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What Parents Need to Know About Feeding Therapy

Should I Have my Child Evaluated for a Feeding Disorder?

Does your child…Blog-Feeding-Therapy-Main-Landscape

  • Experience extreme anxiety or exhibit behaviors during mealtime?
  • Find mealtime to be an exhausting process that requires too much time and energy to complete?
  • have difficulty tolerating a variety of food groups?
  • require you to prepare a separate meal from the family dinner or snack time at school?

If so, a feeding evaluation by a qualified speech-language pathologist or occupational therapist may be warranted.

What Does an Evaluation Look Like?

The parent interview often provides the most valuable information and it is important to fill out all case-history information completely. The therapist may inquire specifically about your child’s medical history of any respiratory, gastrointestinal, renal, and craniofacial issues. Report any food allergies or restrictions (soy, gluten, dairy, egg, nuts) to ensure your child’s safety. If time allows, a 3-4 day feeding diary that includes a detailed report of all the food/drink ingested would allow the clinician to analyze any patterns of behavior and preferences related to feeding. The therapist should know the child’s regular feeding times, a list of all foods and drinks preferred/tolerated, any foods the child used to enjoy but no longer accepts, the length of a typical mealtime, and any positive or negative behavioral or physiological reactions to foods.

The clinician will examine the oral cavity (jaw, tongue, hard/soft palate, dentition, etc.) for appropriate symmetry, strength, and range of motion for feeding. Based on your child’s level of comfort, food and/or drink brought by the parent may be presented. The clinician will observe the child’s postural stability, acceptance of food/drink, munching or rotary chewing patterns, chewing side preferences, and the timeliness/success of the swallow response, and overall rate of feeding. The clinician will take note of signs/symptoms of airway penetration such as coughing, wet vocal quality, watery eyes, or excessive throat clearing. All of this information will assist the therapist in making appropriate referrals and/or developing a feeding treatment plan tailored to fit your child’s needs.

What’s the Difference Between a Picky Eater and a Problem Eater?

A picky eater is a child who accepts 30 or more foods, requires repeated exposures prior to eating the food consistently throughout varying food environments, and has specific routines with food presentation (e.g., needs crust cut off, no foods can be touching, will only eat one specific brand of chicken nuggets). Children who are picky eaters are still able to maintain adequate nutrition and hydration without nutrient-based supplements. Parents complain that new food experiences such as going to restaurants and birthday parties are often difficult due to their child’s feeding preferences.

A problem eater is a child who accepts roughly 5-10 foods and has no more than 20 foods in their food repertoire. The child presents with extreme phobic reactions to new foods such as crying, screaming, throwing foods, and most often times, absolute refusal if their foods are not preferred. Physiological symptoms become evident with facial grimacing, gagging, or vomiting when presented with or during mastication of foods. Parents often feel obligated to allow their child any food so they will eat something. A problem eater likely has underlying medical or functional impairment such as autism spectrum disorder, gastroesophageal reflux disease (GERD), reduced strength and coordination of the oral musculature, and/or sensory processing disorder. Extreme self-restriction can occur if problem eating is left untreated and most often leads to pediatric undernutrition (PUN). Most parents express that the “wait it out” approach does not work with a problem eater and they will continue to self-restrict for days until preferred foods are presented. Children who are problem eaters often require nutrient-based supplements to maintain their health.

A speech-language pathologist can treat both a picky and problem eater to expand the food repertoire and increase tolerance of various tastes, foods, and textures.

What Does Feeding Therapy Look Like?

There are many different approaches to feeding therapy. Your speech or occupational therapist will choose a technique and plan of care that suits your child’s needs most appropriately. Since feeding is a daily activity that requires parent assistance and preparation, you will likely be included in the sessions for education and training purposes.

A feeding therapy session will focus on creating a positive mealtime experience for the child. Intervention targets will likely include increasing awareness, stability, or strengthening the oral cavity, improving the motor plan sequence for feeding, and/or imposing behavioral modifications during feeding, and educating the parent. Behavioral modifications may include a daily mealtime schedule, with no “grazing” in the kitchen allowed, restricting the amount of preferred foods presented to the child, or implementing positive reinforcement for when a child is trialing a new food (access to a favorite toy for 1 minute.) Parents also benefit from behavioral modifications, such as allowing the child to choose foods from two choices, reestablishing trust after hiding something nutritious in the food, and maintaining the promise of “just 5 more bites.”

A technique called “food chaining” uses the child’s core diet (what they will reliably eat across all settings) to “chain” or transition to another similar flavor and texture of foods.

Here is an example of the steps taken while food chaining:

  1. Core diet – what the child will eat reliably across all settings.
  2. Flavor mapping – analysis of your child’s flavor preferences
  3. Flavor masking – use of a condiment or sauce to mask a new taste
  4. Transitional foods – favorites used to transition a child to a new food.  These foods cleanse the palate in-between bites of new foods
  5. Surprise foods – new foods that are significantly different – something you make together, for example: chocolate to peanut butter, apples to pears, and chips to veggie sticks.

Food chaining often incorporates all senses to transition to a new food using a feeding hierarchy. A feeding hierarchy is a tool to teach the child how to taste/trial food in slow increments in attempt to reduce the amount of anxiety associated with trialing new foods. The feeding hierarchy may include providing the child with a goal to interact with the food, or an item of similar consistency a number of times.

Some examples of what may be included in a feeding hierarchy are:

  • Tolerating the food and its scent in the room
  • Allowing the food on the table or on the child’s plate
  • Touching the food with a utensil or hands
  • Touching the food to the lips (kissing) teeth, and tongue
  • Licking or sucking the food
  • Sinking the teeth into the food
  • Taking a small “nibble”
  • Taking an average bite of food

If your child is experiencing these symptoms consult with your physician regarding your concerns. Should you have any questions regarding a feeding evaluation/therapy, consult with a qualified speech-language pathologist or occupational therapist as soon as possible.

References:

  • Fraker, C., Fishbein, M., Cox, S., Walbert, L. (June 2004). Food Chaining: A systematic approach for the treatment of children with eating aversion. Retrieved from Journal of Pediatric Gastroenterology and Nutrition: Volume 39, pg. 51.
  • Fraker C., Fishbein M., Walbert L., Cox S. Food Chaining: The proven 6-step plan to stop picky eating, solve feeding problems and expand your child’s diet. Cambridge, MA: Da Capo Press; 2007.
  • Roth, M., Williams, K., Paul, C. (August 2010) “Empirically Supported Treatments in Pediatric Psychology: Severe Feeding Problems”. Journal of Pediatric Psychology, vol. 24, no. 3, 193-214.
  • Toomey, K. Ross, E. “SOS Approach to Feeding”. Perspectives on Swallowing and Swallowing Disorders (Dysphagia). 2011. 20: 82-87. Retrieved from http://spdfoundation.net/library.html#effectiveness.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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10 Signs of Auditory Processing Disorder

What is Auditory Processing Disorder?

Auditory processing refers to what we do with the messages we hear. An auditory processing disorder occurs due to an auditory deficit that is not the result of other cognitive, language, or related disorders. However, children with an auditory processing disorder may also experience other difficulties in the central nervous system, including learning disabilities, speech-language disorders, and other developmental disorders. Auditory processing disorder may also co-exist with other diagnoses, such as ADHD or Autism. Blog-Auditory-Processing-Disorder-Main-Landscape

10 Signs of Auditory Processing Disorder

  1. Difficulty understanding speech in noisy environments
  2. Inability to consistently and accurately follow verbal directions
  3. Difficulty discriminating between similar-sounding speech sounds (i.e., /d/ versus /t/)
  4. Frequently asking for repetition or clarification of verbally presented information
  5. Poor performance with spelling or understanding verbally presented information
  6. Child typically performs better on tasks that don’t require or rely on listening
  7. Child may not speak clearly and may drop ends of words or syllables that aren’t emphasized
  8. Difficulty telling stories and jokes; the child may avoid conversations with peers because it’s hard for them to process what’s being said and think of an appropriate response
  9. Easily distracted or unusually bothered by loud or sudden noises
  10. Child’s behavior and performance improve in quieter settings

How is Auditory Processing Disorder Diagnosed?

An initial diagnosis of auditory processing disorder is made following a comprehensive audiological evaluation, which is completed by a licensed and ASHA accredited audiologist. Following the diagnosis, the speech-language pathologists at NSPT work closely with the audiologist and collaborate on an ongoing basis. Children with an auditory processing disorder benefit from working closely with both speech-language pathologists, as well as occupational therapists. Professionals at NSPT can collaborate with teachers and other professionals to provide recommendations to help set up a successful learning environment for your child. Therapy will include activities to increase auditory closure skills, vocabulary building, discrimination skills, grammatical rules, and auditory perceptual training.

Resources:

 Bellis, Teri James. Understanding Auditory Processing Disorders in Children. American Speech-Language-Hearing Association. Retrieved from http://www.asha.org.

www.understood.org

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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Common Misconceptions About Picture Exchange Communication System

What is a Picture Exchange Communication System (PECS)? PECS is a form of Augmentative and Alternative Communication (AAC) which uses a picture/symbol system to teach initiation ofBlog-Picture Exchange Communication System-Main-Landscape
functional communication. PECS was developed by Lori Frost and Andy Bondy in 1985 to be used with preschool children on the autism spectrum who demonstrated little to no socially-related communication. Examples include: children who avoided interactions with others, did not approach others to communicate, and/or only communicated when prompted to do so.

Myth #1: The Picture Exchange Communication System is strictly used for nonverbal children or children on the autism spectrum.

A common misconception about the Picture Exchange Communication System (PECS) is that it is strictly used with nonverbal children. While PECS and other forms of AAC have proven very useful and successful with nonverbal children, the system services many other populations with the purpose of eliciting and initiating functional communication.

To fully understand the meaning of functional communication, a distinction must be made between actions directed to the environment vs. actions directed toward a person. A child may climb on a step stool to reach a toy car on a shelf. From this action, we could infer that the child wants to play with the car. However, this is not communicative. If this same child looks from the car to his mother, or leads his mother over to the car, this is considered communication. Neither interaction involved speaking, however the distinction is that communication occurs when an action is directed towards someone else to achieve a certain outcome.

Therefore, Picture Exchange Communication System is appropriate, not just with children or adults that are not verbally communicating, but with those who are verbal, yet lack person-directed communication.

Other populations where PECS might be appropriate (to name a few):

-late-talking children (research is showing benefits for the introduction of AAC as early as 12 months)

-adults with aphasia

-Childhood Apraxia of Speech (CAS)

-children with reduced speech intelligibility

-verbal children with reduced social language and initiating

Myth #2: Using PECS will deter my child from communicating verbally

For some children, verbal communication can be a challenge; speech and language are not developing as quickly as would be anticipated and, accordingly, result in accompanying frustration and associated behaviors. Introduction of an augmentative and alternative communication system like PECS can help bridge the gap for children who are not yet verbally communicating but need an accessible means of communication as speech and language develop. Without an effective means of communication, these children are at risk for social, emotional, and behavior problems, including feelings of frustration and isolation.

Often, parents are concerned that using an augmentative or alternative form of communication will replace or deter verbal communication. In fact, research has shown just the opposite:

“Research over the past 25 years has shown not only that use of augmentative communication systems (aided or unaided) does not inhibit speech development but that use of these systems enhances the likelihood of the development or improvement of speech.” (Bondy & Frost, 2004)

The PECS program mirrors the acquisition of typical language development; children are taught one-word labels for frequently requested items before transitioning to formulation of two-word utterances. Verbally requesting and labeling can be targeted in conjunction with the program. The PECS program also details modality transitioning (i.e., transitioning from PECS to verbal communication), if and when it is appropriate.

If your child is using PECS now, this does not mean that you are “giving up on speech”. It is a system that is being utilized to give your child a means of communicating and interacting with others while speech is developing.

Myth #3: PECS cannot be used with children who have visual impairments, fine motor, or gross motor difficulties.

PECS can be used with a wide range of age-groups and disabilities. Accommodations can be made for children and adults with visual impairments, fine motor, or gross motor difficulties, to name a few.

Pictures can be made in various sizes to accommodate visual impairments. Additionally, you or your child’s speech language pathologist can select and modify pictures to suit your child’s needs; photographs can be used instead of clipart or Boardmaker pictures, and images can be modified to create more contrast.

Pictures can also be put on objects (e.g., bottle tops) to make them easier to grasp and pick up from a table or book for children with fine motor difficulties.

Step 2 of PECS involves ‘distance and persistence’, meaning a child is taught to move across a room, multiple rooms, etc. to select a picture from his book and persist when giving it to his communication partner. Students that are non-ambulatory can use a voice switch or a button to request his communication partner in order to perform the exchange.

If you have questions about PECS and if it would be appropriate for your child, please consult with a licensed speech language pathologist.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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5 Best Apps to Work on Speech and Language at Home

  1. My PlayHome by PlayHome Software LtdBlog-Speech-Apps-Main-Landscape
    • A digital doll house that lets your child use everything inside. You can fry an egg, feed the family pizza, pour drinks, feed the pets, and more! This app does not specifically target speech
      and language skills; however, there are many ways it can be used to work on speech/language at home. While playing with the doll house, you can work with your child on pronouns, identifying actions (e.g., cooking, sitting), present progressive –ing (e.g., drinking), plurals (e.g., two apples), vocabulary (around the house), formulating complete sentences, etc. I also like to use this app as a motivating activity for children working on speech sounds. For example, I will say, “Tell me what the doll is doing with your good ‘r’ sounds.” There is also My PlayHome Hospital, My PlayHome School, and My PlayHome Stores.
  2. Articulation Station by Little Bee Speech
    • This app is fantastic for children working on speech production skills. The whole app is pricey, but beneficial for a child working on more than one speech sound. It is also possible to download individual speech sounds to target a specific sound at home. This app is motivating and excellent for home practice!
  3. Following Directions by Speecharoo Apps
    • Excellent app for working on following directions. Choose from simple 1-step directions, 2-step directions, or more advanced 3-step directions. These funny directions will have your child laughing and wanting to practice more.
  4. Peek-A-Boo Barn by Night & Day Studios, Inc.
    • My favorite app for toddlers working on expressive language skills. First, the barn shakes and an animal makes a noise. Have your child say “open” or “open door” before pressing on the door. You can also have your child guess which animal it is or imitate the animal noises. When the animal appears, have your child imitate the name of the animal.
  5. Open-Ended Articulation by Erik X. Raj
    • This app contains over 500 open-ended questions to use with a child having difficulty producing the following speech sounds: s, z, r, l, s/r/l blends, “sh”, “ch”, and “th”. It is great for working on speech sounds in conversation. Have your child read aloud the question and take turns answering. The open-ended questions are about silly scenarios that will facilitate interesting conversations.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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What Can a Child with Autism Expect in Speech Therapy?

If you are a parent or a professional who has had experience with a child diagnosed with autism, you know that they are all as different as the colors under the sun. Speech therapy services areBlog-Autism-and-Speech Therapy-Main-Landscape typically recommended and necessary for kids diagnosed with autism, as they may have difficulty communicating effectively. These services will be tailored to the individual to ensure the child is making progress and achieving developmental milestones. No two speech therapy sessions are the same, as will be the case for your child. However, there are overarching goals that you can expect your child to be working towards.

Here are factors you should expect to be consistent for a child diagnosed with autism that is receiving speech therapy services:

  1. Speech therapy will be individualized.

The speech language pathologist will complete an evaluation of the child’s current speech and language skills. Based on the results of the evaluation and any observations made, goals will be formulated to target areas to improve.

  1. Speech therapy will target functional communication.

This may mean different things depending on the level of the child. Whether the child is verbal or nonverbal, therapy will address making sure the child is effectively communicating their needs and wants. If the child is nonverbal or has significant difficulty utilizing verbal language, Augmentative and Alternative Communication (e.g., pictures, sign language, iPad, etc.) may be implemented. Therapy may also target talking about events, telling stories, answering questions, asking questions, commenting, expressing opinions, and participating in conversations.

  1. Speech therapy will target social language.

Social language is also known as pragmatic language and includes using language for a variety of purposes (i.e., greetings, informing, demanding, etc.), changing language according to the needs of the listener or situation, and following rules for conversation and storytelling. In order to warrant a diagnosis of autism, the child has already been determined to have a deficit in social communication and interaction. Treatment goals may include maintaining eye contact, initiating and terminating conversations, maintaining topics of conversation, identifying emotions, and utilizing appropriate body language.

The above goals are targeted in a variety of ways, again dependent on your child. Sometimes direct education is provided prior to practicing skills in activities, role-play scenarios, or structured real-life situations. Other times, skills are targeted during play and motivating activities for the child. No matter the skill level of your child with autism, speech therapy is an integral piece to their progress and successful functioning.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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Tips and Tricks to Boost Your Toddler’s Speech and Language

When your child enters into this world, he is immediately exposed to his new environment. Speech and language development begins right away, as your child begins to explore the environment around him. The early years of your child’s life is a crucial period for speech and language development. Blog-Toddler Speech and Language Main-Portrait

As you interact with your child, there are various ways that you can help to boost his speech and language:

  • While you are playing with your child, talk about the actions that he is doing and what you are doing. For example, if your child is throwing a ball, say “throw the ball” as he throws it. This will help him match spoken words to actions.
  • Label objects for your child. As you are engaging with your child, tell him what it is that he is holding, looking at, etc. For example, if your child is holding a ball, say “you have a ball” This will help to increase his ability to identify and name various objects.
  • Expand on your child’s utterances. As your child is acquiring language skills, he will start to speak using short utterances before he can use full sentences. When your child produces one word or short multiword utterances, take his utterance and use it in a full contextual sentence. For example, if your child points to a ball and says “ball,” you can respond with “yes, I see the red ball!”
  • Use natural sounding speech with appropriate intonation when talking to your child. As your child is being exposed to language, not only is he listening to the words, but he is also listening to your tone of voice and looking at your face. Therefore, to help him understand what you are saying, it is important to match your tone and facial expression to your spoken words. For example, if your child is throwing toys inappropriately, tell him “no throwing” with a more stern tone of voice. If you say “no throwing” with a “happy” tone of voice and a big smile, your child may have a difficult time understanding the concept of “no” since the tone of voice and facial expression did not match the meaning of “no.”
  • Sing familiar songs with your child. Engaging in song is a fun way to encourage language development. At first, you will be doing most of the singing while your child closely watches and listens. While you sing, you can use gestures to match words in the song. As your child gets multiple exposures to you singing the song, encourage him to engage in the song by gesturing along with you. For example, when singing “head, shoulders, knees, and toes,” start by singing the song while you touch each body part matching the words in the song. Then to engage your child more, you can sing the song while you help him move his hands to touch the body parts from the song. Another tip you can do with songs is pausing at certain words for your child to say. For instance, you can pause before “toes” each time it occurs in the song to allow your child to say it. Not only can this help to increase language production, but it can also help your child identify and name objects, items, or in this example, body parts.

NSPT offers services in Bucktown, Evanston, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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How to Use Visual Supports at Home for Language Development

For children with receptive and expressive language disorders, visual supports can be powerful tools when communicating. Visual supports are beneficial to aid in not only the comprehension of language, but also to improve expression of language. These visuals can provide a child with information they are missing when comprehending language or speaking. Visual supports are so universal and easily to utilize that they can be implemented seamlessly in the home environment.

How to use visual supports to improve language comprehension:

For children that experience deficits in language comprehension, visual aids are a great way to improve their ability to comprehend instructioVisual Supportsns, rules of an activity, and expectations. Here are some examples of ways to create visual aids for receptive language tasks.

  • Visual schedules can be pictorial, written or both. It is important to tailor the schedule to the child’s abilities. For children with receptive language deficits, hearing their schedule for the day can be confusing and maybe, even a little scary. By presenting a visual schedule, paired with a verbal description, a child will receive the information via two avenues of communication, which will likely improve comprehension of what to expect.
  • A Listening Chart, as shown below, visually depicts the components to being a good listener. When expectations or rules are presented only verbally, information is often forgotten. By using a visual to depict expectations, the child will be more successful and can easily remind him or herself of what actions need to be completed.
  • Presenting choices visually can be a powerful tool for children who have receptive language deficits. For example, if there are two choices for snack (e.g., pretzels or grapes), you can present two pictures of these food items when asking the child what he or she would like to eat.

How to use visual supports to improve language production:

The use of visual aids for language production is slightly more diverse than those utilized for language comprehension. Visual aids for language expression are often used to help a child initiate communication, participate appropriately in a conversation, and to expand utterances. Here are some examples of visual aids used to improve expressive language skills.Smash Mats

  • Smash mats are a great tool to use to expand a child utterance length (e.g., from two word to three words). As shown here, a smash mat can be as simple as three dots on a page. When modeling a sentence, you can touch a dot as you say each word (e.g., Girl is swinging or I want goldfish). You can make smash mats even more enticing by adding a playdoh ball to each dot. Smash mats are also great, because as your child continues to progress in their expressive language skills, you can continue to increase the length of their utterance by adding additional dots to your mat.
  • A Topic Tree is one of many visual aids that can be used during conversations. The topic tree is specifically for topic maintenance (i.e., staying on the same topic of conversation with your
    communication partner). For example, if you are talking about Christmas with your child, each time that you make a comment, ask a question or appropriately respond on the topic of Christmas, you put a leaf on the tree. This is an easy DIY visual aid you can make at home!
  • A Yes/No Board is a great visual aid for an emerging communicator. It is a simple visual depiction of the concepts of “yes” and “no.” Yes/No boards can be visually Y-N Boards2displayed in a variety of ways as shown below. When asking a child a Y/N question, by presenting the child with this visual, you are not only cueing the child that you are asking a question, but also providing the child with the appropriate response choices.Y-N Board

All of these visual aids will not only increase a child’s engagement in a daily activity, but also aid in making transitions smoother. Visual aids can be implemented at any age and in any environment.

NSPT offers services in Bucktown, Evanston, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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How to Get Your Baby Talking

A baby typically starts babbling, using speech-like sounds, between four to six months of age. Usually, the sounds p, b, and m are the first to develop. Additionally, in this age range, a baby is more Blog-Baby-Talking-Main-Landscapeinteractive with the parent or caregiver, laughing and vocalizing displeasure or excitement. Between seven months to a year of age, communication will expand and most babies are producing repetitive consonant-vowel combinations such as baba or dada, using gestures for communication, using vocalization to gain and maintain attention, and by one year of age a baby typically has one or two words or word approximations.

A parent or caregiver can support their baby’s language development or “talking” by encouraging all communication, interacting on their baby’s level, and making communication opportunities.

  • Match your child’s communications and interaction attempts, including repeating his/her vocalizations and gestures. By matching your baby’s vocalizations, you are communicating on a level that allows them to maintain communication turn-taking. Additionally target speech games and songs such as itsy-bitsy spider, peek-a-boo, and gestures such as clapping, blowing kisses, and waving hi/bye.
  • Talk through daily routines such as bath time, bedtime, get dressed, and feedings. You are providing your baby with the associated language during these daily routines. Talk through the plan for the day, what will you be doing, where you are going, who are they seeing, etc.
  • Teach your child gestures and signs to support language development.
  • Teach your child animal sounds (e.g., moo, baa) and environmental sounds (e.g., vroom, beep).
  • Spend time reading to your child and labeling pictures in books.
  • Reinforce your baby’s communication attempts by giving them eye contact and interacting with him or her.
  • Simplify your language during communication interactions with your baby.
  • Make communication opportunities within routines and daily activities.
  • Limit your baby’s exposure to television and/or videos. A 1:1 interaction between a parent and child is preferable to support turn-taking communication.

Remember there is a range of typical development. Not all babies will have their first words around one year of age!

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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What is a Tongue Thrust?

A tongue thrust is the most commonly known type of Orofacial Myofunctional Disorder. According to the American Speech-Language Hearing Association, this is when “the tongue moves forwardblog-tongue-thrust-main-landscape in an exaggerated way during speech and/or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing and at rest.”

A tongue thrust or an Orofacial Myofunctional Disorder may impact speech, chewing and swallowing as well as create changes in the dental pattern. An improper tongue resting pattern may develop as a result of enlarged tonsils or adenoids, allergies, extended thumb, finger, or pacifier sucking. It may also be related to restrictions in tongue movement, lip movement or the shape and size of the mouth.

Who Can Help With A Tongue Thrust?

This issue may be identified by a pediatric dentist or orthodontist due to the bite pattern seen in the child. An open bite (where the front teeth do not meet creating an open space) may indicate that there is a tongue thrust or an abnormal tongue resting position. A Speech-Language Pathologist trained in the area of orofacial myology or a Certified Orofacial Myologist (who may be a speech-language pathologist or a dental professional) are among the professionals who can diagnose an OMD.

To screen for the possibility of an OMD, it is beneficial to look at all the underlying factors including:

Habits – Thumb sucking, finger sucking, tongue sucking, extended bottle use and overuse of a “sippy cup.”

Airway – Open mouth breathing, enlarged adenoids and/or tonsils, allergies.

Lips – Do the lips rest apart or together habitually? Are there structural restrictions that don’t allow comfortable lip closure?

Tongue – Any difficulty moving the tongue to the roof of the mouth? Does the tongue appear to move forward during speech? Any structural restrictions impacting the movement? Sometimes the “lingual frenum” which is the attachment under the tongue is too short or tight and creates issues with tongue movement.

Teeth – What does the bite pattern look like? Is there an “anterior open bite” (the upper and lower incisors don’t meet when the teeth are together)? The “anterior open bite” is a very common pattern seen with tongue thrusts and other OMDs.

Speech – Speech may sound distorted especially the sounds “s,” “z,” “sh” and “j.”

Chewing and Swallowing – May show up as eating too quickly, too slowly, messy eater, as the swallow pattern is altered. This is sometimes referred to as a “reverse swallow.”

How is tongue thrust treated?

The approach to treatment involves first the proper diagnosis and designing a tailored approach to the particular OMD and how it is presenting in the individual patient. The therapist works closely with the rest of the OMD team, which may include the physician, ENT, gastroenterologist, oral surgeon, dentist and orthodontist. Any habits, structural issues, allergies or airway restrictions are addressed by the appropriate professionals.

Using tailored exercises, the treating therapist addresses forming correct placement of the lips, tongue and jaw at rest and the habituation of this over time. Addressing correct swallow patterns and the carryover into the ability to do this on an everyday basis with all foods is also addressed. Also addressed by the speech-language pathologist are any speech articulation issues with increased emphasis of the correct placement of the tongue and the appropriate tongue pattern.

Successful treatment involves ongoing treatment in weekly therapy, daily exercises done in the home and a collaborative approach with the family and the other professionals on the team.

Resources:

The American Speech-Language Hearing Association’s website information page: http://www.asha.org/public/speech/disorders/OMD/

International Association of Orofacial Myology information page: http://www.iaom.com/OMDisorders.html

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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Red Flags for a Speech or Language Delay

It may be difficult to know whether or not your child is showing signs of a speech or language delay. Below are some key red flags to watch for: blog-speech-red-flags-main-landscape

By Age 1, your child cannot:

• Respond to his/her name
• Begin verbalizing first words
• Initiate or maintain eye contact

By Age 2, your child cannot:

• Begin combining two-word phrases (24 months)
• Child does not consistently add new words to expressive vocabulary
• Child does not follow simple instructions
• Child presents with limited play skills

By Age 3-5, your child cannot:

• Verbalize utterances without repeating parts of words or prolonging sounds (e.g. “m-m-m-my mother,” “ssssssister”)
• Seem to find the right words, describe an item or event without difficulty
• Begin combining four to five-word sentences
• Be understood by both familiar and unfamiliar listeners
• Repeat themselves to clarify without frustration
• Correctly produce vowels & majority of speech sounds (closer to 5 years old). Speech should be 90% intelligible to unfamiliar listeners by 5 years of age.
• Ask or answer simple questions
• Use rote phrases and sentences
• Play with peers and prefers to play alone

How Can a Speech or Language Delay Affect My Child?

Speech and language disorders can have a significant impact on a child’s ability to independently function in his/her environment. Without intervention, poor speech and language skills can lead to inability to communicate wants and needs across environments, social isolation and an inability to sustain an independent lifestyle.

How Can I Help Treat My Child’s Speech or Language Delay?

General treatment includes speech and language therapy from a speech-language pathologist, in order to evaluate and treat the specific aspects of the speech or language delay. Individual and/or group therapy may be recommended in order to treat all areas of the delay.

Our Speech and Language Approach at North Shore Pediatric Therapy

Our speech-language pathologists are trained in all areas of speech and language development. With extensive knowledge in typical speech and language, our pathologists can effectively identify and remediate speech and language disorders, using multi-sensory modalities.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

Meet-With-A-Speech-Pathologist