Ibn's 1st Speech Therapy at Feeding Clinic

In 3 weeks time, dear ibn is exactly 2 years old. Still he has not produced any clear verbal output or even any syllable. From his follow-up checkup at KKH in May, he was referred to the Speech Therapist at the Feeding Clinic@Rehabilitation Centre. I agreed to it as it has also been one of the main concerns besides his weight and height matters.

Yesterday, we went for the 1st appointment. Initially, I asked myself what speech development got to do with the feeding clinic (my understanding of feeding is literally related to food)?! While waiting for our turn, there were several observations that I notice about ibn with regards to his sense of security.

1. There are 2 3-D manipulative rollercoasters at the waiting area. When I introduced one of them to ibn, he smiled to me. He refused to go to a seat without me around. I supposed he was not very familiar with the place and yet to feel secure there. So I have him sat on my lap to allow him explore with it. Opposite him was a small boy about his age playing with it. I played along with ibn before he had his hands on the beads moving to the curves of the metals.

2. At another rollercoaster table, ibn was playing with it without me around.

3. Then came a parent with her kids who then played with the rollercoaster. Ibn stopped playing and came to me. Again he did not feel secure with strangers around.

4. When he left the table, the parent took the chair and sat next to her son on the opposite side. Upon the parent getting out of the chair, ibn took the chair back to its original place. (I thought he wanted to sit and continue playing). Actually he was doing some housekeeping. :)

5. In the feeding clinic, when the dietician wanted to take his height and weight, ibn cried. So I had to carry him on the weighing scale for the weight minus mine.

6. During the initial mingling with the SLT, ibn was taken aback to hold any material she gave. After awhile, with her approachable touch, ibn went to her and to a certain extent carry out some instructions without feeling fear/insecure.

After the therapy, he was on his own going to this rollercoaster toys and walking within the waiting room on his own. In order to feel secure, ibn thus needs to familiarise with a new environment by observing before exploring the environment on his own. This is what is called transition.


At the feeding clinic...

WITH DIETICIAN SIEW CHOO
Based on her calculations, Ibn's weight gain is 92%(August) when compared to 94%(in May) from his 1st last 2 visit (9.75kg). He is now about 10.3kg. Still in the 10th percentile. Expected normal weight gain per month is to be 150-240g. He achieved the expected weight gain, but still at the lower area.

I was asked about his one day diet in general. I was then told that ibn needs to take in more calcium food like cheese as in cheese crackers and yoghurt like the "petite mian" brand. I suppose it was due to him taking expressed breast milk. Looks like he has to drink his Friso 3 back (advisable alternate with EBM) - this time more diluted portion, that is 2 scoops : 120ml water at least 3 times a day.

Then I was advised on the amount of Nutricomp Caloric to be put in his food.
That is to start with 1/2 of 5ml spoon : 60ml fluid. Then gradually after 3 days to increase to 1 of 5ml spoon : 60ml fluid.

WITH SPEECH THERAPIST THERESA TO
What did the SLT do to do her initial assessment...

1.Ibn was asked to open the fridge demonstrated by the SLT. He in turned closed it when she opened it, asking him to take what he wanted from the fridge. (Observe whether he can follow instructions)

2. Ibn was given Baby Bites. THe SLT asked him to give the pack to me to have it open. He did that.

3. After being ecncouraged, he took a piece of the baby bite and ate it, being observed by the SLT. She too try feeding him from the sides and the front teeth. According to her, he has very strong front teeth.

4. She then held a hammer shape made of foam to let ibn bite the handle repeated times. This confirmed that he has difficulties to bite using his sides teeth especially the left ones. Instead he turned his head to the left and used his front teeth. Not so much happen for the right side.

5. She then took out a toothpick having foam of star shape at the end. It was used to brush his both sides of his gums and internal cheeks. This is one of the activities to stimulate his oral cavity.

Based on my input, ibn currently produces mainly vowel sounds.

After doing the necessary initial assessment, the SLT informed me that there is not much problem with ibn's eating habits, but need to come for another appointment to further confirm his eating habits. Just that he does not bite from the sides of his mouth and at one point of time, stuffed the biscuit. It is recommended by her for him to see the SLT rather than to the feeding clinic.

My homework to assist ibn in his speech development...
1. Stimulate oral cavity (brushing his gums and internal cheeks)
2. Feed biscuits and nuggets with side teeth
3. Make funny faces with tongue and lips in front of mirror
4. Copy the sounds of /b/, /m/, /p/

Next visits are to see the SLT in about 2 weeks time; dietician in 3 months and feeding clinic in 6 months. I hope ibn develops like a normal kid, but at his own pace, despite his delayed speech development.

by Ummu Zainah (thats why its very long heheheh....)