Episode 252: Nurturing Little Eaters with Tiffany Zilberman M.S. CCC-SLP

Hi and welcome to episode 252 of the Untethered Podcast. Today we have Tiffany Zilberman joining us and Tiffany is a graduate of the CATS School of Yeshiva University in 2018. She has since worked as a speech language pathologist, treating individuals across all age groups and various settings, including pediatric private practices and adult care centers. As her career continued to begin envisioning the possibility of owning her own practice or organically, her interest shifted towards pediatric feeding, especially after the birth of her daughter about two years ago, she continued to build out her pediatric experience and graduated from Feed the Peds training which confirmed that this was the right switch for her by going into depth in pediatric feeding. This past summer she gave birth to twins, gaining personal experience of the unique challenges of feeding multiples and having a twin in the nicu. Most recently, her family and Tiffany relocated to Florida where she has fulfilled her dream of opening her own private practice called Little Eaters llc. 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, 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 tether, dural 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 oral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Tiffany, welcome to the podcast.

Thank you so much for having me.

I am excited to talk to you because I know from one mom to another we have both had feeding journeys with a child or two and it's one of those topics that I think is becoming discussed more, but maybe not always discussed enough. But before we dive into that, I would love for you to just share with us a bit about your background and your own journey treating dysphagia. You know where that started and where you are now?

Sure. Okay. So I started out really exposed mostly to dysphagia through the adult and geriatric population. I didn't really realize so much of it exists in the pediatric field. And then slowly as I was diving more, taking more CEUs and educating myself and preparing myself for my, my current caseload, that there's, I was doing research and I saw that there's a whole world of pediatric feeding and it kind of, you know, was, was present. And then I was also doing part time, seeing part time clients also in a pediatric private practice. So it was kind of like existing and you know, there and then I gave birth to my now 2 year old and it all just came together. I started doing tons of research. I had much so, so many questions as I was experiencing everything. I was like getting more and more into pediatric dysphasia and more and more interested and I was like really being pulled in that direction. And then, so then I decided to take be the PEDs and that kind of like affirmed for me that this is where I want to go. I want to go like, you know, I'm moving away from the adult. Like I felt like at that point I treated from, you know, from little babies, little kids to 99 years old. I saw the whole lifespan and my heart was pulled straight to pediatrics and I wanted to just do that, do you know, pediatric feeding and take it from there.

Yeah, I love that. And it's, we talk about this quite often that in graduate school, like I was taught to work with geriatrics and adult dysphagia and there was nothing surrounding pediatric dysphagia. It really was like speech, language articulation, like a lot of, you know, other types of focuses on peds, but nothing when it came to feeding and swallowing. And so yeah, I mean you echo that experience.

Yeah, totally. I. And you know, also I feel like a big part of it was being a first time mom and going through like the nerve wracking moments of like trying to get a baby to latch. Is the baby gaining enough weight? Formula, no formula, you know, depending on how the baby's doing and is the baby eating and all of this is pediatric feeding. And I didn't realize this because, you know, like, as far as it went for, as far as it goes for most people, it's through a patient consultant. It's through, you know, because we know about that. We didn't know, like no one really knows that there's a whole world of pediatric feeding, pediatric feeding therapists, whether you know, SLPs or OTS. So that was like a huge part for me.

Yeah, yeah, it's, it's again one of those things that we need obviously more SLPs and OTs, stepping into pediatric feeding. But so now. Now that you've had this experience in both the peds world and with, you know, geriatrics and really across the lifespan, you know, would you say it's very different working with pediatrics compared to your. Your older adult population?

Oh, my gosh. It's day and night. Yeah. So it's just so interesting because I feel like a lot of working with adults, of course, and. And geriatrics, it's a lot of maintenance and, like, quality of care, and, like, let's get them to their best. And there's not a lot of movement, unfortunately. You know, once there's a certain atrophy and age, it's kind of like, let's just do the best that we can and to keep them as safe as possible, you know, and keep them away from aspiration. And with peds, it's like, let's build them. Let's, you know, let's help them. Let's guide them. Let's improve their development, you know, so it's like it's two completely two different worlds. And I didn't realize until I started learning more and taking more, you know, more coursework and also having my own kids and also starting to treat PEDs, starting to experience it, you know, and seeing that, like, I'm really building. Helping little kiddos, like, build tools for the rest of their life versus, like, adults. You're kind of helping maintain where they're at and keeping them safe, which is super important. Not to, you know, not to say that that's not a value. It's. It's incredibly important. But my heart was pulled to the peds part of dysphagia versus the adults part, you know?

Yeah, yeah, no, I totally get that. And you really spoke to it in that. It's. It's night and day. It's totally different. And, you know, it's. We're not necessarily teaching compensation regularly to pediatrics. We're really teaching them skills, foundational skills that maybe they don't have, or helping to kind of, like, get them or keep them on, like, a developmental trajectory that's going to help them develop an adult, like, rotary, too, or, you know, it's like. So it is so different when you're kind of habilitating versus, like, rehabilitating. And some kids there is rehab involved, too. You know, I don't want to download play that either, but really just setting them up for life. And I think that's that whole conversation of, like, early intervention and, like, the younger we get in there, the easier it is to address these things. The easier it is to undo certain patterns because there's fewer of them and there's fewer layers to the onion or the snowball or whatever you want to call it. Right. And it's, it feels hard I think, when you're in it as a parent and even as a therapist. But it's so much easier than, you know, several years down the road.

Yeah, yeah, of course, course. And I feel like there's just, there's a big missing component of like mothers having these tools beforehand, before they give birth, before they have these little ones. You know, like I, I had twins five months ago and like, and I already have a toddler at home and having these tools as a pediatric, you know, feeding therapist already in my back pocket, I was able to like understand what was going on despite recover, you know, postpartum recovery and sleep deprivation and like all these things. And I keep thinking about like those moms who just don't have these tools are so nervous, you know, so, you know, recovering from birth, it's like a whole other, it's a whole experience. And then on top of that you're like given this little child to take care of this little baby and like they don't have any good guidance and, and it's, it, this is what I was like, hey, I want to get right in there and I wanna, you know, I wanna help moms exactly like me go, go, you know, go through this experience and help, help them and guide them. And I, I, yeah, I love that.

Well, I want to talk about a timeline here. Right, so okay, so you have a toddler. A couple years ago you have a toddler and that was your daughter and you at that point was, you were still working with adults, right? Like, yeah, I was still working.

Yeah, I was still working with adults. I was doing pediatrics in a private practice on the side. So kind of like two part time jobs together, full time. And I, the whole experience of pediatric feeding with my daughter from like, you know, breastfeeding, latching, then introducing solids. The whole experience like doing tons of research, what's the appropriate time. And a lot of times like pediatricians, which I have a lot to say about that also for my twins. But like pediatricians, they, I feel like a lot of the responses are more like generic and don't like, they're not customized to like what the struggle is that the parent is going through. And I think it could be that there just not enough exposure for those pediatricians to like, be like, okay, I am a resource in the community, which is, like, my goal. I'm going to be going to a few doctor's offices soon and, like, sending them all my stuff because I feel like they don't know where to send out to. Or maybe, like, these resources aren't as well known.

Maybe they also don't realize when there's enough of an issue that they should even be referring. Because, you know, at the end of the day, like, pediatricians, we love our pediatricians, but they're not feeding therapists. They're not feeding. They're not specialized in feeding. And I think, you know, there are some who will take courses just to better their knowledge. But I think we have this conversation where I'm like, it falls on us, unfortunately, to go and educate and say, hey, when you have a baby, where mom is saying X, Y and Z, like, that's a referral. When you have a baby where this is happening and they've now come to you for two appointments in a row and things are not improving, that's a referral. When you have a. You know, it's like, in giving them actual, like, specific scenarios and, like, checklists almost. I think, like, that's.

That's.

That's the best we can do because they see, I feel like, you know, pediatricians are in and out as fast as they're in and out, and there's so much they have to check and like, you know, but it's so frustrating, right, for us as, like, the feeding therapists who are like, oh, gosh, this baby should have been referred.

So, yeah, right. Like, if only I met this baby a year and a half ago, this would have been, you know, this toddler. Now, you know, like, a year and a half ago, this would have been so different. But, you know, we. We take what we get and we work with, you know, and we start building steps from there. But anyway, back to the timeline.

So you have twins and you started a private practice. Which one happened first?

First is taking care of the egg. So first I. So I finished through the feeds in April, and then I envisioned my goal was that I'm going to start my private practice. I don't know exactly when and how things will fall into place, but I kept, like, envisioning it, and I wanted to specialize in pediatric feeding. I. It was like the thought was set, and I was like, okay, but first I need to, like, give birth to two babies and, like, recover. Yeah, yeah. And, like, recover and readjust, like, my whole dynamic of going from you know, a parent to want to. A parent of three and like leaping to that overnight. Yeah, so, so yeah, so I, I had twins. I went, I went past due with twins, which was like crazy. I thought it was wild. I, I gave birth weeks and a few days and 38 is considered full term for twins and thank God, naturally and with Abdurl and they. So during all the sonograms, they kept saying that the babies were about it's boy, girl, twins, by the way. The, the. They kept saying they were like about the same, the same weight, 5 and 5 the whole time towards the end. And then when I gave birth, one twin, twin A, the boy was six pounds, and twin B, the girl was four pounds. And I like immediately noticed like the second they came out, I was like, oh my gosh, why is that one so much smaller? And I like, I started obviously like any mother would. I started like getting really nervous. And then they weighed her and they're like, she's just like, she needs to go to the nicu. And I knew all about the nicu. I literally. You have a whole module. I'm a nicu. So like I knew a ton already, but still like hearing it as a mom, like I was obviously sobbing because no matter, no, even if it's best case scenario, NICU is NICU and like your baby's not with you the whole time. It was just like such a crazy experience of like having one baby next to me, one baby in the NICU like a few floors down. And I had to try and try and latch a nurse with one, then get into a wheelchair because I couldn't walk so much yet. Get into a wheelchair, go down, be wheeled down to the. My NICU baby, try and latch and nurse with that one and like, oh yeah, recover, take care of yourself. You know what? Yeah, I was like running for like three, you know, two in the hospital. It was wild. And then so my baby in the nicu, she. They both have lip ties and I noticed that right away. I self assessed and I'm even now kind of monitoring them for functional issues because that's like a big part that I learned from all my cus and especially from P to P. It's like if it's what is there a functional issue? So right now. So basically the twin that was in nicu, she had a little bit of low tone and she like, she needed to kind of like build up her muscle strength. And that was very evident to me during latching and nursing and even bottle feeding. And I was able Because I had all these tools. I, like, understood past feeding. I understood like, creating stops for her and like, all these things and positioning and that was able to help, like, build her up slowly. Slowly. And then my other twin, he. He did great. He did great with latching. He had the strength and everything. But interestingly, he has his own thing. He has collegiocephaly. So he's like, flat on one side. So now potentially suspected torticollis. So that's like a whole other experience. And I, I. Because I know of, like, the importance of a multidisciplinary team. I'm. I'm already in contact now with, you know, infant. I'm looking for craniosacral therapy to see. Because I could definitely see that both of the twins have tension in some way. And apparently it's really common because there's not a lot of space and they're all scrunched up for a long time in there. So like, they. They're now here and it all. I would never up until this point understand that 10, you know, tension creeps could. Could create feeding difficulties for. For infants, you know, so that was a whole. I'm, like, working through it literally now as I'm, you know, treating also kiddos on the side and doing my own private practice, like, monitoring my own babies for all their, you know, functional feeding issues or not. You know, one, the. The baby who has plediocephaly potential, potential torticollis, like, there's a lot of spit up with that. And, and when I asked the pediatrician at the four month, right before I kind of start. Got started getting going with my private practice, you know, she said, like, lots of tummy time will fix it. And I was like, okay. And you know, like, they're always like, oh, it's a happy spitter. It's all good. Like, happy spitters. And I'm like, okay, yes. Like, he's not like, crying, thank God. Like, I don't see signs or symptoms of colic, but, like, I'm like, this. Is this normal? Like, how much of this is normal? And it's like having that, like, mom guide and having that clinician gut and like, okay, we're going to, we're going to keep researching. We're going to try and get to the bottom of it. So I'm still in the works of figuring that all out with twins.

Well, so I have a question. Now that it's been a month, you know, is he tolerating tummy time? And do you notice it helping at all.

Yes. So it does. Okay. So my other twin also has tension, the girl twin. So she had a harder time with tummy time than he did. And at first she was, like, not having it, and now both of them are doing much better with tummy time. And I feel that it is impacting the, like, all the tension that's in this area. They're, like, able to pull up more, you know, and stay in that position for much longer. And I've noticed that the spitting up has definitely decreased.

Okay.

But, you know, and now that's why I'm like. And I keep thinking, so is there a functional. Functional issue or not? You know, like, yes, they still have lip ties. Is that something I want to, like, get done? I don't know. Like, you know, I kind of. There's like this fine balance of, like, let's wait and see or not, because I don't want to wait and see. And then, like, you know, God forbid there's other issues or, like, developmental delays or anything like that, so. Because yeah, it's a hard decision to.

Make as a parent too. Right? Like the clinician parent. It's almost like you. You're like, I know too much and I don't want to decide for my own child. And so I love that you said, like, you're kind of like, you're like, reaching out to the team, the physical therapist. And like, I. Because you're in Davies. So I. I think I've got a. Somebody who's in Fort Lauderdale who may not be too far from you that I have to find.

Therapist.

So I'm making myself a notion.

Okay, good. Good.

Yeah. And we can talk because I just.

Reached someone and actually not Aventura. I was like, it's. It's like I would do the drive if I had to, but obviously, like, my life is already so crazy. I need everything within it, like, 10, 10 minute radius of me.

Yeah, right. I got it. Like, we drive to North Miami for the kids. Like, you know, dentist who we got.

I remember.

And I'm just like, I love her, so I do it. But, like, it was hard, especially with two kids on two different schedules. Like, we tried to, like, match up appointments as best we could sometimes, but they didn't always match up. So anyways, now we're kind of on the other side of that and more. It's like maintenance and, you know, continued growth at this point, but it's hard. And you've got three kids, two twins, infants, plus a new business, so.

10 minutes. 10 minutes max. Exactly.

So talk about the private practice, right? So you start your private practice. What is that? Like, are you traveling to people? Do you have a facility? Like, what does that look like?

So my private practice called Little Eaters and so we're doing just home based visits and I actually absolutely love that right now. I, I, I feel like getting into the homes of these little kiddos, whether they're little, you know, smaller babies or children, 2 year olds, 4 year olds, they feel their safest places, their home. Like it's, you know, like moms, you know, parents are there, caregivers are there, like maybe siblings are running around in the background like it's home. So because of that I feel like they already have their guard down and I have to spend less time like building rapport and making them feel safe because they already feel so safe, which is like a nice thing because then I'm like, okay, let's get started. Like, you know, let's start different things. You know, on the other hand, it's like cute and fun because like the other kids in the house are like intrigued and interested or popping in or like, you know, I'm treating a four year old now, the two year old's in the house, you know, taking a look or like wanting to play with all my different tools and stuff. So it's kind of like, you know, it's, it's, it's, I, I love the homing feeling. I think it helps so much with kiddos and you know, to help with progress. It's like a huge part I think that will impact progress is like going into the homes now. So that's kind of what we're doing and I'm building my caseload from there. I'm getting right now a lot of, I had a, a week of like a lot of calls of like, you know, consultations with parents and a lot of unbelievable interesting things. And I'm just like, whoa, you need me and I want to help you so badly. Like let's work together. And you know, there's, there's almost nobody in where I live right now. I live in the Hollywood, Fort Lauderdale area. I, I don't, I don't think I, I keep googling. So I'm like, is there anyone else? Like, I want to know who else I'm working with, what else to refer to if I run out of time, you know, because I want to help parents and I want to help kiddos and there's really not a lot. And in my community I, I posted in the various, you know, I'M just starting like, baby steps. So, like, I posted in, just to, to like a soft start. I posted in like, WhatsApp groups and stuff like that. Like, just. And stuff. And so many moms messaged me, like, I have been waiting for this. I need this so bad. Like, I have this child. I have this baby. Like, can you help me? What do you think about this? Picky eating. Textures, you know, texture aversions, lots of picky eating. Like, parents really don't know how to navigate this. And, and I totally get it. Like, I'm a parent. I have a toddler. Like, I, I see when she has her moments of like, you know, weeks of picky eating and like, how to work through it, how to positively, you know, encourage her and expose her, you know, and, and, and it's, it just. Yeah, yeah.

No, I think that's an amazing thing too, because becoming that resource for your community, you know, especially if you feel like there isn't. Well, if it doesn't exist, period, or if there's not enough of it, is so critical. And it's like, it's one of my missions, like with Feed the Peas, I, you know, in the very beginning, I wanted to start a MYO course and my and colleague was like, we really need a pediatric feeding course that like, really, like, goes over all these different things. And I was like, oh, okay. Well, I don't have like, all that experience, which, which is where I pulled in others who have the experience so that we could kind of all like, cover the whole, the whole comprehensive. And I felt like that was a resource that was lacking for SLPs and OTs. And it's like, if we don't have the resources, how do we even go and help our own communities and help the patients, you know, near us? And so I just had this big old vision that was like, well, if we can train, we can help, like, you know, bring the education forward and we can have more SLPs and OT step into, like, being, you know, competent and confident in treating pediatric feeding cases. Like, we can start to make a much larger mark because, hi, I own a private practice and you know, I'm mostly like up north and you know, Maryland, D.C. virginia area is like my primary practice area. And then like outside of there, you know, we get people who ask me all the time, like, hey, who do you know here? And who do you know? I mean, every single day in my inbox is like, can you refer me to this person? Or this person told me to ask you who to go to? And I'M like, we need a directory. And like I, you know, but I also want to know that these people on the directory had a certain level of training. Like, I'm not vouching for people like me, but I at least know that like for example, you were trained. And I can say, hey, Tiffany is in Davey, like call her and like here's the link to her profile, you know, on our website. And I think that's been the most exciting thing for me is just like, like seeing a couple thousand SLPs and OTS at this point go through Feed the Peds. I'm like, wow, like how many more therapists have stepped into like not saying that everybody's actually stepped into it, not saying that every single person's practicing, not saying that people weren't already feeding therapists, but just to know that, you know, we have such a growing number of feeding therapists. It was like, that's exciting because we have so many communities that's so badly needed it.

It's really, yeah, it's, it's amazing. I so also, aside from doing home visits, I'm also you know, state certified in New York and New Jersey because I'm originally from the tri state. So you know, I have like the virtual support component of therapy that I am also offering. And I'm in, I'm in a twin moms group on WhatsApp also. And there's loads of questions like every day, like about, you know, tongue ties, bottle weeding, cuffs, cup, cup drinking straws, like, you know, tons and tons of developmental milestones, feeding solids, how to loads of stuff. And, and it's like interesting because you know, they post and like every mom comes from expressing what their opinion is based on their own experience, which is valuable and important. But I'm, I feel like I'm, I, I'm pretty sure I'm the only one who's like a feeding therapist because like multiple times I'm like, hey, hi, I'm Tiffany. I'm actually a feeding therapist and a mom. And like, let me tell you, like not only from experience but from like evidence, from clinical experience and from you know, evidence based practice, like actually how to help and what you need, you know, and multiple times or like product recommendations, there's that like multiple times I'm like, hey, hi.

Please don't use that. Use this instead.

Yeah, yeah, yeah. And I also like, you know, to like be respectful of other moms and other mom's experiences and everything is so sensitive during that time. And like I'm in it. I'm in the time with all of them. And I'm just like, you know, there's just not enough support. Like, there, there needs to be. I'm like, I keep thinking like, after all my kids are down, all the, you know, like, I'm sure as you know, it's like being an entrepreneur and stuff, like, all the light bulbs start going off. It's like, okay, what can I add? What can I start creating? Where can I get into? What community should, you know, how can I spread more information about this? How can I help more moms? You know, And a big part of what I want to do is like, help moms in the postpartum world. Like, it's such a sensitive and raw time and it's so hard to think clearly and to make good and to make decisions for your child. And you really want to do the best, like, obviously, of course. And I, I want to like, be there with them and like, so to speak, hold their hand and help guide them and support them. Yeah, I love that.

And, you know, it's, it's becoming, I think, a more discussed topic where like, I, I talk to a lot moms even who have gone through Feed the Peas, who are like, okay, here's the journey I went through and I've taken Feed the Peas and now I'm noticing, okay, we've got more resources for clinicians, but parents really need a lot of resources. And it's so interesting because I think a lot of parents have actually turned to like, listening to this podcast, which it's very, you know, it was never, when I created it, that wasn't my, my primary intention, but I love that it's used as a tool. Sometimes parents are like, oh, I listen to your podcast and listen, like, now I know, like, what terminology to use to advocate for my child. And I'm like, that is freaking awesome. Like, I'm like, that is so cool. But I do think we need like more of those parent friendly resources from like, people who are in this space that can say, hey, this is based on clinical experience. And it's something that is very, you know, easily accessible and really speaks to parents who are like, like you were saying, like, you're in your fourth trimester, you're overwhelmed, you're exhausted, you don't want to watch a three hour course, you don't want to watch a one hour course. You want to maybe get some like, quick information in an easily digestible way that you can immediately take and apply in your current situation. And I think one, it's tricky because like, who knows what the right information is? Because, you know, it's obviously we probably should be assessing the child directly one on one in situations where parents, you know, maybe don't know that that's needed yet and. Or don't have the resources. Like, we do need educational information out there for families. So I love that. And I've talked to a lot of other SLPs like, like, you know, specifically like mom SLPs who have a lot of the same desires. Some people have put some things out, but I still feel like there's a big gap, like we still don't have. You know, I can't really think off the top of my head, like, where to send anybody in this instant to get that information. Like, I'll say, oh, go to my blog. But like, yeah, you know what, you're gonna have to like, search and pass up and. Or go through my podcast website, you know, and I, again, it was. Wasn't really created for parents. And I've now started writing some of our blogs. Like, and I have somebody actually on my team who is a speech pathologist and myotherapist and mom of many who is actually like, writing our blogs for us at this point. And so now it's started to shift more to like, that mom mode. Because I'm like, really? This information needs to be out there for them, right? Yeah, but like, you totally, like, there's definitely ways to create things and you know, even with a fee attached to it so that you're making some money for the, like, the expertise that you're putting out there.

Yeah, for sure.

These families can easily, you know, access like, quality information. And when they're kind of like, okay, I need more than the 75 examples I got from my mom friends. Like, is there someone else who maybe can help me, like, which way we go? Because like you said, there's valuable information in there. We don't want to be, you know, rude time. It's like sometimes there's information that you're kind of like, I'm glad that worked for you. But like, how do we, how do we tell people not to do that?

Yeah, yeah, yeah, yeah. A lot of like, oh, you could wait and see. Or, you know, like, just a lot. It's so skewed from a personal experience. Like, I get it. I get where the moms are coming from. And like, they, you know, they mean well. Of course. Another thing that I'm like, really going to slowly put together, another way to support moms outside of the fourth trimester world. It's like busy, busy working moms. Moms that have lots of, you know, multiple kids in the house. I feel like I've been getting a lot of, of, you know, a lot of calls and a lot of messages about picky eating, texture aversions. And it's like such a tricky thing to, to work through because it's, you know, it's really sensitive. Also, moms, we, like, don't have a lot of time. Like, who's gonna have time to like, do all this, like, fun food exploration all the time and like, you know, let's be real, you know, So I, I'm starting to have this, like, a lot of ideas and I'm gonna start building the next, the next, you know, the next few months where I wanted. I'm gonna be running like, like food sensory playgroups in the area and like, for, for like moms to come with their kids and experience it, see it, have them, you know, have these kids who are like, you know, having texture aversions and exploring those texture versions and doing it in like a fun, light, pressure free environment. And I feel like that that's what I'm doing a lot right now with private therapy coming into people's homes. And I'm getting really positive responses from these kiddos. And like, all of a sudden the moms are like, he'll never touch that ever. I can't believe both hands are deep in jello right now. And pudding. Like, he would never go, you know, near any of that ever, or to allow himself to be dirty and like all these things and. And they're like, curious and they want to lick it and eat it all of a sudden, something they would never do before. So I want to create that on like, a bigger level with like, lots of other kiddos, lots of other moms, and like, maybe start offering these kinds of like, like playgroups, coming into daycares, coming into preschools, like, running. You know, they have like, extracurricular enhancement, like music and yoga and gym. And you know, why not this be a part of it? Why not create an opportunity to enrich children through feeding experiences, you know, Love that.

I love that. And like, as you're talking, I'm like, well through like one of the groups. You'll also like moms to other moms who are going through similar experiences. So it can also like, you know, further that community. I'm like. And then going to schools, when you said that, I was like. And really, if you think of it as a cooking class, like, there are schools who Offer classes, but a twist on it where, you know, it's a cooking class that's very inclusive, where we are, you know, inviting children in who maybe struggle to engage or interact or even be around some of these foods. And the expectations of what they do is maybe like, there are no expectations. Your child can sit on the side, they can make their way towards the table, they can start.

Start to touch it.

You know, they don't have to touch it. They'll have a napkin to wipe their hands. It's, you know, like all the different things where I think, like the way that it's marketed in a sense to families, I think like, if. If I did sign up one of my kiddos for a cooking class at one of her preschools, like way back when and during the pandemic, I was homeschooling my now third grader, but she was in kindergarten at the time because our schools are shut down. And I was trying to be creative with like, okay, how do we meet all these like, demands of like homeschooling? Well, for cooking. That kind of is like a bit of science and math too. And so, you know, I. One of the really cool things was just by nature that I saw by nature of like her interacting with these foods. Like, it was like me and her on a virtual zoom with other kids. And like, she was a little bit younger than some of the other ones, but I was like, it's fine. And we were cooking together and she started to try things that she would have not touched with a ten foot pole. And like, we're like cutting peppers and she's like, can I try this? And I'm like, yeah, go for it.

It.

And she like eats a red pepper and I'm like, what just happened? And then she makes like beef, which she would not touch, like meat at all, and then sits down and like takes a few bites at dinner. And she's like. I'm like, what do you think? And she's like, I mean, I like it, but I don't want anymore. I'm like, fantastic, Fabulous.

Like, yeah.

And now I have this kiddo who I feel like, because it was a very safe, like, exploratory and fun environment, like she, she now eats hamburgers and she just. We just had. She had like filet mignon. I'm like, joke. I'm like, she's a kid who only eats like top of the line burgers and filet mignon. Like, she will not eat any other beef.

Hot dog.

Like, yeah, it's just really funny, like, to See how. Not funny, but interesting to see, like, how she's evolved and through what experiences. And I think a lot of time it's just the experience. And even then sending, like, you know, sending home something that says, hey, here's the recipe we made.

Made.

And maybe even like a little, like, note of like, your child, you know, made the dough, didn't want to taste it, they interacted with it. I don't know. Just so parents, like, are kind of like, oh, we could try this at home too. You know, I think that's such a cool idea.

So also, like, enrich. Exactly. To like, 100, like, being able to provide enriching feeding experiences. I feel like it's almost like the preemptive work. Like, so that you won't need. Like, so that they won't need. Let's say two years down the line. Like, okay, my kid's literally only eating four foods now or six foods or 10 foods, and I'm really concerned. Or, you know, this, you know, or if some of a child is like, okay, they're not gaining weight. Like, we, like, I feel like we could try and step into the realm before things get to, you know, get to that end. So that's where I'm like, so many ideas are flowing and gotta. You gotta put it all together. But yeah, I think that I feel like a big part of feeding therapy and being, you know, a clinician, of being a feeding therapist, is to support parents. They're the ones that are offering these foods. They're the ones that are feeding their children, whether it's bottle feeding, breastfeeding solids. Like, they're. They're so much of this experience and like, they, a lot of times need a lot of guidance, and that's super important, you know, Like, Google could only take you so far, you know? Yeah, exactly. Dr. Google. Like, you know, it's. And then you. I really. Yeah, it's like, to really be a support for the parents. It's huge.

I think there's also, like, something in it for the teachers too. Like, I've. I've done, like, not that frequently, but in the past I've done some, like, in services, like the week leading up to school starting and where I went in and like, with my ot, even once, like, we talked about, like, what to look for and what, you know, what certain things may mean. And like, if a child's got food falling out of their mouth and, you know, they're turned around at snack time or you notice behaviors upticking around snack time or look, lunch or whatever. Like we just kind of had these discussions that they all kind of went like, oh, like no one's ever kind of posed it this way before. And I thought that was so fascinating. And then just being going into preschools because I. My whole practice is like home based and going into preschools and everything for years and having this really good relationship with this One preschool in D.C. addis Israel. They're Gonhela Preschool is like the biggest conservative like synagogue and preschool like in the nation or something. And they've just like three like floors of like preschool classrooms. It's really cool. And I, even though I was like a contractor, like are my team even still? Even though I'm not there, my team is still like the recommended like practice. And so we're in there like several days a week. And it was so very cool to be able to just like plug in and go into like their snack times, go into lunchtime. And sometimes I would just go observe because I had time to go do that. It wasn't like a time I was working with the kiddo. But I'm like, I'm really curious to see now that I've seen them in therapy, like, I'm really curious, like with permission of course. Like I want to go like observe and see what that looks like or go and see what lunch looks like. And it was so interesting to watch all the kids, but watch like the kids that were on my caseload and interact with the teachers and educate them. And it just also showed me there was such like room for, you know, education with even the teachers because they want to be inclusive and they want to provide these really enriching experiences. But then you have kiddos who are honestly, it's like their fight or flight clicks, you know, kicks in as soon as they see a certain food like be put on the table and you know, having rules like, well, we're all, it's family style kind of a thing and we're all gonna, you know, offer something to each person at the table and so addressing like really nice social skills and those types of things. Very cool. But then I was like, but this kid is totally like not available for that because they right now just completely shut down just based on what was put in front of them. And the teacher is not, you know, they're not, not. They don't connect those dots necessarily because maybe they don't realize that that's an issue. So it was also just, it was very cool to be able to go in and have these conversations and to support the Children, like, in the classroom, even. So I feel like there's just so much that, like, can be done and that we can. We can be doing and that we can also be helping, like, our colleagues, like, the teachers and stuff, you know, help them carry forward. Because I remember too, like, one of my oldest now was in preschool, and they would make, like, challah or they would make whatever they'd be making in school. You know, they had this little song where they go, mix it once, mix it twice, pass it on to Lily, and, like, then they'd move the bowl over, and it was a really, like, fun, engaging. Like, no one has to touch anything, but we're putting it in front of you and we're mixing, which is fun. And now as we've smelled it, we've seen it, we've kind of interacted with it. Now we pass it on, you know, and it was like they would almost work the sensory system them up incrementally, just by nature of what they were doing. And then the kids, like, when they got their own, like, little, you know, piece of holla or whatever it was in front of them, like, they were more likely to interact with it because their. Their, you know, sensory systems, their nervous systems were kind of, like, already at ease and kind of like, okay, this is new. And I'm not sure that I want to touch that. It seems sticky. But I smelled it, I interacted with it, and I don't know, we'll give it a go, you know, and so you kind of, like, see their faces as they're, like, touching it. It's just. It's very fascinating to see, like, a group of 12 children, like, all have their experiences at the same time. And to go like, huh, that's really interesting. So all that to say if anybody works in classrooms, you know, I think a really, you know, it's a great opportunity to be looking at these things. And if you see a child who really struggles, like you've talked about, like, who's struggling with certain things, maybe that's a referral, you know, or maybe that's a, hey, how can we better help this child in the classroom setting, too? Which I think, you know, just in.

Case you need more business ideas, because I'm not busy. Yeah, no, it's huge. Also in terms of, like, as you're speaking, I'm thinking also about how, like, it's like another big feeding environment for children are. Is in school, like, after, you know, outside of from home, which is a big part, is like, really, they spend a lot of Time in school, a lot of time eating with their, their peers online, like having positive feeding exploration experiences with other kiddos and like, you know, like, feeding off of the excitement together. I feel like, can like set the frame framework, like, create a reality that those kids could then take these tools and then at home maybe will not be as nervous to try certain foods. Maybe we'll be more open, you know, maybe we'll surprise their, their caregiver at home. Like, oh, they're curious now, how did this happen? You know, And a lot of times, like, like, as a parent, it is really disheartening when a child is like, I don't want to eat it or pushes it away or throws everything off. And like, then it's like, what are they going to eat? They're going to starve. Like, what? They need to eat something. And then, you know, you like, default, okay, what can I give them that they will eat? And then it's like finding that balance of like, no, you need to create structure. You need to offer the right foods. Like, don't, you know, not to keep feeding into this loop of like, like refusal and then offering the same foods that they do. Like, like, like finding that balance of like exposing them to foods and also creating safe, safe foods that they do want to eat. Like creating that togetherness, you know, in one, in one experience. And that like, if they have the tools, maybe from like a fun exploration at school, they'll be more open to trying out the foods on their plate, you know, at home. It's like a, a big, A big picture that I'm hoping for.

Yeah, no, absolutely. My daughter takes her school, teaches Mandarin and Spanish. My five year old, my five and a half year old in kindergarten, she has Spanish twice, I think Spanish twice and Mandarin like once in each rotation. She comes home with like recipes sometimes and she's like, can we make this? And like, it's. They're really excited to like, do things at home that they talk about as in school. And like, she's hives. Like, it's still very exciting. Like, preschoolers love that stuff too. So I love that, that suggestion because I think whatever we can do to bridge that gap between their natural environments, like, school's a very natural environment and home is a very, is obviously like the most natural environment. But also recognizing, like you said, that a lot of children do spend a lot of time in school, a lot of their waking hours, especially as they get a little bit older and they're not napping, you know, in school, they spend a lot of waking hours at school and, you know, if not sometimes on days, maybe more at school than at home, depending on, you know.

Yeah, for sure.

So I think it's really key to try and always, like. Like your. I hear you thinking and it's like, very much like, how do we generalize this? Like, how do we help bring what they're doing in one environment to the other environment in a very natural way that they're going to be excited about and that they're going to want to, you know, engage and like, without us even asking, really, like, they, you know, you know, know it's successful if they come home and they're like, I want X or I want to do Y, you know, you're like, oh, that. That's carrying over. Okay.

Yeah, yeah, yeah, totally. Totally. For sure.

So can you. So you mentioned that you with your license in New York and New Jersey, you do some, like, consulting. Do you do, like, any virtual treatment? Is it more consulting? Like, what does that look like?

So right as of right now, I. Not. I. I've been doing mostly like, parent coaching, I would say virtually. Not like treatment per se virtually, but yeah, mostly parent coaching, which I feel like is a big part of it. And then like, you know, those parents kind of checking in with me every few sessions of them, you know, feeding their kiddos, whether it's bottle feeding or breastfeeding or, you know, starting solids, baby LED feeding, all that stuff. So, like, then they check in with me about how it's going. Okay. They, you know, and I help create, like, where there's success, let's build from that success where there's positive experiences, let's add on, like, let's expand those things, you know, so it's been. It's been that virtually. And in terms of home, it's like, you know, like I mentioned a lot of also building from the positive experiences. And then like, okay, this kid, you know, this one child was okay with mixed textures together, whereas before it was like, not even on the reader are. So then it's like, okay, maybe in a few weeks I will. I'm gonna talk to the mom and we're gonna create a dinner plan. You know, let's put one food with mixed text checks textures, and the rest of the foods to be like, the safe foods that, you know, the kiddo is confident with. And let's. Let's have them slowly explore those. Those experiences from the, you know, from the place that they're already succeeding in.

Yeah, I mean, parent, like, coaching is huge. I mean, it's such a big part of what we do. And, and I will admit that it sometimes is the trickiest part for me when I was going into a lot of preschools and like the families weren't there and I was interacting more with the teachers and then sending home a note to the parents and trying to explain to them, hey, this is what we were really successful at today. Please do this over the next week. And our families are amazing and they really did what they could and they do what they can. But I think that's such a huge part that is maybe not talked about out enough. It's funny, like, I came out of the school system where that's all they wanted us to do is parent coaching model in, like in infants and toddlers. And then, you know, I went into private practice and it was like a lot of the focus was all like, oral, sensory, oral, motor. And I was like, no, guys, we need to have like a marriage of the two. Like, yeah, but I think that from, you know, the point of like, what you're. You're talking about what you do virtually for a lot of families, like, if we can just kind of help coach them, I think a lot of their anxieties decrease and they feel more empowered. Like, I know you kind of talk to, like, really wanting to empower parents and, you know, if we can empower them to just try certain things and know that it's coming from sound advice where like, no, you're. We're not. What we're telling you is not going to harm your child. Like, it's going to be okay. Here's how we're going to do it. Like, report back on how it went. We will tweak it from there. And then really, like you said, said, highlighting the positive experiences, like, that's always been like one of my big, like, I don't know if it's like I have to call it a mantra or a value or what, but I've always said we need to build on the positive, like you said. And I, like when you said, I was like, yes, if a child succeeds, they're so proud of themselves. They feel so good, like internally, externally, like that feedback. And we know if they're happy and they feel successful, the parents going to look at them and be like, like, oh my gosh, you did it right. And so a lot of children aim to please, especially like the younger that they are. And I'm like, if we can like, intentionally set them up for success, like, the more success they have, the more willing they will be to take risks. And that's what I started to see in my own now 8 year old. Like when she was in preschool and then kindergarten. I was like, wow, okay. Like she's so proud of herself. And now she was then more willing to start taking more risk risks. And I was like, I mean, human psychology, right. But also actually play out. I was like, this is very cool. So. So yeah. Do you have any like, interesting cases that you, you're able to talk about without, you know, identifying the child?

Yeah, sure. I'm having a lot of fun with, with this current case. It's, it's a boy who has, I would say like just general texture aversions. He. After the evaluation, it was like really cool because I was like based on, on everything, I was able to like connect the dots that he's just generally a hypersensitive, you know, sensory seeking kiddo. And, and it totally consistently plays out in his food. You know, from the moment he was basically eating, like he only wants hard foods, crunchy foods, you know, lots of input that all the foods that kind of give him input, refuses purees, refuses anything soft. And yogurts, like all that like absolutely not to the point where he'll get bag and you know, like anything that's saucy, anything like just it's. It was like a hard no. And I've been having like a lot of fun creating like all these different edible sensory bins that I've been bringing, you know, and the mom is, she's loving watching him explore. Like when we started out, we did like, you know, like yogurt, which he will not, like, doesn't, like won't. Won't really want to engage with or eat for sure. We did like yogurt finger painting and we colored all the different yogurts and it was like this whole art experience for him and also to get his fingers in. And I saw he was very hesitant in the beginning. This was like one of our first sessions. And he, I brought paintbrushes because I was like, no pressure, here's napkins. If it gets dirty and you don't like it because he doesn't enjoy, you know, getting dirty, for example. And, and he started with a paintbrush and then like got rid of the paintbrush, put one finger in. And then I was like, you know, I was doing it with him and I was like, isn't it so cold that we were talking about properties and, and comparing it and oh, this is similar. It's cold. Like ice cream. Oh, we like ice cream. Okay. You know, just like having like a very calm, cool, like pressure free conversation about food. And then by the time I was leaving, oh, and I printed out and spoke to the mom beforehand. So like she told me like the different things that he likes, like Avengers and you know, all these like cute, cute kid stuff. So I printed out coloring pages in the thing that he is most interested and motivated with. And by the end he, I was leaving. His both hands were like in yogurt, like the whole thing. I was like so happy to see this. It was like the most exciting. I'm like, oh my gosh, this is so fun. And like he's had like he's experiencing food and play way, which is like, oftentimes parents don't see that as an option. Like you sit down, you eat, and then you go play. You know.

Messy.

Yeah, exactly. And like as a mom, like, who wants to clean up all this? I. I made sure to bring a tablecloth and wrap everything up so the mom didn't have to do any cleaning. I thought everything through as a mom myself. I was like, I'm getting into someone's home. I want to make sure everything is like seamless and good. So I made sure everything was good to go. We wrapped it up and threw it out at the end, you know, or like she did because he wanted to keep colorings as yogurt. But, but like, you know, just making sure to give the opportunity of like playing with foods. Like, even when I, the first time ever exposing my toddler to, to foods and to solids and like a lot of it was a massive mess. And like my mom, you know, my parents immigrated from the Soviet Union. So like, like they have a lot of like, you know, like typical old school mentality. Like, what is this playing with food? Like they should be eating and eating a lot and you know, and like, huge part it's like it's about quality, not quantity. You know, a lot of feeding experience and a lot of, you know, feeding therapy, it's about quality, not quantity. Because the quality helps build and impact the quantity of how much the child will want to eat or consume. So like seeing that through my, you know, my daughter being exposed to all these different textures and playing with it for a few months, I was like, even I was getting a little nervous. I'm like, I don't know if she's eating anything. And then all of a sudden there was just like, I feel like a food boom. You know, they have like, children have like a. They start booming with language at a certain age. Like, I feel like she had this like, breakthrough where she was just eating everything, every kind of texture. There was like a certain point where I was like, wow, I see the impact of like the play opportunity, the exploration opportunity, then impacting a positive experience even for someone so little, like a six month old, you know, and then all of a sudden they're like so curious to eat everything. So from that experience, and then also from. Yeah, like I was mentioning the, the current case I'm having a lot of fun with amongst all the other ones that I'm seeing.

Yeah, no, but you brought up also another really good conversation just in, in that, you know, culturally, right. Whether it's religious or there's culture, there's some type of, you know, traditions or just something that we need to be sensitive to because, like, my husband is Belarusian, he was born in Belarus. And you know, I grew up in a Jewish household where we actually kept kosher growing up. I don't keep kosher now. So, you know, it's like the marriage of like these two backgrounds into one household with a child who's eating well. There was one point where like we had family visiting. I won't name any names, but force feeding. And I was standing there biting my tongue and I was like, not working, working with infants yet. I was really working more with like two on up. But like, my gut was just like, no, no. Everything about this screams no. And they're like distracting her with this new electronic book they got and it's.

Singing and making noise. Oh, and we're gonna shove it in.

We're gonna turn the page.

And I was like, oh, my gosh.

So I was like, all right. I'm like, I, I, maybe, maybe not a lot of damage will be done one meal. But after that I was like, beside myself. And so I was like, I talked to my husband first and I was like, listen, I really don't know how to approach this. Say like, never again. And it never happened again. And I think that there was also some like, I mean, I didn't want to be disrespectful, but at the same time, like, I was just like my child all like, she was, she was a kid who would eat a lot of things but preferred purees. She was a child who would eat like very tiny little cubed foods. And she was still an infant at this point, right? So, you know, she was getting a lot of her nutrition from breast milk. But it was. Yeah, I just stood there and I was like, okay, my eyes have now been open to an Entire different conversation around feeding. And again, I wasn't working with infants yet, but it really made me cognizant and kind of just aware of, like, the conversations that I needed to even have with families to understand, like, what are their backgrounds? Like, what. What are their traumas? Do they have traumas around feeding? Like, totally. Their experiences, their traditions, are there certain laws they follow? Like, what do you. Like, what do I need to know? And, yeah, it was just completely eye opening. And that's. She's the one who's now eight. But yeah, I mean, she was a great, great, solid speeder in the very beginning. And then it kind of started to change, like, as she was closer to like a year or so. Of course, when you meet them actually, like, eating solid foods, like, you know, regularly to, like, cut things out a little bit, she was okay. And then around, like, I think it was 15 months, she had, like, a bad reaction to getting too many vaccines in one day. And like, the next day just cut out a bunch of food and I was like, okay. Fun. Super fun.

Yeah.

So she's been one of my greatest teachers. I will give her that.

A lot of life experience. That's what inspires us. I feel like, as feeding therapists, it's like, it's the added element of, like, having our own little kiddos that we're. We're exploring with, we're learning with, you know, we're making mistakes and growing from and like, that whole humbling, incredibly humbling experience of having children. Yeah. I also had, like, my, like, what I just described my. My toddler now. Like, she was eating everything, and I was like, yeah, I did it, like, you know, and then she hit the toddler stage and know this and know that and, like, whether it's like, wanting to establish, you know, that, like, autonomy or, like, you know, the cheesing control and whatever else, plus, maybe she didn't like some things, and now she's starting to have opinions on things. And I was like, what happened? It's like, it was like, so heartbreaking that I'm like, oh, my gosh, does something go wrong? Like, I don't know. So now we're like, I'm relearning this experience from, like, a new stage of my child, you know, And I feel like it's so fascinating to, like, build on these different stages and seeing and understanding them from, like, a clinical perspective of, like, developmental milestones and, like, where we need to be holding at. And also now, like, experiencing also as a mom, like, okay, you know, now she's like, really become a picky eater. And I. And sometimes will, like, literally refuse use most of dinner. And I really try to only offer her the food that me and my husband eat. Like, I don't want to be making her separate food, like, separate meals. Like, I'm not about that, you know, so I'm like, okay, let's try this again. So try to, like, you know, work through things and something. Like, for example, like broccoli. She always refuses broccoli, like, any typical kid. Like, why vegetables? And then I always, always, always, always put it on her plate, always, no matter what. And she always pushes it away, doesn't want it. And literally last week, she decided not to eat the rice. She ate the chicken, and she ate broccoli, and she asked for more broccoli. And I was like. I was like, to my husband, I'm like, did you see this? Like, I. I don't know what to do with myself. I was, like, so, so excited. And I was like, this. This is so important. This is, like, such a learning lesson for me. And I'm like, I'm so going to, like, take this into, like. Like, you know, feeding therapy with the other parents that I'm working with. Also, like, keep exposing your kids to all the foods that you think they're not going to eat. Like, she said no so many times more than she said yes. But the fact that she said yes was huge. Like, monumental, like, for me, especially as a parent.

Right?

I'm like, yeah. I'm like, now that she had broccoli once, like, that's it. Like, that means that she would sometimes eat broccoli. That means it would sometimes eat other vegetables that we're gonna reintroduce, you know, slowly, slowly. Because I see that, like, you know, we have to find this, like, fine balance for her. Picky eating. Yeah.

No, and that's exactly how it happens. It's that continued exposure and having it available but not putting the pressure on. And, like, yeah. And then I also, like, she would, like, my own child, you know, would eat something and I'd be like, do I celebrate? Like, what do I say? I don't want to make a big deal.

But also, in my head, I'm like, fireworks going off. Yeah.

Like, cool. Act, chill.

Don't react differently.

Because if you get a different response for this food, then, you know, like, yeah, yeah, yeah. Oh, my gosh. Oh, well, this has been amazing. Thank you so much. Where can everybody find you? Online?

Sure. So my website is www.little eatersfl.com and my Instagram handle is at Little Eaters Flower and I'm going to be slowly building reels and making things and sharing what my experience is and slowly building all these ideas and I'm yeah, thank you so much for having me.

Yeah, thank you so much for joining me. This has been amazing. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcast Podcast and share this episode on your social media platforms. You can access free resources and all I offer@hbalkin.com or pop over to Ally Balkan on Instagram to get all the latest updates.