What if My Baby Won’t Swallow Food? Pocketing with Dawn Winkelman, MS, CCC-SLP

0 (1s):

So when we put our fingers into a baby s mouth, they tend to lean back And. what that does is, especially when babies don't have the best head control, is it tilts their head back and opens up their airway And. that is not safe, especially when there s a piece of food in it.

1 (16s):

Hey there. I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in baby led weaning Here on the Baby Led Weaning Made Easy podcast. I help you strip out all of the noise and nonsense about feeding, leaving you with the confidence and knowledge you need to give your baby a safe start to solid foods using baby led weaning. What do you do if your baby pockets food or won t Swallow. Food I. remember when I was doing baby led weaning with my quadruplets, one of them Dylan, who now is like our total hoarder kid who saves everything but even like as a baby who d always have food hanging around in his mouth long after the meals were over, like I'd go to change his diaper and I remember seeing some random piece of zucchini just up there on the roof of his mouth and it would freak me out, right?

1 (1m 3s):

Cause like, do you go in there with your finger? I mean I could potentially push that food back into his airway cause a choking incident. So today my guest is speech language pathologist who knows all about Pocketing. Her name is Dawn Winkleman. She's a good friend of the podcast, a good friend of mine, a good friend of all of us because she creates these amazing products, lots of great resources that I'm always going to her for. All things related to like learning about your baby's mouth when it comes to starting solid foods or developing speech. So in this episode, Dawn Winkelmann is gonna be talking about Pocketing and what to do if your baby won't Swallow food. So we're gonna chat about like is it ever okay to go into your baby's mouth with your finger? And she has some really easy ideas for helping your baby learn how to more successfully Swallow food. As I mentioned, Don's been on the podcast a number of times before.

1 (1m 44s):

Most recently, well she was back in episode 300 where we talked about her brand new oral development tools. But prior to that episode 254 was called How Babies Learn to Chew and Swallow with Dawn Winkelmann. She's on social at Miss Don SLP. Another great resource for you guys to check out is the easy peasy page at ezpz Fund cuz Dawn designs all of their products. They have an amazing blog with great infant feeding info there. Don and I also co-teach a choking Prevention and response course. We do that in conjunction with a certified CPR instructor. I'll go ahead and link to that course as well. Plus all the other episodes kind of related to this learning how to chew and Swallow stuff that Don and I have done together. That'll all be in the show notes in case you wanna check it out. And that's at BLW podcast.com/ 3 0 8.

1 (2m 26s):

So with no further ado, here is Dawn Winkelmann talking about Pocketing and what to do if your baby won't Swallow food.

0 (2m 36s):

Hi Katie, thanks for having me.

1 (2m 38s):

Okay, I'm excited to talk about Pocketing but before we get started, okay, we used to co-teach a lot of webinars together. She's like, we used to do so much more work together. I miss working with you. So we always used to start out our trainings with what's the last food you fed a baby and how did it go? Go.

0 (2m 52s):

So the last food was a kiwi and breast milk popsicle, which is always fun to be able to introduce that new chapter. Oh my.

1 (2m 60s):

I love your brand new mini pops from Easy-Peasy. I'm just using them with this baby Florence my friend's baby. And we made her an avocado and beat smoothie that I made into a Popsicle and she freaking loved it. It was adorable. I gotta send you the videos. Perfect.

0 (3m 13s):

Yes, please do.

1 (3m 15s):

All right, we're here today to talk about Pocketing. I think it's a pretty self descriptive like what Pocketing entails, but Dawn would you please give us the full on speech language pathologist definition of Pocketing if you can please.

0 (3m 27s):

So food Pocketing occurs when a baby holds leftover food in their mouth without swallowing it. So sometimes the food is chewed and like ends up being like this food ball. It's kind of like stuck and other times it can be actually whole pieces of food. And the key here is Pocketing can be a choking risk, especially if the food becomes dislodged when taking baby outta the highchair or during play or even while doing tummy time or if the baby's sleeping the pockets of the mouth, which is how the term kind of came, is in the cheeks on both sides of the cheeks as well as the front and back of their gum line. It can also be underneath their tongue. So I've, I've found lots of pocketed food under baby's tongues.

0 (4m 10s):

And, it can also be on the roof of the mouth or their pate and underneath the bottom or the upper lip. And as a feeding therapist when a baby is Pocketing in these areas, it kind of gives me a lot of information. So you know, do we need to change the temperature or the texture of the food? Or maybe baby has a tongue or a lip tie that we need to assess. So Pocketing is self descriptive as you said, but it's, it's also really important to know and for parents to actually look for so that they can know whether they need to kind switch something up in feeding or actually reach out to a pediatric feeding and swallowing expert. Okay.

1 (4m 49s):

Is Pocketing always indicative of a problem or is it just sometimes part of learning how to gush? There's this new thing in my mouth and I gotta figure out how to get it out of there. like I, I don't want parents to walk away be like if my baby pockets, I definitely need feeding therapy because I don't think that's what you're saying.

0 (5m 2s):

No, it ends up being it's, it's also when babies Pocketing, you know, the first couple weeks or even you know, the first month or two of baby led winning babies tend to be so interested in that, right? So they are not Pocketing as much as we get a little bit older and we're getting more exploratory with a variety of different foods and tastes and textures. Baby's mouth is constantly developing, right? So a piece of food mango, you know, two weeks ago went down, you know, very, very easily. But now you know we've got some budding of some teeth, maybe we have a little bit of drooling happening with that budding of teeth. And so now the oral cavity has changed and so now the mango is kind of stuck inside of the mouth.

0 (5m 46s):

So what can we do? Oh maybe we can refrigerate the mango and make that a little bit better of a temperature or maybe we'll you know, do a popsicle before we start solids to really alert the mouth. You know, things that parents can do is kind of change that up a little bit when, especially when it's a food that they've had previously. But if a child is constantly Pocketing every single meal, then that's usually how I get the referral that the baby is having a tongue tie or a lip tie or having difficulties with that and end up having to come into feeding therapy.

1 (6m 19s):

You make an interesting kind of correlation there. Thinking the Pocketing stuff reminds me to some degree of gagging cuz we oftentimes talk about how sometimes early on in baby led weaning your baby doesn't gag. Parents are like, wait a minute, I've been training and waiting for all this gagging stuff you say is gonna happen. It's not happening, it's not happening cuz your baby is hardly kidding any food in their mouth on which they could gag. Or very early on in baby led weaning when there's very little actual eating going on, there's so little food getting in the baby's mouth that the likelihood of Pocketing is much lower. But as Don mentioned, as your baby becomes more proficient, things start to change, you might start to notice more of it. So it's something to be paying attention for along the spectrum of baby led weaning as you're helping your baby increasingly get more nutrition from food and Dawn. I'm sure you've heard this question all the time too, but like parents who are interested in learning about baby led weaning, they know from you and me that the safest shape and size of foods for early eaters are those soft strips of foods that are about the size of your adult pinky finger.

1 (7m 9s):

And then they'll inevitably ask, but yeah, my baby picks up that pinky finger sized food and smashes it up and bites or pinches off a smaller piece. Is it then safe for the baby to eat it if it's no longer the size of the adult pinky finger?

0 (7m 23s):

Yeah, so what's great about baby led weaning is that when your baby grabs that piece of food, and I always joke about it calling like the Hulk smash, right? The, they squish that piece of food and they're putting, you know, the edge of that food into their mouth and then they have all these like broken up pieces. What babies actually doing is providing the sensory and motor stimulation needed to help to protect that airway. So if your baby is just gonna kind of put those pieces that are, you know, leftover onto their hand and they're just gonna kind of suck those pieces up, it's actually safe because baby is really exploring that food. They're getting so much sensory receptors from the hand, from the lips, from the tongue as compared to if we took that broken piece of food and tried to place that piece of food into baby's mouth, right, that's actually gonna increase choking risk.

0 (8m 10s):

But if parents are nervous about that, they can always, you know, take those little pieces of food that kind of get, you know, all over the place and they can put it onto a baby lid spoon like the easy peasy tiny spoon that I designed and they can put that piece of food and then offer that spoon to baby. It's basically, essentially preloaded with those pieces of food. And then baby can actually work on their spoon feeding milestones, which is great or they can put it on the edge of the oral development tools so they can actually kind of work on chewing right and really work on that munching chewing ability. Or they can put those pieces of food at the end of the meal and kind of mix 'em with yogurt and make a pop school out of it. So there's a lot of different ways that we can kind of help that developmental piece as baby is really learning how to grade that hand movement to be able to, you know, keep that strip of food and not squish it too much and put that onto their gum line safely.

1 (9m 2s):

Hey, we're gonna take a quick break but I'll be right back.

BetterHelp (9m 9s):

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1 (10m 15s):

And Don, you and I designed and we co-teach a choking Prevention and response course. We do that in conjunction with a certified CPR instructor. So I'm pretty sure I know how you're gonna answer this, but when is it a good idea or when is it safe to put your finger in your baby's mouth if they won't Swallow the food?

0 (10m 32s):

So I never like to put babies in a position where they have to extend their neck back So. when we put our fingers into a baby s mouth, they tend to lean back And. what that does is, especially when babies don't have the best head control is it tilts their head back and opens up their airway And. that is not safe, especially when there's a piece of food in it. And the important part of your question here, Katie, is why is the baby not swallowing the food right? Is the baby not swallowing the food because we actually made the slice too big? Or is the baby not swallowing the food because it doesn't really look appealing?

0 (11m 12s):

Or maybe they need to use a crinkle cutter to give it a little bit more texture or maybe baby needs to have a little bit more sensory input. Maybe we need to heat that meal up to make it just a little bit warmer for them. Or maybe baby doesn't have the motor skills yet to be able to take that piece of food and chew it and know what to do with it. Or maybe we need to kind of wait a few more seconds. Like sometimes, you know, I've seen babies have that piece of food in their mouth, And, it's just kind of sitting in there and parents are wanting to reach in and grab that food cuz baby's just, you know, letting it kind of sit there. Well maybe baby is needing a little bit more time to have that sensory input of that piece of food into their mouth and they just need to, we just need to watch them and kind of help them say, yeah, look at there's avocado in your mouth, why don't you chew?

0 (11m 56s):

And this is another reason why I love for parents to eat the same food that they're offering babies so they can watch us be able to model that chewing, right? And being able to model what we want them to do with their lips and their mouth and their tongue. And when we provide babies with that type of support, then we are not gonna feel the need to stick our fingers into their mouth and and increase the risk of baby choking. Alright,

1 (12m 22s):

So Dawn, let's say you have a baby eight months of age just starting to enter that like golden age of baby led weaning where everything's starting to click and they're starting to jam and pick up the food and put it in their mouth, babies at the table for 20 minutes for a meal and then the last piece of food that your baby put in their mouth, it's just hanging out there and they're not swallowing it and you're like looking at the clock like, come on, I gotta move on with my day here. What should we do in that instance?

0 (12m 45s):

So that's when you know, we can really think about ending the meal a few minutes earlier. So maybe babies getting a little bit fatigued, right? So all of these changes, you know, babies got it down right at the end of month mark usually babies have it down and, and now maybe they're a little bit more fatigued. So maybe we kind of stopped the meal a few minutes early or maybe those last couple bites of food. We need to really amp up the sensory awareness, right? So maybe that we end the meal with some cold breast milk from an open cup, or maybe we end the meal with a cold Popsicle, right? To really help to improve that sensory awareness. Or oftentimes, you know, babies too need to kind of be not distracted at the very end because we tend to give off those vibes, right?

0 (13m 35s):

Like, okay, yeah, we're all done, let's, you know, let's clean this mess up and and move on. But for us to not like look at the phone or get or stand up, right we're we want to be able to sit with baby and really give baby those nonverbal cues that, you know, mealtime is still here and we are trying to provide baby with a baby-led environment to kind of finish their meals. But sometimes we have to kind of look at what baby is doing and really see, okay, why is that piece of food hanging out there? What's happening? Do I need to increase that sensory awareness? Do I need to end mealtime just a little bit sooner? Do I need to decrease some of the destructions that are happening at the end of the meal?

0 (14m 17s):

Or maybe we need to amp up the taste awareness a little bit more.

1 (14m 21s):

Hey, we're gonna take a quick break, but I'll be right back.

3 (14m 28s):

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4 (15m 32s):

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1 (15m 43s):

Yeah, or segue right into the open cup practice. It's kind of a good way to remind yourself that we should be practicing with the open cup for about five minutes after each meal as Don recommends. And I love that idea cuz it kind of, I think ultimately teaches your baby eventually how to swish and flush some of those solid food pieces away from the sides of their mouth as they're also starting to master those open cup skills. So can we talk a little bit about open cup practice and how can open cup practice help babies learn to Swallow food?

0 (16m 12s):

Yeah, so the sips of the liquid provide baby with really interesting stimulation. So what happens is we have lip closure from the open cup, just stimulating that on, especially if you're using the ezpz Z tiny cup that I designed, that soft silicone on that rim really provides baby with that sensory input to close their lips. When they close their lips, they breathe through their nose, they're able to hold their breath and really move that tongue up to the roof of their mouth and produce a nice strong Swallow. So if baby does have some food that's kind of pocketed, that Swallow of that liquid is really going to help. And this is a great thing to really start to implement in your routine so that you can have some open cut practice and really help make sure that the oral cavity is clear before you know you move on to get baby out of the highchair.

0 (17m 3s):

Because I see a lot of, that's when babies have that choking episode, right, is when we get them to lift them out of the highchair and all of a sudden we realize that there's some food in there. So those sips can really help pull the fluid through the mouth in a swallowing pattern that's, that easily clears the debris and then we can change the temperature of that liquid. So you know, for breakfast, maybe we're having that liquid be a little bit cold for lunch, we're having it to be a little bit warm for dinner, we're having it cold again. So we're kind of switching up and alternating those temperatures in order to help baby become aware of the food that still might be inside of their mouth.

1 (17m 39s):

Well, Dawn, this has been really valuable information. I think you've helped set a lot of parents mind at ease because they're tempted to maybe go in there and swipe the food out of the baby's mouth. You've given us some really great tips so we can avoid doing that, that because of course that could potentially increase the risk of choking Dawn. Where can our audience go to learn more about your work and to learn about infant feeding from you? They

0 (17m 57s):

Can go to easy peasy fund.com and of course be sure to use Katie's code, you guys, which is Katie 10 for 10% off all of our pre feeding and feeding gear. And they can also follow me on my social media, which is at Miss Don SLP.

1 (18m 11s):

Well, thank you Dawn so much. It's always great to chat with you.

0 (18m 14s):

Thank you so much, Katie for having me. Bye everyone. Well,

1 (18m 17s):

I hope you guys enjoyed that episode with Dawn Winkelmann. She has one of my favorite people in the feeding space. I always learned so much from her. I'm gonna go ahead and link to a couple of the other episodes that we mentioned that Dawn has been on teaching about chewing and swallowing on the show notes page for this episode, which you can find at BLW podcast.com/ 3 0 8. I will also link to the choking course that Don and I co-teach in conjunction with a CPR instructor. It's a choking Prevention and response course. If the choking stuff really freaks you out, if you've already done your online CPR and you're like, you know what, I'm still just a little nervous. This is a very in depth course that we designed together to bring you all the aspects of, you know, what increases baby's risk of choking, and what can you do to reduce it. Plus, in the event that your baby does choke on food, what do you do as far as response goes?

1 (19m 1s):

That's all in the choking course that we teach together, and I love, love, love, love, absolutely love working with Dawn. She is the most amazing professional and she has such a great way of making really complicated topics, especially about your baby's mouth and airway. Just simple, I hate to say, bite sized approaches and really good practical, actionable tips that you can take to help make sure your baby gets a safe transition to solid foods. So all that stuff will be on the show notes, BLW podcast.com/ 3 0 8. Then a special thanks to our partners at AirWave Media. If you guys like podcasts that feature things like food and science and using your brain, then definitely check out some of the other podcasts that AirWave hosts. We are online at BLW podcast.com and thank you guys so much for listening.

1 (19m 41s):

I'll see you next time.