New Toys and New Foods

We had our first session with April (our vision consultant) and our first session with Katie (our occupational therapist) this week. I plan to post what I learn whenever possible, partly for those of you that are interested, and partly to give me a log of what I've learned that I can easily come back to in the future.

On Thursday, April announced that she had come to change my view of toys. Apparently, children with visual impairments often develop tactile aversions. Now, we all know that tactile aversions can develop without a visual impairment (see my aversion to all things mushy and Doug's aversion to sand, tags, etc.). However, it is more likely to occur in a visually impaired child. As such, it's important to intentionally expose them to many different textures and sounds early and often, to help prevent the onset of these aversions.

Because of this, April brought a pegboard full of "toys" for Elli to explore. (I have a picture of the pegboard that I'd hoped to post, but I realized that the camera is all packed away ready for our trip to Florida tomorrow, and I just don't have the energy to unpack it so I can upload the picture! I'll post it eventually, I promise!) The pegboard has all kinds of different items on it that have different textures, make different noises, etc. The goal is for Elli to learn to explore these items and learn that they are good and fun. April also had Elli play with some metal bowls (not only are they a different texture than plastic or cloth, but they make a wonderful noise and they are cold, which is different), wooden spoons, leather gloves, wax paper, aluminum foil, etc. Obviously, some of those items (wax paper and aluminum foil, for instance) require close supervision so she doesn't ingest them, but the point is still the same.

As a result of this, I've taken a whole new look at the items in my house, to see how they might feel/sound to her. It's been interesting to see what kinds of new "toys" I can come up with. She has never taken a pacifier or a bottle, but when I handed her a pacifier now (thinking that's a different texture than she's used to), she thought it was great fun to chew on. Interestingly, though, she liked chewing on the handle fully as much as chewing on normal part. She did, however, think that chewing on the nipple from a bottle was very fascinating.

So, if I'm ever at your house, and you ask if I need something for Elli to play with, and I say "Sure - do you have any wooden spoons?", don't be surprised. Or if you see my daughter playing with leather gloves and think "Huh, that's an odd toy", this is why. (And have no fear - they will have been properly sanitized!)

Along with the new toy subject, we are supposed to let her play in all sorts of different textures. She normally spends most of her time on a carpeted floor, the sheets of her crib, or a blanket. Since she can sit up so well, April said we should let her play on a wood floor, since that's again a different texture, which echos and makes different sounds. We need to expose her to sand, water, grass, etc. It was suggested that we should take a tub, fill it with sand, shaving cream, uncooked macaroni, water, or kidney beans, strip her down to her diaper, and let her play, with the obvious caveat that close monitoring be done so that she doesn't ingest the stuff. (My mom suggested whipped cream instead of shaving cream, so that at least if she does ingest it, you know it won't hurt her.) The look on Doug's face was priceless when I told him that she needed to be allowed to play in sand. Interestingly, I feel similarly about playing in whipped cream - apparently my aversion to mushy items it stronger than I knew. I guess this will be a growth opportunity for both of us! :-)

I'm thrilled that we're leaving for Florida shortly - it's nice to know that I can consider a trip the beach therapy for her! It will also be nice to know that I can bring her out to play in the grass and know that I'm just doing something that's good for her. :-)

April did say that we are already, without necessarily knowing it, doing a lot of things right that are helping her, which is probably why she is not showing any other development delays - helping her do the Hokey Pokey with her arms and legs, encouraging her to "get our nose", playing Peek-a-boo from early on (even when we didn't know whether she could see us), Doug wrestling with her (which he calls scrumtumbling), etc. It's even more important for her than for your average baby to get a lot of close physical contact so that she doesn't become averse to touch.

On Friday, we had our first visit from the occupational therapist, Katie. She started out by "testing" Elli on all of her fine motor skills. The great news was the Elli passed all of the tests with flying colors except one - that one involved picking up a small block with her thumb and two fingers, instead of raking it with her entire hand. However, the block was a very blah color and quite small, so it wasn't interesting to her at all. If it's not interesting, why would she bother to pick it up? So, Katie said she's not the least bit worried about that.

Katie's main reason for coming was to work with us on Elli's eating. So, she had me feed Elli baby food while she watched, and then gave me feedback on ways to help Elli. Some of you have asked "How would her vision affect her eating?", and I honestly thought the same thing at first. And then I read the following snippet: "Try closing your eyes and having someone feed you with a spoon. You can't tell when the spoon is coming, you can't see what's on the spoon, you don't know how quickly it's coming, etc." Even though Elli has a fair amount of sight, the principle is still the same - it probably startles her to have a spoon shoved into her face!

She did say that we are doing some things right, which was encouraging. To aid my memory in years to come, here are the things that we did that were right:

1) I've tried to choose spoons and bowls that provide good contrast with the food I'm feeding her. So, if I'm feeding her squash or sweet potatoes, I can use a white spoon. But if I'm feeding her oatmeal cereal, I need a purple or blue spoon - something that makes the cereal stand out.

2) Her sippy cups are bright colors, to make them visually appealing to her.

3) I let her make a complete mess, as much as necessary. (As a result, I have a couple of stained outfits that I cannot get clean - anybody have a good way to get prunes or green beans out of clothing - after it's been dried once?) :-) I let her look at the food in the bowl, touch it if she wants, etc. When I first put food on the spoon, I show her the spoon, let her take it in her hand, feel the food, and bring that spoon to her mouth herself. I then try to feed her with another spoon. So, it's not a complete surprise what's coming.

4) I try to make a noise or some other indication that the food is coming, so the spoon doesn't just appear out of nowhere.

5) She's apparently doing just fine with the sippy cup for her age, so that was encouraging. She doesn't swallow what comes out, but that's apparently normal at this age. She does bring it up to her mouth, though, so that was good.

Here's the things that she said we should change/modify/try to help her more:

1) Be consistent with the word I use to indicate that food is coming. I have chosen to use the word "bite" as her verbal cue. So, I will say "Ok, Elli, it's time for a bite", or "Elli, are you ready for a bite?" By using the same word everytime, she will learn to associate that verbal cue with opening her mouth.

2) I should slowly bring the spoon to her mouth, and then always touch her bottom lip with the spoon. I should then wait until she opens her mouth and moves forward for the spoon. If she knows that the food will always arrive in the same place after she hears the word "bite", she will be able to be comfortable with the routine, instead of wondering where it might be.

3) When food comes back out, I should not use the spoon to "scrape" it off of her chin or cheek - I should just let it be. That way, she has no conflicting information about why the spoon is there or where it should be - it will always be at the bottom lip with food on it, not taking food off of her face.

4) Since she's such a tiny little peanut, the high chair we had been using is very large for her. I didn't see this as a problem - since I was feeding her, she didn't need to use the tray anyway. However, Katie recommended that I should put a little of the food on the tray and just let her play with it as I feed her, and the tray on the high chair that we'd been using comes up to her chin. So...we are now using the travel booster chair that we had for all of her feedings, since it fits her little body better. This way, she can explore and play with the food.

5) Katie also recommended that we put black contact paper on the tray. Many of the foods that you feed a baby (oatmeal cereal, puffs, rice rusks, crackers, etc.) are a fairly neutral color, so they don't show up well against a white tray. She will need more contrast than that to see the foods well, so putting them on a black background would be good. (If you think about it, there aren't a ton of black foods that you feed a baby, and if it is black, I could just put it on a light colored plate.) We haven't implemented this one yet - we need to come up with something that can go in the dishwasher and be sanitized appropriately. :-)

6) Katie also recommended that we started with some "meltable" foods - ritz crackers, club crackers, rice rusks, puffs, etc. Items that Elli can feed herself, chew on, but will essentially melt in her mouth, so there's no danger of choking on them. We tried a rice rusk, and she chewed on that thing until it was almost gone!! So, she might be a child of her mother - loving crunchy things and disliking mushy ones. We'll see! I also tried puffs, but although she can rake them into her hand, she has a hard time getting them out of the palm of her hand and into her mouth. We may need to stick with larger objects for now.

7) Katie also recommended that we give her large items that she can explore, but that she can't actually eat yet. Large carrots (not baby carrots) that she can mouth, pretzel rods to play with (she loved that!), etc. This is mostly for exploration and to learn to accept different tastes. So, if you see my daughter chewing on a pretzel rod, don't be surprised. :-)

The good news is that Katie was pleased with what she saw, especially with the rice rusk - Elli was able to munch on that in the correct manner, swallow what came off of it, and move food around in her mouth like she should. So, all signs look good for improvement in the food arena.

The best part of all of this was that Elli just loved both of them - she was thrilled to have two new people love on her and pay so much attention to her.