If you’re a parent of a picky-eater/problem feeder, we understand your frustration when attempting to provide adequate nutrition in your child’s meals. Remember, it is normal for your child to reject foods, however exposure is key! There are various underlying factors that may inhibit a child’s willingness to eat. Some factors include: pain, discomfort, limited oral motor skills, deficient swallowing skills, sensory processing problems, learning/ behavioral and nutritional factors.
The first step is to schedule an evaluation with a speech-language pathologist to assess your child’s overall feeding and/or swallowing skills, as well as their dietary repertoire. Feeding skills include the steps it takes to get the food into the mouth, while swallowing involves chewing pattern, propulsion of food from mouth into throat, and protection of the airway. The speech-language pathologist will assess the underlying factors of your child’s feeding/swallowing difficulties, for example whether they experience a sensory aversion to different textures or difficulty with food transportation.
Here is what to expect during the feeding evaluation:
- Full interview – The speech-language pathologist will complete a comprehensive interview to obtain pertinent information regarding your child’s medical, familial, and developmental history with specific insight to your child’s feeding/food preferences and non-preferences.
- Oral Peripheral Exam – After the clinician has established rapport with you and your child, they will assess the musculature of the oral cavity (i.e., cheek, lip, jaw, tongue), including its strength, agility, and range of motion. They will observe their ability to complete various movements within the oral cavity as well as their ability to manipulate different food consistencies/textures. Additionally, they will examine facial symmetry, tone, and chewing pattern.
- Food Trials –The speech-language pathologist may ask you to bring in preferred and nonpreferred food items. They will observe your child’s interactions with various consistencies, textures, and tastes of food. Additionally, it may be beneficial to bring the child’s favorite cup, utensil or plate to help promote their naturalistic feeding habits as best as possible. The speech-language pathologist will observe your child’s amount of food intake, ability to hold food within their mouth, chewing pattern, formation of chewed food prior to the swallow, timing of a swallow, as well as presence of residue left behind. Furthermore, the speech-language pathologist may assess your child’s drinking pattern including their lip seal, jaw stability, and positioning of their tongue.
The completed evacuation will be followed up with recommendations for your child. Recommendations may warrant the need for intervention as well as techniques that may accommodate your child’s individual needs to assist in the home environment. Some sample suggestions/techniques include implementing family mealtime, modeling good feeding behaviors, discussion of the sensory and visual properties of the food, over-exaggeration of correct motor movements, involving the child in all aspects of the meal prep and clean up, remain at the table until mealtime is completed, and no punishment during meals!
Ashley Feiss M.S., CF – SLP TSSLD
If you have ever found yourself saying, “my drink went down the wrong pipe”, it typically means it went down your trachea, which may lead to aspiration. Aspiration is the entry of food, liquids or saliva past the vocal folds potentially into the lungs; it is more frequently observed when swallowing fluids. Symptoms typically include coughing, difficulty breathing, and in some cases choking. Normally, everyone encounter’s this process every once in a while due complications coordinating the respiratory and digestive mechanisms. However, individuals with swallowing disorders experience this type of pain and discomfort on a regular basis, which places them at heightened risk for life-threatening complications, such as pneumonia, blood infections, or lung abscess.
Swallowing disorders, also known as dysphagia, may be defined as the difficulty with the transportation of liquids, solids, or both from the pharynx to the stomach. Individuals may encounter difficulty transporting hard textured foods while others have difficulty drinking liquids. Dysphagia, occurs in all age groups and may be a result of a variety of congenital abnormalities, structural damage, or medical conditions. Such conditions typically include, Cerebral Vascular Accidents (CVA), nervous system disorders (i.e., Parkinson’s Disease, Multiple Sclerosis, Cerebral Palsy, respiratory complications, esophageal complications including gastroesophageal reflux (GERD), Traumatic Brain Injury (TBI), head and neck cancer, etc. Other conditions may include intake of antihistamine medication or associated psychological behaviors.
The following are typical signs and symptoms of dysphagia:
- Inability to recognize food
- Coughing before, during, or after the swallow
- Difficulty managing food within the oral cavity
- Sudden weight loss
- Change in vocal quality (gurgly/wet)
- Pain when swallowing (odynophagia)
- Gastroesophageal Reflux (GERD)
The four phases of swallowing that encompass the transportation of food to the stomach.
- Oral Preparatory Phase: the formation of the “bolus” or chewed up food
- Sensory recognition of food or identification that it’s in front of them
- Rotary chew pattern/movement and manipulation of the consistency to form a cohesive ball or “bolus”
- Lateralization the tongue and chewing with the back molars for bolus formation
- Oral Phase: the movement of the “bolus” from the front to back of the mouth
- Tongue pushes the bolus backwards
- Labial closure while chewing to prevent food from lip spillage
- Cheek tension increases to inhibit pocketing of food and increase tension for bolus formation
- Pharyngeal Phase: the transportation of the “bolus” from the top of the pharynx to the bottom of the pharynx
- Vocal fold closure and downward movement of the epiglottis to cover entrance into larynx for airway protection
- Velopharyngeal closure to prevent regurgitation (food to going back up nasal cavity)
- Laryngeal excursion is the upward and forward movement of the larynx and hyoid bone while the upper esophagus is opening to help bolus move down. Additionally, it helps to protect the airway by pulling it out of the way.
- Pharyngeal walls contract (pharyngeal constrictors) to help push the bolus through to the bottom of the pharynx
- Esophageal Phase: encompasses the passage of the “bolus” from bottom of the pharynx to the stomach
- Peristalsis is the action of the esophageal muscles to help push the bolus down the esophagus to the stomach
- Referral to a gastroenterologist is typically the most appropriate for patients experiencing esophageal stage dysphagia
Ashley F, M.S., CF-SLP TSSLD
A late-talking toddler typically presents with an established foundation of language learning. This foundation includes receptive (comprehension) language, fine motor, gross motor, and play based language skills. However, they continue to demonstrate limited or no expressive (production) language skills. Although every child’s development is unique to their “own rate” of progression when compared to their age matched peers, there are certain ranges of development that certain milestones should occur. Some children seem to catch up on their own, while others do not. Therefore, parents and early development professionals should remain cognizant of the typical progression of speech and language development.
Critical language milestones to keep in mind for your toddler:
- First Word – Children produce their first meaningful word for communicative intent around 12 months, around the time they begin to walk.
- Combining Words – Most children have approximately 50 words and begin to combine 2-word phases at 24 months (i.e., mommy up, no milk, more ball).
- Asking Questions – Children begin to use intonation to ask yes/no questions and demonstrate use of wh- questions around 12 – 26 months of age.
- Prepositions – Children typically use about two or three prepositions (i.e., on, in, out) by 12-24 months of age.
- Intelligibility – Children around 2-3 years of age should be approximately 50-75% intelligible by an unfamiliar listener.
Some parents may decide to wait and see if their late-talker will catch up to their peers. However, they typically struggle to determine whether their child’s language skills are typical or atypical due to the wide age variation of development. However, it is never too early to schedule and evaluation with a speech-language pathologist to determine whether your child is on the right track! The speech-language pathologist will talk to you about your concerns and determine if intervention is necessary. Intervention may be necessary if the speech-language pathologist notices risk factors that would inhibit future language learning and may suggest intervention or early intervention.
The following are a few risk factors in future language difficulties:
- History of being quiet as an infant
- Limited number of early developing consonant sounds (e.g., /p, b, m, t, d, n/)
- Limited vocabulary use
- Lack of verbal imitation
- Difficulty playing with others
- A family history of communication delay, learning or academic difficulties
Research suggests there are some late-talking toddlers who seem to catch up on their own without intervention by the time they enter school. However, they continue to perform at a lower level than their peers in certain aspects of language (i.e., literacy, grammar). Seek advice from a professional and schedule an evaluation with a speech-language pathologist to address your concerns. In addition, they may offer suggestions and tips to practice language learning at home and support your child’s expressive language development.
As we approach the end of the summer, there remains plenty of opportunities for parents to target their child’s language skills in preparation for the upcoming school year! After a summer of adventure and freedom, language-based activities can be enjoyable while enhancing your child’s overall academic, social, and emotional well-being. Check out the following activities that can be used throughout your child’s everyday activities!
- Story Time: Shared story reading is the best way to promote overall academic by targeting communication, language form/use, and literacy skills. Shared reading is powerful interactive approach involving participation of both the parent and child. As the parent demonstrates proficient reading skills, they involve the child through active participation. This type of involvement will help improve the child’s lexical repertoire (vocabulary), print awareness, as well as the sound correspondences between written and spoken words. In addition, shared reading targets a child’s attention skills, conversational skills, and verbal reasoning. To target their critical thinking skills, ask your child to predict what will happen next or reason why something happened.
- Treasure Hunt: This activity is the simplest way to enjoy a beautiful day with your kids! Take a few household objects and make a list of descriptive words to describe each item as well as the location (behind a chair, under the statue) they will be hidden in your backyard! Give your child the list of clues and have check off each item as they find each item. Additionally, this activity can be modified to target articulation skills if the objects hidden include the targeted sound. For example, to target the /s/ sound: scissors, can of soup, sunscreen, sunflowers, necklace, sock, etc.
- Go on a picnic: This type of activity is great to target vocabulary, sequencing, descriptive words, and following directions! Have your child gather and identify all needed items to go on a picnic (basket, utensils, napkins, cups). Then, create a menu for the lunch you will want to bring on the picnic. For example, if you are bringing sandwiches, have your child identify the ingredients needed. Then, together write down sequenced steps to create the sandwich. Last, have them follow the directions to create their desired sandwich!
- Watch a Movie: What a better way to target language skills than to watch a movie on a rainy day! After watching a movie, conduct a family discussion and have your child provide a recap of the movie. Their recap may include, description of the characters (protagonist, antagonist) and their personalities, discussion of the main idea, sequencing the movie scenes, discussion of both your favorite part and your child’s favorite part (or not so favorite part) of the movie, etc.
- Re-cap the Summer: Discuss all the exciting adventures you and your child have completed over the summer. This helps prepare your child to answer those ice breaker activities typically introduced in the beginning of the school year to begin conversation and help children establish rapport with their peers. Some questions may include:
- Something fun you did this summer
- Name a cool/fun place you visited
- Talk about a new hobby
- What is something you tried for the first time?
- What was your favorite thing to do? or Did you find something new that is your favorite thing to do?
- What do you expect to learn this year?
Ashley F. M.S., CF-SLP TSSLD