Using Chopsticks

Incorporating some fine motor work into our meals, we use training chopsticks from amazon.com (Fred Party People Chopsticks, set of 6) for some food at the table. There are other kinds of training chopsticks available but this colorful set looked like the simplest to use and easiest to clean.

We started with green beans.

Matthew picked up and transferred green beans from the serving plate to his using the training chopsticks. Then he ate them with his fork. Not wanting to be left out, Elizabeth got her own pair of chopsticks too. She used chopsticks, fingers and a fork.

We've been using ice tongs for Matthew to serve himself salad from the salad bowl. He really enjoys being able to do it himself.

Related post:
Toy Review Tuesday: Tongs

Matthew's Dr. Seuss Themed Birthday Party

A person's a person no matter how small. - Dr. Seuss

Dr. Seuss' books have become some of Matthew's favorites. His current favorite is "Green Eggs and Ham". He begs to listen to the audiobook almost everyday and he requests that it be read at naptime and bedtime everyday. He giggles and snickers as I read the story.

I think it's pretty funny too because when I read it, I feel like I am reading about Matthew exactly one year ago. He would not eat anything new or unfamiliar. Sometimes, he even rejected and refused to eat familiar and favorite food. He was on 3rd stage jarred baby food. He would NOT touch a pizza, burger, spaghetti, cake, and other food. It was only a few months after he turned 3, after he went to preschool where they helped me with "food therapy", and after we did more specific oral-motor exercises with him that he began to accept more food textures, tastes, and presentations.

He's still picky and suspicious about new food these days but he's not outrightly rejecting food or seemingly fearful of eating. These days he eats a wide variety of food including raisins, loves burgers, pickles, sweet potato fries, spaghetti, ice cream, and even leafy green salads with ranch dressing.

Hence, Dr. Seuss' Green Eggs and Ham was the perfect party theme to celebrate his 4th birthday, which was earlier this month. Balloons were blue and yellow, which are the colors for Down syndrome awareness.

We had a pull-string pinata. All the kids had a turn pulling a string to release all the little toys in the pinata until all the strings were gone. The pinata had to be torn open, but only after all the bigger kids got a chance at using karate chops and kicks on it.

I do so like green eggs and ham! Thank you! Thank you, Sam-I-Am! - Dr. Seuess

Toy Review Tuesday: Tongs

Pick up, transfer, release. It's harder than it seems especially for smaller hands and low tone.

Using tongs is one way to practice opening and closing the hand with the same motion used in cutting with scissors. This can also strengthen the hands for handwriting later on.

We use cheap plastic tongs with rubber-coated ends from the Dollar store and more expensive metal tongs from the bar supplies section at the grocery store.

The kids like to pick up small toys with them. Sometimes I make it a "pick up the color or shape game" using the foam shapes I made. Matthew concentrates and tries very hard. The rubber ends on the plastic tongs help provide gripping power to make the task more do-able. Elizabeth watches and then decides that poking the foam shapes with the metal tongs.

Doing a more meaningful activity is a more efficient way for Matthew to practice using tongs. He likes pickles. So I have him try to get pickles from the pickle jar and put them on a plate. It takes him a while but he can do it.

Big motivator + More persistence = More practice

Thankfully, he finds the challenge interesting enough to keep his attention and has not resorted to dumping the whole jar of pickles on the plate or reaching into the jar with his hand. Of course, if he's struggling with it too much and it's taking longer than he would like to get a pickle, then I help him hand over hand.

What's next? Chopsticks?

Note: Matthew has not developed a dominant hand yet. He uses his left more but he can still use his right. His occupational therapist (OT) at school has noted that he is showing a more mature grasp with his left hand. Nevertheless, we still offer objects to him at midline (center of his body) so we leave it up to him to choose which hand to use. This is done in the interest of not influencing handedness. It is up to him (his brain) to determine which side will become the dominant side, not up to us to influence.

Here is a short-list of some games with tongs/ tweezers:
Patch Bedbugs by Patch
Wok and Roll by I-Play
Avalanche Fruit Stand by Learning Resources
Operation by Hasbro

A Successful Pizzeria Field Trip

Our first preschool field trip was to Cecil Whitaker's Pizzeria. After a mini tour of the kitchen, the kids made their own pizza.

I had a very squirmy Elizabeth in my arms who would scream if anyone else held her so I didn't even try to hand her off to the other moms who were more than willing to help. She currently has stranger anxiety and separation anxiety issues.

Matthew wasn't too thrilled about using his hands to spread the sauce, cheese, and pepperoni but thankfully one of the teachers helped Matthew through it. He doesn't have a severe aversion to textures or mess but if you gave him the option to use a tool than touch the sauce with his hands, he would go for the tool. So this was a good experience for him. It probably would be a good experience for me too as I don't like to get my hands dirty if I don't have to.

He was looking quite overwhelmed with the new experience and noise after making his pizza and wanted me to hold him. We sat in a booth with one of his classmates. A box of juice made things better for Matthew. Elizabeth was content with her bottle of milk.



His pizza was brought to our table. His usual reaction to new food could involve saying 'no,' turning away, pushing the food away, kissing the food, pretending to bite it, or throwing a tantrum. So I offered him a slice. He bit off a piece of pepperoni, chewed it, held it, and continued to eat the rest of the slice on his own. I was sitting next to him picking my jaw off the floor. And I thought to myself, "Bill would be so proud." Bill's favorite pizza (and primary food when growing up) is pepperoni. Those who know Bill well will testify that he lived on wheat thins, pizza, and pepsi.



I was ecstatic! This was his first time to eat a slice of pizza. More importantly, this is a big step toward our goal of Matthew eating more types of non-Gerber food.

I warmed up the pizza in the oven for dinner and served it in the same box at dinner. He was actually excited to see the pizza and ate 2 slices.



This is a huge success for someone who has been a difficult eater. He had been on 2nd stage and 3rd stage baby food until November last year. It wasn't until he was accepting more store-bought toddler food, as well as some of my home creations, when were finally able to wean him off baby food.

We still have a long way to go in our attempt to add to his "accepted foods" list. I think we can now add pepperoni pizza to the list.

Just Take a Lick

You can lead a horse to water but you can't make it drink. We can lead Matthew to food but we can't make him eat. Transitioning Matthew from baby food to solid food has been one of our biggest challenges. It's an extremely frustrating process.

He eats a decent variety of textures (crispy, crunchy, hard, lumpy, and smooth) but has a very limited selection of food. His diet consists of yogurt, applesauce, regular cheerios, goldfish crackers, wheat thins, pretzel twists, toaster waffles, apples, peaches, pears, canned oranges, and just in the past month, pasta (shells and elbow macaroni). He gets meats and vegetables from jarred 3rd stage baby food.

New and unfamiliar food is typically met with him shaking his head, saying doh! da! da!(no! done! done!), crying and turning away from the food. Sometimes, he gets so obstinate and mad that he'll try to clear the table with his arm in one swift sweeping motion. (Let's refer to this behavior as "Mr. Hyde.") He gets a 2-minute time out for that.

This is a frequent occurrence at our dinner table, as frequent as we offer new food to him. So sometimes we opt not to offer new food to avoid this food battle.

Perplexing Behavior
Sometimes Matthew reacts the same way to favorite or familiar food as he does to new food. It's a phenomenon that we do not fully understand.

If we offer peas and carrots in a plate, Matthew turns into Mr. Hyde. But when I sneak the peas and carrots into his jarred 3rd stage baby food, he doesn't even flinch.

If we offer pasta with cheese sauce, Mr. Hyde comes to the dinner table. When we start singing, sometimes Matthew returns and eats.

Sometimes Matthew will ask for an apple. We always cut it into potato-wedge sized pieces. Once we put it on a plate and set it in front of him, Mr. Hyde shows up! We give him a minute to get over the mood and sometimes he'll start eating on his own. Or sometimes giving him a fork helps. The newly introduced idea of using a fork for the apple is enough to distract him into eating. We're not lucky enough to have that happen all the time though.


Where Did We Go Wrong?
It's been over a year now that we've been trying to transition to solids, seeing that I wrote "Transitioning from Baby Food to Solid Food" in July 2009. On the bright side, we've had some progress during the year - just not the quantum leap we had envisioned. We can't pinpoint exactly how he developed a strong aversion to food but we have a few theories.

Maybe we didn't introduce solids early enough. His inability to chew food when he was younger due to the hypotonia made me hesitant to try.

Maybe we didn't offer a wide variety early enough so he has limited exposure to different tastes and types of food.

Maybe he developed the aversion from the numerous times that he gagged and threw up the solids that he did try, associating a negative experience with solids or new food. These gagging episodes also made us gun-shy about pushing solids.

Maybe we didn't do oral stimulation activities often enough.

Maybe he's just plain picky. After all, he is a toddler. Most toddlers are picky. Bill and I are picky to some extent too. It's in his genetic make-up!

At this point, the reason didn't matter as much as the next course of action.

He's proven to us that he can chew his food, although he still gags on the smaller bits that are too small for his mouth muscles to detect and chew yet too big to swallow without chewing. He has a psychological barrier to accepting more types of food. We need to get past it.

Exposure and Interaction
Thanks to some guidance and ideas from Matthew's occupational therapist and speech therapist, we have a new plan of action in place:
- frequent exposure to new food.
- branch out to new food using the guidelines in the book "Food Chaining: The Proven 6-step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child's Diet" by Fraker, Fishbein, Cox and Walbert.
- use a continuum to have Matthew interact with new food, which means having the new food on his plate, touching the food, kissing the food, licking the food, holding between his teeth and ultimately putting it in his mouth, chewing and swallowing.

We've had some success with the new plan and an equal amount of unsuccessful attempts.

Success Story #1 - Mac 'N Cheese
In introducing the homemade mac 'n cheese, we convinced Matthew to feed Bill. Next, we showed him to kiss it first before feeding it to Bill. Then when he was getting comfortable kissing the pasta, we moved on to licking it before feeding it to Bill. Being the wonderful dad that he is, Bill ate the pre-moistened pasta for the sake of getting Matthew to accept being at the same table as the pasta. It was for the greater good! And I showed him how I put my pasta in my mouth. And with a little bit of hand-over-hand guidance, Matthew put a piece of pasta in his mouth and started chewing! He ate his whole bowl of mac 'n cheese after we got the first piece in.

Success Story #2 - Porkloin
I had Matthew feed me a slice of pork for lunch. He was interested in how I'd have a big chunk on the fork and only bite pieces off. I walked away from the table and when I returned, he had my fork and pork and was licking the pork on the fork and giggling. Then on his own terms, he took a bite and started chewing. He must have bitten too big a piece though because he spit some out. He was definitely chewing though! Then he was done.


Success Story #3 - Ice Cream
He had a spoonful of ice cream on his 1st birthday. He has never had it since then, always refusing to try ice cream. He recently took 10 licks of ice cream using a miniature ice cream cone. Just the fact that he licked the ice cream is enough to call this a success.


Tracking Method
Using a monthly calendar to keep track of when and what new food we introduce has helped. Some days we feel like we've been exposing Matthew to bread for a month without any success. But when we look at the food tracker calendar, we see it's only been 10 days. We also note if he interacts with the food at all (touch, kiss or lick) and how many times.

Pressured and Stressed?
Maybe Matthew feels pressured to try new food. Maybe most of our attempts to transition him to solid food simply causes stress and summons Mr. Hyde to the table. There were a few things he started eating that weren't introduced at the dinner table such as waffles, wheat thins and pretzels.

Maybe we just need to back-off. But not completely especially since it seems we are making some progress with the expose-and-interact strategy. We'll back off from "Just take a bite" to "Just take a lick."

Or maybe our new plan won't work either and we'll be wondering, once again, what else there is to try.

Related post:
Transitioning from Baby Food to Solid Food

Transitioning from Baby Food to Solid Food

Matthew has never been tube-fed so we do not have to go through the complexities of transitioning from non-oral feeding to oral feeding. Nevertheless, we face our own unique set of feeding challenges and oral-motor issues. Not to mention, he's probably entering a stage of development where toddlers are naturally picky about taste, texture, color, and temperature AND he might have inherited his Daddy's picky-eater gene.

Hypotonia or low tone is common for individuals with Down syndrome. It affects their overall development from walking later to eating. With low oral-motor tone, a more intense oral sensory input is required to "wake-up" the muscles in and around the mouth in order for oral motor skills to develop. Matthew's Occupational Therapist (OT) had several suggestions for helping him transition including oral alerting activities, offering Matthew high flavor food, thickening food to increase texture, and practicing chewing.

Oral Alerting Activities
Oral alerting is done to help increase sensory awareness of the face and mouth muscles before a meal, in effect, encouraging more coordinated use of the mouth (jaw, lips, cheeks, and tongue) and developing a more efficient biting, chewing, and swallowing pattern. Some oral alerting techniques are: a cool-cold washcloth wake-up, finger tapping on the face, and vibration using a NUK brush, z-vibe, or jiggler. I'm sure any OT would be more than willing to discuss these in more detail. We have the z-vibe and elephant jiggler pictured here.

Offering High Flavor Food
Did you know that hypotonia affects taste too? Sara Rosenfeld Johnson, a renowned speech and language pathologist (SLP), affirms this in Low Tone Affects Taste as well as Movement on her blog Sara's Feeding and Speech Thoughts. Here's an excerpt:

"...when children are diagnosed with Low Tone/Hypotonicity it also means they may have Hypo-sensitivity/Hypo-responsivity to touch, taste and smell. He likes foods that are highly flavored because he can "taste" them. Kids with hypo-sensitivity like foods they can taste so increasing flavor for these kids is essential."

Matthew does like the tartness of blueberry pomegranate flavored applesauce (Musselman brand). But on the other hand, he also likes bland jarred baby food. Go figure!

Thickening Food
To this day, Matthew eats jarred 2nd (baby) food. Occasionally, he'll eat home-made pureed food mixed with jarred baby food. He also eats jarred 3rd foods - pears and squash only - which do not have the chunks of food like the other 3rd foods do but they have a thicker consistency than 2nd foods. Sometimes I thicken the 2nd foods with rice or oatmeal cereal to add texture. The thicker texture encourages learning to coordinate the tongue and jaw movements to handle the food differently than if it were runny, therefore helping improve oral motor skills.

Practicing Chewing
A teething feeder filled with fruit is great for Matthew to practice chewing and biting solid food without the risk of choking. His OT says that not all kids like this feeder, probably because of the texture of the feeder in their mouths. Matthew didn't care for it initally but he warmed up to it after several attempts of offering it to him. He also eats cheerios, goldfish crackers, small chunks of fresh pear, nutrigrain blueberry toaster waffles, and cinnamon graham crackers. I try to offer one of these after every other meal so he can practice chewing often.

Food Progression
In the last four or five months, I have been trying to step-up my efforts in transitioning Matthew from baby food to table (non-pureed) food. I fed him small pieces of Gerber pasta pick-ups, which caused him to gag and throw up. I fed him 3rd foods Lasagna, which also caused him to gag and throw up. I fed him buttered steamed carrots. He cried a little, tolerated a few pieces then he was done. I tried feeding him some green beans from a Gerber Graduates - Lil' Entrees for Toddlers meal but after getting one piece in his mouth, he cried and refused more.

I recently stumbled upon "Food Progressions for Biting and Chewing" by Suzanne Evans Morris, Ph.D, who is a Speech-Language Pathologist and author of a few books on pre-feeding skills and pre-speech. She identifies 8 sensory features of food (sensory input, size, shape, texture scatter, consistency, placement, and need for transfer during chewing) that help determine the degree of ease or difficulty for biting and chewing, how these require different sensorimotor strategies, and that a high level of success is important.

After reading Suzanne Evans Morris' work, I had an epiphany. MAYBE I sabotaged my own efforts to transition him from baby food to non-pureed food by giving him food that he was not developmentally ready for, triggering his sensitive gag reflex and causing him to gag and throw-up. Because of these unpleasant experiences, I might have created a certain level of fear and distrust of new table food, thereby making the transition more difficult. So it seems I need to re-evaluate my transition efforts and understand the different sensory features that each food presents in order to offer more appropriate choices that match his current level of oral-motor skills. I need to take a closer look at the chart of guidelines for matching oral motor skills with food textures in "Chapter 7: Successful Eating" of The Down Syndrome Nutrition Handbook by Joan Guthrie Medlen, RD, LD.

Despite these few bumps on the road, I'd like to think we are headed in the right direction and employing the right strategies to help him overcome his minor feeding difficulties. Over time, with frequent exposure to different foods and practice chewing, I hope he will eat a wide variety of table food when he's older... unless his Daddy's picky-eater gene has the last say.

Guidelines for Cup Drinking

I am happy to announce that Matthew is now drinking milk from a sippy cup and we are celebrating! Good-bye bottle!

Matthew's Occupational Therapist (OT), who is also a feeding specialist, offered some guidelines for cup drinking. This information is not exactly out of a text book. It is collective knowledge from an OT, Speech Therapist (ST) and Developmental Therapist (DT), who requested to remain anonymous. With their permission, I am sharing it with you (in green text). Keep in mind that these are just guidelines, not strict rules. Every therapist is different. Every family is different. Every child is different. We do what we have to do given our own set of variables.

How Do I Know When My Child Is Ready For A Cup?
Age 3-6 months - hold or supports bottle during feeding
Age 6-9 months - closes lips when swallowing
Age 9-12 months - closes mouth on rim of cup but may lose some liquid from corners of mouth
Age 12-18 months - may drink from a cup independently with frequent spills; sips liquid from a cup using straw
In general, a child is ready to use a cup if they can sit well and play/ manipulate toys in sitting.
A child should be able to drink from a cup without tipping head backwards to allow for a good swallow.

Types of Cups
Use or over use of sippy/spout cups may be a contributing factor in speech delays for some children.

If the sippy/spout cup has a valve, a child has to suck harder which can delay or interfere with the development of a good swallow pattern. It can also cause children to revert back to stronger backward-forward suckle movements of the tongue that they used with the bottle. This occurs when the tongue is placed more forward in the mouth vs. more in the back of the mouth. This may also interfere with oral development especially if there are other underlying oral issues.

The size of the spout on a sippy cup may not encourage as good of a lip seal, tongue placement, or lip placement as on an open cup. Good lip seal and strength, as well as tongue placement, are essential for producing some speech sounds.

What is Actually Recommended?
This varies from child to child as well as with routines of the family. In general, straw drinking or use of a small open cup is preferred. A small Tupperware 2 ounce container or small medicine cup may be used initially as they allow small amounts of liquid that are easy to handle. It is also good to use nectar or thicker drinks when starting out as they are easier to manage.

If you must use spill proof - straws or straw cups (e.g. sports bottle type) are a good alternative. They encourage good lip seal and overall good oral motor strength. If a spout cup is used, the most desirable type is the type without a valve such as the Tupperware thin (and smaller) spout or any type that has the shape of an open cup. These can be found on line at Talk Tools (Recessed Lid Cup) or Maddak, Inc. (Little Spill Drinking Cup).

Children need opportunities to learn to drink from an open cup. Practice (and spills that come with it) makes perfect! This helps stabilize the jaw which is very important in oral motor, feeding and speech development. You can start with just one ounce of liquid.

In my Breast to Bottle to Cup post on May 4, 2009, I wrote about how Matthew transitioned with drinking milk from breast to bottle and not having any success with milk in a cup. I tried many kinds of cups - sippy cups, straw cups, recessed lid cups - and appreciate the encouragement and suggestions I received through comments in Breast to Bottle to Cup. Matthew was fully capable of drinking water or juice from any of these cups. He just was not willing to drink milk from them. The one-meal-at-a-time transition method did not work as he just refused to drink and knew he was getting a bottle at the next meal anyway.

So, on June 1, my husband suggested that we just stop offering the bottle completely. Initially, I wasn't too sure about our new strategy but we did it. The change was met with much resistance and tears as we explained that we drink milk from cups. He unhappily resigned to drinking his milk from the sippy cup. His intake decreased as he was getting used to the change, but on the bright side, he ate more. It took two full weeks before he completely accepted milk from the sippy cup without protest. Now that he's used to the sippy cup, his milk consumption is back up. Over time, we hope to move to a cup without a spout, including straw cups. Baby steps.

A few examples of straw cups include: the Sip-Tip cup from Beyond Play, which allows you to pump the liquid up the straw; the Honeybear w/ Flex Straw from Beyond Play or Talk Tools; the Nuby Grip 'n Sip with Flip-It Straw from Target or Walmart, but be warned that this comes with a built-in valve which may make it difficult for some to drink (Matthew has not succeeded with this); a plain open cup with a straw (be prepared for spills!); and the Leakproof Juice Box made by Arrow Plastic Manufacturing Company, which I found in the plastic container aisle at Target.

On the one hand, we know that the sippy cup is not ideal because of the protruding spout. But on the other hand, it's our first baby step away from the bottle. And while Matthew's OT agrees that this is not ideal, she supports our decision to use the sippy cup for milk now and understands that we just have to do what works sometimes. In the meantime, Matthew still gets plenty of practice drinking juice or water from an open cup or through a straw.

Breast to Bottle to Cup

19 months old tomorrow and Matthew still drinks his milk-based formula (for toddlers 9-24 months old) from a bottle. I have discussed most (if not all) the possibilities to switch him over to a cup completely with his Occupational Therapist (OT), Developmental Therapist (DT) and Speech Therapist (ST). We don't have any strong concerns about his oral motor tone. I think it boils down to his emotional attachment to the bottle. Perhaps he gets some kind of comfort or satisfaction from bottle drinking? I initially tried offering milk in a cup at snack time, you know, cut back one meal at a time. My efforts to wean him off the bottle have always been met with little hands pounding the food tray and waving away the cup. How does one be persistent enough with this without turning snack time or any mealtime into a milk battle? Why couldn't this be as easy as the transition from breast to bottle?

Yes, I was able to successfully nurse for 9 months and supplemented with pumped milk in a bottle. We used standard Dr. Brown's bottles, recommended to us by one of the specialists at the hospital when Matthew was born. Sure, there were concerns about the bottle promoting tongue protusion, a common issue for kids with Down syndrome. I had considered switching him to other bottles but I didn't. Why mess with something that was working well? The Dr. Brown's bottle seemed to prevent colic, spit-up, burping and gas (as it advertised). More importantly, Matthew was gaining weight so we knew he was getting enough. Matthew suckled and latched on well but there were many times when he would tire easily or fall asleep. This was expected though. Because of his low muscle tone, it took more effort for him to nurse. So I always pumped after nursing to make sure he also got the hindmilk he needed. Weaning him seemed to happen naturally as I began to pump more than nurse. Eventually I supplemented with formula when I wasn't producing enough. I think the fact that Matthew was already introduced to the bottle early on (starting when he was in the Special Nursery at the hospital) and that it was easier to drink out of the bottle helped him transition as easily as he did.

As every mom with a special needs child knows, the age ranges in lists of developmental milestones for typically developing kids do not apply. 'Stage Not Age' at Down Syndrome New Mama also points this out. The developmental chart in 'An Overview of the Development of Infants with Down Syndrome (0-5years)' available at Down Syndrome Online estimates 20 months as the average age that a child with Down syndrome would drink from a cup, with the age range being 12 to 30 months.

I introduced him to water in a Munchkin brand sippy cup and water in a clear open cup when he was around 8 or 9 months old with the goal of weaning him off the bottle by the time he turned 1. The new goal is "when he's ready". It's not that he won't drink from a cup at all. He can drink juice and water from his sippy cup and an open cup, with fairly good lip closure at the rim. But he flat out refuses milk in a cup. I've even tried other special cups without the spout, since the spouted sippy cup may encourage tongue protusion just like the bottle. He hasn't warmed up to any of these cups yet. The clear and pink ones are called Little Spill cups that Matthew's OT got for him to try. The only place I have found them is at Beyond Play online. They also have flexi cups (not pictured here) but Matthew only tossed around the one he had. The Playtex cup is available at Target.



In the back of my mind, I know he will agree to drink milk from a cup. Just 'when he's ready'.

P is for ...

Picky eater - Most toddlers are very picky eaters. Matthew is no exception. Time to eat has become time for a power struggle, one of many to come, of him asserting his independence and control over the situation. He can shake his head "no", push the spoon away (or try to grab it), and since I've been teaching him sign language, he signs "all done" even before he has any food. Most of the time, all I have to do is try to get some of the food on his lips just so he can taste it. And usually (not all the time) once he gets that initial contact with the food, he's amiable to eating more. He drinks a good amount of formula/ milk that I'm not too worried about whether he's getting enough nutrition at this point. If he had his way, he would eat cheerios and Yogurt all the time. That's certainly not a bad thing as I know of more extreme and difficult food circumstances than what I'm experiencing with Matthew. Nevertheless, that doesn't make it less frustrating for me. And I'm not convinced that being a picky eater is a stage that he will necessarily get over. (Pointing finger at Bill). For those of you who don't know my husband, he mainly eats pizza, wheat thins, chicken, beef, and Gala apples. So the saying goes... the apple doesn't fall far from the tree.

By the way, Matthew is still on jarred baby food. The only "table food" he eats to-date are cheerios, Yogurt, applesauce, and blueberry toaster waffles. Getting him to transition to regular table food is an entirely different issue, which I'll probably blog about another time.

Poop - While I'm not too worried about his nutritional intake, I am constantly concerned about his poopie diapers. Is it too hard, large, small, of 'normal' color? Ah yes, another discovery about motherhood is that you'll learn to be very comfortable talking about BM. Matthew battles constipation constantly. Thankfully, he doesn't skip more than one day at a time but he obviously struggles (sometimes crying, sometimes short of screaming) with his BM often enough for me to be concerned.

Constipation is a common problem among kids with Down syndrome and may be due to a combination of low muscle tone, poor mobility, diet and inadequate fluid intake. In some cases, hypothyroidism (underactivity of the thyroid gland) can also cause constipation. I've ruled out thyroid disorders for now since his blood test showed normal results when he was a year old. He gets another blood test when he turns 2. Matthew has low muscle tone, compared to typically developing children his age, but he crawls around a lot so I know he's getting his exercise. Foods that are high in fiber help - prunes, pears, whole grain oatmeal - so long as his pickiness doesn't interfere. I'm also trying to get him to drink more water and juice during the day. I read that low serotonin may cause constipation in individuals with Down syndrome. Curious proposition. I'll be looking into that. If anyone has heard of this, please let me know. Also, has anyone heard of Fruit Ease and NuTriVene-D?

Please share resources - Here are a few reading materials that I found useful and interesting (not listed in any particular order). If anyone has other resources, please feel free to share them with me.

1. High fiber foods listed at Mayoclinic

2. "How can I get my 15-m-o picky eater to eat more?"FAQ at Ask Dr. Sears

3. Gastrointestinal problems in children with Down syndromeby Dr. Liz Marder (.pdf file)

4. Gastrointestinal tract and Down syndrome article at National Down Syndrome Society

5. Just Take a Bite by Lori Ernsperger, Tania Stegen-Hanson, and Temple Grandin

6. The Down Syndrome Nutrition Handbook: A Guide to Promoting Healthy Lifestyles by Joan Guthrie Medlen

7. Serotonin and Constipation in Down Syndrome at Einstein-syndrome