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Does my child need feeding therapy?

What is Feeding Therapy? How do I know if my child qualifies?

Contributed by one of our pediatric Speech-Language Pathologists, Stacey Rosensteel, M.S., CCC-SLP

pediatric utensils

Raising a happy, healthy eater is a difficult job for anyone, however with the right tools and support your child can be thriving. Early feeding development includes finding the correct utensils for little hands. Here are some suggestions and things to look for:

  1. Utensils with a short, wide handle: To set kids up for success, give them something to grip that won’t easily fall out of their messy little hands. Adults may prefer a long, narrow handle on a utensil, because our fine motor skills are more developed to poke, scoop and rotate towards our mouth.
  2. The end that goes into their mouth matters too! Spoons should have some curve to them and not too wide for their mouths. An often-made mistake is to give kids a deeper spoon, with the thought that it will hold more food with a deeper “bowl” and therefore the kids will eat more food, faster. Actually, the opposite is true. When kids have too big of spoon, filled with too much food for their little mouths, the experience is overwhelming.  This leads to spilling, coughing, choking or gagging. A flat spoon or one that is not too deep will help kids develop lip closure skills.  Lip closure is  an important part of learning to eat. To be able to keep our lips closed around the food not only keeps it in the mouth, but assists in chewing and swallowing foods safely. Lips play a big role in manipulating food in our mouths and propelling the food backward for swallowing. This is also helpful for early speech development as well.

What is Feeding Therapy?

Feeding therapy helps individuals learn how to eat or how to eat better.  This specialty is provided by trained Speech Pathologists and Occupational Therapists. Occupational Therapists evaluate and treat those with picky eating from a sensory perspective (aversion, avoidance, refusal based on smell/appearance/presentation), as well as teaching utensil use and more. Speech Pathologists provide feeding therapy for those with feeding mismanagement, as in low oral muscle tone and coordination, difficulty chewing and swallowing, acceptance of new foods, increasing diet repertoire, bottle feeding, tolerance of new foods and more.

Feeding therapy begins at different stages depending on an individual’s needs. Therapy is spent teaching how to eat new foods (limited diet) or how to eat (if they don’t know how to chew or manage food in their mouth).

Depending on the child’s underlying challenges, you may see your child participating in sensory integration activities or completing exercises to strengthen the muscles they need for eating.  Exercises will likely be things like blowing bubbles, making silly faces, or using whistles.

Before therapy can begin, an evaluation is completed which will consist of observations of feeding and parent interview. Recommendations will then be made and goals will be written that guide the direction of therapy anywhere from cup drinking, utensil use, increasing dietary intake and learning to chew and swallow.


Who Needs Feeding Therapy?

Depending on the challenges a child is facing, age does not matter.  From newborns to adults, feeding therapy may be needed. For infants not able to latch, picky eaters and everything in between, feeding milestones are important and should not be ignored. Tongue-ties, sensitive gag reflux, enlarged tonsils, low muscle tone/coordination are just a few of the causes of feeding disorders. In these cases and more, your child may end up qualifying for therapy where you will get suggestions and activities to try at home.

What Should you Expect with Different Feeding Approaches?

As you can imagine, there are different approaches to feeding therapy, some of which you may be comfortable with, and some that you may not, but most of them can be summed up into two different categories:

  1. Behavioral– This is the traditional method of feeding therapy that uses rewards to gain new foods in a child’s dietary preferences. For example, your child may be given a sticker, toy, candy for successfully taking a bite of a new food. To get another sticker, toy, or more candy, they need to take another bite. Over time, these rewards should be phased out, so the child does not become so dependent on them, they will only eat if rewards are given.
  2. Child directed– This is a more modern approach and is positive in nature. Parents are more involved with this type of treatment and there is a focus on addressing the underlying cause of the problem (i.e. sensory, medical, etc.). While this approach can take longer to see results initially, there is research that supports the effects and benefits are longer lasting.  The SOS or Sequential Oral Sensory, approach to feeding falls under this category.

If you or someone you know is struggling with eating, do not hesitate to reach out to our team!


What does “teletherapy” look like?

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The whole world has had to shift our way of working and learning during this challenging time. We are quickly becoming accustomed to virtual meetings, virtual school, virtual play dates, even hanging out with friends and family. Virtual speech and occupational therapy, commonly known as teletherapy, has been around for years. The American Speech-Language Hearing Association (ASHA) and American Occuptaional Therapy Association (ATOA) acknowledge teletherapy as an appropriate means of providing therapy.

We have offered teletherapy in our office for several years. While this method of therapy may not be suitable for every client, most clients can make significant progress through teletherapy. We do miss our face to face, in-person visits but we are thankful for our virtual therapy sessions that are helpful in filling the gap of time that we are apart.

Some families have found that teletherapy sessions have been helpful in reducing travel for therapy. Our clients are loving their virtual face time with our creative therapists. Therapists are challenged to think outside the box and create new engaging therapy ideas. We can still use therapy materials that we use in the clinic. We can also play online games that fit into our clients goals. We have even become very creative with using virtual backgrounds to meet specific goals.

Your therapists may see a big mess in their home but your child sees a magical wall of learning.

We can’t wait to get back to in-person therapy but in the meantime, we are having fun with teletherapy!

Contributed by one of our former speech-language pathologists, Noelle McNeil who is now learning the excitement of teletherapy in Alabama.

Summer Camps at Capital Area Speech

We are very excited to offer fun, engaging summer camps for our little ones this year at our office in Austin. Our camps will be led by a speech and/or occupational therapist. While our therapists will be incorporating skills to improve specific areas of language and motor skills, these camps are intended for any child. Check out the details below.

Open Gym (with Ms Farah and Ms Kelsi)
Wednesdays, June 4 – August 26, 2014
10:00-11:30 am
This therapist guided play time allows your child to experience new fine and gross motor activities while exploring our new sensory gym.

Cooking with Words (with Ms. Noelle and Ms. Kelsi)
AGES 5-8
June 16-19, 3:00-5:00 pm
This speech and occupational therapist led camp will inspire little minds with fun themes that involve daily cooking or food preparation activites. The therapists will work on expanding your child’s skills in the following areas:
-following directions
-social skills

Handwriting Camp (with Ms. Farah and Ms. Kelsi)
AGES 5 and up
July 7-10, 1:00-3:00 pm
This interactive camp turns handwriting into a fun multisensory experience by focusing on the whole body. Therapists guide children through engaging activities to improve:
-gross motor skills
-fine motor skills
-eye hand coordination
-visual perceptual skills

Experimenting with Language (with Ms Noelle and Ms Kelsi)
AGES 5-8
July 14-17, 10:00 am-12:00 pm
This camp will encourage curiosity with exciting science experiments. Through this camp our therapists will work on expanding your child’s skills in the following areas:
-literacy and vocabulary
-critical thinking
-following directions
-social skills

These camps do have limited availability. Call or email us today for pricing information and sign up. Ask about a sibling discount if you’d like to sign up more than one child.


Tour Our Office

Our renovations are now complete. Here’s a peak in our office. Some of the therapy rooms and the sensory gym are pictured below.


hall view



OT room


Free Apps For Autism Awareness

going blue april 2
For Autism Awareness, I wanted to share some free educational and special needs apps. There are tons of free or discounted educational/special needs apps today and this week. I haven’t used all of these apps so I can’t go into detail about them. They are worth checking out though. Some of these are only free today so check them out as soon as you can.
rainbow sentencesspeech with milo
Here is a list of the ones I do use and love:
The following two I use for working on following directions, listening skills, and concepts.
Fun With Directions Lite
More Fun With Directions Lite
Picture the Sentence Lite – This app is great for kids to practice listening and picturing what they heard.
The next two apps are great for social language.
Between the Lines Level 1 Lite
Between the Lines Level 2 Lite
Toca Band – Okay I just downloaded this app today. I LOVE every Toca Boca app I’ve ever downloaded! They are very motivational.
Speech With Milo: Verbs – I use this app in therapy quite often.
Rainbow Sentences – This app is a GREAT app for working on formulating sentences correctly, describing pictures, and imitating sentences. only $3.99 today

These apps I haven’t used but they look like they would be useful.
Functional Communication System
Functional Planning System
Picture Card – Can You Do It?
Sorthings For Autism
Discovering Emotions With Zeely
EZCOMMA – This one is probably best for older kids working on grammar.
Sequences For Autism
Sequences For Kids
Feed Maxi – $.99 I have heard only great things about this one.
Conversation Builder – only $3.99 today
Talk + Touch
Sound Swaps – $4.99 This app is good for children with dyslexia or those working on phonological awareness.
Social Stories – $.99
Visual Routine – $.99
Starring Me On Wheels On The Bus

These are stories for teaching good morals or habits:
Even Monsters Get Sick – $.99
Axel’s Chain Reaction – FREE
Listen Up Bear – FREE
Sheldon’s Adventure – Cornered! – FREE
Sheldon’s Adventures – FREE
The Terrible Taunting – FREE – This interactive book teaches that everyone is special in their own way.

These would be great for fine motor activities:
Cursive Touch and Write – $.99
Wood Puzzle Maze – FREE

Thank you to Mary and Smart Apps For Special Needs for sharing some of these apps on twitter and your blog.

The ladies over at Smart Apps For Special Needs compile wonderful lists of free and discounted apps every week. I highly recommend you check out their blog and follow them on Twitter.

If you have any apps you love to use at home or in therapy please leave a comment to share with everyone!

World Down Syndrome Day

Abby and Bailey
Today is a special day that we can help to raise public awareness and advocate for people with Down syndrome. World Down Syndrome Day is recognized on March 21 to symbolize the the extra 21st chromosome which causes Down syndrome.

Ways to support people with down syndrome:
Join you local buddy walk
Support a local nonprofit organization
Support Ruby’s Rainbow and help young people with Down syndrome fulfill their dreams
Wear lots of socks on World Down Syndrome Day!
LotsofSocksWeblink - big

Great blogs about Down syndrome:
Ellie’s Gift I love the blog post about how to teach young children about Down syndrome.
Down to Life
Noah’s Dad
Dear Tessa
There are many other blogs out there written by parents and other families members specific to Down syndrome.

For more information please visit the following websites:
Down Syndrome Association of Central Texas
Down Syndrome International
National Down Syndrome Society

Phonological Processing Skills of Children Adopted Internationally – Research Says…

I am joining fellow speech pathologist bloggers in reading and blogging about a recent research related to our field. For more information or to see more research reviews, check out this blog.

I have several amazing friends who have recently adopted or are in the process of adopting children internationally. Over the past couple of years, I have also worked with a few children who have been adopted internationally. For these reasons, I found this study about certain language skills of children adopted internationally to be a great one to review.
Phonological processing skills are very important for oral language and literacy development. Phonological skills include phonological awareness, phonological memory, and rapid naming. Phonological processing skills are referred to as the decoding component of reading. These skills as well as comprehension are essential for reading success.

The children who participated in the study were adopted from China before 25 months of age. The study was performed when the children were between 6 years, 8 months – 9 years, 3 months. They were individually given a formal phonological processing test. Some of the children were receiving speech therapy for articulation or language impairment.

The researchers wanted to find whether children who were adopted internationally had difficulties with phonological processing skills at the school-age when compared with a normative sample of children their age. After formal assessments, the study noted that these children preformed within the average range of scores to the tests’ normative sample.

They also examined whether age at time of adoption had an impact on phonological processing skills at school-age. The results indicated that age at time of adoption was not correlated with reading comprehension or phonological processing skills. It should be noted that this particular study only examined children who had been adopted before 25 months old. Previous studies have found that age of adoption is correlated with later school language skills. These previous studies may have studied a broader age range of adopted children.

Scott, K., Pollock, K., Roberts, J., and Krakow, R. (2013) Phonological Processing Skills of Children Adopted Internationally. American Journal of Speech-Language Pathology, 22, 673-683.

What is Phonological Awareness

letter blocks
Have you heard the term phonological awareness? This term refers to the understanding that language is composed of smaller units including words, syllables, and sounds. Children with good phonological awareness skills are able to hear and manipulate these words and sounds.

Phonological awareness skills are very important for reading success. Speech pathologists work on phonological awareness skills when children have difficulty hearing rhyming words, learning sound/letter recognition, and have difficulty learning to read.

Phonological awareness skills include the following:
-Hearing and producing rhyming words
-Segmenting words in sentences
-Blending, segmenting, and deleting syllables
-Identifying sounds in words
-Blending sounds to make words
-Segmenting sounds in words
-Deleting sounds in words
-Adding sounds in words
-Manipulating sounds in words

Ideas to boost your child’s phonological awareness skills:
-Sing songs or recite nursery rhymes that have rhyming words
-Ask your child to name words that rhyme
-Clap for every word you hear in a sentence or for every syllable you hear in a word
-Ask what sounds he/she hears at the beginning, middle, or end of words (What sound do you hear at the beginning of ‘Saturday’)
-Ask him/her to say a word then say it without a certain sound (Say ‘ball’, now say it without ‘b’)
-Ask him to say a word then change a sound in the word (What would the word ‘cat’ be if you change the ‘c’ to ‘b’)

You can look back to our post on language and literacy here.

SuperDuperInc has easy to read information here

Reading Rockets has good detailed information and more ideas for how parents can help at home too.

Is Your Child Stuttering?

“My preschooler has started repeating sounds and words when he talks.” “My 3 year old seems to get stuck saying a word when he is speaking.” These are common comments parents express when they become concerned about childhood stuttering.

Diagnosing a young child who stutters can be tricky. Many children go through developmental stuttering or a period of time when they have disfluencies. This may last a few weeks or even a few months. About three-fourths of these children will outgrow this stutter though.

When a speech pathologist sees a young child who demonstrates stuttering, he/she will look at several factors.
Does anyone in the child’s immediate family stutter? – Approximately 60% of those who stutter have a family member who stutters.
At what age did the stuttering began? – It is more likely that they will outgrow it if disfluencies began before age three and a half.
How long has your child been stuttering? It becomes more of a concern if your child has been stuttering for more than six months. What types of disfluencies are noticed? Is your child repeating sounds in words l-l-like this? Are the getting stuck for long periods of time on the specific sounds? Can you see tension in the facial muscles? Changes in pitch or airflow?

More severe symptoms that may be a sign of true stuttering include: multiple repetitions (wh wh wh wh why?), blocks (the child seems stuck and cannot get the word out), tension, changes in breathing during speech, and showing negative emotions about speaking.

Although many children go through a period of developmental stuttering when their language skills are exploding, true stuttering also often begins at this age. If you have questions or concerns regarding stuttering, please contact a speech pathologist.

The Stuttering Foundation has useful information for parents of preschoolers who stutter. They also have a list of speech pathologists who are very skilled in working with those who stutter.

The National Stuttering Association offers great support for those who stutter and their families. They have individual chapters around the nation for support groups, parties, and more.

Speech and Language Practice in the Car

Do you use car rides as a time to talk to you child? You and your child(ren) are stuck in the car. You might as well use the time wisely. Turn the radio off and make this time fun. Go ahead and practice his/her target speech sounds. Try to come up with words that have the sound in them. Have him/her look for things outside the car that may have their target sound.

There are several “car games” you can play that help with language skills too.

Eye Spy – Maybe this would be best for siblings to play and the driver just listen. This game works on using vocabulary and using descriptive words.

The Question Game (as seen in the video) – We play this one all the time. My boys love to trick me. One person thinks of an object or place. Everyone else takes turns (or in our car, blurts out) questions that have to be answered with yes/no. This game helps with forming questions and vocabulary
No worries…I was not driving here. This video is kind of loud. You may want to turn your volume down before playing.

The Rhyming Game – Someone begins with a word. Everyone takes turns thinking of a word that rhymes. If you can’t think of one, you skip. The last person to think of a word wins. This can help with phonological awareness and vocabulary.

The Sound Game – I sound out a short word pausing between each sound (b—a—t). the kids guess what word the sounds make when you say them together. This can also help with phological awareness and vocabulary.

You can also sing together, make up a stories, and just talk about your day.

If you have any fun games that your children like to play in the car, please leave a comment. I would love have more ideas.