of feeding your child. Whether you'd like to do more of a baby led weaning approach, whether you'd like to include purees or you want to do more of a hybrid approach. But most importantly, how to really understand what your baby is saying to you and how to help them learn to tune into their bodies and make their own decisions about how much they're going to eat.
Locating and Treating Tongue and Lip Ties:
Mary: Wow. OK, so way back when babies are born, you know, we breastfeed or get formula and some things they can get in the way right away, I know for Lucas, he wasn't sucking well. He had jaundice. And so that kind of got in the way. He got a little dehydrated. Finally, he started breastfeeding well. I know Rachel, who was on the show recently about her two and a half year old son with speech delay. She just had a new baby boy. He ended up with a tongue tie. So I know we haven't, which affects your sucking in your intake. He had a really bad tongue tie and that was able to be fixed. You know, just very outpatient with an ear, nose and throat doctor. But just quickly, what is a tongue tie and when? When should we be looking for it? I've heard of other kids with autism having tongue tied, so I just wanted to just briefly touch on that.
Melanie: Yeah, let's talk about that. You know, just to help all of your listeners who want to think about feeding difficulties in terms of the whole child. And that's what you just so beautifully said is there are just so many aspects that can contribute to this. It's so much more than just being picky. So a pediatric feeding disorder comes about because of three different things. One, two or three, all three. The first one is something that went awry with physiology, and that's what you're describing there with a tongue tie that when baby was forming in the womb, that little bit of tissue that's directly under the tongue. We call it a frenum, attached in more of a restrictive manner to keep it very simple for the audio. And since we can't be in person to describe or point at my tongue. But it's a physiological difference, and just like any other physiological difference, it is something that can be remedied. There are two other factors, though, that we always consider, and this would influence the baby's ability to eat related to physiology, which is our motor skills. So gross and fine motor skills. And if you have a tethered oral tissue in this case, a tongue tie or perhaps a lip tire both, then your motor skills in your mouth are going to be affected. And then finally, when baby has a hard time with physiology and motor development, thus oral development, they learned that eating isn't easy or they learn to compensate and move their body and their tongue and their mouth in such a way that they can sort of get it to work. So that's just how they're going to eat. But we don't want babies learn to compensate. We want them to learn to eat in a very developmentally appropriate manner. And so something like a tongue tie is something I've worked really, really hard to educate other therapists about to make sure that from every for every single child that comes to see us for speech and language evaluation or a feeding evaluation, they do not leave that evaluation without having a full oral exam that includes inspection for tethered oral tissues.
Mary: Wow. And I know with Rachel's little baby, he was only a couple of weeks old. He was able to just get a clipped really quickly in the nose and throat office. But if it is an older kid, it might require some outpatient surgery. And you know, could as they grow older, it could be more involved.
Melanie: You're right. You're right. And also, we want to keep in mind that there are different degrees of restriction and different positioning of that front. So it sounds like that was more of an A. positioning where it was really visible and easy to remedy right there. But it's not unusual at all for babies to have more significant. Most often laser surgery, but it is still done in an outpatient office. And a speech pathologist who specifically trained and how to support the family will provide therapy before and after that procedure to help the child develop those motor skills that we were talking about.
Autism and Feeding or Drinking Issues:
Mary: OK, so now let's talk about I think those were all good tips about oral motor examination, and it's not just about, I know behavior analyst and I'm one of them myself, but are kind of guilty of let's just take what we have, what we you know, what's coming out of the mouth and try to shape that without really looking and investigating the physical aspects of the oral system as well as things. Like, you know, on my one page assessments, for instance, you know, does the child drink out of a bottle? Do they drink through a straw through an open cup? Because I have found that I have never met a young child with moderate autism who doesn't have some kind of feeding or drinking issue. I see it really coupled, and I know today we're going to talk more about feeding, but they are intertwined. Can you talk to that? Is it? Do you agree?
Melanie: Absolutely. I want your audience to remember that I'm a pediatric feeding specialist, so they're going to come to me if they have feeding problems. However, I'm out in the community. I going into schools, I see siblings. I work in settings where there are other kids coming and going. And in my 20 something years of experience, I have to tell you I have never met a child with autism who didn't have a degree of hesitant eating. Do they do much better after guidance and some loving therapy and learn to be really adventurous and joyful eaters and find that joy and food? Always. In my experience, I've never had a child who doesn't. If we really dedicate the right amount of time and gentle patience to it. But I think also part of that dilemma is and maybe as a mom of a child with autism, you can speak to this. Is that there is a lot of therapy involved when your child has autism. And sometimes if they're only eating six foods, that doesn't really seem to be like that big of a deal in terms of everything else that we're going to work on to help this child thrive. So oftentimes, the kids come to me later in life because they thought that the kids were kind of just grow out of it. But when we look at the whole child and we consider a lot of the challenges that comes along with having the autism diagnosis, we know that motor skills especially are a big part of that, but also anxiety as well. So if you don't feel safe eating, you're not going to grow out of it.
Mary: And what I found, especially with my very young clients and Lucas included when he was young, he did have very picky eating. You know, it got to the point where he was only eating the edges of chicken nuggets and the prize had to be from McDonald's and had to be in the right container and just crazy amounts of picky eating before he did a feeding program. But, you know, a lot of the little kids that I have worked with over the years, they have difficulty chewing, biting on a block, slipping out of a straw. And when you even smiling and you think about, you know, the E sound, you have to smile kind of to say E. And when I see kids to two and a half, you know, even 18 months, a lot of times I'll look at the way they're speaking and they are, you know, it just looks very low tone and looks very mushy. They don't, you know, smile readily. And lo and behold, they're drinking out of sippy cups and they're or, you know, I've had I've had kids enter kindergarten and they still drink out of bottles and still have pacifiers at age three. And all of that oral motor development that's supposed to be happening as you progress from mushy food to texture food to chewing and swallowing is just missed and a lot of times is blamed on autism. It's kind of like which comes first, the chicken or the egg, you know, a non-verbal child or a child who's not speaking yet is almost certainly going to have oral motor development issues of feeding and drinking. So let's talk about. I mean, I know I'm kind of preaching to the choir. And then, of course, I've done a lot of work with this. I have a chapter of my new book on feeding. I've interviewed Dr. Keith Williams, who's an expert. We can link him in the show notes, I've done feeding work, but let's talk about when you do introduce solids and and also when we should be really getting rid of bottles and pacifiers.
Weaning Bottles and Pacifiers:
Melanie: Absolutely. What I want everybody to really understand and I say this in every interview that I do because it's not important. And I also say in every book, feeding is a developmental process, just like learning to crawl, walk, run. And if our children, whether they have autism or a different diagnosis, or if they're challenged by a motor, typical do that lower muscle tone that you talked about. Well, if they have a delay in development, then they're stalled. And what we're trying to do is make sure to get them back on that path of typical development to the best of our ability and follow the same steps that children would who don't require therapy. So we're also following this developmental timeline, and we're trying to do as much catch up as we can and then, of course, support them in any way we can, depending on their individual ability. OK, so with all of that being said. With certain marketing by big companies that advertise and market baby products, it can be very confusing for parents. You walk into the baby aisle at Target and there are so many cups and spoons and pacifiers and bottles. I mean, it is. I got confused there and this is my life's work. So I really try hard, especially on my Instagram and my Facebook, to educate parents about what is going to help your child developmentally and what might hinder. So let's talk about pacifiers to start pacifiers. There are differences of opinion about which pacifier may be ideal, and that difference of opinion comes from the background and the education of that professional. Someone like me, who specializes in speech and feeding and has advanced education and oral facial biology, is going to look at the pacifier from how it's going to support feeding development. Feeding development and speech development are intimately related. Same muscles, same mouth. It's pretty easy to see they're connected. So for pacifiers, I really like babies to be weaned off a pacifier by the day after their first birthday, maybe the week after their first birthday. Enjoy the cake. Get a good night's sleep. But then it's time to wean that baby. And so I have a very short course on my website about how to do that, as well as which pacifiers are best for oral development and why. What goes along with that is this same theme behind thumb sucking sippy cups, straw drinking open cups, and let me walk you through that real quick. The main thing for your listeners to know is that developmentally, between six months and 12 months, babies start to change the way they move their tongue when they swallow and they're supposed to. We call that a mature swallow pattern, and that's the way adults swallow. But if babies have a lot of pacifier, use a lot of hard spout sippy cup use, and as much as they love straws, I love straws. A long straw versus a short one. Holding down their tongue or a thumb holding down their tongue a lot. It gets in the way of them learning how to lift up the tip of their tongue and develop this mature swallow pattern that I outline on my social media. Little hard to describe without visuals, but I'll send you some links
Mary: And we put all the links for these, you know, really great visual social media posts in the show notes. So you could go to Mary Barbera dot com for research one six. Oh, to get to this pages, the episode for all of these links we're talking about, we're going to link, you know, Melanie's book and all these social media posts. I think they're going to be so helpful.
Melanie: That's fantastic. So in short, what happens is when babies are first born, they suckle. They lose their tongue forward, back, forward, back. And if you've ever seen a baby breastfeed, you can see their little tongue moving it that way. It's so adorable. So bottle feeding is a little bit different, but in general, it's more of a suckle emotion. If we continue with something laying over their tongue like that now, breast is different. I'll cover that in a sec. If we continue with something like a bottle nipple, a pacifier, etc. over their tongue for too long, they never learn to develop the mature pattern where you actually rise the tongue tip up. Breastfeeding is different, though, in short, very short answer because the breast is malleable, and so it actually helps to develop the baby's palate, their hard palate above their tongue and their oral cavity. So we really encourage families whenever possible to breastfeed. As long as they would like that, it's very different than the mechanics of a bottle, nipple or pacifier. Last note I love a good pacifier, Mary. I love a good pacifier. I love for kids to have the experience pacifier. There's good research behind it. And we also know that it helps kids stay safe when it comes to sudden infant death syndrome. But we don't need it past the first year of life. So that's why I really encourage parents if they want the optimal facial development for their child to make sure that they don't have these essentially objects in their mouths to hold that tongue down.
Mary: And pacifier use can also. I've seen children with pacifiers over the age of one or over the age of two, and they almost always have severe problem behaviors. A lot of times surrounding that pacifier use, they can become quite addictive and it can be really reinforcing for the parent to have something to plug up the child. And that further reduces not only messes with their feeding systems, but really plugs them up so they're not talking. And when they are making noises, it's crying to get the pacifier back, to get plugged up again. And that is a problem.
Melanie: It can be a vicious cycle, for sure.
Mary: And it also can cause dental problems, which a lot of people don't know. It can cause the teeth not to come down and to develop, too. So for all of those reasons, I mean, we will post something for Melanie about the best pacifiers to use or the characteristics of the best pacifiers. And also when you are transitioning, when should kids go from a bottle to a cup? Is that at the one year mark as well?
Melanie: So we like to start the transition off of bottles, actually, once babies start solid food at six months. And by that, I mean, we come up with a plan and then we slowly implement that plan so that by 12 months of age, the week after that first birthday party, baby sat down with the bottle. Absolute worst case by 18 months. But if you really want to do it sooner, we introduce an open cup and a straw cup shortly after baby has started solids again in that six months, and I have lots of information about that on my Instagram highlights. But I also have a bottle weaning course on my course library too. So I know it's a big issue for parents and it feels very scary for parents to give up that bottle because not only is that comforting, but it's also a source of nutrition, and it's the parents are worried. Once the kids do it, they kind of go that was easier than I thought. But it's easier if you do it when they're younger. But if you've got an older child who's two, three, even four years old and they're still on a bottle, that bye bye bottle course on my course library will help solve that issue for you.
Mary: OK. And I also have a free resource which we can link in. The show notes how to wean six steps to weaning from bottles or pacifiers as well. I'm sure they are very similar. Mine's just a six step guide, and in my courses and community, we talk a lot about weaning, you know, because for kids with autism, it might also be weaning from other things like they need to carry a train around all day long or they need to, you know, they're addicted to X, Y and Z. And so these weaning processes behaviorally kind of look similar, but again, with bottles, that is food supply. And, you know, and with kids with autism, you know, like, I had a lot of advice from well-meaning people when Lucas was very picky and he he actually met the criteria for failure, failure to thrive before we started a feeding program with him at four and a half. And you know, people are like, we'll just stop feeding him junk and present vegetables every meal and and I asked the feeding clinic that I'm like, Is that what I should have done? And they said, No, you know, kids with autism could starve to death. If you do that, if you don't know what you're doing and don't have a multidisciplinary team. It can become very complex. So I don't want to make it seem like it's just do it.
Sippy Cups vs. Straw Cups
Melanie: I think we've just had a full circle moment here, because that's the whole point is that it's not just about let them get hungry, not hunger certainly is an important aspect to feeding therapy, and we utilize that in the moments, right? But we don't let a child starve, and that probably sounded harsh. What do you mean by that? Is, we don't let a child get so hungry that it's upsetting, just like all of us if we wait for dinner. We enjoy our dinner more, so we help them get on a feeding schedule. Mary, if it's OK, I realized I didn't really answer your question very well about sippy cups versus straw cups. Is this a good time to cover that? Absolutely. OK, well, just really quick for your listeners. Many years ago, I wrote an article for the American Speech Language Hearing Association called Step Away from Sippy Cup. And the idea here is just helping parents to understand that sippy cups were simply invented by a really smart engineer who didn't want his little girl to spill juice all over their new carpet. And then he sold the idea to Playtex. And then the rest is history. Now they're everywhere. And the problem with them is, is that because we have cupholders in strollers and car seats at the Highchair tray and I love the fact that kids are getting lots of good refreshing water, hopefully, but. They if they have a sippy cup with that hard spout, that's essentially like that thumb or the pacifier, et cetera, that we just talked about, it holds down the tongue and the kids continue to suckle instead of learning how to suck correctly. And if that goes on for too long, depending on three things duration of suck, intensity of suck and frequency of the sucking, it will actually change their facial development as well as impact their feeding and speech skills. So for anyone who might be listening, that says, Oh, good grief, my kid had a sippy cup till he was seven is just fine. That's awesome. That's probably because there was that.... Yeah, you're lucky because there just wasn't enough intensity, duration or frequency or the changes were so minor that you may not be picking up on it like you, Mary. This is my life's work. So, you know, my whole life is is taking a look at a child's facial development, as well as their mouth development and figuring out how I can help them function better in terms of speech and feeding. So I'm always trying to educate parents on what to avoid as much as what to do.
Mary: Yeah. And you know, we're just talking about the regular sippy cups that half the world is using, or 90 percent of the world, right? You know, they have the spill proof little valve in it. And I remember actually, this is in my first book, the verbal behavior approach, which last week we just had a whole episode about the verbal behavior approach, which is published in 2007. But in that book, I talk about Joanne Guarantor, who we also she's a speech pathologist. We also did a podcast interview with her, and we can link on the show notes. She came to my county. I was in charge of bringing in speakers once a year, and she came to our annual conference to speak. And I took her out to dinner the night before and I had her kind of do a drive by look at Lucas, and she was only here for 15 minutes in my house. And I remember it was my old house and she went down in the basement and Lucas was running around with one of those hard sippy cups, spill proof. And she's like, Get that cup away from him. And I was like really, OK. And I think I was a behavior analyst then, you know, and and I think it's it's just so it was eye opening. And then she then went on to educate me like he's having articulation problems and people in my course are constantly, you know, what did I do? And part of my feeding modules in my course and my book is we've got to stop the grazing of constant food. Oh, they're not going to eat. They're not going to sit at the table. Now we're going to let them roam around the house with a bowl of cereal and drink out of a spill proof sippy cup and also drink other things besides water that could be filling them up. And then they're not hungry for meals. So it's kind of like you, said, Melanie. A vicious cycle of of kids doing, you know, all of those things. But you know, when Joann Garrison, I don't remember what year that was, but when she said, get that sippy cup away, I was like, Oh, really, OK? And I and he had been through a feeding program and everything. Nobody was saying that. But I I am very loud and vocal. That's why I wanted you on the show, guys. I keep seeing your posts and I'm like, Oh my God, I love this one. I love these posts. I love the awareness and education that we've got to. I even have an example. And I don't mean to take away from your time because this is so fascinating. But one of my last independent evaluations, because I basically this is what I do all day long. I do courses and podcasts. And but one of my last in-person independent evaluations was a 17 year old in residential placement to from the time he was eight or nine. You know, a severely impacted young man. And I asked them he was essentially nonverbal, although I found some words when I was there and I'm like, you know, really, when people say they're nonverbal or non speaking, I'm like, they make no sounds, they make no word approximation. Oh, well, he does say Mama, and he will say this and you know, and so there's no focus on this language. But then in terms of drinking, he would just during my one day with him, he would take a bottle, a sports bottle. No, no cap on it, you know, just open cap bottle. And he would drink water and it would literally spill out of his mouth onto his shirt, like even from a. Dignity point of view. I mean, a cleanliness point of view, you know, part of my thought process was, you know, I'm evaluating the whole picture, but I said, can he drink out of a straw like that is not good for his oral motor system to be doing that, Zuckerberg's dignity. And so there they said. I don't know. They went and got a straw and he could drink out of it. Wow. Wow.
Melanie: And all straws are so helpful for kids and adults of any age because one a fairly short straw. My rule is tip of the tongue to the tip of the straw. You don't want it to lay down over the tongue too far because that's like a thumb. But it's so helpful because it helps to pull the tongue back to help that tongue tip learned to rise up that we were talking about earlier. And it develops so many muscles in the face. As a matter of fact, even children who are having difficulty with some of the the rounding sounds we call them like, oh, you know, like kissing muscles, that kind of thing, but who are having trouble saying things like zoo or Zoom. We use straw drinking to help get those muscles activated and positioned in the correct way. So Speech Therapist, Lovegood Straw and on my website, I have a free download on how to teach your six month old baby how to drink from a straw. Oh, my heart breaks that. No one ever considered that for that young man.
Mary: Yeah, exactly. And it's no. And no one's focusing on vocal language, either, which is a shame because yes, no, we should never give up on that. It's never too early or too late to treat any of this before we move on. How about thumb sucking? Because that is something you can't really control. You know, a lot of people stay away from pacifiers and then they get a thumb sucker. So what do you do for thumb sucking?
Thumb Sucking and Oral Fixations:
Melanie: Yeah, no, that's a great question. So for our babies who when we try to wean them off the password, they resort to the thumb, we sometimes will give them a little bit more time with the pacifier. But what we're doing in the meantime is we're doing a lot of providing oral motor input, oral stimulation, lots of teethers, as I have so many good teethers, was on my Amazon store that I love so that the kids are really getting that oral input that they need, that they're seeking from their thumb. Sucking on your thumb is very, very calming. One of the things that thumb sucking does is it presses on the alveolar ridge, the rigid, bumpy part right above your top teeth. And when we press there, it releases chemicals in our brain that help us calm down. So kids who have not developed that mature swallow pattern and push on that spot with the tongue tip, they don't get that calming release, so they will often use the thumb instead. And now we have a vicious cycle again because the thumb is going to hold the tongue down. You never learn how to activate that nerve with your own tongue, and so you desperately need that thumb to calm. So lots of input with teethers and different textures of food and trying to really help to regulate that oral input for our sensory system is very, very helpful. And then we minimize the thumb sucking as much as we can. If they don't grow out of it by age three, three and a half, then we will refer to a certified oral facial miologist and they are trained specifically in how to help that preschoolers stop thumb sucking. But we try to catch it early and redirect.
Mary: OK, good to know. And I also a lot of kids with autism have excessive chewing and mouthing behaviors, you know, chewing on their shirts or chewing on, you know, and mouthing excessively. I did do a couple video blogs on that we can link in the show notes, but do you have anything additional for like kids that are excessively mouthing?
Melanie: I do. I do. And I can give everyone a tip on that right now. That might be kind of surprising. I have on my YouTube channel several videos about that, but the one thing that I always recommend to parents that if they are going to encourage a child to chew on something that is clean and more appropriate and will help to develop their oral musculature versus a sleeve versus their wrist, I had a child who was always chewing on his wrist. Some of these things that we want to redirect into something that's cleaner and safer for the child. One of the best strategies I've found over the years are A.the chewable necklaces with the breakaway lanyards. But the tip is wear one yourself because if you have a three year old who has is willing to wear a chewable necklace. Think about it very like if you said to me, I love your necklace, what's the first thing I do? I touch it and I look down because I'm trying to remember what necklace I have on today? I can't see it. So if the kids have the visual wear, the parent and the teacher in the classroom also has the necklace, then the teacher, the parent can say, Oh, you can chew on your necklace when they start to see the child begin to chew on their sleeve, or they start to see other antecedents that might lead to that behavior so they can dove in there, get them chewing on their necklace, model it for them, perhaps help them find it as it hangs around their chest and get that consequence in place right away to begin to reshape that behavior. So, yeah, so make sure if you're going to use a chewable necklace, order three or four and wear one yourself.
Mary: Interesting. Yeah. And I also have seen in terms of chewing and and those sorts of things. It can also be a medical problem. It can be a nutritional deficiency that can be a led issue and could be a zinc or magnesium issue. and I have seen major improvement. I know Lucas was a big chewing on everything, chewing on markers and toys and sleeves and a shirt, and a lot of my clients have also. So yeah, including all those resources in our show notes would be great. OK, so another question that we get is when should kids be moving out of the highchair? I've seen a lot over the years of, you know, two and a half three year olds sitting in a high chair with the tray in front of them kind of locking them down for feeding and then people want to do therapy in there. And my approach, my easy four step turn autism approach is all about pairing up a small table and chairs. And like I know, I tell people, you know, the feet need to go on the floor. You know, you need a size table that's not real big for, you know, but with your expertize. Can you guide us a little bit on when to get out of the high chair? When to move to feet on floor? Any any other tips?
Moving out of the Highchair:
Melanie: Yeah, definitely. If you have a standard table at home, it's not a bar height table, right? Get rid of that high chair tray right away and scoop baby's high chair right up to the table. They'll have a bigger surface to explore food, and they're less likely to throw things over the side of the tray because there is no tray, it's all in front of them. So I try and ditch the tray as as soon as possible. However, some of my families don't even have a table in their small apartment or in their home, and the highchair tray is essential. So as that baby grows, the most important thing is whether they're in the high chair or they're in a chair with a small table, as you described, or perhaps even just scooted up to a ledge in the kitchen. You know, everybody's different in terms of the different environments where they're able to eat, depending, of course, that they live in a big city or in the country, too. So keep in mind, as you know, Mary, that we want the kids who need their feet to eat. They need their feet to eat. Feet have to be stable on the floor. And if you need to improvise and make a foot rest, I'll be sure to include several posts from my Instagram. How to do that and make your own butt rest at home very inexpensively. Then you want to consider that the child is sitting upright, but also that it's not too hard to do that. So, for example, if you and I were sitting on a bar stool with no backrest, but we still had our feet on the foot rest of the bar stool, we'd be OK for a while. But would we want to sit there all the time for every single meal? It's a lot of work. It's quite the workout on your abs. So an occasion, it's not a big deal, but for optimal attention and are also optimal stability so that we have better fine motor skills as well. Our trunk influences, our fine motor skills that we want to have that child supported through the hips. And we just want to make sure that their feet are on something that they have a good hip and thigh rest, enough seat surface versus a tiny bar stool and that they have their elbows on the table. That's one of the biggest mistakes I see is because I was raised no elbows on the table. That's not polite. But many of our children with feeding difficulties need that extra stability of being able to put their arms, their elbows, their forearms on the table to stabilize, and then they stay at the table longer.
Mary: Cool. So when should families seek out a feeding program or an expert on feeding?
Has Meal Time Become Stressful For Your Family?
Melanie: There are a lot of different signs that a child is having difficulty, but the number one sign that I see with every family who comes my way is that it's causing stress. So the way I was phrased it is talk to your pediatrician and stress that you're stressed and that the advice of our kids are picky. They'll grow out of it, or I'll just give them whatever he wants. Getting back on the growth curve is a Band-Aid solution. We want to get to the root of the issue. So the child doesn't just learn to eat a few new foods, they find the joy in food. Food is such a joyful, wonderful experience, with all the holidays coming up soon and all of the events throughout the year and now after the pandemic that we're really able to start to be together again and begin to connect around food. That's what's most important. So it might be that you're noticing some physiological issues. It might be that you're noticing sensory issues or motor issues. But the number one reason to ask for help is the one factor that goes along with all of those, which is this is stressful, and mealtimes should never be stressful.
Mary: And it is for many, many families. So I think we gave out a lot of resources. So why don't you tell our listeners what your website is and kind of what what they can find there?
Melanie: Oh, thank you. My website, you can find it two ways. My name MelaniePotock.com or MyMunchBug.com because I call all the kids. I work with my little munch bugss. So my MyMunchBug.com or MelaniePotock, and that's where you'll find all my books, all my video courses, my live courses and my speaking schedule, and lots of free downloads for you. But most importantly, my social media. So I hope you'll follow me on Instagram, Facebook, etc. and also tune in to my YouTube channel. So, and Mary, I know you have a phenomenal YouTube channel.
Mary: Yes, I do. I just reached 100000 subscribers on my YouTube channel. I got that plaque back there, that silver plaque with the play button on social media. How can people find you
Melanie: Two simple ways they can go to my home page and click on the icons top right hand corner for all my social media, but in general, it's My Munch Bug Melanie Potok,
Mary: My Munch Bug Melanie Potok OK, and that will all be linked in the show notes at MaryBarbera.com/160, so before I let you go, it's a lot of information, a lot of resources. I think my listeners are going to love this episode. Part of my podcast goals are not to just help the kids, but also help the parents and professionals listening to be less stressed and lead happier lives. So do you have any self-care tips for us today?
Melanie: I love that I do, mostly because you and I are both in our home offices right now, and I have to say one of the things that has helped me the most to take better care of myself is at four o'clock, I leave this office. It doesn't matter. Everything will be there tomorrow. That is my role. At four o'clock, the lights go off and I leave and I sleep better because of it. I have more time with my family because of it. And I have a chance to get in my pretty kitchen and have a little glass of wine and cook dinner for everybody, which is such a good way for me to unwind. So that's my tip. Shut that door at four o'clock.
Mary: OK, well, I do that sometimes, and then I bring my portable laptop with me all over the place, and I'm not very good with that boundary, but a good tip, something I can shoot for in the future. So thank you so much, Melanie. I look forward to collaborating with you in the future. Seems like we have very similar and passionate interests to help kids with speech problems, feeding problems and kids on and off the autism spectrum. So thank you so much for your time and good luck with your new book, Responsive Feeding, and I'm sure it will be great.
Melanie: This has been so much fun. Thank you for all the good work that you do, and thanks for having me on today.
Mary: If you're a parent or an autism professional and enjoy listening to this podcast, you have to come check out my online course and community where we take all of this material and we apply it. You'll learn life changing strategies to get your child or clients to reach their fullest potential. Join me for a free online workshop at MaryBarbara.com/ workshop where? Ah, you can learn how to avoid common mistakes. You can see videos of me working with kids with and without autism. And you can learn more about joining my online course and community at a very special discount. Once again, go to MaryBarbera.com/workshop for all the details. I hope to see you there.
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