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Today’s episode is one of a kind – and expertly leads us into incredible detail into the physical and physiological principles behind picky eating and other feeding disorders, especially in children and adults with Down syndrome.

If that sounds complex, I assure you that while it is complex, it is not complicated. Dr. Kay Toomey, in this episode talks to us about postural stability and breathing and how they relate to feeding Delays, or disorders. 

I love it when an expert takes us back to the basics. We are often so busy looking for hacks to a particular issue that we lose track of the fundamentals. This episode is just that – a journey back to the very basics, so we can pick up what we missed and address the root cause of picky eating.

You can find Dr. Toomey at www.sosapproachtofeeding.com and you can find her freebie made just for you – a collection of Low Oral Motor Demand Foods at www.functionalnutritionforkids.com/feedingsos

Clicking on the above link will also give you an ACTION handout of this podcast.

 
Functional Nutrition and Learning for Kids | Listen Notes
 

 


Audio Transcript:

Vaish:

On. Today’s episode is one of her clients and expertly says in incredible detail about the physical and physiological principles behind picky eating, and other disorders, especially in children and adults with Down syndrome. Now, that sounds complex, I assure you that while it is complex, it’s not complicated. Dr. Kay to me in this episode talks to us about postural stability and breathing, and how they are so important when dealing with feeding delays or disorders. And she has done a phenomenal job of breaking it down. They love it. When an expert takes us back to the basics.

We’re often so busy looking for hats for a particular issue. What can we do right now for picky eating? What supplement can I have? What food can I change? Right? What therapist can I see and so on, that we lose track of the fundamentals? This episode is just that it is a beautiful journey back to the very basics so we can pick up what we missed. And address the root cause of picky eating and any other feeding disorder you may have. And this is specific to children and adults with Down syndrome. But I think you will find that anybody can benefit from the detailed fundamentals that Dr. Toomey talks about. You are listening to functional nutrition and learning for kids. I’m your host Weisz. And if you’re looking for a new approach to learning and nutrition for your autistic child or for your child with Down syndrome, you are in the right place. Listen on. Hi, Dr. Tomi Welcome to functional nutrition and learning for kids. And I’m so grateful and glad that you joined us today.

Today, our focus is on feeding issues and feeding disorders in children with Down syndrome, which I always think is a topic that’s often not addressed enough. So let me jump right in. What are some factors that you consider specifically when working with feeding issues or picky eating in children with Down syndrome?

Dr. Toomey:

So one of the things that make children with Down syndrome unique, of course, is some of the factors and features related to their medical genetic diagnosis. And, and the two major issues that we always need to be thinking about with a child with Down syndrome is the low muscle tone. Hypotonia, of course, is one of the defining features and challenges when we live with someone who has Down syndrome, of course. And then the second is that many of the children have cardiac issues. And that also can create some additional stressors, especially for very young infants with Down syndrome.

Children because of their low muscle tone with Down syndrome, oftentimes, you’re going to struggle with breastfeeding and bottle feeding. And if the baby also has cardiac issues, that is going to create kind of a double whammy for that child, because we know that one of the challenges from a cardiac standpoint is fatigue. And one of the issues, when you have a low tone, in doing any kind of motor task, is fatigue. And so the child who has low muscle tone and a cardiac issue are going to have potentially a double fatigue issue that they’re trying to deal with and trying to work with. So I think it’s probably best for us to focus on the low muscle tone is that’s going to be the majority of the population of children who have Down syndrome. And there are two major components of feeding that that tone is going to impact.

Many times people will think about it purely from a self-feeding standpoint and being able to get the food up to the mouth. But actually, it begins earlier than that with what we refer to as postural stability. So in talking about the body’s list of priorities, the body’s number one priority is not eating. The body’s number one priority is breathing. So if you think about the last time you had a really bad head cold, and you couldn’t really breathe and eat, you take a few bites of something, and then you can’t really breathe, your nose is stuffed or something. And so what do you do you kind of relax.

Then you take a few more bites, and then you have to stop and breathe some more. And about the third time, you do that you’re like, Yeah, and I don’t want to do this anymore. And you’re done. So we know breathing comes first. If you can’t breathe well, you are not going to eat well. And that’s actually why cardiac is a big having a cardiac issue is a big problem for children and causes feeding difficulties. Because while we don’t think about cardiac problems as breathing per se, what the heart does, of course, is the heart oxygenate the body. And, and so indirectly having a cardiac issue is going to impact the oxygenation of the body, it’s going to cause the child to not have good oxygenation, they’re going to have to breathe harder, they’re going to have to breathe more rapidly, because of that cardiac issue, and that’s what causes them to fatigue very rapidly as well. And so, so when you have the cardiac issue, you’re already going to be struggling with priority number one, which is breathing, staying well, oxygen oxygenated.

So for example, I live in Denver, Colorado, and so we’re a mile high. And so we have an issue with oxygen anyway, because of our altitude. But one of the things that’s very interesting here is we’ll have a child was born up in the mountains, so much higher, you know, in the mountains, and the child may come down to Denver because they were born premature or they’re having respiratory issues. And down here in Denver, we can get them transitioned off their oxygen, we send them back home. And to the mountains, where they’re several 1000s feet higher than we are in Denver, even though we’re a mile high, the mountains are much higher. And what we find is the child starts having feeding difficulties, they have difficulties with weight gain, the easiest intervention we can do with that child and with children who have cardiac issues is we actually can look at giving them blow-by oxygen during a meal.

The child actually will start eating better, and they’ll start growing better. Because by having pure oxygen in their immediate surroundings as they’re trying to eat, you enrich the environment or the oxygen in their immediate environment. And they don’t have to work so hard to breathe, and they don’t have to have their cardiac system work so hard to stay well option, oxygenated. And so you know, what we find is that when you struggle with your breathing, you increase your respiratory rate, when you increase your respiratory rate, you burn more calories because you’re burning more calories, you’re not going to gain weight very well because we’ve reached your respiratory rate, you’re going to fatigue more rapidly. So in the body’s list of priorities, breathing is number one, and not falling on your head is number two. I call it not falling on your head, because it’s really about the body protecting the brain, ultimately. So you don’t want to fall on your head.

What do you have to do? And what do you have to have in order to not fall on your head during a meal, but have good postural stability? And so postural stability is really the second priority breathing is the number one factor of stability is number two, as the priorities go. And of course, the low muscle tone for a child with Down syndrome is definitely going to impact that postural stability. So the poor child with Down syndrome, whereas both low tone and a cardiac issues is going to have problems with Priority One and priority two. But that postural stability is the one that we’re going to see most commonly impact the children who have Down syndrome. So the low tone, if, as you know, the low tone happens in the arms, legs, head, neck, and trunk is what we think about when we think about postural stability, that ability to sit in an upright stable position.

Now, after children sit up straight, most children on average are going to learn to sit at about seven months of age, depending on a child with Down syndrome level of low muscle tone. They may not be learning to sit until eight months, nine months, or 10 months. So one of the things we need to do is we need to always be thinking about a child with Down syndrome. How do we support their postural stability, from early infancy all the way into being an older child and even an adult with Down syndrome? We always have to think about postural stability. So when babies first start on baby food, we are going to put them in a slightly reclined back position. A swing seat is a good seat to think about feeding a baby with Down syndrome.

A bouncy seat is another option. And then there certainly are Adjustable infant feeding chairs where you can lean that baby back in a slightly leaned back position. And that actually would be my preference over a highchair. high chairs actually are not really constructed very well, to be supportive of children who have special needs. So an infant feeding chair, a swing seat, and a bouncy seat, would be a better option for families to begin feeding their child who has Down syndrome, you want the child to be leaned back so that their back is supported, and their head and neck are supported. And then they will be able to accept purees into the mouth from that position.

Vaish:

Are you saying that doctor to me because of number two, where you’re saying that postural stability is important that you’re saying when you’re in a highchair say then you’re a little bit more wobbly? So priority number two is not met is that what

Dr. Toomey:

so so when children first start spoon-feeding, we support their postural stability before they have good head control for the study by leaning back a little bit, okay. And, and, and one of the problems with high chairs is, and small infants. And many children who have Down syndrome are either born premature, so they’re small, or they’re born small for gestational age. So there’s Ma is that many of those high chairs, those big highchairs are too big. And, and, and the baby is kind of locked in that highchair because it’s too big. And that’s why a swing seat, an infant seat, or bouncy seat, or an infant feeding chair is going to be more than a highchair. What highchair manufacturers do the WHO adjust them so that parents can feed their children from infancy to however old they want them in the highchair is they have to make a high chair that’s going to fit the size of multiple children, right, and the size of multiple children as they grow up.

Children who have tone issues, really need to be put in the right chair, right from the beginning. And so of course, when we’re bottle feeding breastfeeding an infant, we’re going to be holding them in a breast or bottle-feeding position. But when we want to start doing spoon feeding, we need to be looking at when is the appropriate time to start it? And how do you know your child is ready to start those purees. And then how do we support them. For the most part, we typically are going to be recommending that puree started about six months. And that recommendation is in place in part because of gut maturity.

As well as the fact that there are certain vitamins and minerals that the baby gets from the mother in utero. And there are stores of certain vitamins and minerals, iron and zinc being two of the most important that are used up by about the time the child is six months of age. And so generally we want to introduce complementary foods around six months of age because children have used up that store of iron and zinc that they got from their mother when they were in utero. And, and so we need to think about that. The second major factor, so one is that maturity. So the one it has to do with is that you’ve used up your stores.

The third actual major thing that most people look at is the child’s ability to sit upright for about 10 seconds with good head control. So if you put your child in a seated position, they can sit upright for about 10 seconds with good head control without falling over. So they’re not sitting independently yet, but they have pretty good head control. Now the challenge is that most children with Down syndrome are not going to be able to meet that criterion. If you put a child with Down syndrome in an upright seated position at six months of age, many of them don’t have good head control, and they’re bobbing and they’re falling still. And so what we have to think about is how do we provide extra support for the child who doesn’t yet quite have the postural stability they need to start baby food purees and that is To be in that infant feeding Chair of bouncy seat, a swing seat, where the baby can lean back and have the back of the chair supporting their position.

Right. So sometimes even in that infant feeding chair, bouncy seat, or swing seat, the baby may collapse, right, right, the one side or the other. So, again, we have to think about how we provide extra support for that baby. So one thing to do is to take a hand towel, roll it up, and put it under the child’s arms, neck, to their sides in the chair, to give them extra side support, some trunk support, and that will help the baby not do that collapsing to one side or another. And so we just take a regular hand towel, roll it up into a tubular shape, and then put it right down the side of the chair. To help keep the child in position. What you’re going to see is that at some point, when the baby gets better had control, chest control, poor control, when you’re spoon-feeding the baby in this position, they’re going to start doing what we call baby situps. And they’re going to start and they’re going to start pulling themselves forward. Because they sit up more straight. That’s when you know, it’s time to put them in an upright seated position. Because the baby is now demonstrating to you that they have enough core, chest, neck, and head control that they want to sit up, right, sit up straight.

For most children who don’t have Tony’s shoes, that’s going to be around seven months of age or so we start feeding typically around six months. In that back, leaned back position, and about seven months, most babies are going to be ready to sit in an upright position. Again, with children who have Down syndrome, depending on how low their muscle tone is, it’s likely going to be closer to eight months or nine months or even for some children 10 months before, they’re going to start really demonstrating that they can sit upright independently with good control. So you would continue to make sure they’re supported in that slightly leaned back position.

Once your child sits upright, once children learn to sit upright, then we need to support them in what we call the 9090 90 positions. But that means we want to have in their seated arrangement 90 degrees at the ankles, which means their feet need to be grounded on something 90 degrees at the knees, and 90 degrees at the hips. That’s what we’re looking for a 9090 90 position.

Vaish:

Does that position hold for older kids and adults as well?

Dr. Toomey:

And adults, you and I should be seated in a 990 90 position. That is the correct position for all of us. Those of us who spend all day at our desks seated in a chair. Part of the reason why we end up with back issues and IP issues is that we’re not seated in an appropriate 9090 90 position. I am an adult because I’m kind of on the short side. I actually sit in my desk chair with a footrest under my feet to get me in the correct seated position so I can type on my desk.

Vaish:

Because I’ve been seeing my son try to find a good foot position and he’s also five foot one inch. So I think he’s just not getting that 90 In his right feet. Yeah.

Dr. Toomey:

Right. So So if you think about it, one of the things that that that you see, for example in a highchair is that when you put a baby who can sit upright in a highchair, their feet are nowhere close to the footrest. Their feet kind of dangling out there. So I want you to do an exercise with me. Okay. You’re the people who are participating in this podcast, watching this podcast, do this exercise as well. The first thing I threw together, we’re gonna sit up straight. I want you to sit up straight with good posture. And I want you Just think about what did you just do to sit up straight with your good posture? Well, what most of us do is scoot our hind end to the back of our chair, suck in our belly muscles, pull up our chest muscles, and put our feet flat on the floor. But what happens if you don’t have the ability to put your feet flat on the floor or flat on the footrest. So in a high chair, for young children,, the footrest in a highchair doesn’t ever let them put their feet flat. So so it’s not an appropriate tool on a highchair? Or in an older child, when we put them in an adult chair. Their feet are dangling in the air.

Vaish:

Right. So we still dangle Yeah,

Dr. Toomey:

Yeah, sit back up, right for me. And I want you to pick up your feet off the floor. And we’re going to pretend that our feet can’t hit the floor. Now, this is going to be a little artificial, because we have our feet out in front of us, right, and we’re using a lot of thigh muscle here.

Vaish:

I’m pretty short. So it’s okay.

Dr. Toomey:

If your feet can’t hit the floor, think about how much more effort it is to maintain your core strings. And to keep your body in a nice upright position. Now let’s pretend that we have low muscle tone, like a child with Down syndrome. So one of the things if I have low muscle tone, is I’m going to slouch a little bit, right. And one of the things is that if I’m slouching, and I’m on a slippery surface like most chairs are that don’t cloth on them, is I’m gonna start wiggling around, I’m gonna start flying. Yeah, one of the things you’ll see, children who have low muscle tone do is try to cheat or compensate by using their joints to do the work of the muscles, because their joints are going to oftentimes be stronger than the muscles which have. So if you sit up, right, bring your feet up off the floor for me, I want us to pretend that we’re going to lock through our hips, there are two things you might see a child do, they might lock forward. And so they have a big kind of bow on their back.

So they might walk forward. And in this really locked forward position, I want you to notice how your jaw and your mouth juts forward. And now I want you to try to chew. And I want you to take a dry swab. And see how uncomfortable that is. So most of the children don’t lock forward in their hips, but you’re gonna see most children do is they locked back in their hips. And if you push your hips forward in your chair, what’s going to happen to you, you’re going to slide down out of your chair. So what happens then is children who have feeding challenges, what you’re going to see is they are going to be really uncomfortable sitting in an adult chair if they don’t have good foot support because they’re going to try to compensate for their low tone by locking their hips. And that’s going to make them get in an incorrect position for eating.

Now, what some children do is they figure out, well, I can’t really lock through my hips very well. And you’re gonna see some children locks through their shoulders. So if you’ll take your feet back off the floor for me. And we’re going to slouch through our belly, like someone with low Tom. And now we’re going to compensate by locking our shoulder blades back. So you should feel a little more partially stable. But now I want you to try to feed yourself. Yep.

You can’t feed yourself if your arms and shoulder blades are locked back. So if you ever see a child in a seated position, who has their shoulders locked back, and their arms kind of up, it’s because they’re having a problem and not being pastorally stable. So that’s another issue. Now the third way that children experience problems from seating or when they have is if they figure out they can’t walk through their hips. They can’t lock through their shoulders and feed themselves.

The only place they have left to lock is the head and neck. So I’m going to have you sit back again. Take your feet off the floor. This time we’re going to slough pure our bellies and I Have their shoulders. And we’re going to try to compensate and make ourselves more stable by using our head and neck. So you could pull back, you could lockdown, you can lock up, you could chip to the side. So whichever position feels more stable to you get in that position. And now I want you to chew again, and take a dry spot. All right, and now we can put our feet on the floor. So when we don’t have good stable foot support, when we’re not grounded, what happens is our body tries to compensate. And it’ll either compensate, if I don’t have good foot support, oh compensated the hips, the back, or the head and neck. All of those compensatory actions are going to interfere with you being yourself and interfere with your ability to swallow properly. So that 9090 position is absolutely key. And the most important piece of the 9090 90 positions is the footrest.

You have to ground the feet, you need that 90 degrees at the ankles. Now, what we recommend, after an infant feeding seat, is it possible that the family will purchase an adjustable wooden chair? Now we know that those adjustable wooden chairs are expensive. We recommend you go to eBay, you go to overstock.com. You go to the variety you know, my good neighbor, the various kinds of websites that are parent exchange websites, right, where you can ask for, are you using your wooden chair anymore, and people will send stuff to you, right? The adjustable wooden chairs are key, because you can move the footrest and the seat and you can adjust those from the time the child is nine or 10 months when hopefully, many children with Down syndrome would be able to sit upright, and sit in that adjustable wooden chair all the way up to nine to 10 years, or even older, some of those adjustable wooden chairs. You can sit in them until you’re about 100 and sometimes 100 150 pounds.

Vaish:

Did somebody I interject with a question? Yeah. So I don’t know if we’ll have time to talk about pureed eating. But what you said made me think about if a child is lacing and all of these different positions that you mentioned, tightening, whether it’s their face and jaw, or their shoulders or their hips. And so you, you talked about how each one of them got in the way of chewing and swallowing. So if that pattern is said, and then nobody’s aware of that pattern, could that potentially lead to a child maybe not progressing into chewing harder foods?

Dr. Toomey:

Absolutely, absolutely. If you do not have a good foundation, if you don’t have good postural stability, you are not going to be able to chew well. And, and so that’s why we recommend for all of those children who have Down syndrome is that once they’re sitting upright, and they go into those adjustable wooden chairs, you just have to make sure they’re adjusted correctly. So he has to drop over the front edge of the seat. And you want the seat to be supportive, have as much of the thigh as you can. And that. So you have to adjust the seat up and down but forward and back as well. The footrest as well. You need to make sure you have the footrest adjusted. So the child can put their foot flat at that 90 degrees on the footrest and the foot rash far enough forward that the whole foot can rest on the footrest and you want the seat far enough forward that the whole thigh is supported. But you don’t want the seat so far forward that the child can’t get a 90-degree angle at the knee. And then hopefully you’ve got 90 degrees at the hips.

The other thing we recommend is to get some of the no-skid matting that you would put under your carpet to keep your carpet in place or the kind of shelf liner that’s the squishy, rubbery stuff that you might put in your kitchen drawers to keep your utensils in place. Keep your glasses someplace, and you want to cut a piece of that out and put that on the seat of the chair. Because the child is going to compensate for low tone, what we want them to do is actually lock at the hips. And when you put the no-skid mat on the seat of the child’s chair, it makes their little rear end, stick to the bottom of the chair to the seat of the chair. And, and it lets the child walk through the hips, and free up the upper body and the head and neck to be able to eat better. So those are the things that we’re going to want to do. So all the beading begins from the foundation of good postural stability. After the child sits upright, it’s that 9990 positions, and that is going to last throughout their entire lifetime. And as we know, many people with Down syndrome are short, in height, right?

My sister-in-law, I think, barely made it. Five, two. And so you know, when when you’re only five, two, and you sit in adult chairs, your feet don’t hit the floor. Think about as an adult, the last time you went to a bar or restaurant that had a tall top table, you got this stool that had no rungs to it? How uncomfortable is that? What do you do as an adult? Well, don’t you start by swinging your feet? And then you start squiggling around trying to find a good place and then you’re leaning on the table. Now on the back of the chair, you know when you put a foot up, and this is why children wiggle and squiggle at mealtimes. If they don’t have good postural stability, they’re not going to sit upright and they’re not going to sit still. You only have so much motor brain available to you at any one time.

Vaish:

That’s interesting. I’m just going to have you repeat that you said you only have so many motor graders.

Dr. Toomey:

Yes, you only have so much motor brainpower available to you at any one time. So if you’re using up all your motor brain power, to make sure that you’re not going to fall on your head, you’re not going to have the motor brain power, you need to make your mouth work correctly.

Vaish:

So it’s like a seesaw. So if you’re putting into postural stability, you’re taking away from chewing?

Dr. Toomey:

Exactly. Yeah, yeah. And I think about it like that domino effect, right? Is it or think about it is, you know, a series of steps you have to accomplish in order to get that step. If you don’t have good postural stability, you’re not going to be able to make your mouth work correctly. And that’s a huge issue for children with Down syndrome that most people are missing if you get the child postural, the stable, you put in the correct support. So your child can sit upright, and maybe it means you’re going to still have to build side supports, those adjustable wooden chairs don’t have side supports, what we do is we actually velcro yoga blocks to the seat on the sides of the child to give them side support. Oh, that’s nice. That’s yeah, yeah, we just take doubles, sticky Velcro. And we just Velcro yoga blocks on the sides of the child to give them that extra practice for once you have them partially stable. Now they can focus on making their mouth work to advance from purees. But this is going to be one of the major reasons why children with Down syndrome do not advance to the next stages of food.

Vaish:

Because they haven’t established that postural instability is really stable. And this can happen with older kids too. And regardless of you could be I mean, you’re right that typically heights tend to kind of maybe it’s more likely that even an adult is is is shorter in height than somebody else. But regardless of that, you could still be partially unstable.

Dr. Toomey:

Correct? Correct. So the best thing you can do to support any child who has Down syndrome is to get them in the 9090 positions regardless of their age.

Vaish:

And I’m going to go in a foot dress for my son, right after this.

Dr. Toomey:

Yes.

Vaish:

Thank you, Doctor, I think this was this this this you came in from the perspective of a child but I mean, like but what you’re saying is, I love the I love that the two top priorities I had before I read your work, I’d never heard about the fact that breathing was the first priority and postural stability or not. falling on your head is the second priority. And you’re saying that unless these two are addressed, there’s you’re really not going to see much progress in any form of feeding or chewing. Yeah, any form of feeding. And this may even manifest as picky eating but may not really be picky eating.

Dr. Toomey:

Right, exactly. And when I don’t have good respiratory, when I don’t have good postural stability, I’m going to want to stay on the easiest textured foods. So I drink my calories because I can suck those down, and clear them out of my mouth quickly. Or I’m going to want a puree that’s just going to slide down quickly and not take a lot of effort.

Vaish:

And so eventually becomes a pattern that is hard to break. Right?

Dr. Toomey:

Absolutely. Because then you’re not laying down brain pathways to learn how to eat other foods, either. Because if somebody tries to give you textured table food, and you can’t manage it, then what you have is an aversive learning experience where you have tried something and it didn’t go well.

Vaish:

So so we really have to think about how do we physically support the child with Down syndrome first, and when they have good head control, and we feel like they’re doing okay, with the pure age, we do need to start introducing other textures to build that sensory tolerance, and at the same time, build the stability, right.

Dr. Toomey:

Because they are going to need to put more effort into learning how to chew because have low muscle tone. So low muscle tone isn’t just in your head, neck, trunk, right arms, and legs, low muscle tone, is all the entire GI tract, and gastrointestinal tract. So your gastrointestinal tract starts from the tip of your tongue, all the way out to the bottom of the anus, right? That is, and it is a muscle, right. And so if you have low muscle tone in your arms, legs, head, neck, and trunk, you’re going to have low muscle tone in your GI tract. And so that means that your tongue may not move correctly, you may have difficulties getting the food, specially textured food, to move down the esophagus with the correct muscle move movement is what’s called peristalsis, you may have problems with the sphincter muscles in the GI tract, so the valve or sphincter at the top of the stomach may be a little bit loose. And so these children can have problems with gastroesophageal reflux because that valve at the top of the stomach that’s supposed to keep your food in the stomach is loose.

Food comes up into the esophagus, that’s what we call reflux, it could be that the valve at the bottom of the stomach is loose. And so you’re having a hard time getting the valve at the bottom of the stomach to close correctly, to keep food in the stomach, so you can digest it correctly. Because after you finish eating, you have to have the valve at the top of the stomach, close to the valve at the bottom of the stomach close so that you can digest your food because there are muscle contractions as well as enzymes and other kinds of things. And then you have to be able to open that valve at the bottom of the stomach, release the partially digested food into the intestines, then your intestines have to have good motor muscle peristalsis to move the food all the way through the rest of the system. So that you can take out the nutrition you need. And to make sure that you can eliminate the waste. So one of the things we know is that people who have low muscle tone have problems with constipation.

Absolutely yes, because they don’t have the muscle tone to move the, you know, bowel waste through the large intestine and out correctly. We know that when you’re constipated, that actually can cause you to have a poor appetite. And if you’re constipated severely enough and backed up very far into the large intestine, it can actually cause vomiting as well. So, the low muscle tone is going to have this domino effect beginning with postural stability and also then impacting digestion and then also impacting the Tao waste removal and potentially creating constipation, which then cycles back if you don’t have an appetite and creating all sorts of issues.

Vaish:

Right? So it is definitely, there’s a huge cascade of muscle tone. So there are so many areas, there’s actually the outward physical area that inward, it’s also physical, but it then becomes physiological as well and eventually becomes biochemical. There’s, there are so many areas, thank you, thank you for your actually such in-depth and intense knowledge, I’ve made two pages of notes I wrote down so much this is so beautiful. How can parents of parents reach your doctors from your work with you or your organization?

Dr. Toomey:

So the best way to reach us is through our website. And that is going to be www.sosapproachtofeeding.com.

Vaish:

Can I link that in the show notes?

Dr. Toomey:

And one of the things that I’ve done for your participants is I’ve created a set of recipes, which is what we call low oral demand. Rest, I love it. Yeah, so they’re high in nutrition, but they don’t require a lot of heavy duty to do it. Because the jaw is a muscle, and the tongue is a muscle. And to chew correctly, you have to first use the tongue to move the food between the G. And then you have to be able to chew with enough strength and a rotary pattern to break up the foods to get the nutrition out. Right. So one of the things you’re going to see with children who have low tone is they may be swallowing food that is not fully chewed up. And what happens is that digestion begins with chewing. And so if you don’t chew your food up all the way, sometimes the food can’t be properly digested.

So what if parents are seeing full food in their child’s bowel movement, that’s a problem. Because what that means, if the food looks the same coming out the back end, as what it went in the front end, it means the child exerted all that effort trying to digest that food, and they got nothing out of it. And if you are having full food, in your bowel movements, you are going to have an issue that also contributes to constipation. So not only did you not get any of the calories from that food, you burned calories, trying to digest that food, and it’s made you constipated on top of it. And so now we have a whole nother layer if you can’t chew properly, on a top solution. So at this point, we probably want to think about a talk about how to help support children chewing and how they learn to chew. But in the meantime, this set of recipes will give your podcast followers some lower oral motor-demand foods that hopefully their children can manage more easily, that have better nutrition in them, and will be easy to digest as well.

Vaish:

Thank you for taking the time to create that handout and you know, sharing it with all the listeners I know that you know it’s super valuable. Thank you so much doctor to me. And I know that there’s you have so much I feel like I could take every one of the things that you said we could make that a completely different podcast, I definitely want to want to talk to you again, whenever you have a chance. Let’s there’s just so much it’s I thank you for all my heart for all so much that you’re sharing with our audience.

Dr. Toomey:

Let’s have people start with a good foundation. Yes. And think about how do we build on that foundation? Absolutely.

Vaish:

I think this is a good first place for your families to start is build a solid build foundation and back up to what’s most important and what’s most foundational.

Vaish:

What a phenomenal podcast right now I’ve put together Dr. Toomey’s freebie on my website and that is functionalnutritionforkids.com/feedingsos okay. And this is her freebie made just for you which is a collection of low oral motor demand foods. Again, it’s functionalnutritionforkids.com/feedingsos  I’m working on a pamphlet that will have a summary of all the strategies that she mentioned. We will have a one-page action sheet to take from this podcast. This will be available by Sunday evening May 8, 2022. So today is the day the podcast is being released May 6. So if you check the website before then make sure to check it again. So you also get the action handout. Thank you for tuning in and bye.