Put Down the Pouch

If you have a child under the age of five, you are probably quite familiar with the popular “pouches” of pureed foods that have taken over the grocery store shelves! This modern convenience has totally revolutionized on-the-go snacking. It is easy to see why they are so popular – blends of fruits, veggies, legumes, and even meats are packaged in single-serving pouches that have a long shelf life, don’t need to be refrigerated, and are easily sucked through a neat little spout at the the top. Kids can slurp down 1-3 servings of healthy goodness in no time at all!

But before you jump on the “pouch bandwagon,” let’s pause for a moment. As a pediatric speech-language pathologist and feeding therapist who specializes in children under five (and a toddler-mom myself), I recommend taking a few points into consideration:

1. Oral Motor/Fine Motor Development

• Babies and toddlers acquire very important oral motor skills while learning to eat solid foods. If a child is mostly eating purees, the mouth is not having to do very much work. We want those lips, tongues, and jaws learning how to move in different ways to chew and swallow a variety of textures of foods. Sucking through the spout of a pouch promotes an immature oral pattern, similar to that used with a sippy cup or a pacifier. Additionally, eating solid foods allows the child to practice picking up foods with fingers, and later with utensils. These skills take practice!

2. Sensory Diversity

• Purees in pouches are a silky smooth texture that is easily swallowed with minimal oral manipulation. Lack of exposure to a variety of textures could result in decreased tolerance of more textured foods down the road. If you notice that your child already tends to gag or grimace when eating more textured foods, it is important to give him exposure to a variety of textures, and not have him get too used to smooth purees.

3. Picky Eating

• Purees in pouches advertise themselves as being filled with a variety of flavors, but in reality, they are all fairly bland and it is difficult to tease out individual tastes. I can’t tell you how many children I have evaluated who will eat a food in “pouch-form” but not in any other preparation. We want to expose our children to a variety of flavor profiles early in life to promote a well-rounded diet and willingness to try new foods. Furthermore, pouches are often “sucked down” quickly, without much time for tasting/savoring flavor. It is important that children explore and taste foods to develop a diverse palate.

4. Overeating

• With so much emphasis on fighting childhood obesity, it is important to consider the habits we are teaching our children. Pouches pack anywhere from 60-200 calories a pop. Children may get accustomed to quickly downing a pouch for a snack, and not necessarily factoring that in when choosing foods later. For older kids, pouches aren’t very filling, and therefore, it is easy to overeat.

5. Social Skills

• Meal time is more than just nutritional intake. It is a social experience. Taking time to eat a snack bite-by-bite lends itself to sitting with a friend or family member and chatting. Children learn manners and social norms surrounding meals, and watching others eat can encourage more adventurous eating.

All that being said, there is no doubt that pouches are a convenient and easy way to get some fruits and veggies in your kids. They are especially great for on-the-go snacking!  As a busy working mom myself, I have certainly been known to appease my screaming toddler with a fruit pouch in the Target checkout line – I totally get it! My professional recommendation is to use them in moderation and prioritize eating solid foods as much as possible. I suggest keeping pouches reserved for snacks outside the home and avoiding them at meal times. Fostering a love of trying different foods will promote life-long, healthy-eating habits. For more ideas of ways to encourage trying new foods, check out our previous post on picky eating.

Happy Snacking!

– Elizabeth Clark McKenzie, MS, CCC-SLP

Cause and Effect

One of the earliest developing skills and interests of a child comes with cause and effect. We talked about some important toys that assist in children’s development previously, but wanted to delve a little deeper into these toys that have all the “bells and whistles” that may be so interesting to your child. These are toys such as ball poppers,
door poppers, and anything that makes noise or does something “exciting” once a button or switch is activated. It has been noted that these toys decrease interaction between parents and children since the kids can play with them on their own. But we have some ideas on how to make these toys more interactive and reciprocal.

In December 2015, a study was published that cautioned parents against the use of cause and effect toys for language development. The study (from JAMA Pediatrics) was conducted on 26 families with children ages 10 months to 16 months. The families received a variety of toys, which included a set of noisy, flashy cause and effect toys; wooden puzzles, shape sorters, and blocks; and board books with basic concepts. Results yielded information that suggested books were the most interactive and language-rich activity, followed by traditional toys (puzzles/blocks). Least interactive were the cause and effect toys. As SLPs, we are definite advocates of book reading at a very early age – start right away! Books have the power to teach concepts, character and story development, sequencing, and so much more. What a great way to get started on early literacy! But we’re not always able to sit with our kids and read all day. Playing with a variety of toys is great too. Traditional toys definitely teach great skills, including problem solving, turn-taking, fine motor development, and others. So what about those noisy, flashy toys that you already own and your child absolutely adores? Here are some suggestions for more interactive play:

1. Turn taking: facilitate a back and forth play with a turn taking routine. You can use language, like “your turn!” and “my turn!” to start this concept early. Of course, with the little ones, it doesn’t have to be such a rigid back and forth; instead, be playful!
2. Eye contact: wait for your child to look at you before turning the toy back on (most of them have an on/off switch that you can manipulate and control). Eye contact often indicates some form of communication and an awareness that you can give them what they want – another turn!
3. Requesting: to work on early-developing sounds, you can practice “ah” (for “on!”) and “m” (for “more”).
4. Problem solving: give your child wait time and see if they can figure out how to operate a button/switch or to pick something out (I’ve seen kids exhibit very nice fine motor skills this way).
5. Narration: depending on the toy, you may be able to talk about an object. For example, in a toy that has different animals you might be able to say where they live, what sounds they make, what they look like, and other attributes.
6. Increased utterance length: once your child has begun to use one word at a time, you can model phrases: “want more” “ball in” “go ball” “go in.” Typically, children begin to combine two words around 18 months.
7. Prepositions: in, on, under – all these represent locations that are likely possible to talk about with any toy.

The aforementioned suggestions will take some degree of modeling. Don’t just expect your child to do it independently. Some cues include gestures (like pointing), verbal cues (like short, easy directions – “ball in”), and hand over hand assistance. You may need to work hard to make a cause and effect toy be more effective for language development, but the most important thing to remember is to have fun! They’ll only be this little for so long. Enjoy!

Childhood Developmental Milestones

As a speech-language pathologist, I am often sought after by friends and family to provide solid information on development. My go-to responses often include: one year-one word, two-word combinations by 18 months, and walking around a year. Early developing sounds include all vowels and consonants /b, p, m, t, d, k, g/ (within the first 2-3 years).

However, this is not a perfect science. In fact, there are several schools of thought in the research about the when of sound development. The Virginia Department of Education uses the Iowa Nebraska Articulation Norms in schools as a guide but then the Goldman-Fristoe Test of Articulation Norms present some discrepancies.

So what do we do? This seems far from NORMal. My rule of thumb is often to use these as a guide. When testing children, we need to have some kind of reference and we can think about early (those named above) vs. late (“th” and “r”) developing sounds.

Another important “milestone” that is a good measure of sound development comes within a child’s intelligibility. I usually think of the following numbers when it comes to intelligibility to an unfamiliar listener (parents and teachers are deemed “familiar listeners”) when context is unknown: by 2 years old a child should be about 50% intelligible; by 3 years old a child should be about 75% intelligible; and by 4 years old a child should be about 100% intelligible. Keep in mind that I don’t think anyone is always 100% intelligible – this will specifically happen on the phone, in a crowded and noisy room, or when someone mumbles. Remember, these numbers are just a guide to get a general idea, as all children develop differently.

In any case, I always recommend visiting a licensed speech-language pathologist to assess articulation if you have the slightest concern. “Mother knows best,” as they say so go with your instincts. It’s always better to be safe than sorry!