Archive for October 2017

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6 Tips To Help A Child With Autism Eat Better

There are ways to support picky eaters and children who refuse new foods. I’m back with Dr. Dolezal further discussing feeding challenges for children with Autism Spectrum Disorders (ASD). The first post explored why children with Autism have challenges with eating (almost 90% do). I often say that a typically developing child will not starve with a full refrigerator, but this advice just doesn’t hold up with ASD children. I love Ellyn Satter’s advice and mission in helping adults and children be joyful and confident with eating. Her resource and guidance inspires a “division of responsibility” that basically a parent’s role is most simply to provide great healthy food and a child’s job is to choose what and how much of it to eat. But we have to acknowledge that parents to children with ASD need more information about challenges and often far more support. Here are Dr. Dolezal’s 6 tips to help a child with autism, or any child who choses to eat only a few, certain foods, eat better.

Children who graze are really not open to trying new things. — Dr. Dolezal

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Why Children With Autism Struggle With Eating

If you’re a parent to a child on the autism spectrum, take some comfort in knowing that up to about 90% of children with autism struggle with significant eating challenges. You are NOT alone in this. The challenges can range from picky eating to dependence upon PediaSure or g-tube for caloric intake. We know that children thrive in an expected world. But children with autism can take that to the margin where a preoccupation with sameness can drive them to eat only the same thing every day. Despite these staggering numbers, there are evidenced-based treatments and models of care that can help improve the lives of children and families from a nutritional and quality of life perspective. I had the pleasure of having Dr. Danielle Dolezal on the podcast to discuss this topic. The first podcast here is an overview of why children with Autism Spectrum disorders have these challenges with eating.

Rigidity and sameness contributes greatly to feeding picture. Eating is one of the most sensory experiences you can have.” ~Dr. Dolezal

Dr. Dolezal is the Clinical Supervisor of the Pediatric Feeding Program at Seattle Children’s Autism Center. She’s super smartypants and created the highly sought after (nearly 500 families on the wait list, unfortunately) interdisciplinary team model and program at the Autism Center. That means patients that have multiple factors contributing to feeding issues (medical, skill, motor, physiologic, and psychology) get to see a variety of team members under 1 roof. She started off her career with a masters in special education with special emphasis in early childhood and children who struggle with severe challenging behavior. She then got her PhD in child psychology with further emphasis in behavior analysis specializing in feeding disorders and severe challenging behavior. So needless to say….she knows her stuff. Her podcast is so good. Insistence on sameness is a common theme and can be horribly challenging for families who worry about their child’s nutrition.

A Few Quick Tips:

  • Try to not let your child slip into patterns of grazing, which is very common and leads to disrupted hunger/satiety patterns. This makes it difficult for them to try new foods because they graze to take the edge of the hunger all day long and are never really sitting down to eat a full meal at set meal times. They will be more apt and ready to try new foods if you keep to a set schedule. They don’t have to stay seated in a seat. They can stand up. But the food stays at the table.
  • Try celebrating and reinforce flexibility with something the child is already doing. So if they are eating dry/crunchy textures, try branching out to ANY type of cracker. Go from white cheddar Cheez-It to regular Cheez-It. Celebrate that as a new learning experience and new demonstration of flexibility.

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Alternating Acetaminophen And Ibuprofen For Fever

Lessening a fever in your baby or child, with multiple medicines, can be tricky. And it may not always be necessary. Many pediatricians urge avoiding “fever phobia” and allowing a fever to stick around, especially if your child is acting well. See this recent piece, “The Case For Letting Fevers Run Their Course,” by Dr. Paul Offit, an infectious disease expert on this take, the data behind it, and why fevers can sometimes help children fight infection.

Lots of families consider alternating medications like acetaminophen and ibuprofen at home to treat pain and fever, but I’m unconvinced that this leads to better outcomes for kids and/or improved fever control. It’s not my recommendation that you try alternating medications, and this post is not here to endorse this approach, rather if you choose to, I’m hopeful that this will help you do it more safely.

It’s important to note that the dosing amount for one medicine AND the duration of time between doses for medicines can be different from one medicine to another. So it can get confusing, FAST. However, armed with a plan, alternating medicines can be a good way to feel in control of supporting your child with medicines that relieve fever, improving your child’s behavior and comfort.

First….and I know I said this but I gotta say it again: it’s not necessary to treat every fever. And it’s certainly not ideal to treat the numbers on the thermometer. What always matters most is how your child looks to you and how they appear. Fever is a natural response of the immune system — it’s a response to illness, not illness itself. Fever ultimately can be productive and may assist your child’s body in fighting off infection. There may be no reason to make a fever disappear if your child is otherwise acting well, playful, and staying hydrated.

Second…there are some fevers that do require a visit with the pediatricians. It’s important to seek care when fever persists after 3 days in infants and children, any fever in a baby 3 month old or less, and if fever is over 104 degrees it’s wise to get support. Talk to your doctor before giving a pain reliever or fever reducer containing ibuprofen if your baby is younger than 6 months. Talk to your doctor before giving acetaminophen to a child younger than 2 years to obtain the proper dosing instructions, or see charts below.
Before giving your child any medicines, make sure you know your child’s weight. Dosing is always based on a child’s weight, not age.

Last… trust your instincts! If your child looks unwell in the face of fever and doesn’t seem to be improving as you would expect, call your pediatrician for help! If the fever is unexpected in a way, consider calling in to get support and education.

Ok…now that we’ve got all that out of the way, here is one way you can alternate between medicines (acetaminophen and ibuprofen) every 3-4 hours: Read full post »

After The Vegas Shooting: What To Do Now And How To Talk To Children About Firearms

In the wake of the recent Las Vegas shooting, I went on the Seattle NBC affiliate, KING5 News, to discuss how to talk to your children about guns and violence. Frankly, it’s not the first time I’ve covered this topic and as horrifying as it is, it probably won’t be last. I’m upset and sad that these shootings are becoming a part of American culture and I’m committed to doing my best to learn and translate what the experts advise us to do to decrease deaths from firearms.

I have lost people I love dearly to firearms so like so many of you, this is personal.

No question that we can feel helpless after horrific events. Focus on what you can do and share that with your children. If there is a gun in your home, keep it locked, unloaded & separate from ammunition. Remember that exposure to violent media and violent video games will change your child’s relationship with firearms – the “weapon effect” is real – so think carefully about what video and media your children use. Common Sense Media is a great site to help you sort out your choices.

Guns And Violent Media – A Toxic Mix With An Available Antidote. <— read this, it’s amazing. Basically the gist: violent media changes what children think of and may do with firearms and firearm safe storage reduces firearm suicide and accidental shootings by 75%. Seventy-five percent reduction of suicide deaths and accidents from firearms just with storage. Talk about it, do it.

As individuals we obviously can’t prevent mass shootings by what we do in our homes today, but we can communicate openly and honestly in age-appropriate ways with our children, we can build a safer culture with our firearms in America, we can vote, and we can remind children all of the things we do to increase safety in their lives. We can make sure that those around us know how much we want to keep firearms out of children’s hands, too. This will help. Read full post »