Hi Robynne, I need some help/advece on my 2 year Sammy. i am posting a link I wrote to you last year and this kind of follows it: http://www.infantrefluxdisease.com/forums/showthread.php?t=32573

Sam is dependent on his g-tube and his feeding and *regular* behaviors are out of hand. In fact I see a lot of symptoms as over-sensitive (I don't even know if that's right) this really is new to me. I will describe some of the behaviors: Basically everything is HARD-his hitting, throwing, touching. It's hard to explain but he is too rough. I have 4 boys so I really feel this is out of the norm. He still prefers frozen textures but also spicy. He is so careless with jumping from furniture that I am wreck. He throws absoulutely everything. He is constantly pushing/shoving and hitting his brother and cousins at social gatherings. If here's near a table with things on it he has to throw everything off. He pulls everything from bookshelves, he hits me. I have tried time outs and spanking. He literally laughs at me if I smack his hand. Then on the other hand he is totally shy. If you even correct him he puts his head down and will just sulk terribly. He has terrible mood swings and it's like walking on egg shells around him.

What we do right now is use his pacifier and his pillow (whcih has stringy fringe) to calm him down. He will lay on the pillow and just rub the fringe and settle down. Do you have any ideas or advice on how to make his touch gentler all around?

Hi Kerri!
It sounds like you are doing a wonderful job with Sam. I went back and looked at last July’s post and I hope I answered your questions back then. I cannot believe you have Sam eating frozen Neocate with food in it! It is not the best tasting formula on the market, but it is used on our celiac babies, ones who are in need of gluten free foods, and our frequent retchers.
I can see where you would be frustrated with 2 different OT’s who might be specializing in different developmental areas. Is one of them is providing sensory integration therapy for Sam?
I am actually seeing more signs of an under-responsive neurological system than over-responsive with Sam from your descriptions; however I see some of both. It also appears as if Sam is also acting his age at times…lol! Sam is favoring cold and spicy foods to “alert” or wake up his mouth (under-responsive sensory). In addition, cold or thermal stimulation to the laryngeal muscles facilitates a safer swallow. It wakes up the over 50 muscles we use to swallow with. Is Sam’s feeding clinic using behavioral techniques during treatment to transition him to new textures? Have they increased his oral intake since you started treatment in July?
Now let’s talk about the “hard” play Sam is seeking out. Again, his neurological system is under-responsive because it sounds like he is over-compensating to get some deep pressure input (hitting inappropriately, pushing, shoving, and throwing). Has his OT made you a sensory diet = appropriate activities for home to help Sam get the input he needs and is seeking out? Has she taught you the Wilbarger brushing protocol and given you a corn brush to provide proper input to Sam’s pressure receptors so he doesn’t want to knock his cousins around? It sounds like he is in need of these two things. Kerri, he is probably enjoying the hand smacks because of his under responsive sensory system. Most other 2 year-olds would cry with a hand slap. He is like Bam Bam!
Okay…now for the over-responsive sensory behaviors. I think the over-responsive “sensitive” behaviors are occurring because Sam’s neurological system is in over-drive and eventually crashes. The origin of the over-responsive reactions stems from the GER and feeding aversion. All of my aversive kiddos are in over-drive as soon as you put them in the feeding chair. They are defensive and protective of their airway because of their histories with GERD and dysphagia. Getting the brushing done is like a massage. It is a calming mechanism that wakes up those pressure receptors under the skin. In addition, it calms those pressure receptors that are overly sensitive. I really think a brushing protocol would help “calm” him down and assist with getting some equilibrium of both the under and over-responsive systems. You might want to try this before oral feeds.

One of the verbal cues I use during feeding therapy when a child is throwing their arms up to block entry of food is “Hands Quiet.” I say this in a positive and soft voice as I gently touch their arm. Then I gently place their hands on the table and say “This is hands quiet” as I model the desired and appropriate behavior. Afterwards, I praise them with “Super hands quiet!” or “Fabulous hands quiet!” We might do this several times until they understand we are working on that specific behavior vs. getting a bite of food in them. You can apply this verbal cue to Sam when he goes to hit or push. Show him the desired behavior and praise him for keeping his hands down. At first he might think you are crazy, but little ones usually want to please and they love the primary reinforcement.

The pacifier is soothing as is playing with the fringe. Sucking also helps that esophagus contract, sending anything above the Nissen or upper esophageal sphincter to the stomach. There is nothing wrong with him calming down this way. Sam won't go to kindergarten with the pacifier and we are trying to promote that putting things in his mouth is a positive thing. Please write back with questions!

Robynne

Hi Kerri!
It sounds like you are doing a wonderful job with Sam. I went back and looked at last July’s post and I hope I answered your questions back then. I cannot believe you have Sam eating frozen Neocate with food in it! It is not the best tasting formula on the market, but it is used on our celiac babies, ones who are in need of gluten free foods, and our frequent retchers.
I can see where you would be frustrated with 2 different OT’s who might be specializing in different developmental areas. Is one of them is providing sensory integration therapy for Sam?
I am actually seeing more signs of an under-responsive neurological system than over-responsive with Sam from your descriptions; however I do see some of both. It also appears as if Sam is also acting his age at times…lol! Sam is favoring cold and spicy foods to “alert” or wake up his mouth (under-responsive sensory). In addition, cold or thermal stimulation to the laryngeal muscles facilitates a safer swallow. It wakes up the over 50 muscles we use to swallow with. Is Sam’s feeding clinic using behavioral techniques during treatment to transition him to new textures? Have they increased his oral intake since you started treatment in July?
Now let’s talk about the “hard” play Sam is seeking out. Again, his neurological system is under-responsive because it sounds like he is over-compensating to get some deep pressure input (hitting inappropriately, pushing, shoving, and throwing). Has his OT made you a sensory diet = appropriate activities for home to help Sam get the input he needs and is seeking out? Has she taught you the Wilbarger brushing protocol and given you a corn brush to provide proper input to Sam’s pressure receptors so he doesn’t want to knock his cousins around? It sounds like he is in need of these two things. Kerri, he is probably enjoying the hand smacks because of his under responsive sensory system. Most other 2 year-olds would cry with a hand slap. He is like Bam Bam!
Okay…now for the over-responsive sensory behaviors. I think the over-responsive “sensitive” behaviors are occurring because Sam’s neurological system is in over-drive and eventually crashes. The origin of the over-responsive reactions stems from the GER and feeding aversion. All of my aversive kiddos are in over-drive as soon as you put them in the feeding chair. They are defensive and protective of their airway because of their histories with GERD and dysphagia. Getting the brushing done is like a massage. It is a calming mechanism that wakes up those pressure receptors under the skin. In addition, it calms those pressure receptors that are overly sensitive. I really think a brushing protocol would help “calm” him down and assist with getting some equilibrium of both the under and over-responsive systems. You might want to try this before oral feeds.
One of the verbal cues I use during feeding therapy when a child is throwing their arms up to block entry of food is “Hands Quiet.” I say this in a positive and soft voice as I gently touch their arm. Then I gently place their hands on the table and say “This is hands quiet” as I model the desired and appropriate behavior. Afterwards, I praise them with “Super hands quiet!” or “Fabulous hands quiet!” We might do this several times until they understand we are working on that specific behavior vs. getting a bite of food in them. You can apply this verbal cue to Sam when he goes to hit or push. Show him the desired behavior and praise him for keeping his hands down. At first he might think you are crazy, but little ones usually want to please and they love the primary reinforcement.
The pacifier is soothing as is playing with the fringe. Sucking also helps that esophagus contract, sending anything above the Nissen or upper esophageal sphincter to the stomach. Please write back with questions!

Robynne