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

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!

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CLASP- Providing A Voice for the Voiceless

Providing A Voice for the Voiceless

Contributed by Amy Delk, Capital Area Speech Therapy Staff

 

Providing a voice for the voiceless. This is part of what Speech Pathologists do each day for their patients, both young and old. CLASP International has taken on this mission as well. CLASP International, or Connective Link Among Special Needs Programs, is a resource that is endeavoring to provide training to Graduate students in Zambia, Africa. This organization is certifying students at the University of Zambia to treat patients with special needs, such as feeding/swallowing disorders, cleft palate, and communication disorders such as autism.

Currently, within the communities of Zambia, such as the capital town of Lusaka, there are no permanent therapists who have the knowledge base and experience required to help those in desperate need. Many times, those in Zambia who need the most urgent help are hidden away. There is a stigma attached to those who are born with congenital, developmental, and acquired medical issues. They are often times seen as cursed, and kept from interacting with others, and kept from being a part of their communities. In severe cases, children born with special needs are neglected and abandoned.

There is hope. CLASP is making huge strides towards teaching the community that therapists can help make a difference, and in many cases save lives. When CLASP provides training to local licensed Zambian therapists familiar with the culture and people, the community sees that there are treatments available, and that there are explanations for speech disorders and other medical conditions. Instead of hiding in shame, those who need help are treated, and have improved quality of life. They thrive, grow, and become part of their community.

Here are some ways that you can help make CLASP a continued success.

1. Visit: claspinternational.org and find out more about this outreach program.

2. Donate: If you are able to provide financial support to any of the therapists that make the trip to Zambia each year, please donate in their name, or the general fund. All donations are tax deductible. More information can be found under the Donate tab on the home page of the website.

3. Volunteer: If you are a licensed Speech Language Pathologist, an Assistant-SLP, an Occupational Therapist, or Physical Therapist, you are urged to apply to the CLASP program on-line and volunteer your time and efforts either stateside or in Zambia.

Is the PROMPT approach effective?

Yay! We are back to blogging about research. You can check out what research says about other speech and language related topics over at Gray Matter Therapy. The blogger does an awesome job of rounding up speech pathologists around the nation to read research and blog about it.

This month I, along with other therapists from our office, are going through the big PROMPT training. While I hear so many good things about the use of this technique in therapy, I really wanted to know what research says about it.

PROMPT stands for Prompts for Restructuring Oral Muscular Phonetic Targets. PROMPT combines auditory input and visual cues with a tactile kinesthetic approach to therapy. So in addition to hearing and seeing, the therapists actually touches the client’s face in order to guide them to their target sound, word, or phrase. You can learn more details about PROMPT at their website.

Here is some research that I found related to PROMPT.

Dale, P. and Hayden, D. (2013) Treating Speech Subsystems in Childhood Apraxia of Speech With Tactile Input: The PROMPT APPROACH. American Journal of Speech-Language Pathology, 644-661.
These researchers examined the effects of using PROMPT with children with childhood apraxia of speech. Childhood apraxia of speech (CAS) is a speech sound disorder involving the planning and programming of movements required for speech sounds. These children are very difficult to understand.
Participants and Method: Four children who had been diagnosed with CAS were divided into two groups. Two of the children received eight weeks of full PROMPT. Two of the children received four weeks of PROMPT techniques without tactile kinesthetic prompts then four weeks of full PROMPT. Target words were chosen for each child. Standardized tests and untrained probe words were used for assessing progress.
Results: All children in the study showed significant improvement in the 16 weeks of intervention. Scores on the untreated probe words and on the articulation test showed some evidence that including the tactile kinesthetic cues results in more success.

Grigos, M., Hayden, D., and Eigen, J. (2010). Perceptual and Articulatory Changes in Speech Production Following PROMPT Treatment. Journal of Medical Speech-Language Pathology, 18, 46-53.
This study was to determine whether speech sound accuracy changed after PROMPT treatment.
Participants and Method: Two three year old males were participants in this study. One was a typically developing 3 year old was assessed. The other child had a speech disorder and received PROMPT treatment twice a week for eight weeks. This study differed in the first discussed in that, in addition to formal testing and untrained probe words, they used a motion capture system to receive a visual of the child’s articulatory movements.
Results: Pre-treatment, the child with speech disorder displayed severe deficits on an articulation assessment. He also demonstrated inappropriate oral motor behaviors. Results of this study indicated improvements in both articulatory movements and speech sound accuracy.

Other research about using PROMPT has been published regarding children with cerebral palsy and autism. You can also find research on the effects of using PROMPT on adults with aphasia and apraxia as well.

Does your child need an evaluation or a screening?

Speech-Language Screening vs. Evaluation
What are the differences?
By Ashley Ward, B.A., SLPA

When there are concerns regarding your child’s speech and language development, there are two main first steps to begin the process of acquiring answers. Speech-language screenings and full evaluations are two different assessments with a common goal: to provide information about your child’s speech and language skills. Below are the contrasts of these two types of assessments.

Speech-Language Screening:
Speech-Language screenings are generally conducted as a brief meeting to determine strengths and weaknesses through informal protocols.

• Typically occur in the fall at the beginning of the school year.
• Can be completed at a school or in a private clinic.
• No formal testing is used—Speech-language pathologists will bring age-appropriate printouts of colors, shapes, objects, etc. and ask simple identification questions to get an idea of your child’s speech and language skills. They will also bring a short screening form to record observations and comments.
• No standard scores are calculated comparing your child’s skills to their same-age peers.
• No formal written report of the speech therapist’s findings will be compiled.

Generally after a screening, a written summary will be provided with the results of the screening and recommendations on what steps to take next. This can include a request for a full evaluation, a wait period for a re-screen, or a referral to another type of therapy.

Speech-Language Evaluation:Speech-Language Evaluations are longer assessments where formal testing materials are used based on the type of concern (difficult to understand, small vocabulary, substituting certain speech sounds for a different sound, etc.)

• Mainly conducted in a private clinic.
• Insurance is generally contacted prior to the evaluation to determine eligibility and coverage of services.
• One or more formal tests will be administered.
• Standard scores will be calculated, placing your child in a percentile ranking comparing their skills to their same-age peers.
• A formal evaluation report will be written with your child’s background history, specific details of their performance, standard scores from the administered test(s), and recommendations on what to do next.

After an evaluation, a follow-up consultation will be scheduled with the speech-language pathologist who performed the testing to go through the comprehensive written report and to discuss further recommendations.

Getting your child screened or evaluated is the first step in ensuring they receive the services they need to develop and thrive.

Capital Area Speech offers free in-office speech and language screenings for all civil service employees as well as for the employees of the following: Dell, City of Austin, and the University of Texas at Austin.

For more information on what to look for, visit identifythesigns.org for the American Speech-Language-Hearing Association official campaign for identifying the early indicators of communication disorders.

Should you get help or wait and see?

The Importance of Starting Therapy Early
By Ashley Ward, B.A., SLPA

Decades of research demonstrate the importance of beginning speech-language and/or occupational therapy early in a child’s life. Otherwise known as early intervention, this strategy is centered on building and improving a child’s speech, language, communication, social-emotional, and play skills. Infants and toddlers who are not reaching their developmental milestones or are at risk for a delay or impairment can greatly benefit from early intervention services.

A child’s earliest experiences have a huge impact on their brain development. Research shows that the time between birth and 36 months is a critical time for progress and growth where specific circuits in the brain, which create the foundation for learning and behavior, are most “flexible” (The National Early Childhood Technical Assistance Center, 2011). These early years present a window of opportunity for development that will not be available later in life. Early intervention therapy can minimize, and even prevent developmental delays, in children with impairments.

What is a Phonological Processes disorder?

So what is a phonological processes disorder? It’s more than just an articulation (speech sound) disorder. When children have multiple sound errors, we look to see if their errors fall into certain patterns called phonological processes. For instance, if the child produces /t/ for all /k/ sounds and /d/ for all /g/ sounds, he may actually be demonstrating the phonological process, fronting. Children with phonological processes are often hard to understand if you aren’t familiar with their speech.

The following describes some common phonological processes.

Final Consonant Deletion – the final consonant sounds are omitted from words
(bed sounds like “beh”)
Consonant Cluster Reduction – one consonant in a consonant cluster is omitted
(stop sounds like “top”, blue sounds like “bue”)
Syllable Reduction – the weak syllable in a word is omitted
(banana sounds like “nana”, telephone sounds like “tephone”)
Gliding – glides (w, y) are substituted for liquids (l, r)
(run sounds like “wun”, leg sounds like “yeg”)
Fronting – front sounds (t, d) are substituted for back sounds (k, g)
(go sounds like “do”; key sounds like “tea”)
Stopping – stop sounds (p,b,t,d,k,g) are substituted for continuant sounds (m,n,s,z,sh,ch,f,v,th)
(sun sounds like “tun”, funny sounds like “punny”)
Prevocalic Voicing – voiced sounds (sounds that use your voice) are substituted for voiceless sounds
(pig sounds like “big”)
Postvocalic Devoicing – a voiceless consonant is substituted for a voiced consonant
(bed sounds like “bet”, bag sounds like “back”)

Like individual sounds, these processes should be corrected by certain ages. There is a more detailed chart for phonological process elimination here.
Gone by around 3 years old:
Final Consonant Deletion
Prevocalic Voicing
Postvocalic Devoicing
Fronting

Gone by around 4 years old:
Consonant Cluster Reduction
Syllable Reduction
Stopping

Gone by around 5 years old:
Gliding

A website that deserves its own post

The American Speech-Language Hearing Association has made a wonderful website to educate the public about communication disorders. Identify the Signs has topics about identifying early signs of speech and language disorders as well as hearing loss. ASHA is one of the most credible websites for finding information about these topics. I love how this site is organized too. Check it out!

Speech sound development

Let’s talk about speech sounds. Speech is a very complex task. All sounds are not developed the same way or at the same time. Some sounds are much more difficult and complex to produce than other sounds. For instance, vowels typically develop before consonant sounds. Certain consonant sounds develop before others. It is common for very young children to mispronounce sounds in their speech. This is one reason so many of us think our kids are so cute when they talk. I am a speech pathologist and mother of three little ones. I often hear “Mama, do you wite dis?”, “Wet’s doe to duh stuh.”, “I wub oo”. I too love to hear these cute little voices too. When do we begin to question whether it could be a problem?

One thing we look at when we diagnose an articulation disorder is how well people understand him/her. This is referred to as speech intelligibility. Often the parent may understand 75% of what their child says but other listeners may only understand 50%. We also look at the sounds he/she pronounces incorrectly in correlation to their age. It is important to remember that, as with most developmental milestones, every child develops differently. The ages and sounds given below are a general guideline for typically developing speech sounds.

Children should be able to pronounce the following sounds around the ages specified:

By 3 years old: “p”(pot), “b”(boo), “t”(two), “d”(dog), “k”(cat), “g”(go), “m”(mom), “n”(no), “w”(want), “h”(home)
By 4 years old: “ng”(king), “y”(yes), “f”(foot), “v”(van)
By 5 years old: “s”(see), “z”(zip), “sh”(shoe), “ch”(cheese), “j”(jump), “l”(leg)
By 6 years old: “zh”(treasure), “r”(run, tiger), “th”(this)
By 7 years old, a child’s speech should be understood by anyone they speak to. It should be very similar to adult speech.

 

Language Development

Is your child not talking as much as his peers? When should you be concerned? So many people ask these questions. I hope this chart will be helpful if you ask yourself these questions?

Before we look at the chart, let’s discuss a few terms. When a speech pathologist evaluates a child’s language, we will talk about comprehension and expression. Comprehension is how we refer to the way your child hears and understands language. Expression refers to how the child communicates and what he says. Another term your speech pathologist may use is “speech intelligibility”. This refers to how well people understand your child’s words.

The following information is based on typical language development. Some of the information found here is gathered from the American Speech Hearing Association and Hanen. For more information about child language development, click on the links above. If you have concerns with your child’s language development, please contact a speech-language pathologist. Research consistently indicates that early intervention is best.

Welcome to our blog

Welcome to the Capital Area Speech Therapy blog. This blog is intended to provide parents with information regarding speech and language development and disorders. Blog posts are made by ASHA certified Speech-Language Pathologists unless noted otherwise. We hope this information provided will be beneficial to you and your child.