Toys to Give : 12 months to 24 months

Installment 2 of Toys to Give, this time for ages 12 months to 24 months.  

A spinner

a trampoline or two

beginners basketball

lawnmower

walker-car

rolling pull toys!!  I haven’t met a little one who didn’t squeal with laughter when their toy puppy chased them

Are you noticing a theme?  Why am I recommending all of these toys that have more to do with movement than speech, you ask?  Because we know that gross motor precedes fine motor in development (speech is a fine motor movement).  Get your squirrel movin’ and shakin’!  Movement helps connections in the brain grow, establish, and fire the way they are supposed to do.  Here are some more toys I love.

Duplo!! or MegaBloks

toys that aid in visual tracking like this or Car track by Fisher Price

V-Tech’s smart garage

Mr. Potato head to start learning body parts

Little movers airplane for teaching beginning concepts in, on, up

toys that encourage the beginning of self-play, functional play, and imagination like

trucks/cars

toy food like that or this or this (New Sprouts brand toy food is an investment that your kids will play with for years to come.  I use these in therapy and they’re durable and easily cleaned.)

pots and pans

farms

babies to wash, dress, feed

jumbo sized beads for fine motor skills and color learning, matching, and beginning patterns

Don’t forget the MESSY PLAY

paint

cups and brushes

dot art

huge stamp pads

rollers and stamps

play doh and this awesome truck or dentist kit

water play

<p style=”text-align:left;”><a title=”Like This!” href=”http://getsociallive.com/gslike.php?likeurl=http%3A%2F%2Fwww.becausetheygrow.wordpress.com&amp;liketitle=Toys%20to%20Give%3A12%20months%20to%2024%20months&#8221; rel=”nofollow” target=”_blank”><img style=”border:0;margin:0;padding:0;” src=”http://getsocialserver.files.wordpress.com/2010/08/gslk2.png&#8221; width=”49″ height=”23″ alt=”Like This!” /></a></p>

Infants 0-12 months: Gift List

This is the beginning of my toy recommendation list.  It’s not all inclusive by a long shot.  What I’m striving for is a few good go-to ideas of what to give your little squirrel this Christmas (or any occasion really).

0 to 12 months

Lamaze Discovery crib toys or floor mirror for tummy time

Classic Sassy toys

Suction cup high chair toys like this or this

Teethers and Chewthat offer multiple textures and shapes to mouth like this one or this one

Cause and effect toys like this Bright Starts chicken barn or for the lil’ guys Bright Starts cement truck or this Gumball fun

Edushape Sensory Balls like these or Pull and Go Cars  get infants exploring texture and motivated to move 

Things to entice crawling or rolling after like this Fisher Price Snail

Little Shopper playset  putting in, dumping, pre-linguistic vocabulary development

Music toys like this or this

and of course, books, books, books!  Some of my favs include :

basic animal photo books

books with other babies and different expressions

baby sign books, research teaches us that babies can sign and understand sign before words

board books like this or this or this

Toolbox Tuesday: Preschool Language Activity With a Side of Fuzz.

Its toolbox Tuesday!  Let’s see what’s in the bag today.

The Fuzzy Puzzle by Ceaco KIDS!  I came across this 24 piece farmyard puzzle at my local Target.  I was intrigued at the “fuzzy”.  Lucky for me there was a sample piece attached to the outside of the box!  WELL PLAYED Ceaco, well played.

It’s fuzzy, but not overwhelming fuzzy.  The backside of the puzzle pieces are soft diamond pattered squish.  I don’t know how else to describe it.  Squish.  Again, not overwhelmingly squishy so it was PERFECT for my kiddos.  It offered a subtle tactile experience.  But that’s more OT, and I’m here to talk about speech, language, and feeding.  Right?  Right.

This little puzzle is only four weeks old.  So far, I have been able to work in a number of receptive and expressive language concepts (understanding and producing) at a variety of skill levels.  So I will do my best to organize and present what I do with this little tool.

Let’s start with RECEPTIVE language, or understanding  language. The following are language targets that you can focus on using the fuzzy puzzle.

• Vocabulary (cow, pig, sheep, chicken, rooster, dog, cat, bunny, birds, chicks, ducklings, butterfly, dragonfly)
• Animal sounds
• Basic concepts (together/apart)
• Counting
• identification

For example, at the most basic level, begin with one section of the puzzle, placing the pieces together .  Bombardment is the first step in teaching a skill, so the phrase “Let’s put the (pig, cow, horse) together!” should come out of your mouth no less than twenty times as you construct your fuzzy farm.

After each animal is made, model the name and sound it makes.  You could even drag out the Old MacDonald Had a Farm song through the entire fuzzy activity (approx. 10 mins).  Sing a round of “moo moo here, and a moo moo there” each time you’ve made a new farm animal.  Be sure to really ham up the animal sounds.  Kids love it when you make a silly fool of yourself.  If you’re working on sign language, note:  make sure you have reviewed your farm animals and are ready to sign them!

Have the child find an animal that you name (identification).  Have a race- see who can find it first. Of course, you can win once or twice, but praise him/her for how quick he/she found it.  “You’re the fastest finder!!”

Model counting the animals.  Again, bombardment is the key here.  By the time you’ve completed the activity, you’ve had an opportunity to count to 5 (blackbirds/crows) and at least ten opportunities to count different animals.   “How many cows do we have?  One, two… TWO!”

For advanced concepts, target on top/under, next to.  “the bunny is next to the birdhouse.  Can you find the bunny next to the birdhouse?”  There’s lots going on in the puzzle.

Now for EXPRESSIVE or producing language (speech).  The skills you can target are infinite if you think about it.  From one word to a thesis paper, depending on who you’re working with.

• Animal sounds
• One word animal names (labeling)
• Two words- “see ___”
• Three word sentences “I see ___.”
• 2 types of sentences, expository and interrogative
• Initiating the next piece to put together, or a turn
• Requesting using words (help, puzzle piece)

So, beginning at the basic level assemble the puzzle (with or without help from your friend)and name the first animal that is made.  “Look!  We made the horse!  What does the horsey say?”  HERE YOU MODEL WHAT YOU WANT THE CHILD TO ANSWER.  It’s the perfect starting point.  It gives support, lets them know what the right answer is (errorless learning), and is easily faded as you proceed.  Woo-hoo the child when he/she tries to imitate what you’ve modeled.  Any attempt to speak is worth gold at this level because the goal is to get them vocalizing with intention.  It may not resemble the target modeled sound that you made, but hey- how good did you look the first time you tried to roller blade, ice skate, or surf???

To work on 1 to 3-word sentences, the foundation looks the same.  PROMPT, MODEL, PRAISE, MODEL, PRAISE repeat.  This might look like the following exchange.  The child’s utterances are in parenthesis.

“Look at this one.  What’s he called?  (sheep)  That’s right!!  A sheep.  Tell me “I see sheep.”  (sheep) Good try.  Let’s try “see sheep” (see sheep)  YES!!  See sheep (see sheep).  Awesome, you’re a rockstar!”

The types of sentences you can target are expository (It’s a sheep) or interrogative.  I like working interrogatives into my receptive task of finding the animal in the constructed puzzle.   It looks like this:

“Can you find the dragonfly? Let’s call him.  Dragonfly, where are you?”  Depending on the child and his/her skills, answers may range from (are you?) to (fly, are you?) or (Dragonfly, where are you?).  I’ll incorporate this as many times as I can for speech practice.  I like to teach functional phrases from the get go.  For some reason I have the vision of a small child misplacing his mommy or daddy in a store, unable to find them because he can’t say “where are you?”

Finally, requesting can be targeted with many activities.  The fuzzy puzzle pieces could stay in your box, close to you, or somehow in your control.  Note that in order to request, MOTIVATION MUST BE HIGH.  So if your friend is “meh” interested in the puzzle it might be better to save the requesting for another activity.  Focus instead on hamming up the other targets.

Labor Day Dog

Lots going on behind the scenes the past two weeks, my apologies!  While I’m bustling about, take a look at some of my recipes here or here.  I leave you with a happy photo and wishes for a safe, enjoyable Labor Day.

Now all Willie needs is a grill like Sabrinut’s.

Coming Soon, The Holistic Interviews: Speech Therapy and Complimentary and Alternative Medicine

I am ABSOLUTELY STOKED.  Yes, I said stoked.  Enthusiastic beyond words, exhilarated and excited about something new.  What’s new you ask?  WELL.  I am stoked to announce that I will be interviewing an outstanding family chiropractor, specifically regarding pediatric treatment.  Dr. Charles Langrebe of Langrebe Chiropractic  has agreed to collaborate with me to bring YOU answers.  I would like this to be the first in a series of interviews that takes a look at Complimentary and Alternative medical (CAM) professionals dedicated to treating the CAUSE of dysfunction instead of only the symptoms .

Now what does chiro-practice have to do with speech?  HA.  What does speech have to do with movement?  What does a lion have to do with a hyena?  Am I losing you yet?  Remember the circle of life from Lion King?  It’s all connected.  Brain to gut, ears to  balance, vertebral subluxation to reflux, reflux to feeding disorders.  Ah-HA.

Our bodies are funny like that.  One disruption creates a ripple effect that I, for one, am prone to ignore. That is until I am completely out of sync and crippled.  It’s only then that I begin taking the steps to uncover the root of my aches and pains.  I’ll admit here, though, it’s usually after a few weeks of trying to “band aid” my pain with medicine, or worse, compensating with awkward movement and making things worse.

Health is like spaghetti, not waffles.  Our body’s amazing systems work together as one whole string of noodle, not in separate waffle boxes.  There is abundant research that confirms the interdependence of one system to another.  For example,  our brain and spinal cord (central nervous system, or the supreme overlord) receives and sends all information through the nerves to muscle and regulates our organ systems.   I am grossly oversimplifying, but my point is, there isn’t one part of you that isn’t affected by another part of you.   I have to go off on a tangent here. If you know how a computer works (and I know very little about how one does), there’s a constant scan at some ridiculously fast speed that detects key stokes and user input.  Well, our bodies are still CRAZY FASTER than a computer in detecting, processing, and adjusting to user input.  Can you tell that I am a huge neuro-geek?    I am in awe of the brain.

Now, where was I ?  OH, yeah.  Interconnection.  Body systems,  Information.  Chiropractice.  CAMs.

In 2013, it is not uncommon for families of children with Autism, SID, ADHD, reflux, CAS and other diagnosis to seek out alternatives to the “here’s your script” approach.  From a therapist perspective, information n about CAMs and their benefits is not mainstream,  just yet.  There is not a  largely available and publicized bank of research and information.  You really have to dig.  Instead, I feel like it’s a still a mystery to many.  It’s the 1920’s “speakeasy” that you have to know someone to find its entrance.  As I am a holistic therapist, it’s my passion to be a detective and look at all of the evidence in differential diagnosis AND treatment.  That’s where CAMs come in.  Why not compliment speech therapy with alternative medicine that optimizes progress?  Why would you say, “no thank you, I prefer to draw out my recovery” or “Nah, I don’t want my child’s development to be optimal.”

Well, that’s all I’ve got for now.  In anticipation of my pending chat with Dr. Langrebe, what would YOU like to know about chiropractice and pediatrics?

references

Alcantara, J. (2009, 10). The Safety and Effectiveness of Pediatric Chiropractic: A Survey of Chiropractors and Parents in a Practice-Based Research Network. Science Direct. Retrieved 08, 2013, from http://www.sciencedirect.com/science/article/pii/S1550830709002079

Alcantara, J. (2007, 10). The successful chiropractic care of pediatric patients with chronic constipation: A case series and selective review of the literature. drdianemeyer.com. Retrieved 08, 2013, from http://www.drdianemeyer.com/Dr%20Meyer.pdf

Gotlib, A. (2005, 03). Assessing the evidence for the use of chiropractic manipulation in paediatric health conditions: A systematic review. NCBI. Retrieved 08, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722516/

Meade, T. (1995, 08). Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. BMJ. Retrieved 08, 2013, from http://www.bmj.com/content/311/7001/349

Pickar, J. (2002, 05). Neurophysiological effects of spinal manipulation. Science Direct. Retrieved 08, 2013, from http://www.sciencedirect.com/science/article/pii/S152994300200400X

Ressel, O. (2004, 10). Vertebral Subluxation Correlated with Somatic, Visceral and Immune Complaints: An Analysis of 650 Children Under Chiropractic Care. Sierra Chiropractic. Retrieved 08, 2013, from http://www.sierrachiropractic.com/PDF/2004-1022_ressel.pdf

 

Toolbox Tuesday: Speech and Language Therapy with a Bear. WHAT??

Since I’m doing in-home sessions some days, I have to make the most of what I bring.  I try to pack what I think will be the “perfect” therapy toy.   Truth is that all plans are tossed out the window if my little friend isn’t interested.  Then it’s all about improvisation and expertise with what I might have in my bag of tricks.    It was after one such session that I thought “Hmm, it might be interesting to someone to know how to take a toy on the fly and  turn it into an amazing speech toy.”  Well, maybe not amazing, but pretty cool.  I had planned a session for my friend Gus*.  Gus had no interest in it, but was eyeing a puzzle he happened to have caught sight of at the bottom of my bag.  Therefore, without further delay, I bring you Toolbox Tuesday.

Today’s challenge?   one small wooden treasure chest and a bear puzzle

Target skill:  Receptive Language (think comprehension) & increasing vocabulary

Place said empty wooden bear puzzle in front of your buddy.

Lay out three faces, describing each (ex.  Here’s happy bear, here is sad bear, and here is angry bear).  Change your voice up- cry for sad bear, smile for happy bear, and make angry eyebrows for angry bear.  Ask your friend to pick which his bear happens to be.  Is he happy, angry or sad today?

Next lay out two articles of puzzle clothing.  I will talk about making this a more difficult task later.  Ask your buddy to “find”, “pick out”, “give Mr. Bear  the ____”.  This is a basic task to get your guy’s language processing center to decipher information and formulate a response.

Making this harder.  If your child has his basics down and is ready for a challenge, you can increase the task complexity by either adding additional clothing pieces to choose from OR increasing the characteristics you are asking him to identify.

For example, if you have a field of two items to choose from, he has a 50% chance of choosing the correct item you’ve asked for.  By adding the third item, there is more information for him to visually process and identify.

Similarly, placing two items of clothing that belong to the same semantic group (ex. 2 shirts or 2 pants) and increasing the target identifiers (the pajama pants) requires a higher level of identification skill.

Once Mr. Bear is fully dressed, talk about his fine outfit with the child!  If he is wearing pajamas, what does your friend think Mr. Bear will do?  If he is in his winter clothes, what does that mean?  Chat Mr. Bear up about where he goes and what he does.

Vocabulary:  Next, you can cover more basic toddler vocabulary:  eyes, nose, ears, mouth, arms, paws (hands), tummy, legs, shoes.  Following is an example of what this would look like:

Ask your guy to show you where Bear’s eyes are.  Make a big fuss when he gets this right, high fives and woo-hoos.  Then ask your child where his eyes are.  Follow it up with your eyes.  You have now practiced finding eyes 3x!  If you want to get crazy, get anyone else in house in on the action.

By now you might be wondering what to do with the little wooden treasure chest.  I like to keep my puzzle pieces hidden as we work through this kind of task.  It eliminates too much info, keeps control of the complexity level (I only take out what I need), and it looks cute.  What kid doesn’t like a treasure chest?  So parents and SLPeeps, what’s in your toolbox?  ooo…. maybe there will be an Iron Therapist show……..

 

 

 

 

 

 

Bad Speech Therapists: They Do Exist.

Today was a good day, I suppose.   I returned to work this week following a two week medical leave.  Today was a first visit with a new family.  I am their third speech therapist, and their child is 2 years 4 months old.  He has Down’s.  As I gathered therapeutic history, I asked at what age Noah* began therapy.  Mom responded that his first therapist came when he was about 6 months old.  That’s great, I thought.  “but” mom continued, “she said she wouldn’t do anything with his mouth.”  So, after a month of watching the therapist shake rattles at Noah, mom ended therapy.  Strike 1.

I continued with therapy history.  The second therapist came in when Noah was just over a year old.  He was not gaining enough weight.  He wouldn’t eat, had tremendous difficulty with texture, and often vomited.  At one point he had bouts of diarrhea.  Mom reported that she was happy the second therapist was going to address Noah’s feeding problem, someone would help him with his oral skills.  Mom said that it only got worse.  Therapist #2 said that Noah should learn to eat more solid food, and suggested moving to stage 3 & 4 baby foods.  Eating became an unpleasant daily occurrence for Noah and the family.  Therapist # 2 began to force feed him, holding Noah’s arms down, insisting that his behavior was a stage and it would pass.  Therapist #2 insisted that Noah could not go to school eating baby food.  I sat listening to mom, taking the information in, thinking how horrible for Noah.  Mom continued to explain that she was concerned watching therapy sessions.  Noah would cry as soon as food was brought out.  She felt meals were becoming a punishment to him.  She brought her concerns to her GI during a visit.  The GI confirmed that force-feeding was not the solution and agreed to consult with Therapist #2.  Mom said that after the consult, Therapist #2 did not force Noah to eat for the next session.  Then things returned to the same.  Mom ended therapy shortly after.  Strike 2.

Unfortunately, this is not the first family I have taken on as clients with poor therapy experiences.  I suppose they won’t be the last.  I am acutely aware of how much trust we, therapists, inherently acquire when we begin services.  We are the experts in our field.  Most families have little or no knowledge of treatment or materials.  They take our recommendation, most times without question.  That’s a lot of power to wield.

To families that have had less than stellar therapy experience I say this: All therapists are not created equal.  It is in your right to end treatment, seek another therapist, and to question what goes on in your session.  A good therapist will explain why he/she is doing what he/she does.  That person will welcome your questions and provide you evidence based treatment choices.  The goals treated should be based on what YOUR FAMILY wants and needs.   The child he/she is treating is YOURS after-all.

To my fellow therapists, I encourage you to grow.  I encourage you to research.  I also encourage you to change professions or populations if you are just showing up.

If your vision and heart aren’t in your practice, then why are you doing this job?  There is no room for adequate therapy, mediocre treatment, or rattle waving.  Turn in your rattle.  Have the integrity to decline a client because you are not familiar or comfortable treating that child’s disorder or syndrome.  Refer out.  Make connections with other therapists.  Excuse yourself.  If you find yourself in a position that does not hold your client’s well-being of utmost importance, discharge yourself from the case.  Read your ethical code.

I think I’m done venting.  It was a good day, for the most part.

Commitment Issues

Today was a good day.  No, a great day.  I ordered my first big girl business cards.  It ranks up there with graduating.  Well, not quite but it’s up there.  See, I have a thing about commitment.  I can’t decide which kitchen towels to buy, a silverware design, or bowls I like best.  Thoughts like, what if I don’t like them in a month?  Do I really want to look at that bowl for the next year? two years?  I can’t breathe!!!!

So, for me to-1.) collaborate on a logo, 2) select a template,  3)decide what words I want printed on 200 cards (still feeling a little residual anxiety, not gonna lie),  and 4) click checkout -was a mountain climbing experience.  A five month climbing Himalayan climb.   Can you hear me down there? (((echo)))  I’m wearing my big girl pants today…. That’s right.  I made an executive decision.  ‘Tis good to be queen.

And now I continue on my quest to establish the best private practice in the universe……………………………

 

Down Syndrome, Pediatricians, & the Baby Whisperer

It occurred to me that many people, including pediatricians have no idea what the heck an SLP does.  SO, I am going to blog about it for two reasons.  First, KIDS WITH DOWN SYNDROME.  Second, so that parents of all children know, when in doubt have your child screened.  It’s always, always better to hear “Your little one is right on track” rather than wait, wonder, compare, wait some more and LOSE PRECIOUS TIME.  I can’t say this enough.

Pediatricians.  I am a fan.  Honestly.  And I would not presume to know everything that a pediatrician does,knows or treats because it isn’t my field of expertise.  Instead, when confronted with something that doesn’t fall under my scope of practice,  I research, read, and err on the side of “Let’s see the doc to rule this out”.

It could just be me, but what happens on this side of the fence is that  parents come to me much  later than they should have because their trusted pediatrician told them that ” I’m sure Noah will develop his first words soon.  Let’s wait til his next check up and see where he is.”   Or “lot’s of kids are picky eaters, he’ll outgrow it” and there is no oral motor exam done.   Doesn’t the doc know what I do??  I’m like the baby whisperer.

People assume an SLP only helps someone talk.  Part of the problem, I admit, is our title:  SPEECH therapist, SPEECH-LANGUAGE pathologist, and an SLP that is trained in COMMUNICATION disorders.  Speaking only of SLPs that specialize in pediatrics, an accurate title would read:  SPEECH, LANGUAGE, FEEDING, ORAL-MOTOR, SENSORY, BEHAVIORAL, COMMUNICATION, AAC*, REASEARCHER, DEVELOPER, PATHOLOGIST & THERAPIST.  But that would be silly.

*AAC refers to alternative augmentative communication (sign language, dynavox, iPad, etc)

I don’t want to generalize.   Often, hospitals have a team of specialists following a child, including SLPs, OTs, PT,s nutrition and pediatricians.  It’s a beautiful thing.  But what about the majority of children that are home, with no medical diagnosis, no team to report to, that are not severe to profoundly disabled?  Once in a while I’ve found a plugged-in pediatrician that had an slp in his network of go-to’s.  They are far and few in between.  The average doc is swamped in his/her own practice and quite frankly, not trained or not thinking about my area of expertise.  That’s not an excuse.  I need doctors to be minimally educated in what SLPs do, for children’s sake.  I need pediatricians to learn to do a simple OM screen.  I need them to know what to do when that quiet little one-year old comes in without first discernible words.   I need them to know up to date guideline.  What’s with waiting?  Did a broken arm get set properly waiting? Was a tumor diagnosed benign waiting?? sigh.  Most (if not all) SLPs will screen for free.  No harm, no foul.

Now, why did I put Down Syndrome in my title?  Originally I was going to blog about the benefits of beginning therapy at birth with feeding and continue through speech.  Babies with Down’s have a number of challenges when it comes to oral motor tone and skills for feeding and speech.  It’s best to begin working these skills as early as possible for the most optimal outcome.  PLEASE, don’t wait.  The sooner we start, the farther they will go.  And that’s for everyone.

Sippy Cup, Sucky Pouch and Oral Motor Development

Remember way back when?  We played outside all day.  We rode bikes to school, uphill both ways.  We endured horrible discipline that taught us to respect our parents and elders.  But remember the cups we used to drink from?  They were cups.  You know,  tumblers, open-tops.  It was way cool if you went to McDonald’s and got a cup with a lid and straw.  Even better if  you got a swirly straw party favor.  Remember the food we ate?  It was junk sometimes, like hot dogs and mac-n-cheese.  But it was real food.  Real fruit, like apples or grapes.  I remember having a contest to see how many grapes my  friend and I could shove into our mouths at one time.  It’s amazing we survived childhood.  But it was food we ate, not stuff that we sucked out of a pouch.

I walk through the grocery store and observe.  Almost every kiddo I see has some form of sippy cup, and on many an end-cap there are pouch foods for kids.  Organic or not, what are we doing?  From a parenting standpoint, I get that we’re all “on the go”, but what are we sacrificing for that “go”?

From a therapeutic standpoint, I cringe at seeing all the little mouths sucking away on sippy cups that cause tongue thrust, or a reversed swallow.  The next generation of lispers in the making.  A “Sippy cup”, while looking like a cup, is nothing more than the publicly acceptable version of a bottle.  If it has a valve, it’s simply continuing to promote a sucking pattern that the bottle started.  The child’s tongue is NOT learning a neutral position that encourages a symmetrical palate and appropriate position for speech articulation. Instead the tongue is habitually pushing forward, much like it did when nursing or bottle drinking.  And sucking food from a bag?  More of the same.

Around 12-15 months,  it’s important for the tongue to begin establishing what I mentioned before- a neutral position.  This position is learned when a child begins to eat (or be fed) regularly with utensils.  Spoons and open-cups or straw drinking reinforce the tongue’s retraction into the oral cavity.  Straw cups offer lip rounding/strength building which is another awesome skill that a kid needs to master.  It will serve him well for articulation and keeping milk from spurting out of his mouth when he’s giggling.  If the cup MUST have a lid, opt for the straw cup, with NO VALVE.

Let me switch to the parent perspective again- I understand how tedious it is to have a stumbling little person walking around the house with a cup full of chocolate milk.  Why not keep the liquids on a leash?  Cups at that table.  If you want a drink, come get it.  Then leave it here.

From the feeding specialist perspective- kids need water.  They need nutrition.  But they do not need to graze and drink calories throughout the day.

One mom asked me, “what’s going on with all the kids and poor oral motor skills?”   There is no simple answer, but there are things we can do to start them off in the right direction.  Ditch the sippy cups and pouch food.  Get them using their lips, teeth, and tongues.