Episode 241: Feeding and Swallowing Therapy ​One Side Bite at a Time with Cheryl Pelletier

Hi and welcome to episode 241 of the Untethered Podcast. Today we have Cheryl Pelletier with us. Cheryl, also known as Shasha, was a nickname given to her 30 years ago by a child learning to speak, which stuck is an SLP specializing in feeding and swallowing disorders for over 35 years. The last 21 years, she was working as the lead feeding and swallowing specialist in an outpatient setting with babies, lactation coaching all ages of children and neurologically diverse adults with developmental delays. In 2017, she invented and then patented the Side Biter therapeutic chewing swallowing tools because she needed a new chewing swallowing device that used actual diced and frozen food to help her own patients. She's currently working in her private practice called Nosh Inc. And she provides home visits, staff education and facility and school consultations. 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 treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner 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, airway, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener as we jump into today's episode. Remember to listen with correct coral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Cheryl, welcome to the podcast.

Well, thank you so much for having me. What made you so interested in my private practice and my products?

Honestly, when I saw this, this side Biter and I know that we're going to talk all about this today, I just went, I wish I had something like this when I was getting started in feeding therapy and just really even with my MYO patients, to be honest, because being a speech pathologist working with feeding and myo, I would get patients where I'd go, something greater is going on here. It's not just, you know, an orofacial myofunction disorder. It's not just maybe a feeding disorder, there's sensory issues, maybe there's some cognitive delays or disorders at play. And I had a Lot, I would say a lot. But I had a good number of patients who would come to me for MYO who could not lateralize their tongue. They could not elevate the tip of their tongue. And that impacts how they chew and swallow. And so, you know, I started to look at them and go, huh, if only there was a really cool thing that would give them the input that they need over here on their molars and then help us move across their tongue maybe to the other side of their molars. You know, I was trying to use the tools I had, but I just, you know, I feel like if I had something like the tool that you created here, I think it would have just given that sensory motor input and would have made a. They would have made a lot faster progress, if you will, because they did eventually make progress, but it took much longer than my, you know, other traditional MYO cases or even some of my other feeding cases. And so, yeah, I just, I was so fascinated when I saw that you created this tool. And I was like, okay, we got, we gotta talk.

Well, this tool actually selected me, I guess. You know, I was working for many, many years, over 21 years in an outpatient center. And I would get patients across the spectrum from babies, very little babies, and then on up to 50, 60 year old patients with cerebral palsy that then had a stroke and were in a group home. And there was just a lot coming through the doors of older children as well. So the other piece of it is that caregivers were very reluctant to carry over anything that I was trying to get, to get them to elevate, rotate. Because what you were saying is lateralizing on both sides is the basis for function, for rotation of the tongue. And to get them to have the idea of moving the tongue and moving the jaw at the same time and having it associated with food. So I thought to myself, you know, when you have a mouthful of molars and you're maybe medically compromised and you weren't ready for feeding therapy or myotherapy, and now you're ready and you go to a clinic and they say, have you ever tried feeding therapy and you're 10 and then you come and it's like, you're not going to start with these strips that we're always. This is the snap pea that we all use dissolvables and we crush it and we try to get it back there. But how do you really get it back there? If. So this is why I have today loaded in there, why I really like adding this component because you can go back and forth in the same session and utilize this to get a nice movement. And the way my brain works is kind of systematic. So that's why there's the kit that has zero holes and then five and then 10. And the reason is it took me back to when I worked in inpatient with adults, and you're in your white coat and they send you to ICU and post stroke is just waking up and they want the speech pathologist to go in and get the mouth going. And I used to be petrified because I'm like, all we had was glycerin swabs and tooth deaths. But they're delirious and they have a bite, a tonic and clonic bite. And this would have been perfect just to give a little flavor, just to get that. That mouth going and some sucking. There's just so much that you can do with this informal treatment. So that's why I decided to bring it forth and find a silicone company that makes baby bottle nipples and breast shields. And that's basically what this is made of.

Oh, I love that.

Yeah. It's made from a company in upstate New York, Extreme Molding, who uses FDA approved mouth safe silicone that's highly durable and highly heat resistant. So you can boil it and you can freeze it. I love using it with frozen foods and. And frozen liquids. So in level one, I turn it upside down like this. It's on my website too. And I fill it with something like cranberry juice. And you don't put the plunger in until after you take it out. Or like put it in a cup like this. And then you get. The reason it's level one is you don't want it to escape. You just want the thermal stimulation of it all. And then you can dip it in the cranberry juice or something like that and use scant flavors to get somebody to just be like, wow, cool flavor. And I can move my mouth. And if they're motivated. So I don't know about you or people in the audience, but keeping somebody motivated if they're not being successful is really hard. They stop coming or they gag and they have problems and the caregivers are afraid. So sometimes, depending on the client, I'll say, okay, you can eat, you can chomp on anything you want in level 5 and come back and see me in a week, or because we had teletherapy, because of COVID if they have one on their side like you do, and I have a side butter on my side I can guide them through. Okay, now try it. Take it out. Swallow. Great. Now move your tongue for the flavor to try to get more movement. And caregivers loved it because they weren't afraid. Yeah, like, oh, you got to cut it. Cut the French toast this big. Oh, that was too big. Oh.

That'S my French toast. This morning, I was going, okay, I have to make sure it's the right size to fit in here. But also, it's really. Because you say, you know, oil the. The green part. And so I put some oil on it, and so it just slides right in. And it really did a nice job of just kind of helping push it down. And, you know, the first time I did it, there was still, like, space at the bottom. I was like, oh, okay. I could have done a little bit more. Okay. So it's very intuitive and very, you know, easy to even just take it out and add a teeny bit more to push it down the rest of the way. So I found as a user, like, it was. It was simple.

Yeah. So when you side bite, like, I have my pea crisp here. Let's do it together. When you side bite, my name is Crunchy. What do you think? What's happening in your mouth?

So I was able to pull out a little piece that doesn't feel overwhelming. It gives me the taste. It doesn't alert my system in a way that I feel overwhelmed, but it alerts my system in a way that goes, oh, there's something there, but it's also very tiny. It's manageable, and it's safe.

So level three, that has the 10 holes, what I try to do is I try to turn it in different ways so that the food is escaping in different parts of the mouth.

Okay.

And so for, you know, the one that's level five, that just has five holes, I can turn it so when somebody bites down, it goes in the cheek so that I can hopefully get some excursion that way. And then I can turn it toward the tongue so they can get the taste. I also like with the French toast, I really like to. It depends on their level of function, but I really like to put a little butter or maple syrup on the outside so that we can. I can put it in the cheeks so it'll be a target for them. I can put it right in like this and see if they'll go for that. I really like it when the client is holding their own, and then I have one, they have one, mom has one, everybody has one, and I follow their lead to see what Maneuvers they're going to make with their lips and their tongue and their jaw. And then I build on that like, whoa. That was a movement I didn't see before. Awesome sauce. So the other thing I really like to do is have a savory, which is the pea crisp here, or chili or taco meat I really like in here. Or pizza. I just did a video about that. And in here I have, in honor of Halloween, I have candy corn. So I actually had never used candy corn. Every time I, you know, see a food, I'm like, I wonder what that would be like. So you could have like sweet potato or sweet potato fries or a donut. So you cut it and you, you put it in Also it comes with this little scrubby brush, but I use it as a tamper downer. Really high tech vocabulary. So say you have a peanut butter and jelly sandwich and the mother's like, this is what I want my child to eat. And you're like, so. But you can, you can put it in, you can cut it and put it in. So you have a savory and a sweet. And I often will have my clients tell me which one they want. You know, I'll say, oh, I have a crunchy cracker or I have sweet candy. Now how many of our kids and adults during holidays, they can't have what everyone's having, or a birthday cake or a donut. Everyone's out, you know, and it's not like mom or the caregivers can bring a blender. I always say carry one of these because really, like taking the donuts and, or whatever and making it so that person can participate. So they either look at it or they point. And that's a great language opportunity to be like, you know, you know, your sound candy, whatever that's in the back. Now we're going to front. So I use it as a language sim. And so I don't know if you could see it. You can really, really see. What I like about it is that. So that the patient can actually see it and then, so nothing's happened to it, then you can guide them and say, okay, crush it with your, with your teeth. And you model it and you tell them with the teeth, crush it. And then they can, if they're doing this, nothing's crushed, right? So you're like, okay, it's right here. Really make it go. And you're like, yes. So then if they really crush it.

They get that feedback. Yes.

But they can see it. You can be like, wow, your teeth.

Did that yeah, that's very cool.

And that's why I like the audible ones like the Ritz crackers or. It's not for nuts or seeds or popcorn because it would probably break this. Or granola. I actually did that once because I was searching for ideas for crunch. But this really crunches. This is the pea pie crisp. There's no manners in feeding therapy, by the way.

You get the full experience, which is what I love. And it's like all the senses. Right. Even though it may, you know, even on some of these, you know, on the one that has no holes, if you're dipping it into something, they have a little bit of flavor that you can still include the taste aspect of it too, once you get there. But it's. I think that's really very cool that so for.

So what I've learned in a long lot of years is that wet foods do clients to suck, and dry foods, even in a powder form, really cues some movement. So try it yourself. Like, so I love dust. I love dust of food. And I can the level one. And then they're like, oh, yeah, I can feel that. And it's so scant and it makes people salivate. And that's in there anyway. It's the thin liquid that's already in there. So for swallow frequency increase, I love adding flavor. Cheese powder or something like that that reflects what is actually in here. You can make candy corn dust really easy. And it's, you know, not. It's. It gives a lot of input. So anyway, there's a lot that we can do with it. And we were talking earlier about doing some tongue elevation, doing some pressing, doing some lateralization. And what would you do with it if you. If you were like, think back to those patients you were telling me about.

Yeah. So I mean, being that I work a lot with pediatric feeding and also just myo across the lifespan, you know, what I would find was it was really challenging. Like kids who are not lateralizing their tongue. Well, you can put peanut butter or you can put something sticky or wet on a tool and hold it over here on the side of their face. And, you know, sometimes that would work, but oftentimes if the food got on their face, they would kind of go, or, you know, I've had some people say, oh, put peanut butter like on their cheek and have them try to lick it off. And I'm like, okay. I mean, if the kid is into that, sure. But if their tongue is not moving, because maybe there's something cognitive going on and they really can't coordinate, you know, their muscles with what they're trying to have them do. I just feel like having the ability to even chain them, you know, biting. Like, we know they're safe to swallow and we could even start with, you know, the ten hole option. You know, if they were to bite it and we could kind of move it around, I might have them start on the molars because if they're chewing there already, I want to kind of kick things into gear and go, oh, yep, okay, I know how to do that. And then it would probably move the bite around their mouth and even see, like, does the tongue follow? Okay, great. Now can we. All right, we move the tongue around the mouth. Can we put it over here outside the mouth and lateralize and lick the food off? Yes, I know. So I probably, because I would say one of the biggest issues that I had with some of these little ones who are MYO patients were honestly the lateralization and elevation factor. So I would just try to get creative with that.

The thing is that when we're looking at function, we don't really. I mean, I get we're doing exaggerated lateralization, but when you're eating it's inner cheek. Yeah. That you're trying to get. And preening is so important to get the food off of the teeth and to have that control and to swallow again. So that's why I like the energy. I like to bring it in all the way in and see if we can get it to move. And there's lots of other things that we have already available that are smaller, lighter, you know, that you can put in that for target practice. But the fact that this holds food is a real game changer. And I get, you know, there's a place in our toolbox for anything that we're going to need to support function and motivation.

Yeah, yeah.

And so that's what I really like. I had a patient the other day who was a big drooler. In fact, I just posted about that. Like, we don't outgrow it when we're six, you know, stuffing and whatever. But what he was doing, which I really liked, was because he doesn't have lateralization, he was really sucking hard and I was doing some resistance with that. And it really, really helped him gain strength and stamina. And his drooling really decreased. And I actually hadn't thought of using it that way because I'm thinking two, two, two, whatever. But like I said, it lends itself to so many things, especially the level one that has no holes. So you can use it with nothing and really suck. Oh, that's not the one I wanted. Yes, it is. Okay, it is. But anyway, and I love that because we were playing tug of war with it, which was super interesting. And so one thing I also want to. People are like, why is it so long? The reason I like it so long is because for tongue excursion, also that it can be implemented across the lifespan and it holds 5ml or 1 teaspoon amount. So when you're an inpatient, we kind of take data on teaspoons or mls and I wanted something that you could take data with. Like, Johnny was able to eat using level five. He was able to chew and swallow five mls, and then you fill it up again of sausage or whatever, and then they graduate to level three, which has a faster flow to that. So I thought data would be super important to collect. And the size and shape also needed to be easily cleaned. So if it's skinnier or shorter, I am actually thinking about doing a mini one. But as I was telling you, each mold was extremely expensive. Yeah. So anyway, I. I am thinking of doing a mini one, but I need to kind of see if maybe they could do an insert to the mold and make it shorter. But I feel like that when kids or adults or anyone, they're using it and maybe they gag. That's actually a good thing. Sometimes we want to elicit some more sensation. We want them to learn, oh, boy. When food is back that far, I need to do something. So it's not always a bad thing, right?

I completely agree. I mean, I think the gag reflux, we always say we don't want to eliminate it is a protective mechanism. We want to move it further back in the mouth. We don't want it at the front of the tongue. We want it towards the back so that if something feels out of sorts, your body goes, whoa. And it's protecting you. So I completely agree.

Kids that have never eaten or adults have never eaten their G tube fed, they don't have the experience with things far back in their mouths. Even toothbrushing is so difficult. The other thing I want to point out before I forget is that I have always learned that as goes the hands, so goes the mouth. So I really like having the mouth and the hand doing something instead of somebody doing something to you. I feel like, you know, because our patients can't see their mouth unless they have a mirror. Right. I'm trying to see it. I can't see it. So it's kind of nice if you have that proprioception of moving your hand and your mouth.

So I think there's also a sense of control. If you are able to control. I think the nervous system also kind of takes a little bit more of like a. Okay. Like, I can handle this. So, you know, working with a lot of children that come to us for feeding aversions or because they've cut out so many foods and they're now down to five to 10 foods, a lot of these children have been treated at, not treated with. And so I like to make these children feel like they are in charge and that they are driving the ship here so that we, you know, one, we gain their, you know, we build trust with them so they'll actually do something with us. But, you know, I will never be one who force feeds. And that's one of the reasons why I don't always go in immediately with food. You know, if we have a snack together during an evaluation or initial session, fantastic. But it's going to be a snack that they like. They're going to be feeding themselves because I want to see what they're doing. And, you know, and I make it very clear to you early on, hey, if you're not. If you don't want to eat today, that's fine. But I think that still having food present and learning to trust, you know, the therapist you're working with from the patient side and then maybe even having something like this where we go, you know, maybe we could try this thing. This is pretty cool. Like, you're not going to have any food go into your mouth. Let me show you. Watch what happens. I'm just going to crunch, crunch, crunch it, you know, crunch. And they say, oh, yeah, it's still in there. Okay. So I don't have to, like, touch it or taste it. I can just kind of crunch it. Whoa. Like, that's cool. And, you know, that's where I think, you know, things like these, this are super handy. And I know there's also one thing you mentioned earlier where you said it's all about function, right. And we want to be doing things that are functional. And so I'm also, you know, that's why I had hesitation when people say, oh, put some peanut butter on their cheek. And I'm like, you know, if the kids into that, okay. But also, like, like you said, it has to be functional. And so I typically don't work on more than bringing the tip of the tongue to the corner of the lips, because if we can do that, we can. We have enough range of motion. To also clear our lips and clear the corners for, you know, which becomes functional. So I love that you really highlighted that because a lot of people will say, oh, it's not functional if you're not using food and you're using tools. I disagree. To get towards function, we have to address the nervous system. We have to address the sensory or motor skills. There's. It, it's an onion. There are layers to this onion that we have to peel back. And we also have to figure out the best way to do that with each patient. So I am, I love, I love this.

So I never told you, but do you know why it's green?

No, why is it green?

Yes.

I don't know. My brain went to veggies, but.

Well, the reason it's green is because most vegetables say a green bean is fibrous, which takes a lot of oral motor strength and coordination and swallowing and also is not in the repertoire of most of our white and tan menu food friends. So I thought if, even if I got something green near the mouth, it's a win.

Yeah.

And I really like having kids that can, or adults that can load their own side biters and they have to pick up the. Whatever it is and put it in and they're, they're, they think they're helping me, but really I want them to touch it and like, does it smell like pizza or a green bean? Oh, yeah, it's green. And it goes in just for some sensory and some vocabulary building and load it and show them, you know, oh, a little bit comes out or nothing comes out or this mouth can make it go out and oh, there goes the tongue. Let's do that too. So there's a lot that you can do vocabulary wise and sensory wise to have people buy into it and then they could just take it home. Like, I don't, I don't sell it to my patients. I give it away because I want. And it's not for everybody. I mean, I have a lot of clients and not, not all of them are using it. It's only for certain clients that you feel need that bridge or could use some more oral stimulation, proprioception, sensory aspect of moving their tongue, jaw, lips, and activating a swallow on time. So when people are like, well, do you use it with everybody? Absolutely not. That's why you need a skilled feeding and dysphagia assessment.

I love that. I love all of this. I want you also, we can come back to the side better. But I want you to talk about like the process of actually going through and, like, inventing this tool. I know you kind of talked about it a little bit in the beginning, how it found you and patenting it and everything. And I also want you to highlight that you sell this at cost, because you're not making anything off of this.

No. Well, okay. So to summarize, first, I learned a lot. I grew a whole new brain because I'm not a business person. I'm just a clinician. And I was like, well, how do you manufacture this? Okay. So I made lots of sketches. I contacted a manufacturer that. That made things out of silicone and asked them what to do, and they said, you need an engineer. And I went through many engineers. Most of them were like, what do you do with this? Like, ah. And so I was always explaining. Well, so finally, Fast Forward found somebody, actually in Florida who was fabulous at forge engineering. Adam. And he. His grandmother had just had a stroke, so he knew all about dysphagia. And so he right away made, like, this computerized CAD thing that shows how it goes in and out and whatever. And he's the one that said, this is going to have to be super tight because you don't want raspberry juice to come out on the hands.

Right?

And so I was like, absolutely. So he got it. It was great. He made a 3D rendition, and we went through a few of them. It used to be three parts. It had one handle and that locked, and then three inserts. And then I got nervous that people would pull it off. So I thought. I asked them, can you just make one big thing? One big.

You know.

And he said, yeah. And I said, I need a drool guard. So we made that, and that actually cut down on some of the cost for the molds. I was telling you, in manufacturing, they have to make a steel or an aluminum mold. Each one of those is over $50,000. So just. There's that. So. So I had to have it. So anyway, what we found out was that when it was wet or had a little bit of oil, tiny bit of oil, it would slide in really easily. And it doesn't slide in easily without that because there's drag on it. There's polypropylene, which is this part, and then there's the silicone. But it works like a dream when it's slightly wet, so it's good to do that. And it slides in perfectly and locks at the bottom, which I like. So anyway, that engineer sent the computerized rendition to the manufacturer. They create it. So during this time, I was patenting It. So you fill out your application, and the patent is the concept. The therapeutic chewing and swallowing device is patented, and it is called the Sight Biter system. And it's like 35 pages of explaining how to use it. And so it takes about three years to get a patent, and it's quite expensive. And it did go through, which was wonderful. Yeah. And so all this was kind of happening at once, and the packaging and that kind of thing I was trying to do. I loved creating it, and I loved trying to think about how it was going to work. Work and ordering the brushes and how you clean it, and you could go through the levels or you could have it separate. That I loved. What I really struggle with is I'm not. I'm a therapist, and I work a lot, and it's. I. I'm not good at, like, the infomercial. Like, here, this is. Try this. You. You know, so trying to get people to try it has been challenging. I give a lot away, and I give, you know, promo codes because I know that it helps people. Yeah.

But, you know, you have some great videos online, and I know you sent me some of them, and I'm watching them, and I was like, wow, just these little clips of seeing other people use it makes it so much easier just to go, oh, like, I can do that, too. And one of the things I've learned just from teaching SLPs and OTS in my feeding course that, you know, we've had a. Now we've had. We've had like, 2000 SLPs and OTS in the past, since 2020. Go through my Feed the Pete's course. And one of the biggest things is fear. Fear of, you know, starting to feed somebody and not knowing if they can manage the food. Fear. Like, I don't want to hurt anybody. And I have to tell you, I feel like the system really reduces or takes away that fear just for the therapist side of things, because if a family can use this, a therapist can use this too, you know, And I think being able to have a system where you can try something out with a patient that, you know, is not going to deliver food, but it's going to give them the experience. Otherwise, I think, will also help to alleviate that. And some of the therapists will go, oh, okay, yeah, we can do this, you know, and we can slowly move our way up in the system. Now let's move into this one with the five, you know, holes and so on and so forth. And, you know, we. I always say you can teach a therapist course after Course after course after course. But until you actually get out there and have the experience with the patients, you're never going to feel confident or competent. It doesn't matter how many courses you've taken. And so I also think there's really. I think it's a really cool tool because I think that it also has a place just in terms of helping therapists help more patients.

Yeah. I see that it has a place for oral cancer as well. Because trying to get movement back after having radiation and putting things back far enough to get that maneuvering. Because like you were talking about this, older adults are very kind of undignified easily. They don't feel like that it's something that a dignified adult should be doing. But if they see that it has a function and they can put something in it. Like I had a testimonial about 85 year old that was able to eat cake and then from there was able to eat more things, but was able to participate and have some without somebody trying to puree cake. Because under her own power was creating her own puree. Kind of. Because it then comes out. So I really. That's why I picked candy corn, because all the kids are going out and getting candy corn and there's always somebody left out in our feeding. Kids that can't experience that.

Yeah.

But they could be involved and even just be at the table and have Twizzlers or something like that. I've even put pepperoni in here. Like the Slim Jims fit perfectly in there.

My kids love those. Yeah.

Because you have to work really hard to get it out. And I know that it works because you, if you're motivated to get this candy corn out.

Yeah.

I can't even explain to you how much movement they're going to get. Yeah. And in clinical trials, I've seen it. I mean, I haven't actually studied it myself because I'm the creator. But I always, when somebody asks me, I said, could you please study this? I'd love to know how much force it takes to crush a veggie stick and what that means and how often you swallow when you have something that's leaking food in there. It's not like it ejects out.

No.

I put a muffin in it this past couple of weeks. Apple muffin. And it's actually delicious.

Yeah, I mean, I just, I took another bite of my French toast with it and just to kind of see like how it felt again when it's coming out the sides and it's coming out both Sides. Yeah, they positioned it to do that. And again, it's not. My body didn't go like, whoa, that's weird. It was just kind of like, oh, there's some food there. Like, it's not ejecting out very quickly or in an alarming way. It feels very manageable. And even with the French toast, because of the type of consistency, it also kind of almost stays put on the sides of the side biter until I actually remove it or use my tongue or my cheek to help, you know, clear it off the side. So I feel like it's very, very functional. I really like it.

So what I like about it, too, is feeding friends. Really, like when I count or when mom counts or you do a song about it because it's very bouncy. And so they make a choice, right? And then you could ask them, you know, we could make up a song about chewing or count. 1, 2, 3, 4, 5. Take it out. Wow, that was an awesome swallow. Now move it to the other side. 1, 2, 3, 4, 5. Mmm. Oh, the candy corn is delicious. I have to tell you that. It's coming right out, and it makes me salivate a lot. So the high frequency of moving your tongue and jaw and lips. What we know is the more we do it, the better we get at it. Just like if you're running a marathon, you just got to start somewhere.

We talk about that a lot. Even in myofunctional therapy, that neuromuscular programming that re education for some and education to begin with for others, we're trying to basically create. Create those. Those, you know, movements and create those patterns. And again, I just. Like you said that. That repetition is so important, but we're also building up our masseter muscles, and we're building up our ability to apply this to other foods. So, I mean, I love that. You know, it's. I always. People always say to me, well, why does this child love carrots and steak? But, you know, they won't eat, like, this whole other list of things. And I go, well, sometimes if you're motivated enough, you will put in the work. Even if it's really taxing to your body, you're gonna do it anyways. And there's people then who either don't have the ability to do it regardless, even though they like it, or they're not willing to put in the work. You know, I don't know. But, you know, I do see, like, I can feel my jaws doing some work on this too.

No, your tongue actually gets tired. My tongue within the session, I'm like, wow, my tongue has really got the work out here. Yeah. Be speaking seven languages now because my tongue is so agile. But I wanted to piggyback on that about how kids, as babies and on up, they blueprint to the movements that they can actually do. So if you've had a feeding tube since birth and you've had experience with liquids and purees you and you have motor difficulties, it's more than that. You've blueprinted your brain that this is what I eat or this is what I swallow. So I always talk to families about, we're trying to change the blueprint and making it so that, you know, like you said, you can't just go to this. You have to crush it or offer it or smell it or kiss it or move it or watch other people eat it. You know, model it, how you go. There has to be some steps involved to re blueprint somebody. And this is such a safe way to get the idea that, I mean, can you imagine how scary it is if you've never heard a crunch in your head?

Yeah.

You've never heard it because you've had liquids or nothing. But yet we know that dissolvable solids kind of helps with getting to diced table food. And I'm not going to start with diced table foods because they have fibers and they don't fall apart. I love that you use French toast, but we might have to do this to French toast. We might have to use a grinder and then go. But even then you're tongue mashing. You're not.

Yeah.

And then having to do something. So anyway, that's why this exists and that's why my company is nosh, because it means to chew or have a snack. I'm very corny. That's why my Phone number is 5087202. Very corny.

I love it. I love it. No, I think it's. Everything you're saying is very important. And we do get those children where they are mashing or pocketing or just holding the food because they don't have that blueprint like you're talking about. They've never had to do this before. And it's going to take time to build those skills. And so we tend to see a lot of. A lot of those kids who will put a food right on in on the tongue or maybe it goes in on the molar side and that moves to the center of the tongue and it just stays there and it gets broken down with saliva mashed against their palate before they swallow it back. They've got residue all over their mouth or they're pocketing it, it's moving to the cheek and they're just holding it there because again, we don't know what to do with it. Or it's sitting there and now we're not so sure how to move it. Or maybe we don't feel it. I mean, there's so many things that could be going on. But I love that you really, you highlighted that.

The one thing that you said was fear. And I always put myself in my clients shoes and I can understand where fear can come in on the client side because they've never had this feeling, what are we asking them to do? Maybe they're non verbal. Maybe they're just learning to move their tongue up and down for speech. And we're asking them to do side to side rotary, which is what we need for eating. And you get the resistance and the behaviors because they're afraid and it's hard. If it was easy, they'd be doing it.

Yeah, right, right.

You know, so making it fun and making it functional, Believe me, I used every single tool that there is in the world. I have in a huge. I have everything. I have probably 10 of everything.

I have a closet of organized, you know, tools by like size and shape and color from this company and that company. I totally get it. It's like, yeah.

And then you get the client that you're going, yeah, you're going, okay.

Nothing in my toolbox is working or.

Like it just doesn't seem functional.

Yes. Yeah.

Like, you know, I, I've been to conferences and people were like, just wrap a hot dog in gauze. And that is scary to me because the person can't hold it. And if you let, if, if it unfurls, then you know, with the adults or with adolescents or whatever, then you have a random hot dog and pieces of gauze. I don't know about you, but I always put tools in my mouth first.

Oh yeah. I try everything before I ever have anybody else do it.

Have you ever used gauze in your mouth?

I've tried it, yeah. And I've not used it with my patients.

But that's the thing. It's still being used and that's fine if it's working. But I feel like we need something that's sort of pliable, that balances the jaw. I really like the baby feeders for like six to nine months, but they're bulbous and they don't. And they're not for older kids, but yet they're kind of good because they get them, you know. So this was my take on it because it reaches on the back molar. That's why it's for children two and up. Because once you have teeth, you hopefully can do that excursion like you were talking. Yeah, yeah.

Now there's a lot of things out there in this world that people are using that are a little scary. And I know that you, you had said like when in producing this, you are using food grade, you know, approved materials with this product. And it's a little scary to see sometimes when people share they use in feeding therapy. Because I'm going, that should not be going in the mouth, let alone for a feeding patient, like, yikes, no, thank you.

I spent a lot of time researching about what brush to use to go in and take like the Mac and cheese out. And it can be, you know, boiled and it can go in the dishwasher. Really wanted it to be easy for, for patients to use. And again, you can just use it easily, but it has a nice grip to it. And you know, the, with OTs use when they put an extra external, I think it's called the easy grip. It fits on here perfectly. So clients that can't hold it, it's miraculous. And it's been a really great thing to even get them to dip in their purees. And maybe they won't go beyond purees, but what if you use the crunch in level one and have them dip it in their puree of, you know, whatever, gravy. And they started to get the idea of I can hear it. And everyone's going wild because you can hear it. The possibilities are pretty endless.

Yeah. Now this is, this is very cool. I love it. I'm excited for you. I'm excited for this tool and the feeding world. Do you have any, like, examples or cases that you want to discuss or share that you've used this with? Yeah, examples today.

Okay. So I guess I'm gonna just kind of tell you when the last straw was. When I was like, I'm not gonna do this, I realized it was beyond me and this is awful and whatever. And in comes a 10 year old, he might have been actually 12, who was a micro preemie 12 years ago and his mother's a nurse. And he told his mother he's real high functioning, walking, talking, fed by G tube pretty much from birth, wanted to go to the mall and eat with his friends. So he said, I want to learn to eat. So he Came in and, you know, he could drink some liquids. He could. We got him. So we expanded his yogurt variety and then we went to some dissolvable solids to try to give the idea about chewing. He was. He's like, I don't get it. I don't understand. I don't understand what.

It's.

What we're doing. I had pulverized dust of Ritz crackers, whatever. We tried easy cheese. We tried. And he's like, I just don't know what to do with it. I hold it in my mouth. And he was fully verbal. So I've learned so much about the client side, right? Like you said, we do things to try to get to the next step. Not proud of it, but I said, okay, I'm going to take a Ziploc bag. Because really, I wanted to give him the baby chewer thing, but he's, you know, cognitively intact, wants to hang out and eat pizza at the mall. I'm like, not going to be that. So I said, okay, here's a Ziploc bag. I'm going to put in this. Roll it up tight. It basically looked like this to get him the idea about when your teeth come together in the back, this is what happens to the food. Because I want him to see it before he could feel it. Because he had sensory problems and he couldn't get past the feeling. That's why we were using easy cheese and some other things to bind it together and lots of different creamy things that. But. But again, wet foods make you kind of sucked. And I wanted him to get the idea about maneuvering the tongue. He's like, I don't know when it's time to swallow. He had no idea. And it was then when I thought, if I had this tool, I could help you, but I don't have it, you know. So I tried a lot of different things. We, we. We got, you know, to some, like pancakes and strips. We didn't get to pizza. He wouldn't. He just. He sensory wise, he just couldn't do it. And I felt bad. And he, you know, we expanded where he could have a cool cup and go to the mall and, you know, drink smoothies because they were in vogue and whatever. And that was a look into kind of our history as speech pathologists. How, you know, a long time ago, some of these micro preemies were not living right. And now we have complex cases because medical technology are saving kids near drowning and adults after a stroke. And we need to have tools that will bring them to another level, you can't just say, well, I can't get you there, so we can't always help everybody.

But I think also to speak to it as an slp, you know, it's funny, we do communication and we do feeding, and what is, you know, eating is a very social activity. And if you, you know, want to be a part of that social, you know, experience with your friends, but you can't chew or swallow, I mean, that's. You've got two barriers here. And so I just. I think it's very, very cool that you, you know, it's. I've said this in the past. When I first started my online business, I was like, I'm going to create a MYO course. And I talked to a friend who runs a big online SLP company, and she. Well, she's a small business, but she's got a lot of slp, like, in her membership, and she's got a son with special needs who she talks a lot about. And, you know, she said to me, holly, we really. We really need, like, a pediatric feeding course that kind of is just comprehensive. That, like, changes. It brings critical thinking. We need people to think critically. We need people to understand. I started thinking like, this sounds really heavy. Like, I've never worked in a nicu. I've never worked in a hospital setting with. With pediatrics. Like, I worked in the schools and then early intervention and then private practice. So, like, the. The kiddos that I was seeing were very different than, you know, I'm like, I could speak and teach about that, but that's not comprehensive. And so I was like, I don't know. And she was like, all right, well, I'll go tell someone else to do it.

I was like, yeah, okay, I don't know.

Give me till tomorrow. And so day I came back and I was like, all right, all right, we're going to do it. And so Feed the Peas was born. And that was, you know, we launched the first time in March 2020, and it really has been a very cool experience to put out the course that I wish that I had when I graduated with other providers, other SLPs, OT. You know, it's very interesting to see the journey that therapists go on and even the critical thinking that evolves and how the questions change from week one to week 12 with us. And, you know, it's been a really very, very cool journey. But I think that, you know, I always say there's no one better to do this kind of work than those of us who really Fully grasp that there's so much more to it than just chewing and swallowing. We really understand that it's being. It's being part of a community. It's being able to participate in activities every day that people take for granted because they don't realize it's sitting at a lunch table or going out to dinner with a friend. You know, these are things people don't do because they. They can't.

Yeah.

Yeah.

Yep. I just have one other little thing to say is that I also worked a lot with quadriplegic children, very young quadriplegics, different syndromes and things. And, you know, if you think about the natural progression of teething and how you really need something on the gum surfaces to help the teeth to erupt, there was a case where very, very involved trach everything really couldn't, was NPO and was not a candidate for eating. But with level one with zero holes, we would freeze water in it. And the mother said she would just because this is a quadriplegic little boy and would rub it on the very tender gums that were trying to erupt. Erupt with. With teeth. And it was a lifesaver. She's like, he loves it. He wraps his mouth around it. He. He bites down on it and it's cold and nothing goes in his mouth. And he, you know, and so I thought, well, I've never thought of that before either. So we used it as a soother and it really got back there where, like, a frozen washcloth would be dangerous for him. And some of the teethers are only in the front, but the molars are coming in here. And we don't know. I mean, this is. I think he was 18 months, so we don't know where he's going to go, but we do want to engage his mouth.

Right.

So I thought that was really very wonderful of that, mom, to think of it.

Yeah. I'm sure there'll be, like, so many more uses, too, that, that, you know, come your way. And I would encourage anybody listening to reach out to you and share those with you. So I think you've done, like I said, a very nice job of getting some videos on your social media of others using the tool because it's just shown like, oh, okay, this is very easy to use and might spark other ideas, too.

Well, people are actually posting on their own because as I said earlier, I have a real hard time fishing for customers. Like, I'm just not comfortable with that. But I do say, if you have a success story, let me know I'd love to hear about that. And that's been a really good support of the use of it. I also just wanted to say that anytime that we are seeing a child or an adult that has an eating, altered eating, absolutely. Make sure that you have a dietitian on board because a lot of times the dietitian will have ideas about what foods would be ideal for them. And we can offer them in the sidebutter or in our therapies because if they've never had food before, it would be great to offer the variety. Like, I wouldn't just go for candy. People are going to say, oh my gosh, Shasha's putting candy in there. That's my nickname. Well, I'm doing it for flavor and for motivation. But the dietitian is your go to shoulder to shoulder clinician. That will help you grow this person.

Yeah, no, I love that. Well, and you're going to be at Asha at the ASHA convention. Share that with us.

Yes, I will be at asha. I will be in the Asha Entrepreneur area.

Okay.

Booth 1258 and I have lots of games and activities. I've had a really fun time using my creativity to figure out how to do the spin to win and lots of freebies and it'll be a lot of fun. My daughter's going to be there. She's a speech pathologist in Boston area and I live on Cape Cod, so it's really close to me. So I'm excited to see a lot of my colleagues there. Hope to see you there.

I love that. So. And I know you're available for consultation or even services. So how can people find you if they're looking for that?

Well, you can go to my website, which is probably going to be on your podcast. That would be side by side. I have an email there, cherylshfeeding.com I'm on Instagram. You can find Sidebiter on Instagram and my phone number is 5087202 and that you can always reach out to me. I'm actually starting to do a lot of lunch and learns at facilities and they're free. So if anybody wants a lunch and learn at a facility, I'm going to be traveling through the Northwest doing some in services through Montana, California, Utah, and I made a lot of connections. This summer I'm going back to Alaska doing some in services. So call me and we can work something out or give me a message because everybody gets a free Sidebiter and I just want people to know that there's an option out there for children that have molars on up to adulthood. That's why I wanted it to be wanted the side biter to be flexible. Didn't want it to just pigeonhole to a certain age. I wanted it to be functional and something that could be used by an occupational therapist for grip, for movement, for jaw rehab, for tmj, for anything that people wanted. I needed a cylinder shaped bouncy silicone device.

I think you've accomplished that. So I love it. I love it. And I know you gave us a discount code for the listeners that'll be good for a week, FTP 20. So we'll make sure that all this information with your website and everything is below this episode. And thank you so much for joining me today.

Thank you so much for having me. This was so fun. And I love that you put gluten free French toast in there. That is awesome sauce. Thank you.

I will tell you, it was actually gluten free challah that I made with my daughter.

Perfect.

Then we it was on the counter, I was like, oh, I'm gonna make French toast with it. Perfect.

Awesome. Well, because bread is so difficult and like I said families, I mean things around the house, people like, well, what do you put in it? I'm like, well anything. Unless it's very juicy and the patient is not cleared for liquids. It's all on my website. There's tons of ideas on my website.

Well, thank you. Thank you again.

Thanks for having me. Have a great day and chew on.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and feedback related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources at all I offer@halbalkin.com or pop over to Holly Balkan on Instagram to get all the latest updates.