Active Learning study group - Chapter 7 This video is posted online with the following chapter markers: Chapter 1. Normal Development of Eating Skills - Normal development of eating skills can take up to 4 years. Chapter 2. Teaching Eating Skills - Adapted your approach to teaching eating skills based on child's developmental abilities Chapter 3. Facilitating Learning & Independence - Best practices to facilitate learning & independence Active Learning study group - Chapter 7 Transcript [ Music ] [ Slide start: ] Narrator: Texas School for the Blind and Visually Impaired Outreach Programs present Active Learning Study Group, March 3rd, 2015; presented by Kate Hurst, Statewide Staff Development Coordinator and Matt Schultz, a Deafblind Education Consultant for the Outreach Programs. [ Slide end: ] CH00:00:25 Chapter 1. Normal Development of Eating Skills [ Slide start: ] Matt: So we are here today to talk about Chapter 7 in Lilli's book, Early Learning Step‑by‑Step. It's kind of a fun chapter, kind of an easy chapter. I think she outlines the information in a real as a matter of fact standpoint. It's kind of easy to follow, which is nice. And it's all about learning to eat. Kate: Yes. Matt: And kind of teaching to eat. Kate: Yes, yes. Matt: At the same time, right? We learn about both. I thought it was interesting, in the first part of this chapter she points out that, "Students without disability learn to eat in a span of 2 to 4 years." Kate: Yeah, which, you know, I tell you for me, I thought that was ‑‑ it seemed like a long time. [ Slide end: ] [ Slide start: ] Yeah. At first, too, then you start to think about when that process starts, you know, and It starts to make a little more sense. She also had a statistic that said, "Students with disabilities typically take 4 to 10 years to eat." And that got my wheels spinning, thinking back to the students that I've worked with and I think that -- that maybe y'all have this experience, too -- you know, I've worked with kids that are all over that spectrum. And -- and 10 years and counting I think. Kate: Yes, that's true. That is really true. Matt: Which, you know, Lilli kind of addresses in saying every kid looks different, depending on their disability, depending upon their ability. So it's kind of a hard task that she sets out to explain this process, but I think she does a pretty good job. We will go through it together and see what we think. In the beginning, of the chapter, Lilli starts out by explaining to the reader what the typical pattern is for an adult's approach to teaching a child to eat. [ Slide end: ] [ Slide start: ] Says the adult shares the spoon with the infant -- to play with, maybe as the adult's feeding, to kind of keep the child busy, as mom is trying to eat her meal. Typical that adult uses the teaspoon to feed, which we saw in that little picture. That the child is still sucking, that they're not really opening and pulling the food in, skillfully. They are using that sucking motion to get the food off the spoon, and then the end of that suck results in the food being expelled out of their mouth, often on to the chin; and then it's really typical to see an adult then kind of use that teaspoon to scrape their chin, and clean it up, and get it ready for that next bite in. And I know, you know, from experience in seeing people, it's all about efficiency and getting the volume in the belly. Kate: That's right. [ Laughter ] Matt: You know, I don't think a lot of people, a lot of moms and dads at this point in their eating ritual are really thinking a lot about teaching. Kate: No. Matt: I think it's -- it's trying to get that feeding completed and on to the next day's task. Kate: That's right. That's right. Matt: So I think it's interesting that Lilli kind of cues us in that even though the adults may not thinking about that, the kid is! They're learning, so... She points out that typically the adult will move to a bigger spoon as the meal gets bigger, but continues scraping that chin. And then at the end of the meal they scrape the plate to get all of that food up out of there and into that kid's belly. Also typical that the adult allows the child to use their fingers to feel the food; up to a certain degree... [ Slide end: ] [ Slide start: ] Kate: And then they get cut off! [ Laughter ] [ Slide end: ] [ Slide start: ] Matt: And then they get cut off. Yeah, yeah. That could be dependent on the person that's eating with the child, could be dependent on their mood that day I think. Kate: Or the particular food. Matt: Or the food, yeah, good point. That if the child is teething, that a teething biscuit or chew toy is usually provided. That the adult will give the spoon while feeding with another spoon. So like the child will sometimes hold another spoon while we've got the -- Kate: When they decide the little one is about ready to try, they'll give them one. Yeah. Matt: That the adult will fill the spoon for the child and place it on the plate and that the -- the adult reduces the feeding to a minimum. I think it's switching as much work load as possible right? Kate: They start backing off and allowing the child to do more of the feeding and -- Matt: As they're ready... Kate: Yeah. [ Slide end: ] [ Slide start: ] Matt: This guy is kind of advanced here. Kate: Yeah, got that spoon but he's using those hands. [ Laughter ] [ Slide end: ] [ Slide start: ] So that's typical. That's good to know, right? That that's okay. Also with the adult's approach, adult accept child uses fingers, like we're talking about, sometimes even placing the food on the spoon. But sometimes if it's too messy, the plate goes away. Sometimes the adult may insist on helping the infant, although the child is really determined to eat. Again kind of dependent on some other factors, kind of a shared responsibility. Kate: Well, I kind of remember with every kid that I've ever been involved in, they hit this place where "No," you are not feeding them. It's the, "Please mom I would rather do it myself!" kind of syndrome. So, yeah, that's always interesting when they hit that place. Because -- and even though they still may need a little help with something, it's like you will not be feeding them anymore, you know. [ Slide end: ] [ Slide start: ] Matt: Now she kind of switches and talks about the infant's approach. So, kind of what this looks like from their perspective. The child will grasp and let go of the spoon, often just for play, you know, just starting to experience that the spoon is part of this process. They would hold the spoon, accidentally tap the table, maybe their head, maybe the adult, maybe both. They move the spoon from hand‑to‑hand, if they have that ability. In the high chair the infant will grasp the food using their grip and bringing it to mouth, smearing it all over. It's messy... Kate: That's that great [lips smacking], you know, just sort of smushes in their face that I love so much when they are doing that. [ Slide end: ] [ Slide start: ] Matt: It gets messy. They might take the spoon from the adult, or sometimes just kind of ride along; I see a lot of kids do that. Again taking it in, learning those motor patterns, learning what's involved in this process. Again lots of tapping. They might stick the spoon in the food without actually being very successful, but they kind of know that's part of the process, they're not very good at it at first, but the spoon is touching the food. And they might try to pick the food up with their hand and put it on the spoon. Kate: Yeah, that's one of my favorites, is when they get into their plate, they put it on the spoon, and then they're like, "Whoa..." and then it falls off! You know, they barely make it. Matt: When I've seen teachers quickly -- like correct the student or supply them with help in that situation, but I think it's good to know that they are trying to do what's being asked of them... Kate: It's kind of an important step in a lot of ways. I mean, one of the things it's demonstrating, they know that that food is supposed to go in the spoon, you know. That you're supposed to use that spoon, you know, and It's just a motor activity that's a little too much for them. [ Video start: ] Narrator: A little girl with a bowl, with what looks like cream or yogurt, and she's playing with the spoon. Her mom is trying to feed her some with another spoon, and her mom puts the spoon in. She tries to put her spoon in, but really doesn't get anything on it. And then she gets a little bit, but it mostly goes on her face. [ Video end: ] [ Slide start: ] Matt: So Lilli talks about the fact that infants use -- eat some food using fingers, they grasp crumbs, maybe dip one finger in the bread or milk, there's a lot of tactile exploration as they start to develop this pincher grasp, which is a really important developmental skill...in eating, both at this phase of the game, for infants, but we all use that grasp regularly, right? Anybody that goes to a Chinese restaurant user the pincer grasp to use your chop sticks. The infant will grasp and let go of some food, they'll put some bits of food in their milk, kind of gets all over the place. Again a theme. They'll place food on the table next to their plate. It's messy! If you -- just even watching that video...it kind of looks like a disaster if your goal is to, like, eat successful, but they're not there yet. So it's practice. Kate: And they are really exploring their food as much as it's about eating. You know, It's experiencing those textures, seeing what food does if I drop it off my tray and it goes to the floor. Kate: All of that development stuff that we've been talking about, through movement, through student or kid initiated movement, is being brought full force into the eating arena. [ Slide end: ] [ Video start: ] Narrator: A child sits at a high chair with small pieces of food on the tray. He carefully pinches the food with his two fingers to grasp and successfully puts it in his mouth. He continues to pick up another piece of food in the same way. [ Video end: ] [ Slide start: ] Kate: I think a lot of you have seen this going on, but it's that behavior that you see from children when they have these things on their plate and they begin to go for these tiny, tiny little crumbs. You know, there will be big hunky pieces, but they'll go for these tiny little crumbs and pick them up in a pincer grasp and put them in their mouth with one finger. And it -- they will continue to eat for a long time, but again, it's got more of a play quality to it than, "I'm hungry and I'm trying to nourish myself." Then once they kind of continue on, you see them taking an adult's fork, and this is always a real interesting place, when they try to stick a bite of food on their fork, and they can't quite do it. And she talked about this, and I had forgotten this, but you see it with kids; they do a big thing with their elbows, where they raise everything up and come at their food like this. She explained that a lot of that is kids -- they don't have the strength, a lot of times, to puncture the food and so they're using all of their upper strength to kind of get -- get into that bite of food. Then you see them eating with the fork and then, it seems like around four, if I remember, is when all of a sudden they get real interested in knives. And I can remember that because my great niece, at four, was very interested in knives, and every time she would come to my house for dinner, we would have to have long discussions about what knife she could have; and I finally got a little butter knife, put it at her plate so that she could use it. But it was, you know, she would imitate what we would do to some degree, but she kind of used a knife more like a fork, at first, and then she began to sort of get that you had to do something back and forth with it. But she'd do it without holding on, or she'd hold it with her hand, eventually. She would do all of this playing with a knife but a knife became really important to her. And then that place where a child is just going to stop eating if the adult interferes too much. And this is when I think, you know, my niece right about four and a half, she was pretty adept and if, you know, if mom started, you know, wanting to help her with any bite of food, it was just like I'm done, you know. You haven't getting another thing down my mouth, you know. [ Laughter ] Alright. So Matt... [ Slide end: ] [ Slide start: ] Chapter 2. Teaching Eating Skills Matt: So next Lilli talks to us about changes that can occur in our approach, if our goal is to help our students become independent eaters or independent as they can be. For bottle fed students, Lilli recommends that if a student cannot reach midline, that the teacher should offer a warm doll's bottle for them to hold, so they have kind of a like object, that they get to experience during that process, and the idea is that that will help -- give them information about what's happening until they develop that midline skill, when they can -- they can touch the actual bottle. She does point out that forcing the child to hold the bottle is ineffective in teaching them to become eaters. So I think that's something for us to remember. As tempting as it can be sometimes to just make them want to get to somewhere they're not, it not effective. They really have to go through the steps to get there. She also introduces some questions or kind of a talking point at this point saying, "Okay, if they're going to learn what we teach them, we really have to be mindful about what it is that we are teaching them." And if the typical approach, like we discussed, involves scraping their chin between every bite, what are we teaching the student to do? Kate: Scrape the food up, put it in your mouth. Yeah. If we see them with the spoon on their chin we're going to go, "Whoa, that's not what I want you to do." So, be mindful of what we're teaching. So if we don't want them to scrape the food off their chin, maybe we should let it go. Lilli recommends using a serviette, which I had to Google. Kate: It's a napkin. [ Laughter ] Matt: Contextually, I figured it was such, but I did have to Google -- it's a napkin -- what the Brits call a napkin. She also says that a change that we can do is changing the amount of food on the spoon. If it's getting all over their chin, maybe we need to take a little less than that teaspoon up in the spoon to kind of minimize the amount that ends up on the kid's face. She goes to say and discuss like -- that we should be placing the spoon on the plate after each bite, even if the student can't see this step, they may be able to hear it. And the reason she wants them to be able to hear it, is they need to understand the spatial relationships between their plate, the food, the utensil and their mouths. And every time they hear that spoon go back to the plate, after they've eaten, they know that that's where they have to go retrieve it. And then they'll learn that, first you retrieve it, then you scoop, then you bring it up to your mouth, then back down to your plate. That kind of pattern -- if we keep them out of that step, or keep that information from them, they are not going to learn. Kate: Well, I was thinking, too, with that, if we have been working with the child and developed an appropriate bond with them and allowed -- and not overly handled their hands but gotten in where they are more comfortable riding our hands, how nice it would be if we could get their hands to stay with ours as we did that process and brought it back because, you know, I think especially by the deafblind child, they might not be able to hear that spoon. Matt: Good point. Kate: The other thing that I was thinking about is -- is if they won't do that and you are trying to cue them on that plate is maybe bringing that spoon down a little harder on the plate, so that perhaps there's some kind of vibration, you know, or that the volume is enough that there might be some better possibility of them picking up that sound. Matt: Yeah, kind of exaggerating that bit of information. Kate: Just a little bit, yeah, yeah. Schultz: And I know, Kate, I have seen really skillful teachers help students with this step as kind of as they are finishing that swallow, going hand-under-hand and inviting... Kate: Let's see, get me over here... Matt: Coming in, if I'm the teacher, Kate is the student, coming in hand-under-hand, kind of inviting them to the spoon and then peeling away as the student develops that ability. Kate: Right, right, right, right. Matt: It's an important step if we're going to teach them to be as independent as possible, they need to understand that spatial relationship. Kate: Now, I was sort of puzzled by this "refrain from plate scraping." You know, and I thought well, I kind of scrape my plate at the end of some meals if it's something I really like. I wasn't quite sure how I felt about that, but I get her point, you know, on some level. Matt: Yeah, to me there's -- I think because the eating ritual is such a cultural experience, every family kind of has their own line of what's appropriate and what's not, you know. Yeah, I mean, I slurp my cereal bowl, I'm going to have to be careful as my son gets older. Unless we decide it's okay to slurp your cereal bowl. Kate: That's exactly right. That's exactly right. [ Slide end: ] [ Slide start: ] Matt: Lilli points out if a student that's spoon fed, the spoon should be placed in their hand for feeding. So even if they're not doing it. Again, getting back to this idea that they need practice, they need experience with the objects involved in their routine. Kate's story about her -- your niece wanting to practice with the knife, is a good -- illustrates the fact how much all kids practice with things. So we can't expect our students just to -- to have them in their hand and develop that skill overnight. They need exposure and practice, you know, thousands of times. So by having another spoon in their hand during that meal, they are learning the concepts, they are learning that that item is associated with feeding and they start to learn the motor patterns with the object. Lilli points out to never guide the child's hand and the spoon to his mouth or plate. Your job is to give them the opportunity. Going back to this idea of not wanting to force the kid to do something. And I think it's helpful in our heads, as teachers, to remind ourselves that our job is to provide an opportunity to practice these skills, and that's all. Kate: I think, you know, if you are seeing a child sort of initiate something with a spoon, they're trying to get something or maybe like with a fork they are trying to pierce something; if you feel like that there is a need to actually support them in it, if you have to do anything, touch the fork itself, don't get their hand. Matt: She point that out, right, yeah. Letting the kid do as much as of the motor movement as they can... Kate: As they can do, yeah. [ Slide end: ] [ Slide start: ] Matt: In facilitating a young learner to eat, Lilli talks about opportunities to experience, this is what we're talking about, and to practice the skills required to do so. This is the best way to teach these kids independence and eating. Opportunities that provide experience for practice. Students who have only been fed or trained, you know, where the adult is doing a lot of forcing, a lot of hand guiding, they are not being given the opportunity to practice to develop these skills and this impacts kind of how they view themselves. If someone is being trained or hand guided they are -- they're going to feel and be someone who is fed. As opposed to through opportunities to practice they are going to identify as someone who can feed. Kate: Right and that's important. Matt: I think that again that's something for us, as teachers, to keep in mind, that that's our goal, is to help the student develop an identity as someone who can do things, who in this area we're talking about, who can eat. What a cool thing we get to teach someone, you know. Kate: Yeah. Matt: Lilli points out it can look different for all children depending upon the level and I think we all know that. Kate: Yes, yes, yes. [ Slide end: ] [ Slide start: ] Matt: So again first and foremost, opportunity to play with spoons outside of the eating ritual or the eating routine itself, Lilli talks about the importance of providing other times for the student to play with these objects and get exposure; grasping them, pushing them, dropping them to see what they sound like on different surfaces. Learning all of that conceptual information about these things that are needed. A blind child never sees other people using spoons or silverware. They need that time to experience the touching of the silverware, the sound, the movements, all of those bits of sensory information together before they are going to be skillful practitioners. Kate: And just in terms of activities for children, you know, this can be a really wonderful independent -- independent exploration time. I mean, if you think about utensils for eating, period, there's so many different shapes, there's so many different materials that they are made out of, you know, there's so many different sizes, and having a collection of those things for children to explore, and almost all of them have interesting patterns on them, you know, if you are looking at forks, they've got tines as opposed to a spoon that doesn't, you know. They're really very rich materials. And so I could see, you know, very easily just literally going around to Goodwill or flea markets and getting very inexpensive variety of different kinds of spoons and knives and forks and putting them in a big box or bucket or whatever and just letting the child explore and play with them. I also can see hanging them on a position board, you know, where they really have the opportunity to hold it and transfer it from hand‑to‑hand and explore which end is up, and, you know, how it feels in my mouth, you know, along with like baby spoons, all of the different kinds of baby spoons. Maybe the, you know, like OT's often have a variety of different kinds of spoons that they will suggest for a child, it might be an opportunity to put several different kinds out and sort of watch and explore -- see the child explore them to see if they seem to gravitate towards a particular spoon or be able to manipulate that spoon one better than the other. [ Slide end: ] [ Slide start: ] There's just a lot of things that you could do with those spoons and then on a resonance board playing with those spoons as, you know, playing little games of tapping, playing games of like bringing it up to your mouth. And just putting it in your mouth or letting -- following what they're doing with the spoon, if they're putting it in their mouth, you get it up and put it in their mouth, so they can experience that we all can do these things, put these things in our mouth. Matt: I like that point, Kate, because it provides the child the experience of doing something with somebody with the silverware, which is really what we're going to ask them to do in the eating routine. I know we have another video...This is a guy whose teachers did put some silverware in a box and provide a time for him to explore the silverware. One of the issues going on was that the little guy didn't...want an adult to be involved in his eating routine. When that silverware came out, he wanted to take control, but he didn't want to have the adult involved whatsoever, it was kind of hampering his progress as an eater. So the goal of this routine was to have some enjoyable moments with some spoons and an adult. And we're going to see his teacher Scott, see if Colby will let him play with the spoons together. [ Video start: ] Staff: Oh! Jerrod! I’ll have to tuck my big foot in. Staff: [child vocalizing] Jerrod, unh uh. Staff: Come here baby. [spoons tapping] [Colby vocalizing. Scott repeats vocalization] [background voices] You want to get your balloon? Go get your balloon. [child vocalizing; indiscernible voices] [background voices] You need your nose cleaned. [indiscernible voices] [background voices] Oh, [indiscernible]. No ma'm! Hey, you stop at the star, right there. You can't go past that. Colby humming a rhythm] Camera person: Yeah. Scott repeats humming rhythm] Scott repeats humming rhythm] amera person: Your turn. Colby and Scott humming] Kate: That's a great video. [ Video end: ] Matt: So again, Colby had was expressing some oral defensiveness during the eating routines, possibly because eating routines for Colby hadn't been that pleasant. So this was an attempt to kind of...get rid of that experience, and have some nice experiences with an adult and spoons and you can see, you know, just how much patience it required on Scott's behalf, but it wasn't that long, a minute and a half, Colby was inviting Scott in and I think the goal is to continue these type of activities with Colby, so that he can have good, positive, interesting experiences around spoons and adults, and that can translate back into his eating routines. Kate: Yeah, I think that is so important and I think, also, about our kids that are primarily tube fed and aren't able to take nutrition, that most of their nutrition orally, you know, keeping them playing with spoons and things that are associated with oral feeding, and having that opportunity to put that in their mouth and explore it could be nothing but beneficial. You know, I think that sometimes we think when a kid gets on a tube that we're just, you know, we're just done with that. But...that...there's so much information they can gain from their tongue and their lips, their mouth, that giving continuing to give them those objects associated with eating. I know food for a lot of these kids -- you can't put, risk any food going in their mouth but you can let them play with some of those utensils and mouth those utensils and I think that's a good thing. All right, shall I go back to the PowerPoint? Matt: We better. So a great example that it takes a lot of time and experience to learn these concepts. Colby is getting some time and experience to learn these concepts outside of an eating routine. Kate: The use of a buncher, I was going to ask you about that, maybe ask the group out there, how many of you have used bunchers with your students for anything, but especially like around feeding? Maybe put something in the chat. Any of you doing that? Twinkle is. Twinkle what has been your experience with the buncher and giving a buncher to a child who is maybe not able to hold on spoon on their own? Do you see them -- like have you done it when their feeding situation has gone on and do you see them, you know, being more participatory, at least trying to do something with that spoon that's similar to what is going on in feeding? Twinkle: Yes. Sometimes I would ask the O&M to help me out, I mean not the O&M the OT to help me out, it's usually about grasping, things like that. A lot of times they would just play with it because it was something foreign on their hands. It really took a while because that was another foreign object that we put around their hands to let them understand. But the OT would help me, also, because they have other adaptive pieces to help them. But my experience was all around feeding. Along with the classroom teacher and the OT. Kate: Well, I ‑‑ I think you brought up a really important point that we haven't mentioned when it comes to feeding, you know, you really want to be working with that OT, and asking them to help you get creative about how to bring this on line, because they may have some other ideas that would tie in to some of that feeding and stuff like that. But, you know, that whole issue of trying to get kids to experience what a typical kid is feeling with the utensils in their hands, with it coming to their mouth. Lilli talks about spatial orientation, when you get a spoon in your mouth, that tells you that you know where your body is in space, you know how to control the muscles things like that. And so having just that buncher there where you are not having to fight gravity or doing too many things at one time can be a real plus, I this I think. Matt: Twinkle I loved your point about involving the OT. And I think, another partner to think about involving in these eating routines is the families knowing that the kids eat a lot of their meals at home. And...the more we can communicate and stay on the same page, home and school, the better it's going to be for the kid. For sure. Kate: And you know, that makes me think, too, working with the family to suggest even if their child, for example a child that's being primarily tube fed can sit at the tail with the family and maybe, you know, have a spoon in their hand when others are eating, you know, and to smell the aromas of a meal. I have to think that keeping them engaged as much as possible, and I know for some kids it's not possible, but as much as possible in those family activities, even if they not actually sitting down and eating the meal, but they're sharing that social interaction, the smells of the food, things like that, can be really, really important. [ Slide end: ] [ Slide start: ] Matt: Lilli talks about when to introduce a fork, which is something that I hadn't received a lot of information on, so it was appreciated. She says when a child begins to chew is when the introduction of a fork can take place. I think she's talking about now within the eating routine itself. Hopefully that child has had some exposure and experience with forks outside of the routine. But for in the eating routine introduce the fork when the child begins to chew. After they take a bite from the fork, replace the food without touching the child's hand. That's what Kate was talking about earlier. You can if they need some help try to use the end of the fork. To get that next piece of delicious meat on the tine. When they begin bringing the fork to the plate, touch the end, provide other activities or games to help facilitate the increase in strength needed to stab the food. If the kid doesn't have the strength to stab the food, and you want to make them stab it during the routine, that's an easy way for things to go south pretty quickly. If they don't have the strength, think about other ways, other activities, other routines that can help facilitate that strength, that they can bring back to that eating routine and stab with more success. Kate: I was thinking, you know, you could do things like putting, you know, playdough or -- out with a fork and just poking it into the playdough to make images. You might even take a fork and do bubble wrap on a tray where you could pop the bubbles to work on just building that sort of stabbing, you know, kind of approach to things. Matt: You know, I was thinking of like sandbox activities... Kate: Yeah. Matt: ...or even gardening... Kate: Right. Right. Matt: ...when you are kind of pushing some objects with some resistance. Kate: Right, right, right, right. What about ‑‑ do any of you guys have other ideas for things that you might do to sort of work on that strength for stabbing? We'll have to think about that, come up with a challenge for things that we might do for stabbing. [ Slide end: ] Chapter 3. Facilitating Learning & Independence [ Slide start: ] Lilli ends Chapter 7 with a nice little kind of guide for -- for teachers. To facilitate the -- it facilitates the child's learning to eat if these things are in play. Okay. So if the spoon or fork fits the size of the child's hand, you are facilitating the child's learning to eat. If the plate has a shape and a size that makes it easier to use fingers or utensils, you are facilitating the child's learning to eat. Brings up Twinkle's point I think about OT's. Kate: And adaptive plates and bowls, or plates that have the one end with the raised lip so that they can scoop and it won't fall. Matt: I have seen some in the last couple of years, Kate, I haven't seen in years prior. And when I saw them, I thought, "Oh, man I wished I had those!" It had like a small reservoir inside the plate so that the food kind of fell into that reservoir. So if the student just had like one main scooping pattern, that the food would fall into that area, and the spoon would be kind of trapped into the bottom. Maximizing the success with each scoop. Kate: Important. Important. Matt: Yeah. A piece of dycem she recommends to prevent the plate from sliding. The handles of the cup are easy to grasp, or just the cup itself, you want to make sure it's right for the kid -- that it's the right size, that if there's handles, the child can use the handles to get the cup to their face. It facilitates the child's learning to eat if the bites are adapted to the right size, very important. Kate: Little tiny bites and cutting things up into little tiny pieces. Matt: Right. You know, all of us learn tasks that are hard, and we know these tasks are hard for our kids, making the task easier helps build success, which help builds skills. Keeping those bites really small at first is going to make it easier and more successful for the student. Making sure that the food offered is one that the child likes. Kate: Oh, geez. I...have, still, nightmares about being -- working with little bitty preschool, or actually daycare setting, and lunch time and trying to get them through the food that was served when it was something they didn't like. Oh, my. It's not worth it, you know. [ Laughter ]. It's not worth it. Matt: You can't really do it. Kate: No. You can offer them a taste, but that's -- you're going to have to try it one taste at a time to build the repertoire. Matt: The last point that Lilli makes is -- points out, it facilitates the child's learning to eat if the atmosphere during mealtimes is pleasant. And you know we've touched on that -- in the whole hour. But it's good to remember just how important the meal rituals are; to our students, to their families, to our families. And...how important it is that we teach these skills to kids in a pleasant manner so they can take them back and enjoy this time with their family. And I also think, you know, she talks about throughout the chapter that...there's a lot of skills and a lot of concepts involved in teaching eating. So, you know, hopefully Chapter 7 has brought us -- made us more familiar with them, more aware, you know, sometimes we find ourselves in conversations with other staff or other administrators who don't understand the importance, or that eating is an instructional time. Well, you can refer them to Lilli's book, because without question it's an instructional time that has huge implications for our kids. Kate: Oh, yeah. Well, and I also think for our kids that are, you know, visually impaired and multiply impaired; when we are thinking about independent living instruction, what can be more important than teaching someone to be able to feed themselves. You know, that is such a critical part of, you know, sort of survival, really, You know, but even thinking about kids that are going to...going to need life‑long support, if they can feed or help to feed themselves to some degree, it's a huge thing. It's a really huge thing. And I think because we do put so much social importance around eating and sharing meals and things like that, the more we can facilitate a child being able to participate in that kind of activity, which has so many potential rewards for them. It's a highly motivating activity, you know. I think that it's just really, really critical. But, you know, in terms of ECC instruction, it's kind of a must. And I think for most parents the better their child can participate in something like sharing a meal, the better it's going to be for them as a family in their social life, you know. They can go to places with other families, out in restaurants or things like that and feel like that their child is just a typical child, you know. But it is really important and I think going back and, for me, what this chapter did is going back and really looking at videos on YouTube about, you know, children feeding and reminding myself you're in the primo position now that you have a little one of your own to really watch all of those phases, but it's like remembering how many phases there are to a child getting to a place where they can feed themselves. And how much is involved and how... Matt: Practice. Kate: And practice and, like you say, we don't really think about teaching them to do it but we do. Incidentally, we are teaching them all the time. We are not always I think doing that same thing with our students who are visually and multiply impaired. We have a very short amount of time, a bunch of kids that need to be fed. It's easier to feed them. But the more we can get them engaged in that activity, if they are able to take food in orally, the more that we are looking at how with can we expose them and keep them exposed to those pieces and parts of eating and feeding; even if they are tube fed, you know, how critical those things are. And when we are looking for activities to do with these students, which oftentimes we struggle, this is a natural one. It really is a natural one. Matt: And highly motivated for a lot of kids, like you said. If you find the right food. Kate: Absolutely. And you know, if you look at a lot of our kids that are very developmentally delayed, I mean, I keep thinking about different things; like she talks about if you're feeding an infant at first, everything is a suck response. You know, how many kids have you seen that are like eight, nine, 10 years old, and they still only have that suck response. You know, are there things that we can do to...to work on that and will exposure to some of these strategies that Lilli proposes, you know, benefit these children as well? So...thoughts, guys? Questions? Comments? I'm not even really sure y'all are out there still. Renee: I'm still out here, Kate. I don't deal with feeding with my kids, but I do give them those spoons and forks and knives and, you know, all of those little things and I bury the plastic in the metal and big and little and all of that kind of stuff because, you know, you never know when some child might be given the opportunity to start to eat again, and it's just -- it's one of those things that gives them a lot of different opportunities to explore different things; and compare and contrast and all of that good stuff we like for our visually impaired kids to do. I still do that, even though I'm not teaching them to eat. Hurst: Well, you know, Renee you really are in that very unique situation where I don't I guess maybe one or two of your kids actually are able to take in food orally. But, you know, like you say, just that exposure is pretty -- pretty important and you just don't know where they might go. Renee: Well, then it helps with the oral defensiveness, too, you know the little boy exploring all of those foods. All of my kids because they don't eat by mouth are very orally defensive and this kind of thing allows them the possibility to do that and put it to their lips, to their mouth of their own accord. If they can do that. and if they can't reach it themselves, I try to give them that opportunity to feel different things with their mouths and, you know, it just happens to be something that, you know, typically developing people put in their mouths. So there you go. Kate: That's right, that's right. Matt: That's kind of in line with Hillary's comment on the chat, Hillary says: I'd love to know if there are ways to encourage mouth movements, other than sucking and swallowing. Even when they feed, so often their food is pureed. Kate: I didn't get much in this book about it. To me I would really like to sit down and talk with an OT about, you know, how they approach feeding, but I do know in earlier chapters a lot of the things Lilli talked about in terms of giving them opportunities to mouth a lot of objects is that that mouthing, besides giving them information, also develops tongue movement and lip movement. Things like that. And so I would think that, you know, the more exposure you can give them to things that they really can mouth, the better... Matt: Even when they're mouthing, they're swallowing, because a lot of times the salvatory glands produces some saliva, for students that are mouthing, which allows the throat to swallow that saliva. So that is in a way practicing those prerequisite skills, getting them ready to be chewers and swallowers. Kate: But I think working with your OT would be so critical for this piece of it, and figuring out how to go, and coming up with ideas like maybe even being able to put a little something on a spoon; like I'm thinking, you know, dip it in honey and get most of the honey off, but there's just enough where there's a little taste, it's a little sticky, you know whatever. Or a little bit of pudding or something, but again you've got to talk to your OT. You have to make sure that you know what you are doing. [ Slide end: ] [ Slide start: ] Well, I see our time is gone...we're still trying to plan for next year, so I would really appreciate your thoughts and ideas. [ Slide end: ] [ Slide start: ] Thanks, again, everybody. And we look forward to seeing you in April. Everybody go have a nice spring break. I'm ready for it.