Episode 145: The Missing Link In Your SLP & OT Screenings

Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space.

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Let's get started. Hi and welcome to episode 145 of the Untethered Podcast. Today it's me, your host, Hallie Balkan. I wanted to take an episode and talk about pediatric screenings that SLPs and OTs are already conducting. And the missing link, what is missing from most of the screenings? How, what was, what prompted this? Right. My own daughter. So we've moved to a new school setting and in a new state and she's in preschool, she's in a three year old class and you know, being an SLP mama, they offered SLP screenings where an independent speech pathologist came into the school and did speech and language screening at her preschool school. And so obviously I don't have concerns but you know, I was curious to see what kind of screenings they're doing down, down here in our, our new, our new city. And so I signed her up and it's always nice also to have input from a professional in your space that's not you because sometimes you forget as like a mama therapist you for, you know, you don't forget but you don't want to over qualify or under qualify your own child's skills and it's not really, you know, valid if you assess your own child. So, so anyways, I had no concerns but I sent her through the screening. Again, call it spying if you. I was curious to see like what do they screen for and what is the process down here Because I also own a private practice in the D.C. maryland, Virginia area that also treats virtually in New York, New Jersey and Florida and Pennsylvania. And so I wanted to, you know, we go into schools in the D.C. metro area, we don't really go into schools in other areas for pediatric SLP and OT screenings. And I do what I consider a comprehensive screen. We also have different levels of screening. When we do a school wide screening, they're typically 15 minute screenings and they include like, let's talk about the speech language 1. They include speech language. And that breaks down into various areas, right? So language breaks into both receptive and expressive language. Speech breaks down into both articulation and phonology in the sense that we're looking at. Are there patterns and sound errors which are going to be challenging to gather information on in 15 minutes in a screening. And phonology is technically a part of language, but we're not going to go into all that fun stuff. But how do you look at articulation, right, without looking at oral motor skills? Okay, that's the question I want to pose here. That's the question I want all of you SLPs to think on for a second. If your tongue is not in the right place, if your palate is too small to fit your tongue, if the child is really hard to understand but they can't use their oral structures properly, shouldn't we be screening that? You know, I don't think an articulation screen where we have them repeat a few words or say a few words or name a few things and listen to how they produce the sounds is sufficient as a screening. Okay, so ponder that for a minute before we circle back OT. Now, I'm not an OT, but one of my OTs created a screening that we use and we have. There really isn't a standardized OT screening out there like at all. So, you know, thankfully in SLP world, we do have some standardized screenings that we can do very quickly in the least language arena. From an OT standpoint, we've created a screener that we've tailored to 2 year olds, another one that's tweaked to 3 year olds, to 4 year olds, to 5 year olds and so on and so forth up through age 7. One of the things that we've also come to learn is that kids with sensory processing concerns, well, we need to look at what's going on in their mouth. We need to look at oral motor what we need to consider feeding, right? Because that's all intertwined. We need to consider if there's maybe tethered oral tissues or an airway issue, right? And the same can be said for our speech language screenings. So all of this to say what I want you to be focusing on here is not like, oh gosh, Ali's giving us more work. We're already trying to cram all these things into a screening and now she wants us to do more. No, I'm telling you, you can do a screening in 15 minutes. Now you can do a more comprehensive screening in 30 minutes, but now you're really starting to get into like eval mode, right? If you're taking like 25 to 35, 30 minutes to do a screening, you're going to start getting more information and it's going to start to overlap with information that you would obtain in a comprehensive eval that might take an hour. Right? So like I said, we do offer different levels of screenings for different schools that we go into sometimes. For example, like I said, when we do a mass screening at a school, we do 15 minute screens. When we go into a one off screening in some of the schools we have relationships for with, we do a 25 minute screen. But then also, like I said, that information gets a bit deeper and can help us to continue an evaluation without having to redo certain aspects. Right. We can, we can do standardized assessments, but we've already gathered a lot of information on the front end in a longer screening. So just wanted to throw that out there. All right, so why am I like, so why am I so hung up on doing this? Well, first of all, let me just remind everybody, in case you have not been following for too long, that we do a screening training three times per year. And our next Feed the Peds free screening on how to do these type of screenings that I'm talking about is coming up January 31, 2022 through February 4, 2022. What we basically do, I'll break it down for you real quick, but if you want to sign up for that and get notifications or reminders, you're just going to want to go to feedthepeds.com backslash training. That is a free training. You get five hours of continuing maintenance hours on a certificate. If you end up joining the course, if you end up taking Feed the Peas, then we actually will submit that with Feed the peas, you'll get five hours of CEUs for having participated in the free training. So feed the peds.com backslash training, you'll get more information there on what we do. But basically we take the free screener that you also can go download right now@pedefeedingscreening.com and I walk you through how to do it. Right? I basically walk you through how to screen your first pediatric feeding patient. And I say pediatric feeding patient, but it can be any child, right? And there's a couple of things I want you to keep in mind. This screener takes a matter of minutes. So if you're already doing a speech and language screening. And then you want to add in this aspect. It's not going to make it longer. I'm going to challenge you to do an entire speech, language screen, including this screener, in 15 minutes. My team does it. It's very simple. In fact, it's not a screener where you really have to do much. We give a child a snack, we have them eat like a graham cracker and we have a little Dixie cup of water. And they get to do that for like the last two minutes of the screening as like their reward. Right. Like, okay, it's nap time. Like, you did a great job with the screening. It's nap time and as they're eating the snack, we're observing and we're just checking a few things off the screener. And if we have any concerns based on what we're seeing, then voila, we can make a referral. Right. So it's not meant to give you more work. It's not meant to be anxiety provoking. I know a lot of people go like, oh my gosh, but I don't even know anything. And look, if you don't want to be a pediatric feeding therapist, you still, as an SLP or ot, have a due diligence to screen these children. And if you're not going to assess and treat them because that's not of interest to you, it is still your responsibility to screen them and refer them on to a different specialist who can do an assessment or do an assessment and treatment if necessary. Okay, so let's talk a little bit more about, like why I am so passionate about this. Right. So I mentioned that my daughter's recent screen had no oral motor feeding, myo airway, none of that screen. And I mentioned that it only takes a few minutes. Okay, but the reason why I'm so concerned about this is because about 20 to 50%, depending on what research you look at, of normally developing children, typically developing children, children who are going to pass your speech, language and OT screenings, otherwise they have some type of a feeding problem. And then 70 to 89% of children with developmental disabilities are reported to experience some type of feeding problem as well. That means the children that you're already flagging for further evaluation and or the children that are on your caseload, 70 to 89% of them that may have a developmental disability also have a pediatric feeding disorder. That's a big number. Big number. Okay. Prevalence figures reflect for those who are not like, you know, familiar, like with prevalence, first incidence. But like prevalence figures, let's talk about those a bit more and break this down as, like, how many children you know out of what present with this. It reflects the burden of a particular health condition. Okay. Gives you the given. It looks at the given. Describes based on the given time portion of the population that has the condition. Okay? So based on recent national prevalence studies, the prevalence of a pediatric feeding disorder is between one out of every 23 children and one to every 37 children under the age of five. That's on an annual basis in the United States. Okay? So between one to one out of every 23 to 37 children. If you know 23 children, if you've got a classroom of preschoolers, let's say you got a classroom of pre K students with 25 kids in there, at least one of them has a pediatric feeding disorder, is what this is telling you. Got a kindergarten class of kids who just turned five, one of them's got a pediatric feeding disorder. And I will tell you this holds true. In every single classroom that I have walked into, there is a child who struggles, at least one who struggles with feeding. And it's not because they're lazy. It's not because they're picky. It's not because they want to be difficult or they're stubborn or all these different things that parents and sometimes even, you know, professionals label them with because they don't know any better. Right. I'm not blaming or shaming or anything, but people don't know better, so it's just an easy label to attach, especially if a pediatrician attaches it. Oh, they're just lazy. Oh, they're just picky. They'll grow out of it. Yeah. No, most of them don't. Most of them do not. Okay. I want to point out, too, that this number, this prevalence figure is higher than other childhood conditions like autism, which is 1 in 54, and cerebral palsy, which is 1 in 323. 1 in 23 to 1 in 37. 1 out of every 23 to 37 children have a pediatric feeding disorder, we are failing our children. If you're an SLP or an OT and you work with children, especially children between the ages of, like, birth to seven, okay, I'll say birth to five, but, like, really birth to seven, you better be doing screenings that include oral motor, airway, tetheral tissue, you know, screens. I'm not saying do a full assessment. I'm saying you need to screen for it. And that's exactly what I'm going to teach you. Between January 31st to February 4th, this is brand new to you and you need five hours. You want to join me? Okay. Feedthepedes.com training but. All right, let's keep talking. So you're like, okay, Holly, this is great and everything, but why. Why do we need to be concerned about this beyond the numbers that you've given us? Let's think about it, okay? Certain children who don't get all children who don't get proper nutrition or don't drink enough fluids, right? Maybe they're unable to eat and drink enough. One, they teach their body that they only need so much, and then they live in this. It's like this catch 22. It's this cycle of always being undernourished and under hydrated, right? So they struggle. They struggle to have proper nourishment. They struggle to be hydrated. Guess what else is impacted when you're not getting proper nutrition or hydration? Your ability to attend, your ability to. You know, I know young children don't necessarily have a advanced ability to reason, but once they do start to, they become more combative. They become those ADHD like kids sometimes. Because now it's impacting their sleep. If your body is hungry, undernourished, under. Maybe they're not even feeling hunger cues. Some of them don't feel hunger, but they might be undernourished, they might be dehydrated. That impacts your quality of sleep. That impacts your ability to learn. Okay? So it also can lead to constipation. So now let's say, all right, now they're constipated because they're dehydrated. Maybe they don't chew their food properly. Maybe their food is falling out of their mouth. Maybe they're messy. Maybe it's, you know, but going back to not chewing it properly, that can lead to constipation. And if they're constipated, they're uncomfortable. And if they're uncomfortable again, it's going to impact attention. It can impact sleep. I can't tell you how many kids we treat who have these issues. And it's not talked about enough. A lot of teachers are not educated in how to identify this as, you know, and that makes sense. It's not their job. Right? But we as SLPs and OTs can, one, screen for it. And two, we can educate preschool programs and daycares and nannies and people who spend a lot of time with children during the day, including parents. But if we're looking outside the parent unit, that immediate family unit, into the extended unit of caregivers. We need to be talking about these things. We need to be talking about what happens when. And obviously there's going to be children who are more medically complex, who might be on feeding tubes, who may require more extreme levels of intervention. But I'm really focused right now on those kiddos who are falling between the cracks because it is so many of our children. I really would love to see a push for more SLPs and OTs. I know we all came together, those of us who work in early intervention, those of us who work with infants, those of us who work with toddlers, preschoolers up through kindergarten and even first grade. If we made a push to screen these children and make it mandatory, right? Universal and mandatory, we would be able to catch these children much earlier, get them the help they need, and it would really. One, you'd be doing them a major favor. Two, you'd be doing yourself a major favor because we wouldn't have these kiddos showing up on our caseloads when they become more involved down the road. Right? So it's something that we really need to consider. And what I do in the pediatric feeding services screening training is I take you through the packet, as I mentioned before, I have you screen my daughter who is a typical feeder on day one, and then I present my older daughter who is not a typical feeder, and we screen her together and we go through it throughout the week. And I teach you all about what's on that feeding development chart, because I give you a chart of milestones that compares, you know, both the feeding method, like what they're using to feed, whether it's breasts or bottles, food and cup straw, et cetera, to some of the gross motor skills. And then we take a deep dive into looking at the jaw, the lips and the tongue. Because I will tell you that a lot of these kiddos get stuck in a munch too. That is a skill that develops between six to nine months of age. That is a skill that we want these babies using when they first start to eat solids. But a lot of our 3 year olds are 36 month olds who should have a rotary chew. They're still munching. They are still munching. And guess what? If you're munching and you can't move food from one side of your mouth to the other, which is a skill that develops between 9 to 12 months of age and they haven't developed that skill yet, well, that's a problem. And then by 18 months of age, they should be dissociating their jaw from Their lip from their tongue, meaning they should be able to use these structures independently of the other. But instead we see children using them all as one unit in that munch to, unable to move their tongue left and right, unable to manipulate the food and turn it into a proper bolus. So now they're swallowing food that's not prepped. Right. Remember before I said sometimes these kids do not break their food down enough. They swallow either pieces of food that are too large or that are not prepped properly, not mixed with saliva, not ready for the stomach to digest. And that leads to things like constipation. It all comes back to our milestones, our oral motor milestones and really our sensory motor. The oral sensory motor milestones. Because we can't pull sensory out, right? Sensory and motor are intertwined in our bodies. We cannot separate them. So we have to look at both and we do. I take you through the feeding form, the screening feeding form. That is. It's got like the top 50 most common symptoms, but it's a checklist and they're separated by section. And so once you've done it once or twice, you very quickly can just glance at it, pull what you need from it and put it on the child's screening form. And it's very easy. Now, if you want to do a more comprehensive feeding screening, you can use this. And we've got charts, and that's what I'm going to take you through. But still, it's something just takes a matter of minutes. Okay? So I don't want you to dismiss this because it feels overwhelming or like a lot of works. My job is to make it simple for you. That's exactly what I do. But we need to be looking at feeding skills. Our numbers tell us that our children need us. The other thing that I want to highlight and why we need to be doing these screenings is the psychosocial component. Children who struggle with pediatric feeding disorders sometimes struggle to sit with food in front of them. Well, how are they going to eat with their peers? How are they going to enjoy a snack time? If there's foods put down on a table where they're supposed to share those with their peers, they're supposed to take from a shared plate, right? What if they refuse to eat everything put in front of them? Do they not get snack? Does a parent have to send a special snack in every day? Does the teacher have to keep a special snack box for that child? Some children might not care, but for others, this can be very alienating. Feeding and eating are very social. It's a very social activity. Okay? It becomes disruptive for mealtime, for snack time, because behaviors start to present when a child goes into fight or flight. You put a food in front of this child that their system kind of goes, oh, no, I can't handle that. And all of a sudden they go into fight or flight. Right. They're no longer in what we call rest or digest. Now they're in fight or flight. And their system, it's like their alarm bells go off and so they're physically unable to remain calm in that situation. And what do we do? Well, caregivers say, sit down, it's snack time. You need to sit with your peers. You've not been dismissed from snack. You can't go sit in the book corner. Right now. We're all eating snack together or it's lunchtime, you know, same deal. Or parents will say it's dinner time. If you're not going to eat, fine, but you need to sit at the table. That can be really challenging. Right? And then we get bribing and threats and yelling. And again, I'm not shaming, I'm not blaming. It really comes down to a misunderstanding of the root cause of why children are behaving a certain way. And less than 5% of children are truly behavioral feeders. Those 95% of children who act this way are doing so because there is a physical, sensory, oral, sensory, motor issue that needs to be addressed and we are missing them. By not screening them, you can make these children's lives so much easier. These parents lives so much easier as SLPs and OTS. If you add just a couple minutes snack at the end of your screenings that you're already doing and you use a screening tool@peedfeedingscreening.com you use that to flag any issues and make a recommendation. Okay? Because early detection and treatment of pediatric feeding disorders is proving to be key. It impacts the patient, this pediatric patient now, but also long term. Okay? From a psychosocial standpoint, from a nutritional standpoint, you know, feeding skill standpoint, etc. Right. We get that there are a number of other things that come into play when we're talking about children with pediatric feeding disorders. And sometimes they appear more mild and sometimes they appear more medically advanced, we need to recognize that just because a child is not vomiting at the sight of food or they don't have a feeding tube and maybe they're two and a half and they're just a little picky, my rule of thumb is that if they have picky eating kick in and it doesn't go away in a couple months, like two months max, that we do an evaluation because a phase is a phase and a phase only lasts a couple of months. A phase does not last for three months, six months, a year. You get to that three month point and it still hasn't gone away. You definitely should be referring for an eval. So we need to be considering the holistic human and we need to be considering that even if you're not the right person to assess beyond a screening, that's okay. Refer to somebody who can. Okay, we have pediatricfeedingtherapist.com I know I've given you a lot of URLs in this, in this episode, but you can go there for people who've gone through Feed the Peas, who you can refer onward. We're going to be creating a certification as well later this year and so you know, there will be even more, more coming our way for those who are interested. But I'm just pleading, I am pleading that more SLPs and OTs stand up and make it mandatory that these types of screenings happen when you're doing your other general screenings. I will also, I want to share one thing and then we're going to wrap up this episode. Don't mind the clicking and opening my email. I got an email yesterday from a listener and I was like so excited. Oh gosh, is it here? Let's see, where is it? Okay, so she emailed me and said and I didn't ask her for permission, so I'm not going to use her name, but she is located in, let's see, where is she located? She forwarded me the email that she sent to Texas public schools regarding pediatric feeding disorders in Texas public schools schools. And she said she was inspired by a recent podcast, one of our podcasts focusing on feeding therapy in the public schools. And so she contacted the Texas Department of Education, who directed her to the Texas Education Agency tea and her request was accepted. Assign a number. And so she's waiting for a response that she should hopefully have within 10 days. But basically she sent an email stating that, you know, she wants that she says, let's see, she wants the Texas Department of Education to explain their legal obligations for basically working with students in the Texas public school setting who has a pediatric feeding disorder and or pediatric dysphagia. And she asked them to present other information to her as well. And she is requesting basically a time or place to have her further discussion targeting PFDs, skilled intervention service requirements, legal Risks, academic performance impact, child malnutrition risk, safety concerns for students diagnosed with PFDS in public schools. And so I just want to say like, major, major kudos to you because this is the kind of email that starts to make headway. These are the kind of conversations that start to lead to requirements of screening children with pediatric feeding disorders. And so yes, we need more of that. And I love that she had a goal and purpose. She highlighted this that basically talks about creating a cost efficient solution to bridge the present gap for these children in the school system in Texas. And so like seriously, like clap, clap, clap. Yay. Yay, yay. I am so excited to see this. But those of you in private practice, it's not that hard. It's very easy. It's you just making a decision that you want to do this. So I would love to hear from you all. You are welcome to email me and say, hey, I already do this in my screenings. Or hey, you have excited me and motivated me to do this. Do these, you know, do this in my screenings. Because we need some kind of like a coalition or something to come together and mandate this, this must happen. This is not a choice that we should be making this to do it or not do it. This should be a question of how do we implement this and how quickly can we do it now? How can we make this start happening by January 31, 2022? Not. Oh, you know what, I'm going to put it on my list. I'll deal with that in three months. No, these children are falling between the cracks now. This should be a priority now. So if you're someone who is out there screening children or you already assess children for speech language disorders, you better have a pediatric feeding screening going on during your comprehensive language evaluations. OTs. That goes for you too. Anyways, that's the end of today's soapbox. Thank you guys for joining me. Like I mentioned at the beginning of earlier on in the episode, you can join us January 31st through February 4th, 2022. Get five free hours. Go to FeedThePedes.com training and sign up for notifications. You'll get the email notifications. They'll tell you exactly what you need to do from there. Cannot wait to see you guys in there and I hope everyone has a fabulous week. We'll chat soon.

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