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What Parents Need to Know About Feeding Therapy

There are a variety of reasons why a child may need feeding therapy. To many of us, it would seem like Feeding Therapyeating should be a basic instinct. However, eating is one of the most complex activities we do, especially for the developing, young child. Eating involves several processes in the body, including sensory, oral-motor, muscular, neurological, digestive, and behavioral systems. Feeding problems can arise involving any one of these systems, and often more than one of these is implicated.

The following are reasons why a child may have feeding difficulties:

  • Sensory processing issues
  • Picky eating
  • Food allergies or severe reflux
  • Autism
  • Developmental delays
  • Complex post-op recovery course
  • Transition from feeding tube to oral nutrition

Feeding therapy is usually done with one or more clinicians. Depending on the type of feeding problem, therapy may involve a speech-language pathologist, an occupational therapist, a registered dietitian, a social worker or behavior therapist, and/or a physician.

A speech-language pathologist will approach feeding in a comprehensive manner, looking at the actual physical swallow mechanism as well as the sensory aspect of feeding. Before beginning a more structured feeding treatment approach, it is key to rule out any medical reasons that a child is not safe to be taking food or drink orally. If there are concerns regarding vomiting, choking, gagging, etc. then the family should seek further guidance from their pediatrician who may recommend a modified barium swallow study. This test looks at the actual swallow mechanism in real time using x-ray to determine whether or not food or liquids are being aspirated (i.e., food items may slip into the lungs rather than where it is supposed to go). If a child is aspirating, physical symptoms may or may not include choking, wet/gurgly voice, and refusal to eat. Feeding therapy can move forward once it has been determined that a child is safe to take food by the mouth.

In addition to safety concerns, therapists will also look at the various chewing and swallowing stages to see if there is a breakdown in this complex process, once food is in the mouth. There is a developmental sequence of chewing for a child as well as development of independent feeding, first using hands and then moving to use of utensils. Each child will have different needs and a feeding therapy plan should be developed that is unique to your child. One approach to feeding therapy that has high success and is evidenced based is the Sequential Oral Sensory Approach to Feeding.

The Sequential Oral Sensory Approach to Feeding is a therapeutic intervention developed by Dr. Kay Toomey. Certification by Dr. Toomey and her associates through a training course is required for therapists to utilize this technique. Once certified, occupational therapists, speech language pathologists, dieticians, social workers and other health care professionals can intervene using the SOS approach. Under this approach, children are exposed to a variety of foods to increase their comfortability with a range of foods, focusing on exploration of the foods using all the senses: sight, sound, touch, smell, and taste.

Each week, the therapist will send the family a list of 8-14 foods based on sensory characteristics that will help the child experience foods that he/she might never have tried before. The family then brings these foods to the therapy session that week. During the session, the child and therapist (and often the caregiver) engage with the food in a playful manner to move up the “Steps to Eating” with each food, a 32-step process involved in eating developed by Dr. Toomey.  The ultimate goal is for the child to explore a variety of foods and expand the range of foods that he/she tolerates. The goal initially is not for the child to eat the food, rather discover and interact with a variety of foods and develop the skills needed to do so. Parents receive feedback after each session and are given recommendations to continue practicing these techniques at home during the week for ultimate success and generalization across environments. Using this approach, children become more comfortable with and generalize the skills needed to eat a wide variety of foods.

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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This blog was co-written with Julie Paskar.

J-PaskarJulie Paskar is a speech-language pathologist, and the Branch Director at the Lincolnwood clinic. She joined North Shore Pediatric Therapy in August of 2012. Julie obtained both her Bachelor of Arts in speech and hearing sciences and her Master of Arts in speech-language pathology at Indiana University in Bloomington, Indiana. She has lived and worked in the Chicago area for the past eleven years. During that time, Julie worked for a pediatric clinic providing Early Intervention services as well as speech-language therapy services to children ages 3-12. She has her Early Intervention credential in speech pathology as both a provider and an evaluator. Julie’s areas of interest include: phonological disorders, motor speech disorders: specifically childhood apraxia of speech, feeding disorders, and expressive language disorders/delays. Julie is a Hanen certified therapist, has also attended both the Introduction to PROMPT and Bridging PROMPT trainings, has attended Picture Exchange Communication System (PECS) Level 1 and Level 2 trainings as well as the Kaufman Speech to Language training. She has been trained in the Orton-Gillingham program which is a treatment program for dyslexia. Julie is a member of the American Speech-Language Hearing Association and is licensed to practice in the state of Illinois. Julie is dedicated to working with children and their families to make communication both fun and functional.

speech and language activities

5 Quick And Easy Speech And Language Activities

The amount of language that happens naturally throughout our day is immense. Even some of the most classic childhood past times involve fundamental speech and language skills. The ultimate goal of speech-language therapy is for your child to generalize the speech and language skills he is learning in the therapy room to his day to day life. By incorporating several minutes of targeted speech-language practice into your child’s life, the better the prognosis it is for your child to be successful! Try one of these easy speech-language activities at home and your child might not even realize they are practicing his language!

5 quick and easy speech and language activities:speech and language activities

  1. Categories Game – Choose a general vocabulary category, such as food or animals, and try to come up with as many items within that category as possible. If your child becomes stumped, provide him with semantic clues, for example, “Can you think of other farm animals?” or “What animal lives in a jungle and has stripes?”. The category game is an easy way to increase a child’s semantic network and to introduce him to new vocabulary words. The game can even become competitive by keeping track of the number of items stated and trying to increase that number each week.
  1. Simon Says – This classic game targets a core skill in a child’s receptive language – following directions. This game can be made simple by using one-step directions (e.g., “Clap your hands 3 times) or made more challenging, progressing to two-three step directions (e.g., “Clap your hands 3 times and turn around in a circle). Improving a child’s receptive language will have a positive impact on his ability to succeed in the classroom.
  1. I Spy – Increasing a child’s utterance length, such as increasing a child’s average utterance from three to four word sentences, is a common goal in speech-language therapy. The game “I Spy” is a great way to work on a child’s expressive language in a fun way. The game can be tailored to a child’s skill level – working on 3-word sentences (“I see cat”) or progressing to a 5-word sentence (“I see a brown cat”).  Descriptive words can also be incorporated. The best part of this game is that it can be used for improving advanced language as well, such as using complex sentences (“I see something that is brown).
  1. Board games – Any activity that involves taking turns provides a great way to practice using pronouns. During a game have someone announce whose turn it is – “It is my turn”, “It is your turn”. Not only can it be used to announce turns, but also to describe the items that people have, “I have three pieces and you have two pieces”. As a child’s language skills improve, third-person pronouns can be practiced, such as “It’s her/his turn” or “She/He is on a blue square”.
  1. Decorating a Letter – If a child has articulation or speech sound goals, these skills can also be easily practiced. Cut a block letter out of construction paper that is the same as your child’s speech goals. Go through a magazine to search for items that have that target sound within its name – in the beginning, middle or end. For example, if your child is working on saying the “k” sound at the beginning of words, look for pictures of items that have that sound – cat, can, kangaroo, etc. Cut the pictures out and glue them on your letter! The decorated letter can then be hung up and referenced at later times for additional practice.

Check in with your child’s speech-language therapist to ensure the activity is appropriate for your child. He or she may have suggestions on how to best adapt the game or activity to your child’s skill level.


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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. 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 today!

Child speeking

Childhood Apraxia of Speech: What Is It?

What is it?

Apraxia of speech is a motor speech disorder caused by a disruption between the planning of muscle coordination in brain and the body parts needed for speech (e.g., lips, tongue, jaw). It is not due to muscle weakness or paralysis. A child with apraxia of speech knows what he wants to say, but their brain has difficulty coordinating the oral movements needed to produce and combine sounds to form syllables and words.

What does it looks like?

Childhood apraxia of speech can look different in each child. Not every child show all of the signs and symptoms of apraxia. The following is a list of potential indicators that your child may have apraxia of speech:

  • Little to no cooing or babbling as an infant
  • Limited imitation of syllables and/or words
  • First words occurring after 18 months of age
  • A two-year old who:

o   is non-verbal

o   uses non-speech sounds without any word approximations

o   uses gestures, rather than words, to communicate

o   becomes frustrated around communication

  • A child who is able to produce single words clearly, though becomes unintelligible in phrases or sentences
  • A child who deletes sounds from words after age three
  • A child who has previously said a word clearly, though cannot imitate it when asked
  • Family members often have to interpret for the child

How is it diagnosed?

An audiologist should complete a comprehensive hearing evaluation to rule out any potential hearing loss.

A certified speech-language pathologist will complete a comprehensive speech-language evaluation. This will assess your child’s oral-motor abilities, speech sound development, and language development.

Childhood apraxia of speech is a differential diagnosis, or a diagnosis that is made by examining all the possible causes for a set of symptoms in order to arrive at a conclusion. Due to this, an official diagnosis of apraxia may not be made right away. It is important to rule out other potential causes for your child’s speech difficulties before coming the apraxia diagnosis, such as phonological disorders. However, it should be noted that with or without a diagnosis your child will still receive effective therapy to improve their overall communication skills.

What treatments are available?

Research has shown that frequent (3-5 times per week) and intensive speech-language therapy yields more successful results. Furthermore, individual therapy is more successful than group therapy for children with apraxia. Improvement in the planning, sequencing, and coordination of oral muscle movements is the main focus in intervention. Visual and tactile cues, such as tapping on the arm or looking in the mirror, provide multi-sensory feedback which helps to improve the child’s coordination and production. The most important piece in therapy for apraxia is practice; both in therapy and at home. The treatment of apraxia takes time, patience, and commitment. A supportive environment is crucial so your child can feel successful in their communicative interactions.

If you have any questions regarding childhood apraxia of speech, contact one of our speech-language pathologists today!