Episode 306: Ped Feeding 101 with Hallie Bulkin, MA CCC-SLP, CMT®, CPFT™

Hello friends and welcome to episode 306 of the Untethered podcast. Real quick, if you're joining us live the week that this launches, we now have the doors open to feed the peeds. So go to feedthepeds.com because as you know, if you followed us for a while, we only open doors three times per year. This is a 12 week course. We all pace together. Go to feedthepedes.com read all about it and if you have any questions at all, you can always reach out to us at Hallie Balkan on Instagram or supporteadthepedes.com with any questions. We're always happy to answer those. The website has all the information about what the course covers, the ceus involved, all that fun stuff. So go and run, get your spot and feed the peads@feedthepedes.com we have some bonuses if you enroll early in the week, otherwise some of those bonuses disappear. So run, join us. I cannot wait to see you in there. Okay, let's jump into today's episode. Quick disclaimer. All information, content and material of this.

Podcast are the opinions of the speakers.

And is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or.

Medical treatment of a qualified healthcare provider. Welcome to the Untethered podcast. I am your host, Hallie Balkan. I'm a certified 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.

Okay friends, so I wanted to dive into Feeding Therapy 101 today. And feeding can be like and swallowing, right? I'll call it feeding, but I'm really talking about feeding and swallowing. It can be such a complex topic.

But I want to just break it.

Down into some very simple bite sized, digestible little nuggets. Um, so maybe get yourself a snack, sit back, relax, and let's talk about feeding therapy. So what is feeding therapy? Let's, let's just understand it very basically right? It's Basically, when you have an individualized program that is designed based on the patient in front of you, we're talking about pediatrics, we're talking about birth to 21. A lot of the times over here, I'm even more hyper focused on birth to five and even birth to three, because that's typically when we develop a lot of our basic skills, skills, as we talked about in last week's training, using our milestone chart, and really understanding when all the foundational skills are developed throughout the body, not just in the oral cavity, but throughout the body for feeding. And so sometimes when we have challenges present themselves related to eating, you know, feeding, swallowing, this is where we really need to have a good grasp on what feeding therapy is, what happens in it, and you, you know. But first we need to understand that these challenges can stem from different medical issues going on. Maybe there's something sensory happening, maybe there may be some behavior. But I will tell you, behaviors are usually the root of something else. Ultimately, there's maybe something developmental or something that's just kind of going awry that needs to be addressed to help the child get back on track and. Or develop skills that they either have never had or. Or maybe they had and they lost. Right. So one of the big goals of feeding therapy is to improve a child's relationship with food. And so we want to, ultimately, if we can prevent any aversions, that's always a huge goal in feeding therapy. But if the aversions are already present, then we're going to want to address those. Right. And aversions or any difficulties surrounding the relationship with food. We want to promote healthier, you know, eating habits. But first we have to make sure that we build rapport with the patient, and then the patient starts to trust us. So they know we're never going to ask them to do anything that might be detrimental to their, you know, their. Their nervous system, really. And so it is really important that in order to understand it deeper, we get. We dive into continuing education and. Or we seek guidance, you know, mentorship from other professionals, like speech language pathologists who are in the feeding space, maybe occupational therapists, you know, feeding specialists in general. There's even some pts that are highly specialized in feeding. It's less common than the SLPs and OTS, but I want to plug that in there. And so what are some signs that we might want to look for? I want to go over some signs that might signal the need for feeding therapy, what our role is as feeding therapists, and the importance of early intervention. And that's all we're going to really dive into today. So. So signs that may signal the need for feeding therapy with one of our patients. Sometimes these patients are already on our caseload. There could be picky eating that is going to become really. They're going to become very, very significantly or severely limited in the number of foods that they will accept or eat or be around. And so it's no longer really picky feeding at that point. Then it becomes sort of like a problem. Right. Because now we have an issue where the child is refusing so much and it's stressful for everybody. We're worried they're not getting proper nutrition. The child just keeps cutting more and more foods out. Right. And we tend to get parents who will panic around the time that kids maybe cut out foods to the point of having only 20 foods they'll accept. We definitely get parents giving us calls when they're down to 10 foods. And parents are in absolute utter chaos once their child is down to five foods. That's been our experience. Now some parents are obviously going to be calm, cool and collected throughout it all. And that's great. They have a very in check nervous system. But oftentimes the calls that we get are because parents are like, we're down to 10 or five foods and we need help. We don't know what to do anymore. Um, so what do we do? We come in and we evaluate. Right. But some other signs that may signal a need for feeding therapy. Excuse me, include if there's difficulty swallowing.

If they are gagging a lot, it's.

Not just like a gag on an initial introduction to a food, first for a first time and then they're okay thereafter. No, it's like repeated gagging. It becomes an issue. It's interfering with feeding or if there's actually choking episodes and it happens, you know, more than once. The choking is never good. And the big difference between gagging and choking, just to clarify here, I always like to clarify this in my free training and I did last week, but gagging is when you're, you know, we're trying to protect our airway and so the body starts to try and push the food out because it fears that that food or that liquid is going to go, is going to enter the airway. It's going to go into our trachea instead of our esophagus. And so we start to, you know, like gag. It's almost like a. Sometimes people will say, oh my gosh, don't you know they're going to throw up well, it's a way. We're trying to expel that food. Right. We're trying to protect the airway. We can still breathe. We can still make noise. However, the difference. That's a big difference between gagging versus choking, where with choking, the airway becomes blocked. It is now obstructed. We cannot make any noises. The skin color will tend to change. You might become more bluish or purplish because of the depleted oxygen. Oxygen, Right. And so we cannot breathe, and that is true choking. So we'll get a lot of families to say, oh, my kid chokes a lot. We need to clarify what that looks like. And it's, you know. Yes, we need to educate. But I always like to say to parents, okay, can you tell me what happens? Like, what are the noises they're making? Are they not making any noises? Does the color of their skin change? Are they vomiting? Are they, you know, like, what else is happening during this time? Are you having to do the Heimlich on them? Have you had to use one of those tools to expel the food out of their throat? What does this look like? Right, so difficulty with swallowing, gagging, or choking during meals or, you know, snack time, then if there's just an absolute outright refusal to try new foods, maybe other extreme reactions to certain textures or flavors, and that could be them crying, it could be them pushing the food on the floor, it could be them throwing up, it could be a gag when the food has come nowhere near them. Right. There's all different kinds of different reactions when touching certain textures or experiencing certain flavors or maybe even temperature sometimes. So something to be aware of. And then mealtime battles when there is stress or anxiety or both for the child, for you as the caregiver or the therapist. Right. That usually tells us we need to intervene or we need to assess to see what's going on. Right. So let's talk about the role of feeding therapists, because now we know kind of what to look for. And obviously there's many other signs and symptoms, but those are some general ones that really can be very obvious. If you sit down and have a snack with kids on your caseload, and here I am talking to you therapists. You know, you've got these kids on your caseload already who probably need help. You may not be aware, have a snack with them this week, have the teacher provide it, the parent provide it. You don't have to provide the snack because, hi, we live in a world where there's all kinds of challenges when it comes to allergies and, you know, I just, I always like the parent to either approve the snack or to send the snack in or the school. For going into a school, they'll provide it. Okay, so the role of a feeding therapist. Basically, as feeding therapists, we assess. We can screen, right? But then we can assess fully assess a child's feeding and swallow swallowing abilities. We then identify our concerns areas either for further assessment and. Or when we're doing our assessment, we recognize that there are some problems we want to address. From there, we can create a treatment plan, a personalized, individualized treatment plan to address these. These issues. Right? We set goals and we address them in therapy, and we do, we intervene. So when we do this, we also work closely with the family to develop strategies that are going to be successful for the child when working with us and when the parents are implementing them at home. So it needs to be very tailored to that family. And feeding therapy looks very different from one patient to the next. We want the parents to be able, you know, or the caregivers to be able to support progress at home. And so we need to work with them to develop strategies that they can actually carry over and that are realistic for their schedule for their home life culturally, and so on and so forth. Right? And then, you know, as a feeding therapist, our role is to figure out basically what tools in our toolbox. What range of techniques are we going to include in our intervention? Maybe we're using some form of oral motor exercises, sensory integration. Sometimes there may be behavior modification, depending on the child and the situation, you know, to basically help shape positive eating experiences and let the child know, again, you're safe with me. You're safe with this food. I will never make you do anything. Your parents will never make you do anything. Your caregivers, right. We'll never make you do anything that makes you uncomfortable. We might stretch you a little bit, but we're never going to do anything that will hurt, hurt you. Right? And so we have to figure out what tools in our toolbox will help us make that progress while keeping the child safe and helping them know that they're safe and allowing them to continue to feel safe. So that is a big role of ours. I like to follow the child's lead, and they will communicate a whole lot to you if you're listening and you're just paying attention. All right? And then the importance of early intervention. I can't record this without at least talking about that, especially because I tend to focus a lot on the birth to 5 population. But the earlier the better. Right. Early identification and intervention significantly improves a child's relationship with food and can prevent longer term feeding difficulties. Now, is it too late if your child is older? Absolutely not. I will just be completely honest. It may be a little more challenging, it may take a little bit longer and it may not. Right. It just depends. Sometimes we say, you know, there's more layers to the onion the older you get, like the snowball snowballs bigger. And so as we have to peel back more layers around things, sometimes it's just we have to massage it a little bit differently. Right. It takes a little bit longer, but it's absolutely possible. The sooner a child does receive support, the better the chances are of helping them develop healthy eating habits and, and really just helping them to enjoy mealtime, like have a positive mealtime experience and have that, you know, continue more long term. So the one last thing I really want to say is that parents and caregivers play a role, really critical role in observing and addressing feeding concerns in their children and seeking professional help when needed. So it is also our job to educate them early and often so they can help recognize when something is going on and then help get their child, you know, the services that they need. So feeding therapy obviously is a very vital resource for families that require them and for children that require them. And so, you know, I just wanted to kind of hit home on the basics of feeding therapy. What it looks like, kind of, you know, taking the initial steps towards assessing, treating, you know, what we're looking for in children who are really overtly needing these interventions and just really highlighting that we want to help the child have it and the caregiver at the family unit really have a positive relationship with food and have a nervous system that's in check, right? Rest and digest. We don't want everybody in fight or flight. We want everybody to be in rest, indigest. And every small step we take towards helping to educate the public and even identify the children who need these services is a win and a win in and of itself. So here's to nurturing happy and healthy eaters one bite at a time. Just a reminder again that Feed the Peds is open this week. If you go to feedthepeds.com, you're gonna basically jump into a 12 week course with us where you're gonna learn all about normal prenatal development, normal development between six months to two years and beyond. Up through when we expect all those feeding skills to be developed, we dive into assessment, we even give you our assessment Template and report template as well as our. We teach you how to use our assessments. And we have two different assessments. We have birth is six months and six months plus. And that's because we divided up by our pre solids and then solids on up, basically inter, you know, assessment, because we're looking for some different things in those assessments. We then break down treatment into a couple of different modules. Well, into a bunch of different modules actually. But we jump first into figuring out where to start your session with exercises and compensations and modifications, including thickening considerations, how do we prevent aversion and deal with aversion, all that fun stuff. And then we move into treating, learning about treatment with a special focus on sensory processing and autism spectrum disorders. We then go into tethered oral tissues, you know, tongue and lip ties. That's one of my modules. We go into treating orofacial myofunctional disorders in the little population when they're not actually age appropriate yet for Mayo. But how can we work with them? And you know, that looks very different than a traditional MYO program. So I teach you all about that in module 8. And then we go into medical complexities, NICU, NAS PREM, you know, prematurity. We go into craniofacial disorders and various other syndrome syndromes. We talk about neurological, cardiac, and in gastrointestinal issues. We go into, you know, airway considerations, instrumental assessments, the IDZI framework. There's just so much goodness packed into this course and so many bonuses too. So go to feedthepedes.com you can hear from a whole bunch of past students who have recorded videos. They've got lots of, you know, they've given us their testimonies that we've got on the website. Read all about that, but always reach out to us if you have any questions at all at Hallie Balkan on Instagram or supportthepeds.com um, if you're ready to jump in and don't need any of that, just go to FeedThePedes.com, jump right on in. We cannot wait to see you in there. We will close doors later this week, so snag your spot now before it fills up and we'll see you inside. I'll talk to you guys soon. Bye.

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 Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halibalkin.com or pop over to Hollybulcken on Instagram to get all the latest updates.