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.

 

References:

https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965&section=Assessment

http://72.29.72.224/~ohsnapor/wp-content/uploads/2017/02/FeedingChecklist.pdf

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.

The Impact of Speech on Social and Emotional Development

Expert Corner Speech Disorders Speech Therapist Speech Therapy for Kids Uncategorized

From birth, children’s developmental capacities are constantly growing and maturing. Speech provides all of us with imperative tools for learning and interacting with others. Uncovering speech issues early on in children can be beneficial for future emotional development.  For some parents it may be difficult to decipher emotional signs, as opposed to physical signs correlated with speech or language complications.  I spoke with child and adolescent psychotherapist, Irena Kenny about the importance of speech in a child’s everyday life, as well as emotional and social obstacles, which might arise if a child is struggling with self expression.  

 

Q: How important are speech, language and communication skills for a child’s social and emotional development?

A: Speech and language are vital for the development of emotional and social skills in children. Communication is one of the most important developmental tasks, which takes place during early childhood development. It is then, children begin to form their initial understanding of the world. Difficulty in the realm of language and communication during childhood can hinder a child’s ability to confidently express their ideas and observations of the world around them. Some younger children, who do not have a well developed fund of language have all of these ideas and observations of the world in their minds, but feel unable to make themselves understood to others. Older children who suffer from speech issues such as poor annunciation, stuttering, and other unclear speech patterns may isolate themselves, withdraw from peers, and avoid situations such as speaking out loud, or minimize verbal interactions with others. A few symptoms of difficulty to express one’s thoughts clearly at earlier stages of development are low frustration tolerance, emotional outbursts, and excessive shyness. However, there are also children whose speech might appear less advanced than that of their peers, but they seem unbothered and confident.

Q: How do speech and language challenges affect academic progress?

A: Speech or some forms of linguistic expression are important for academic success; this is because, reading, writing and verbal apprehensions are essential elements of the entire learning process. When a child begins school they start to observe their surroundings and socialize predominantly with kids their own age. At this point they begin to notice a difference in their own speech compared to their classmates. For children with speech issues, it may seem majority of their peers have the ability to express themselves in a more articulate, more easily understood fashion. This realization of sounding different can have an emotional effect, ultimately leading to lower confidence, potentially causing lower class performance. But again, while some children become overly frustrated, others may not have any awareness of their speech issue. However, for some of the more self- conscious kids, rejection and teasing by peers may cause all energy to be expended on dealing with the social aspect of functioning and little energy is left to be put toward academic growth . For others, the need to avoid dealing with uncomfortable interpersonal situations can lead to isolation and possibly focusing heavily on the academic growth whilst inadvertently neglecting the social growth and development.

Q: When should speech and language enrichment take priority over other enrichment activities?

A:  If you ever feel that either speech or language (either receptive or expressive) seem to negatively affect your child’s ability to fully enjoy and participate in daily life, you should consider contacting a specialist. If a child is constantly struggling, due to speech related issues and does not seem to be making any progress, it is important to intervene and find the appropriate help best suited for you and your child. As a parent, I feel it is important to remember there is a range within each and every age group, and anxiously comparing your child to those of your peers does not always provide a clear cut sign of an issue. If you are uncertain or concerned, speak to your child’s teacher or pediatricians, who are qualified to advise you about what is and isn’t developmentally appropriate and together you can explore your concerns. If necessary they will help with making a referral to a Speech Therapist/Speech Language Pathologist, who will be able to determine the exact nature of your child’s speech related issue.

Q: What steps should be taken to find the right SLP?

A: It is a joint effort when looking for a Speech Language Pathologist best suited for parent and child. Speaking with your child’s pediatrician for an initial evaluation may help determine whether there is an overall need for therapy. Your physician will be able to provide names of SLP’s they have worked with before. Another helpful tip is to speak to friends, family members, or parenting networks, such as Park Slope Parents about recommendations for clinicians who may have previously helped their child. Ultimately, you want to find an SLP who is knowledgeable, plus able to work comfortably and safely with your child in order to promote the mastery and fine tuning of new and existing speech and language tools.

Guest post by Samantha Cardinali

Expert corner: Frequent ear infections in children

Expert corner: Frequent ear infections in children

Expert Corner Hearing and Speech Hearing Loss Speech and Hearing Disorders

Frequent ear infections in children: Signs for parents with concerns about speech and language development.

Ear tube surgery – it is one of the most common childhood surgeries.

According to the New York Times, nearly seven-hundred thousand children a year in the United States have tiny plastic tubes inserted into their eardrums.

“No one wants to see a child in pain,” said renowned pediatrician and parenting expert Dr. Jen Trachtenberg. “The main reason to get the tubes is that it helps with hearing loss. When you have the tubes, all that fluid and pus comes out of the ear, therefore, you don’t have the pressure and the temporary hearing loss.”

Although ear tube surgery may be among the most common surgeries for children, Trachtenberg says the number of such procedures being performed is excessive (“doctors are doing too many,” she says) and that parents should think twice before they “jump the gun” and opt for ear tubes.

Dr. Jen Trachtenberg, expert pediatrician in NYC

Dr. Jen Trachtenberg, expert pediatrician in NYC

“I never take it lightly,” says Trachtenberg. “I would never jump to just doing tubes surgery on a child. That said, not all infections need to be treated with antibiotics.”

Doctors say that ear infections are one of the most common childhood ailments, with eighty percent of kids experiencing at least one instance of infection by they time they turn three years of age. Ear infections also account for more than 30 million doctor visits a year, so the potential for excessive use of the ear tube procedure would seem to be possible.

What, then, should a conscientious parent do if he or she is considering ear tube surgery for his or her child?

First, remember that, if left untreated, otitis media (the common ear infection) can lead to loss of hearing in your child and delays in terms of speech development. Dr. Trachtenberg says it’s more important to focus on the length of a child’s ear infection, in terms of how long the fluid remains in the ear rather than  just the number of ear infections that may occur. “This is why continuity of care and having a primary pediatrician is so helpful,” she says.

According to the American Academy of Otolaryngology (A.A.O.), parents should not opt for ear tube surgery in otherwise healthy children who have had just one episode of ear fluid lasting less than three months. On its website, the A.A.O. says that infections of “short duration” will probably go away on their own.

However, if there is evidence of speech delay, then opting for ear tube surgery could be the right decision for your child. As for how much hearing loss is required before parents should consider themselves to have reached this point, some physicians say that early ear tube surgery can be considered in kids who register a hearing loss of forty or more decibels.

As for signs of what parents should look for, Trachtenberg says that persistent fluid and persistent hearing loss would mean that parents or caregivers should ask their pediatricians about referring them to an ear, nose and throat (ENT) doctor, who specializes in the ear tube procedure.

If it does come to getting the surgery, doctors say parents should be aware that the procedure involves general anesthetic, but is also generally an easy one to carry out.

“About fifteen minutes,” says Tranchtenberg, when asked how long the surgery lasts. “Kids in general tolerate it very well. Not much pain. Your child may get antibiotic drops for the ear. Generally they do really well.”

photo credit: Doctor Aunt via photopin (license)

 

Find a speech therapist

Modifying Board Games for Articulation Therapy

At Home Ideas Expert Corner Parents' Corner Pronunciation & Lisps Speech Therapy Techniques

game closet

Source: theboardgamefamily.com

Nothing says childhood like a good game of Candyland. But what if you could also use great childhood games in speech therapy? Just like the modifications and creative uses of Angry Birdswe wrote about last week, classic games can be cleverly engineered for articulation. Modifying might mean changing the way the game is played or the pieces used to do it.  The nature/goal of each game does not need to change too much in order to keep it fun and interesting and lowers your budget for speech therapy materials and if you’re a recent grad struggling with  student loan debt , the last thing you can afford is expensive materials. Instead, use what you already have. Games for articulation therapy are easy to create and fun to play.

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The Fun and Function of Using Silly Sentences in Articulation and Language Therapy

Expert Corner Pronunciation & Lisps Speech Therapy Techniques

 

two witches tongue twister

Source: eltexperiences.com

You might remember the phrase, “Sally sells sea shells by the sea shore.” To some it’s a silly tongue twister, but to a speech therapist it’s a classic example of using silly sentences to stimulate language and articulation targets in speech therapy. These sentences are usually made up, use alliteration (using the same sound or letter to start every word), rhyming words or use made up characters in crazy situations. They usually involve a character (Mateo the matador), an action (makes millions on macaroni museums) and a location (in Madrid). Silly isn’t just for laughs, silly can be fun and functional in speech therapy.

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