Feeding Therapy – Mom Dishes It Out

September 22, 2015

Eat Like A Baby

By Dina Cohen, MS, RDN, CEDRD

Photo Credit: Mait Jüriado via Compfight cc

My girls are confident self-feeders by now, and it’s a lot of fun to watch them eat. When I put a new food on their trays, they curiously examine it, poking and prodding with great interest, and finally cramming it into their little mouths. By the time they are done, their noses, ears, eyebrows, and hair have all had a share in the meal, and naturally, the floor is a disaster, but it’s great fun for them, and for me! The babies are fascinated by new colors, textures, and tastes. While they recognize their favorites and will grin and gurgle at each other in appreciation when I serve something that they think is fabulous, they’re still very open-minded, and I take full advantage. It’s so entertaining to see their expressions after I shock them with an entirely new texture or flavor. I love that they are so curious and will always try at least a bite or two, no matter how different a new food looks, smells, or feels. I don’t know how long this will last, but I hope it always will! I’m certainly appreciating it for the moment.

Eating with my girls is showing me how enjoyable a meal can be when you involve all your senses and approach it with a sense of discovery and adventure. Watching their active participation in their meals reinforces how valuable it is to eat mindfully. Mealtime is about more than simply filling your stomach and moving on to your next activity. Eating is a much more satisfying experience if it involves noticing and appreciating the color, texture, and flavor of your food. Is it as good as you expected? If you were brave enough to try something new, how much did you enjoy it? Is it worth going back for another bite? Not everything you eat is always going to taste super-amazing, but once you’re eating, your food should taste good to you! My girls aren’t finicky, but they don’t compromise, either. They enjoy a variety of textures and flavors, but if they aren’t impressed with a particular food, they’ll abandon it after a few bites. They listen to their stomachs and will leave over food when they are full.

I try to vary their menu to keep them curious and so that we don’t get into a Cheerio rut. It’s important to me that their meals are stimulating and fun, as well as nourishing and tasty. But I’ll admit that my own meals don’t always receive the same level of attention. As moms, even dietitian moms, it can be easy to put ourselves last and eat the same thing day after day just because it’s easy, and, well…mindless. How different might our eating look if we ensured our meals included a variety of colors and flavors? When did you last try a new ingredient or a unique recipe? How much time do you take for your meals, and how much do you enjoy them? Are your meals enjoyable? Satisfying?

Eating mindfully is something we were born knowing how to do. Noticing how food makes us feel while we’re eating it and how satisfied we are afterwards is not a special talent. We all started out with this ability. Somewhere along the way, though, most of us were socialized to focus more on external signals as opposed to what’s going on internally. We eat in a hurry. We eat past the point of fullness. Sometimes we might finish a meal barely noticing what it was we just consumed. None of this is a crime; sometimes, when life is busy, it’s a necessity. But there’s no question that it’s a less-than-ideal way to eat. The good news is that mindful eating is something that can be relearned. You’ve done it before, and you can do it again. If there’s an opportunity in your day (or even a day in your week), when you can slow down enough to enjoy a meal that’s appealing to your senses and satisfying to your body, you’ll be eating the way it’s meant to be done. So as I amusedly watch my babies’ gleeful faces as they squish and smash their way through their gloriously messy mealtime, I can’t help but think, “Hey…they’ve got a point!”

September 8, 2015

What To Do When a Good Eater Becomes a Refuser

By Danielle Viola, RD, CSP

Danielle Viola Pic Blog-1

We’ve all been there. Just when we think we have our children figured out or on a good schedule, they change it up on us! This applies to so many things in our kiddos lives, from sleep to behavior and beyond, but a big area this can impact is eating. Even the best eaters can go astray at times.

As a mom and dietitian, I’ve been fortunate that my first son has been a pretty good eater. Some of that is due to work I’ve put in with him, but a lot of it has to do with the fact that he was open to trying lots of new foods before he hit about 18 months. As long as he was accepting, we kept throwing new flavors and textures his way. For his second birthday he requested Salmon with a Puttanesca sauce (olives, capers and tomatoes for those who are unfamiliar), spinach and roasted potatoes.

You can imagine my dismay when my child who previously ate all things decided that he wanted more control over what he ate and all but gave up on trying new foods and even started to shun some foods that he had previously enjoyed, like sweet potatoes.

For anyone out there struggling with this or even just dealing with a child who is less willing to try new things, the good news is that this is normal and the solution is relatively simple. It just may take some time to actually work. It’s frustrating in the short term when all you want is for your child to be eating well-rounded meals, but it’s more important to look at the big picture and help your child to maintain a healthy relationship with food.

Here are my top 5 tips for dealing with a good eater gone astray:

Model good eating behavior. If they see you eating it, it will just be normal. You can’t expect your child to eat peas if you won’t touch them, how fair is that? I find that the older my son gets, the more likely he is to try foods from my plate when the pressure is off and he is the one doing the asking. He wouldn’t get that opportunity if I weren’t striving to eat a variety of foods.
Eat dinner as a family. Eating together is a key way to model eating behaviors and to talk about food. Family dinners end up becoming so much more than just a time to eat and with everyone eating together, some of the pressure is removed from a child who would otherwise be eating under the watchful eye of his or her parents. The more you chat together at the table, the more relaxed the atmosphere is. That inviting atmosphere helps kids to feel more comfortable to experiment with their eating. Plus, who wants to eat alone?
Talk about food in a positive way. Studies show that children are more likely to try and eat new foods when caregivers talk about the benefits of foods instead of the negative consequences of “bad” foods. Think talking up the benefits of broccoli over the harm in eating cookies all day. Choose something that motivates your child. Our oldest was desperate to ride a roller coaster at a local amusement park. We talked about the types of foods that would help him to grow big and tall in order to do that and guess what he started asking for more of? It totally works!
The food choices that children make will only be as good as the foods that are offered to them. Enough said.
Don’t force your child to eat. Kids will eat when they are hungry. As a parent, it is your job to provide a variety of foods to your child. Your child should be deciding which of those foods he or she will eat and how much. Battles over finishing food at the table only result in frustration on both ends and can ultimately disrupt your child’s ability to sense when he or she is full. Trust that ultimately, your child’s body knows what it needs and in turn, your child will become more adventurous as he or she begins to trust that you won’t be forcing food at mealtimes.

Disclaimer: These suggestions are for children who are otherwise growing and developing at a rate deemed appropriate by your child’s physician. If you are struggling with eating habits in a child who is having growth failure, it is important to seek out individualized advice from a professional, such as pediatric dietitian.

August 25, 2015

How to Grow a Healthy Eater, Naturally

By Dina Cohen, MS, RDN, CEDRD

6975859184_75b8da2343

When my friend Esther told me that her kids prefer broccoli to pizza, I knew we had to talk

some more. Esther is a mom to three children under the age of five, and she is also one of the

most relaxed, serene individuals I know. I’ve chosen her as one of my “role model moms” (I

collect them) and the way she feeds her children is just one of the many things I admire about

her. I’ve asked Esther to share her techniques for raising healthy eaters. Here are her tips!

1. Expose kids to a wide variety of foods. Kids each have their own preferences, so by

exposing them to many different foods, you enable them to find their healthy favorites. Esther

doesn’t get stuck in a rut of serving only things she knows they’ll eat. In her house, “Kids taste

everything. After that, they can have an opinion. If they don’t like something, it’s not a big a

deal. They’ll meet their needs at another meal.” Esther finds that involving kids in meal prep is a

great way to motivate them to try new foods. She suggests saying something along the lines of

“Libby helped make the salad today. Doesn’t it look delicious? Thank you, Libby!”

2. Know that whatever Mommy eats is exciting. There is nothing more powerful than role

modeling. “Kids pick up on your vibes,” Esther says. “Let them see you eating and enjoying

healthy foods. I love fruits and vegetables. I really think they taste good, and so do my kids. I

stocked up on of fruits and veggies at the beginning of the week and cut them up into snack

bags for my kids to take to day camp. They were ecstatic. My four-year-old ran over to me with

her veggie bag and said, ‘Mommy, smell it! Smell it! It’s so yummy!’ ” Esther shares how she

recently bought fresh cherries and her daughter was so excited she tried to climb up to the top

shelf of the fridge to get them. Her younger son loves imitating his big sister as well as his mom,

and he eats plenty of fruits and veggies too. Cherry tomatoes are a family favorite. “They enjoy

putting one in each side of their cheeks and looking weird.” Mealtime is a wonderful time for

role modeling healthy behaviors. Esther makes a point of sticking around during mealtime. “Sit

at the table with them and they will have an easier time eating. The more people at the table,

the better. I’ve noticed that whenever we have guests, they’ll do better at meals. It’s always

best if you can eat with them. You can beg them to eat a bowl of cereal and they’ll refuse, but

sit down and have one yourself and they’ll come crowding around.”

3. Help kids build healthy habits early on. Because her daughter refused water at a young

age, Esther began giving her juice, but she always dilutes the juice with water. “I dilute it so

much, it’s like flavored water. The other day I’d diluted the juice while it was still in the

container, and when I poured some for my daughter, she said, ‘Hey, you didn’t put in water!” I

try to give my kids whole grain products and while it doesn’t always go over successfully, it

often does. They aren’t fans of whole wheat bread, but they really like brown rice. “Get away

with it when you can.”

4. Provide all foods. Esther sets the stage for healthy choices but she knows when to step

back. “I do let go because I don’t want my kid to be the one eating candy under the table.”

Recently, her four-year-old has been asking for a freeze pop upon coming home from day camp

because she sees the neighborhood kids having them, and Esther has no problem allowing her

to have too. She’s ok with it because her daughter enjoys many healthy foods as well and she

does not want her to feel deprived. She knows her daughter is used to a healthy routine and

understands that all foods can be part of a balanced lifestyle.

5. Understand that it will be challenging. Things don’t always go smoothly at Esther’s table.

“It’s hard when you put in a lot of work to prepare a meal you think they’ll really like but then

they don’t eat it.” However, Esther believes that this is because “Children are challenging! It’s

not food-specific. They don’t always do what you want, and you’ll have to readjust your

expectations. Don’t drop the whole thing, but know that you might have to rework the

scenario.”

6. Don’t have an agenda. Esther feels it’s important not to get too worked up about your

children’s eating. “When they feel you are anxious for them to eat something, they won’t want

it. It’s like when you’re anxious for them to go to sleep on time because you have a babysitter

coming; they’ll sense it and won’t go to sleep.” She believes it’s best not to be overly invested in

the outcome, or at least to “pretend you don’t care!” When I asked Esther to share some

rewarding moments, she replied, “I don’t view it that way because I don’t put in intense effort. I

don’t have an agenda. We keep trying things, and when something doesn’t work, it doesn’t

work. And something that didn’t work at first might work later on. So rather than individual

rewarding moments, I get slow, gradual gratification. I’m seeing that the seeds I’ve planted

have successfully grown.”

August 11, 2015

The Power Struggle: Kickin' and Screamin' About Food

post
By Mommy Laura Cipullo RD, CDE, CEDRD

Now it is always a RD’s recommendation to never have a power struggle around food. But what happens when your kid is the one who is running the show? I have seen this with clients, where the kid becomes so picky with the food, the parent obliges. A few weeks ago, I was thinking to myself, was this happening in my home with my youngest son.

School was out. We moved homes on the last day of school and literally left one week later for South Carolina. Billy just seemed off. He had heat stroke one day and as a result hadn’t eaten much or well for a few days. Then when we went on a Pirate Ship tourist trap kind of cruise and the employee commented on his height. Now this is something I am sensitive about. I do wonder if his shorter stature is just him or is it because he is a picky pescatarian. He eats one fish and only some of the time. With all of the emotional change he was definitely being pickier. I got to worrying.

Billy wasn’t even willing to try any foods. I made him a veggie burger with cheese on both sides while I served Bobby his chicken. This was the Bell and Evans Chicken Tenders. Meanwhile at the restaurants, Bobby and I share steak and other normal foods. I thought a veggie burger was a very nice compromise for Billy. Of course he did not agree.

The power struggle began. But I really didn’t want to give up. I hate that it had to come to this but I was legitimately worried about his health. I was not asking him to eat the veggie burger; rather I was asking him to try it. The fact that he would not try it, really got to me and I decided I was not giving in. I was ready to sit with him until he tried the veggie burger.

At first this was a game for him, until he realized I was serious and 45 minutes later still sitting with him. He would leave the table and I would bring him back. The night before he had refused his fish sticks so I was without options. Soon Billy was crying to me. I explained I was concerned and as a parent I would irresponsible to not feed him adequately. Plus I was really worried for his health emotional and physically without proper protein. And that is when he said it!

He said, “Mommy, I will eat chicken.” He whispered it. I said, “Really, you rather eat chicken than a veggie burger?” He was on board with eating Billy’s chicken. So I made him a chicken tender and he ate it. It was a small tender but he was cool with it. And guess what, her ordered chicken tenders the next night at the restaurant. And on Saturday night he ate chicken parmesan at a very fancy restaurant.

Just last week, I retuned from the South. My sister was watching my boys and gave all of the children chicken nuggets. Guess who ate them? Yeah, my Billy. My husband who had not been privy to the power struggle form the week prior told me Billy ate the nuggets without hesitation but later told my hubby that this chicken was not good like ours and was different in texture. He didn’t prefer these. But he did eat them.

Now call me crazy, but Billy grew. This could be coincidental or potentially the result of his new diet. I am grateful for both!!! The growth whatever the reason is timely, because Billy now thinks eating protein means growing tall. It is no longer mommy and daddy just saying it.

I have no idea if he will continue with the chicken. I have no idea if the chicken initiated the growth spurt. I just know that the power struggle was necessary in order to get my very strong willed child to eat something with all 8 essential amino acids. So while I hate that it had to happen, the end result seems to be okay.

I guess I won’t know until he is older and comes home to tell me that I ruined his relationship with food per his therapist. This is a joke of course, but at the same time, my worst nightmare ever. I hope my sharing of this situation can help you to set boundaries around feeding and eating with your own child. I hope you learn from my mistakes and benefit from our successes. Raising kids to have positive relationships with eating and neutral relationships with food is super hard but super necessary for our future generations.

Please let me know if you find this helpful and if you do, please share with your friends. I work with many clients who suffer from eating disorders and this is the last thing you would ever want for your child. Please spread Positive Nutrition and #AllFOODFITS!

July 21, 2015

Finally Free from Fruit Fears?

Photo Credit: woodleywonderworks via Compfight cc

By Christie Caggiani, RDN, LDN, CEDRD

So you may recall my disclosure in a previous blog, sharing that my son is anything

but a fruit lover. He politely refuses whenever offered any – whether it’s the

sweetest, most amazing strawberry, or the crunchiest red apple. When he has tried

the occasional bite, his eyes water, he gags, and just can’t move beyond it. He’s

made it into his teens allowing only raisins, applesauce and an occasional juice into

his otherwise varied nutritional palate. While he enjoyed fruit as an infant and

toddler, something switched when he became a more independent preschooler, and

while I accepted that there must be a lesson of humor and irony for me as his

nutritionist-mom, I inwardly believed that he would just shift out of it as he became

older and around other kids who ate fruit freely.

While I’ve held onto that hope, I’ve become a little more concerned that the mood

may never just strike him out of the blue. I doubt he’ll wake one morning saying,

“Cool – today’s the day I’m super excited to try blueberries”, unless I give him a little

more assistance. And that help must somehow go beyond “just try a little bite”. A

wise friend and extremely gift occupational therapist, Wendy Chen-Sams, MS, OTR,

NDT, actually confirmed my suspicions. She said that the likelihood for young adults

to expand their palates greatly diminishes once these teens have left their childhood

home, particularly when there are strong aversions to flavor and/or texture, as is

my son’s case. Fortunately for him (and me!), he’s become more curious and

actually would like to explore and expand. He’s motivated to grow to his height

potential, and assist his overall health. Cool – the critical first step of motivation is

achieved!

Wendy recommended that we not only move slowly, but also focus on only one

sensory area at a time. Since he seems to have some taste and texture aversions, she

suggested we begin first with introducing a new, mild flavor. Of particular interest

to me was the fact that colder fruits would be much less likely to trigger his gag

reflux, and will slightly numb the sensors so it’s less overwhelming — homemade

popsicles are going to be our new friends!

Our first step will be to combine familiar flavors – banana (which he loves in

pancakes & bread) and orange juice – with a new one, pear. Because we aren’t

exploring texture yet, we will be blending them together until smooth, then pouring

into popsicle molds. Once they’re ready to go, he will explore the taste receptors on

his tongue, particularly on the tip and sides. The receptors at the back of the tongue

are more sensitive, so we’ll gradually make it to those.

Once he’s tolerating (hopefully enjoying, too!), we will introduce some ever-so-

slightly larger pieces of pear within the pops, and graduate to even more texture.

As his acceptance of taste and texture improve, we’ll gradually introduce the same

pear flavor at refrigerator temp. The ultimate goal is for him to eat a pear or new

fruit without any processing. As important as it is for kids to repeatedly try new

and different foods as they begin to acquire a taste and tolerance, it’s also crucial

that we don’t try the new food every single day. A few times a week is just fine, says

Wendy.

So this is part of our summer adventure, and you can be sure that I will keep you

posted as it unfolds!

________________________

Of course there are a plethora of different sensory food aversions, and I am aware

that my son’s are quite mild. If you have a child struggling in a manner that is

interfering with his development or quality of life, it is crucial that you seek some

additional assistance, first checking with your pediatrician who may then refer you

to an occupational therapist, speech pathologist and/or registered dietitian who

specialize in this arena.

Two suggested reads:

Meals Without Tears: How to get Your Child to Eat Healthily and Happily,

by Dr.Rana Conway

Just Two More Bites! Helping Picky Eaters Say Yes to Food,

by Linda Piette

May 3, 2015

Fear about Feeding

by Jennifer McGurk, RDN, CDN, CDE, CEDRD

I have a love/hate relationship with feeding my son. I love watching him try new foods and learn skills like grabbing food in his hand. But on the other side, I am scared he will choke on something (he always seems to gag a lot) and I’ve had many moments of “am I doing this right?”

The only thing I know for sure is that there is no “right” way to feed a baby. As many mom friends have told me, it’s up to your mom instincts and a little bit of guidance from a doctor or dietitian. As a dietitian who doesn’t work with infants, I needed some help. I bought one of the best books, “Fearless Feeding” by Jill Castle and Maryann Jacobsen. (http://fearlessfeeding.com/) These two dietitians have saved me!! I also decided to sign up for an Infant Safety course to review CPR and choking. The class was scary but I feel more prepared. I also now know the difference between choking and gagging, which I learned is common when babies learn how to chew and swallow.

I’ve read the infant section and learned a lot so far. Now I know what’s appropriate for an infant in terms of food groups, portions, and signals to know hunger vs. fullness. I also have learned about introducing puree’s vs. baby-led weaning and slowly learning how to feed himself. The authors also review that as the amount of food goes up, the amount of formula will go down. My 9.5 month old is now eating 3 meals/day consisting of every food group. He mostly does purees and lumpy foods, but we’ve been working up to finger foods and he’s getting better at the pincher grasp every day. He will mostly eat oatmeal, soft mushy fruit, pureed veggies, potatoes, hummus, avocado or guacamole, fish, scrambled eggs, and bread. His favorite food is whole milk flavored yogurt- it tastes like dessert to me! My infant also needs me to feed him with a spoon vs. other babies might feed themselves at this point. I’ve learned to let him practice this in his own time. He has weaned himself down to 4 bottles per day, ranging anywhere from 4-8 oz (all depending on how much food he’s eaten). I’m still surprised at how variable my child’s appetite can be. Ellyn Satter (http://www.ellynsatterinstitute.org/) created the Division of Responsibility, which says the parent is in charge of what and the child/infant is in charge of how much (and everything else). I try my best to apply these principles now of healthy feeding behaviors to create a healthy relationship with feeding from the beginning.

I admit that even though I “know” a lot about this, I’m not a perfect mom. But who is? There are days when my child gets too much sugar and there are days when I realize he didn’t get any veggies. But there are also days where he eats a lot of healthy foods and I know he’s getting nutrition. It’s all about balance, variety, and moderation. These concepts aren’t just great for adults and healthy eating, but can be applied to children of all ages.

April 28, 2015

DIY: 7 Steps to Progress Your Picky Eater

DIY: 7 Steps to Progress Your Picky Eater
By Laura Cipullo RD CDE CEDRD CDN and Mom

Picky eaters

“I just want to go home and eat what I eat everyday for lunch.”

Is this your child? It is most definitely my child, as this is what he said to me on Friday when we walked into the burger joint known for its burgers and milkshakes. When he said this, I just let out a deep breath and decided it would be milkshakes for lunch. He doesn’t like change, and therefore he doesn’t like change in food, rules, or where he puts the furniture in Minecraft.

But this does not mean that you or I should take the summer off from exposing our kids to new foods and/or textures. Actually, summer is ideal because schedules are changing, and you can create a new schedule that incorporates trying new foods, say, twice a week. There is no school, stress, or homework, so take advantage of this time.

I am trying to incorporate different foods into dinner meals on Sundays and Wednesdays. Just yesterday, the boys tried fresh mozzarella, which neither would eat. They liked it melted but not cold. Last week they tried vegetarian sushi with avocado (they both licked it). Remember, touching, licking, or just getting it on their plate can help. Of course, they get these new foods alongside their faves or sometimes before their favorites are served. They tried a falafel burger and cocoa-dusted almonds!

My oldest, Bobby, has taken to eating fresh corn on the cob with butter and salt each night with his dinner, while Billy has incorporated strawberries without the skin at each of his dinner meals. That’s right, no skins. One night he said, “Mommy, I like the insides of strawberries.” My husband told me that Billy would eat the strawberries’ flesh, but he could not take a big bite. So I got the peeler out and voila!! He is now my strawberry man. So as summer begins, we will take this opportunity to continue exposing the boys to new foods and even former foods.

The food exposure may follow this progression or something similar.

Recognize that this is helpful for toddlers, children, and even pre-teens.

First, get the food on the same plate
Next, get touch involved. Maybe your child touches the food with their fingers or puts the food to his/her cheek or lips
Employ the One Lick Rule
Employ the One Chew and Spit—if you must
Use the One Bite Rule
Use the Three Bites Rule if your child has achieved the One Bite with that food
Make the food part of the main meal on a regular basis

If you think that your child may have issues with sensory integration, get the expert advice of a speech pathologist and/or an occupational therapist. Books that may help include Happy Mealtimes with Happy Kids: How to Teach Your Child About the Joy of Food by Melanie Potock, MA, CCC-SLP, and Ellyn Satter’s Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook.

Keep your eyes open for MDIO’s (Mom Dishes It Out’s) upcoming blog on when to get a consult from a speech therapist versus, occupational therapist or dietitian.

And of course, let us know what works for you. Does your child fit the description of Potock’s case examples, or does your child easily follow the flow set by Satter’s “Division of Responsibility”?

March 17, 2015

Baby Led Weaning: A Developmental Perspective

Baby Lead Weaning: A Developmental Perspective

By Melanie Potock, MA, CCC-SLP

*This post was originally published on ASHA’s online blog. The original can be found here.

Photo Credit: Leonid Mamchenkov via Compfight cc

One of the things I like best about teaching courses on feeding to parents and professionals around the United States is learning what new trends are evolving around family mealtimes. Over the past year, one of the common questions I’m asked is, “What about Baby Led Weaning?”

Baby Led Weaning (BLW) is a term coined by Ms. Gill Rapley, co-author of “Baby-led Weaning: The Essential Guide to Introducing Solid Foods.” Rapley graciously chatted with me about her philosophy and explained that although she did not invent BLW, she found the method to be successful in her work as a former health visitor and midwife in the United Kingdom and continues to study the topic today while earning her PhD.

In a nutshell, BLW centers on the philosophy that babies are developmentally capable of reaching for food and putting it in their mouths at about 6 months of age. As stated on the BLW website “You just hand them the food in a suitably-sized piece and if they like it they eat it and if they don’t they won’t.” Please note that the word “wean” is not referring to weaning from breast or bottle, but instead refers to a term commonly used in the United Kingdom for adding complementary foods to the baby’s current diet of breast milk or formula. According to the BLW website, ideas for first foods include “chip size” steamed vegetables such as a broccoli spear with the stem as a handle, roasted potato wedges, meat in large enough pieces for the baby to grasp and chew, rice cakes, cucumber, celery and dried apricots.

As a SLP who focuses on pediatric feeding, I view feeding as a developmental process. Whether I’m working with a child experiencing delays in development or offering advice to a parent whose child is meeting milestones with ease, I always ask myself “How can I respect and support this family’s mealtime culture while guiding this child safely through the developmental course of learning to eat?” Thus, for families who are interested in following the BLW method, whether their child is in feeding therapy or not, I try to support their wishes if the child is capable, while offering the following BLW points to consider:

To continue reading, please click here to be redirected to ASHAsphere.