Pediatric Feeding Evaluations, What to Expect

Pediatric Feeding Evaluations, What to Expect

Expert Corner normal speech milestones Parents' Corner

Many people believe that the role of a speech-language pathologist’s (SLP) is limited to speech and language, however, we have a list of responsibilities including pediatric feeding evaluations. SLPs are experts in the oral mechanism all the way down to the esophagus, allowing them to support individuals with feeding and swallowing difficulties. Feeding involves all the steps it takes to get food off the plate and into your mouth, while swallowing includes chewing, moving the food down the throat, and protecting the airway that leads into the lungs. A swallowing disorder is known as dysphagia. If your child has any aversion to certain foods or has trouble swallowing without coughing, your pediatrician may suggest you visit a speech-language pathologist. In order to assess your child’s feeding and swallowing abilities, the SLP will conduct a natural feeding evaluation. If this is recommended, here’s what you can expect…

Your Pediatric Feeding Evaluation, Step by Step

Baby feeding and swallowing problemsFirst, the therapist will conduct an initial interview. They will ask you questions about your child’s developmental history, family background, your family’s daily routine, feeding preferences, and wishes for therapy.

After the SLP and child become acquainted, she will complete an oral mechanism exam. From a parent’s perspective, this procedure may appear like your average snack time. However, the SLP is observing everything your child does to determine what needs to be done next. For young children, speech therapists often disguise this examination with play activities. Modeling and asking the child to make funny faces, the SLP will observe the child’s ability to move their oral structures (lips, tongue, cheeks, ect.) and any asymmetry or weakness is noted.

Next, the therapist will begin to offer the child different foods and textures. In order to create the most natural feeding possible, the SLP may request that you bring in some of your child’s favorite foods or utensils from home. Food and drinks of different consistencies will be presented in order to identify your child’s strengths and weaknesses. As the therapist and child enjoy the different foods, the therapist will observe the child’s ability to hold the food in their mouth, chew, and swallow without leaving residue behind. The evaluation may be video recorded for later analysis and the therapist will take notes throughout. A checklist such as The Developmental Pre-Feeding Checklist: A Sequential Approach (1987) may also be used to make a thorough diagnosis.  

Once the evaluation is complete, the SLP will be able to make recommendations for therapy. If further evaluation or intervention is needed, the therapist may refer you next to other professionals such as an occupational therapist or a physical therapist. For more information on pediatric dysphagia and feeding assessment, please visit ASHA’s website.



Early language development – how to support your child

Early language development – how to support your child

Language Building Skills Language Development Reading

Literacy (reading) skills are important for a child’s early language development, social communication, and academic success. Before a child can pick up a book and decode the words on a page into something meaningful, they must first develop an understanding of what written language is and how it is used throughout their environment. Logos, signs, and labels may be teaching your child how to read without you even realizing it. Preschoolers also learn early concepts of literacy by watching their caregivers interact with written language. These first steps in learning to read are called emergent literacy skills. While you may already be teaching these skills in your day to day life, here are some other ways we can support literacy.

One important skill for early language development literacy is understanding that sounds can be manipulated in order to become words, which is known as phonological awareness. You can support your preschooler’s phonological awareness by talking about and teaching different speech sounds during shared reading activities.

Another skill that helps support reading is print awareness. When children  demonstrate they understand the logos, signs, and labels in their environment have meaning, they are showing  they have print awareness. Print awareness also involves holding a book upright and knowing that the words on the page tell a story. Even before they are able to read the words, encouraging your child to follow the words with their finger from left to right while  reading to them will support print awareness. It is also beneficial to discuss the physical parts of the book, who is the author and who is the illustrator.

Alphabet knowledge, or the understanding that letters represent sounds and letters can be grouped together to become words, is another skill that we can teach while reading together. There are many children’s books about the alphabet, but you can identify individual letters anywhere and talk about the sound that it makes.

Finally, oral language skills are needed for early language development and reading comprehension. Everytime you engage in conversation with your little ones, you are modeling oral language skills. Teaching new vocabulary is essential for oral language and early reading because while reading teaches vocabulary, some word knowledge is needed in the earliest stages of literacy.

Reading is a valuable skill to have throughout a child’s life that encourages children academically, socially, and creatively.  Children who learn to read early on are often more successful than their peers, and reading is also a source of knowledge. Reading also exposes children to new words and language uses. Books teach children about emotions and individual points of view. Appreciation of others thoughts and feelings will help children communicate and build relationships with peers. Of course, reading is also enjoyable and amplifies creativity.

Baby talk: does it help or hurt how your baby learns language?

Baby talk: does it help or hurt how your baby learns language?

Language Building Skills Language Development Parents' Corner

Often referred to as ‘baby talk’, Motherese (or Parentese or Fatherese) is a term used to describe the quality of speech caregivers often use when speaking to a newborn child. Using a higher pitch, more exaggerated articulation, and great facial expressions, we seem to naturally talk in this manner to babies.

Many have debated the importance or hindrance that use of baby talk has on a child’s speech and language development. Some parents believe that baby talk is an important first step in teaching a child to talk and some believe that using baby talk limits a child’s language comprehension. Researchers have conducted studies to find an answer. While modeling adult language is beneficial to a child’s speech and language development, baby talk has withstood the test of time and been a useful tool in creating a bond between an infant and their parent. This attachment helps a child learn to develop relationships with others throughout life. Babies from many different cultures around the world, speaking many different languages have shown interest in this quality of speech as it grabs their attention. This type of interaction can also give an infant their first experience with social cues such as turn taking and eye contact, and speech sounds.

Within the first days of life, a baby’s brain has remarkable neuroplasticity, meaning they can create new neural connections quickly and absorb new information like a sponge. As they experience their first sights, smells, and sounds, they make many first impressions that are everlasting. Studies have shown that babies often learn to recognize and prefer the sound of their caretaker’s voice. Although researchers have not been able to identify whether it’s more beneficial to use adult speech right from the start, use of brain scanning technology has allowed us to see the reactions infants have to adults using baby talk in their native language as well as foreign languages. This TED talk by Patricia Kuhl discusses one of these studies.

Remember- there is no clearly defined right or wrong style of parenting or teaching. If you are a new parent, no matter how you choose to speak to your child, just make sure you do it! Even when you are not speaking directly to an infant, they’re constantly taking in information and making connections. Whether by choice or instinct, if you do use motherese with your child, it is recommended that this type of speech be weaned off as the child reaches toddlerhood and begins develop speech and language skills.

More resources to check out:

ASHA: How Babies Form Foundations for Language 

TED: The Surprisingly Logical Minds of Babies

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Get to Know Sandra Williams, CCC-SLP

Get to Know Sandra Williams, CCC-SLP

Expert Corner Hearing and Speech Speech Therapy Techniques

Speech Buddies:
How did you become a speech therapist?

SW: I became interested in speech pathology while completing my undergraduate degree.  I was well aware of the special needs population due to a family member receiving services throughout my childhood.  I developed a keen sense for those persons needing assistance to communicate effectively, while optimizing the strengths they already possessed.  After exploring several options, I realized the speech pathology was a great fit for me.

Speech Buddies: Do you have any specialties?

SW: I have spent the majority of my career working with the pediatric population, including children ages 0-3 through high school. I have developed the skill of being able to see the child’s strengths and systematically build on those strengths to address their challenge areas.  I have had success working with children on the autism spectrum, children with significant expressive language delays, children who have difficulties in the area of articulation, as well as, children exhibiting expressive language delays   I have also worked with children who have challenges in the area of fluency.

Speech Buddies: What is your favorite part of being a Speech Buddies Connect therapist?

SW: My favorite part of being a Speech Buddies’ connect therapist is the expediency with which services can begin and significant results can be achieved.  I love the motivation and engagement of the parents in this process which facilitates carryover of learned skills.  The process is streamline and  effective in matching eager clients with committed therapists.

Speech Buddies: What can clients expect from virtual therapy? What is different or beneficial about virtual therapy?

SW: Virtual therapy will allow flexibility in terms of scheduling for the client and for the therapist.   In this way, location and time constraints will not be a barrier in conducting effective therapy.  If the child is younger, the parent will play a direct role in carrying out the session objectives which can only help to solidify the acquisition of target skills.

Speech Buddies: What is one question you get most often from clients and parents?

SW: Most parents want to know what they can do to improve their child’s speech-language functioning.  I am able to give them strategies that they can employ during their natural interactions with their child to directly address areas of concern.  In many cases, it affirms what the parent is doing while also introducing them to new strategies they might want to try.  Parents begin to feel empowered that they, too can positively impact their child’s life in the area of communication.

Speech Buddies: What advice would you like to give to families considering seeking speech services?

SW: If parents are concerned about their child’s speech-language development, trust their instincts and seek assistance.  They can obviously speak to their pediatrician, and if concerns still remain contact the Department of Health, and/or contact Speech Buddies and have a general screening assessment done by a professional.  These initial assessments may allay their concerns or may indicate further testing and therapy is warranted.  Research indicates that the earlier a child receives therapeutic intervention when needed, the higher possibility of an overall positive  outcome.

Find out more about Sandra or book an appointment here.

Pragmatics: Unspoken Rules of Communication

Speech Therapy for Kids

The Role of Pragmatics in Communication

As children grow and their language develops, they learn more than just words. They learn about the world around them and how to socialize with different people in different contexts. They learn how to adapt their behavior depending on their conversation and social environment. These rules of communication are called pragmatics, and will vary depending on the development and culture of the child. Kindergartners will behave very differently on the playground than in the classroom. Likewise, preschoolers in Japan and France may have different social communication expectations placed on them. While the United States remains a melting pot of many different cultures, research shows some common benchmarks in the development of social communication. And while it’s important to remember that all children may develop at their own pace, growth of these social skills is important for both social and academic success.

Our eyes can reveal a lot about us and our social use of eye contact is a vital act of communication. They can reveal whether we are interested or distracted, whether we are telling the truth or a lie and suggest how confidence we feel. This is why it is important for children to develop a communicative competence through appropriate eye contact  in order to become better engaged with others. Children begin learning pragmatics at birth and continue to develop these skills throughout life. Within the first year, typically developing children will show social communication with eye contact, vocal turn taking, and facial expression and recognition. As they develop, children will continue to learn from their environment, and begin to understand pragmatic rules and social clues. Children with disorders like autism tend to have significantly reduced eye contact than is considered socially accepted. This may lead communication partners to misinterpret their reduced eye contact as a lack of interest; often, the “rules” of eye contact in a social context are difficult to master for this population. Understanding social thinking, as well as the inherent challenges certain children may face here, can help build meaningful relationships.

Pragmatics and Neurodevelopmental Disorders

It is important to remember that children with neurodevelopmental disorders will display a number of developmental “red flags”, and not every child will have the same presentation. If you are concerned that your child is not meeting these milestones, you may want to consult with your pediatrician. If your child is then diagnosed with a social communication deficit, speech therapy can be an important piece of their intervention plan. Speech-language pathologists (SLPs) are not only experts on speech and language development, but also nurture the social and emotional growth of their clients. Children who struggle to make eye contact and other social communication challenges often benefit from group therapy, where they can interact with like peers who are working on the same or similar goals in a format moderated by the SLP. SLPs may also use cognitive behavioral therapy to help reduce anxiety and negative thoughts associated with social communication in order to help clients self regulate and process emotions. Additionally, SLPs work collaboratively with other specialists such as occupational therapists and therapists trained in Applied Behavior Analysis (ABA). There are many different approaches to therapy and it may take time to determine which approach, or combination of approaches, is right for your child. So continuing to educate yourself as a parent will help you make the both informed clinical decisions as well as maximize your effectiveness as a home-based partner in your child’s total therapy program.


Autism Speaks

Social Thinking