This week I wanted to discuss coinciding topics that I have observed often in the past couple of years: low tone and reflux. (Take a gander at my two other posts touching on our “low tone” kiddos: Low Tone: It Is Not Just a Speech Thing and Kiddos Who Overstuff at Mealtimes.) A colleague and I were just discussing this topic and it looks as though more research is warranted. For today, I am going to reference my experience and these two articles. One article is from a parent perspective and one is from a nutritionist. I would love to hear from you if you have witnessed similar patterns in your practice. Why talk about reflux in a speech pathology blog post? Great question!
Kiddos that have a significant history of reflux may then go on to have feeding concerns such as what we like to call “picky eating”. When your belly does not feel well and you consistently have a burn in your throat do you feel like trying that “new food” or a less preferred food? I have to tell you from a personal experience perspective that burn in your throat is not fun. It is a distraction, it is harder to pay attention and block out the burn, and you just do not feel well. If you have apraxia, processing challenges, speech and language delays, etc, this impacts your ability to focus on receiving information from your environment and communicating, let alone when you do not feel well.
I have the privilege of participating on a developmental evaluation team every Friday with a Developmental, Physical and Occupational Therapist through Early Intervention. These gals have many years of experience and are a great team to work with. Time and again we have seen kiddos who do not tolerate tummy time; often have trouble with dairy products; do not sleep through the night; present with lower tone; torticollis, are “fussy” or “colicky” in general; excema; and/or have breathing difficulties. Within the 18 to 36 month age range I have observed these kiddos to walk on their tip toes, tend to run by leading with their chest and their arms are up in the air, still are not sleeping through the night, have breathing treatments, are more apt to get sick, and are picky eaters.
My kiddos with low tone may be “couch leaners”, “w-sitters”, pronate their feet inward, “overstuff” at mealtimes, have a slight open mouth posture, have rounded bellies, delayed speech, and are slow to respond to the environment in general. Then, with low muscle tone, may come poor posture for feeding. This may cause coughing, decreased toleration of foods, etc. So, why is it important to think about reflux? Because, it is uncomfortable. Often reflux is paired with low tone which can impact a variety of developmental skills; it is not just about speech. We need to think about kiddos globally and how the medical piece impacts their development. And by golly if it is impacting a child’s speech, it will impact how they perform during the day and their ability to learn.
I have to tell you that I am a coffee fan. My friends reading this post are nodding their heads. I have low tone and take awhile to get going in the morning. The energy it takes to see my kiddos during the day requires caffeine. Persons with low tone have to exert more energy to perform. That being said, I went through a phase in which I was eliminating food due to possible food intolerances and reflux. Do you know that when I stopped drinking Starbucks coffee the burn in my throat pretty much went away? Strangest thing. I can drink an Americano but not the regular brews. Sorry Starbucks, my friend over at Babies First Fitness has me on a kick of Dunkin Donuts “easy cream”.
Here is the thing, I can make those food and drink changes… your child cannot. It is up to you as the parent and the therapist to think about changes and to make the changes. I have been on a couple of cases in which the therapy team suggested dairy free for a couple of weeks. One kiddo possessed low tone with a history of reflux. She tended to overstuff at mealtimes. Decreased agitation, decreased need for albuterol, and better pooping was the result of no dairy in the diet. I am not hear to say this is the cure-all, but it is worth taking a look at a child’s diet. Why? Because, when you feel better, you sleep better and you perform better… It is not always just about speech.
It is important to pay attention to patterns and how your child is feeling. Here is a great article from Zero to 3 on managing reflux. I would rather see an infant on a trial of reflux meds early or trying different formulas than at 3 still running with his or her chest out, arms in the air and requiring breathing treatments, not sleeping well, etc. Your child does not have to be spitting up to have reflux. Usually when you see an outward symptom, it means whatever is going on in the body has reached the maximum it can take. And remember, low tone and reflux do not necessarily go hand in hand. In my experience, I have seen many kiddos where this is the case. Talk to your pediatrician. Rule out the medical piece if you have other concerns revolving around development.
If you are so busy thinking about your body and how poorly you feel, it is challenging to learn a new skill or to focus on an activity. And, of course, be told what to do when you are 2! Thank you for reading my post this week. If the post interests or reverberates with you consider signing up to receive the blog posts via email and ask a friend to join you.