Episode 316: Navigating Pediatric Feeding Therapy | Brittnee Tollison, M.Ed, CCC-SLP, CBC, CPFT™

Hi and welcome to episode 316 of the Untethered Podcast. This is your host, Hallie Balkan, and today we have Brittany Tolleson joining us. Brittany is a speech language pathologist, feeding therapist, and certified breastfeeding counselor. She's licensed to practice in Georgia and is a member of the American Speech Language Hearing Association. Brittany received her Master's Degree in Communication Sciences and Disorders from Georgia State University in 2014 and her Bachelor's in Communication Sciences and Disorders from the University of Georgia in 2012. She's trained in Feed the Peds, Sophie SOS Feeding Therapy, Beckman Oral Motor and and more. Brittany has experience working with adults as well as pediatric populations. She's been working in outpatient pediatrics for the last nine years and she's passionate about what she does, especially with her work with breastfeeding mothers and pediatric feeding and swallowing. She loves forming lasting relationships with her patients and families.

Welcome to the Untethered Podcast. I am your host, Halle Balkan. I'm a certified myofunctional therapist, feeding specialist, PODC 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.

Foreign.

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 health care provider.

Brittany, welcome to the podcast.

Hi. I'm so excited to be here. Thank you for having me.

Of course I'm excited to have you here. I know we were just nodding a bit before hitting record, but I want you to share with everybody you know. You know you're a speech language pathologist, feeding therapist and more. I want you to kind of share it with everybody, like who you are, how you know where you started in the feeding world. I know you've got PEDs and adult experience. Tell us the whole history and kind of like how you came to even find like feed the peds. Go all the way back to the beginning.

All the way back to the beginning. Oh, my goodness. So my beginning was almost 12 years ago, so I started in the adult world. I actually knew in grad school I had a desire for pediatrics, and pediatric feeding was always a place of interest for me. So trying to figure out where and exactly how to move coming out of grad school and to find those positions, I was very lucky enough that the university I attended for graduate school placed me at CHOA for one of my externships. And so I got a little taste of the pediatric feeding world there. And as I continued on in my clinicals and just trying to discover what I was going to do and how I was going to move, I ended up moving into adult skilled nursing. So I still had the feeding component, but it was on the adult side and was still in the medical field. And I was there for almost two years. And then a position opened up in Macon, Georgia, that's where I'm from, for a pediatric slp. And I jumped on it. So I went in for the interview and I was like, I have all of this experience here, there. I did the externships here. And one of the questions they actually asked me in the interview was, do you have pediatric feeding experience? And I said, I do in the externship, but not as that being my primary role as a clinician. So I was very fortunate that the outpatient pediatric rehab that I ended up at and that I'm so still at right now was like, well, we will provide you some training under our therapists. So I took that position and I have now been in the world of pediatrics for nine years, pediatric feeding for eight years. And they gave me some training. And then I went on a deeper dive. I took other courses to gain more knowledge. And then I would say it was around 2019, towards the end of it, the 2020, when I found I stumbled across, truly stumbled across, it was a God thing, Feed the Pete's course. And I was like, I need this. This has all the pieces I need to move forward with this. So I took your Feed the Peds course and I was like, it makes everything make sense. So I had great mentorship at my position, but just your course made it all click and made it all make even more sense and gave me a good foundation. And then after I got done, I was like, I want more. I need more. When is more coming? And I was telling my co workers about your Feed the Beads program, as well as one of my good friends, and she ended up taking Feed the Peds. And during all this process, I'm doing other things. I became a certified breastfeeding counselor for those mommas that need support because I found that that was a huge area of need, especially because at our program, we see 0 to 18 years of age. I see them straight out of the nicu and so many mamas want that opportunity to breastfeed and want that opportunity to give that support. And they. There wasn't enough resources there, in my opinion. So I was like, how can I further my knowledge so I can be a better support for them, not only as a feeding therapist, but to help them on that breastfeeding side as well? So I've been able to go get that certification and provide support there. And while all of this is occurring and I'm treating feeding patients and I'm also doing language, all of the, you know, all of the avenues of what the SLP covers, which is a lot, my friend contacted me and she said, did you see Hallie's email? And I said, her email? No, I haven't seen an email. What is it? And it was the friend that I had actually told about your Feed the Peas, and she had recently finished your program, and she's like, she's going to do a certification. You've got to look. And literally that same day your email came through and I was like, this is it. This is the next that I wanted. This is the next piece. And, and. And then I had that one on one phone call with you, and I was like, this, this is what I need to not only take it to the next level, but to continue to provide the support and everything that my kiddos need and to be even a better therapist. So that's how I ended up at your doorway yet again for another program.

So I love it. I love it. And I love that you got that email too, because we apparently have been having, like, email deliverability issues that we did not realize last year. So as we were sending out some of these emails, like, people were not necessarily getting, like, even one of the mentors has a friend who's taken Feed the Pizza a couple years back, and she, like, saw her recently and she was like, yes, she had no idea that you were doing the certification. I was like, what do you mean? She's on our email list. And she's like. She said she didn't get any of the emails. I was like, well, we're fixing that, so hopefully now everyone's getting our emails. But. But yeah, it's so funny. I was talking to another one of the members the other day too, and she was like, you know, she was like. She was also in one of the earlier cohorts because we launched the first time in March of 2020. That was the first course we ever offered to feed the peds. And now we're. I think we're in course 17, about to go into course 18, which is, like, wild because we only do it three times per year. So I'm like, oh, my gosh, this is so crazy, but exciting all at the same time. But, yeah, I remember some of, like, the earlier students were like, hey, what's next? Like, are you going to do a certification? Are you going to do this? Are you going to do that? And that's kind of where I got the idea. It was because everyone was asking for it. They're like, there isn't a pediatric feeding certification that exists that, like, will really help us get that deeper dive. Like, yes, there's, like, you can get certified in different courses, programs, you know, things like that, but not, like, a comprehensive pediatric feeding certification. I was like, okay, that. That's accurate. I was like, and this feels like.

A lot of work.

I don't know. But I was like, I feel like, you know, when there's a need, there's a way, right? So when there's a will, there's a way. So, yeah, it took us several years to kind of put it together. I think I was telling Sami or one of the other members that I chatted with on a recent podcast that we just. There were many iterations of it before we actually launched it, and it kind of evolved into what it is now. But our big goal was how. Just, like, be the pizza. It was like, how do we functionally create something that actually helps y' all get out there and, like, get that deeper dive of knowledge, get more experience with patients, get the mentorship while you're getting that, and really, truly help you all feel like, like, I mean, obviously, none of us know everything, right? We're all lifelong learners. But help you feel like you have that advanced level of knowledge and those advanced skills to help these children, where you really are, like, able to come up with ideas kind of on the spot. And you're like, oh, maybe I should try this. Oh, maybe I should try that to the point where you can now also mentor others. Right? And maybe educate others. And. And so I know that's not everybody's goal to, like, go and educate and create courses or anything, but just being able to educate other providers or families, caregivers, you know, I just. Yeah, I've had several people tell Me, like, the graduates, you know, from this, this first round, be like, I. I have just. There's so many doors that are opening now, like, that I didn't even anticipate, and people knocking on my door asking for X, Y and Z. And I just was, it was just fascinating to like, start to hear these things that are happening. And I'm like, this is so exciting because really, at the end of the day, my ultimate mission was to get kids off feeding waiting lists. And I'm like, I can't do that by myself. But if we can help bring information to y' all and like, help you help your patients, right? Like, we can all reach more together holistically versus, like just Hallie staying in her private practice, treating day in and day out. And so I was like, I just feel like we're getting, we're getting more kids off of those feeding waiting lists. We're training more therapists. And it just makes me so happy.

Yeah, it's absolutely amazing. I attended a alumni, kind of, everybody get back together and see what you're doing. Check in for my graduate school. And I just, I raved about your program. I was like, just please let the, you know, the students know that are about to graduate, if that's where they're interested. And I spoke to the swallowing instructor and I was like, she said, I remember you, you had such a passion for feeding the babies and you wanted to do that so badly. And I'm so happy to hear that you're living out your dream now. And I said, I am. And I want you to know and please share resources, because there are resources out there that are wonderful and that make you feel prepared as a clinician to move forward.

Well, thank you for that. I appreciate that. And, and it's interesting too, because, you know, in my brain I'm like, we should have these conversations with myself, I'm like, why do they not have more pediatric feeding courses? Like it is 20, 25, 10 years ago, 15 years ago. They didn't have them in most programs. And if anybody had it, it was maybe like one three hour lecture on pediatric feeding. Like, you're not learning anything in a three hour lecture. You're like getting your toe wet. Like, you know, you're like dipping your toe in. It's. It's such a disservice to these little ones. Like, there's such a need. And it's just, it's still mind blowing to me. Like, I think we can count probably on two hands how many programs actually have pediatric feeding courses. In their graduate level program. And that is so highly concerning and sad. Yeah, I mean, I had a dysphagia course, but. And it was with like a world renowned slp and like, she actually did surgical procedures on like the whole, you know, swallowing system and everything. And she was phenomenal, but it was all adult focused. And, you know, I know you could probably speak to this better than me because I never really, outside of grad school rotations, and I never worked with adult feeding or swallowing. Yeah, like, it's night and day, right?

I mean, yeah, it is totally night and day. And when I sat for that interview at the place that I'm now at, the outpatient pediatric rehab, and I said, well, I have swallowing with adults. That was one of the. Well, that's two different worlds. And I was like, I know, but I have swallowing with adults. I promise I could. But I mean, I was eager to learn. And I mean, it is. It's totally night and day. And when we've had. We are very lucky at the time, same facility that I'm at, we've had patients see patients, you know, for a long time, a short time. But through that, we've had students come in that have been able to see and get that intro into that pediatric sweep feeding and swallowing, and just telling them too, when they haven't yet had that adult experience. I'm like, it's night and day. I can tell you it's night and day. And with adults, you're rehabbing a skill set that they already had and there's a desire there to gain back what is now missing or slightly different. Whereas with pediatrics, they never had it right. Or they didn't get that time in utero that they needed. And they're here super early and now they're trying to figure out even just how to be in the world. Yeah, yeah.

So no, I love that you pointed that out too, because even, like on the myo side of things, a lot of people talk about neuromuscular rehabilitation. And I'm like, we are not rehabilitating when we're talking about pediatrics. Most of these kids did not have the skills. And then, I mean, yes. Are there cases where they had skills, they lost them, and we need to rehab. Absolutely.

But for a lot of our little.

Feeding kiddos, they never, like you said, they never had the skills. They never. Or maybe they didn't have the opportunity. Were they preemies? You know, whatever the case may be. Right. They didn't have them. You're teaching them something for the first time. And yes, kids are, you know, their brain is plastic and, you know, not plastic, but there's neuroplasticity. Right. And it's like, you know, they're. They're learning new skills. Skills all the time. But that's also part of the issue. They're learning new skills all the time, and we're asking them to learn some more. And, like, how much energy do they have to really take? Eating takes a lot. Takes a lot of energy, but it's also one of the most important skills we have. So it's. Yeah, it is a very challenging but rewarding, you know, space to exist in, especially with pediatrics. So I love it.

That's what I loved about your courses, too, that just even with Feed the peds, you got that foundational piece that you took us from start to a certain age and just looking at it and learning and realizing too, that there's so many foundational concepts and pieces that these babies need before we can even get spoon to mouth. Yeah. So I just love that that foundation piece was there and then now you're building upon it with this new program. Say.

Yeah, well. And it kind of dawned on me. I was like, most courses I was taking, look, look, they're great courses, but a lot of them didn't really talk about what happened in utero. They didn't talk about what was missing. Like, if we don't know what's expected. Right. What typical development. Typical, you know, what's actually typical, but, like, what typical development looks like, how do we know what we're working towards? How do we know what those foundational skills are? And so I was like, we need to go back. We need to go from, like, conception to birth to when we expect that child to have developed all their feeding skills, which is generally around 36 months of age. And, you know, we know most kids are not always going to be around that. It's. It's a range. But, but I was like, if, you know, if you're working with an older pediatric kiddo, we still have to go back to, like that birth through, you know, in utero, through like 36 months and see, okay, what do we have? What's missing? What do we need to support, you know, in order to really actually help them feel safe and develop those skills needed to, you know, break food down and swallow it. So, yeah, I was like, I just, I just. It felt. Felt almost so simple, but not at the same time because there's so much information and it's highly medical and, you know, so we make it sound so simple when we talk about it, but it's in. It's involved. It is involved. Yeah. Even I get people who are like, well, I'm not working with medically complex kiddos. I'm not working with NICU babies. I'm not working. I'm like, but are you working with children? Because they all go through development, number one. Number two, you may not be in the NICU or working with a new NICU grad, but did you check the medical history? Was that child in the nicu? Because there's a lot you need to know if they were. So that's still part of their medical history. And it's been interesting, too, because I've had a couple conversations about the CPFT and the NICU course in particular, where some individuals were like, I had no idea what I didn't know. And taking that NICU course, it was not necessarily on the top of my personal list of courses to take, but it became one of my favorite courses because it just helped me understand what's going on. Even one person was like, I might want to work in a NICU now. And I was like, well, that's cool. You know, so we're hearing things like that. And it's, again, just having this more holistic knowledge. Even if it's not directly related to, like, what you're doing day, day in and day out, I can tell you it's still connected. There is still a connection. We still need that information and that knowledge.

For sure. I completely agree with that.

Yeah. So have you been in a NICU at all, or you've all. You've always done, like, the outpatient rehab?

I've always done the outpatient, but we have a very relationship with our NICU SLPs, and I actually got to go for a day and spend a day in the NICU and see what they're doing. So just to get that. That piece, because like I said, they literally, once they're released, they're referred to us. So as soon as they're ready to come out, I mean. And, you know, some of those babies, even though they've spent months in the NICU, come out with an adjusted age of 0 days.

Right.

So I. All of the courses, I will say, that are in the CPFT program, I could not get enough of any of them. I feel like they just all. Like you said, it's very holistic. It gives you all of the different perspectives. But in all of these pieces, too, to help you kind of look at. Oh, wait a minute. I do need more knowledge in that. That was really interesting. Oh, well, I can shape this. I wasn't even thinking about that or applying that yet. And which I think is a great thing too, as a feeding therapist. We're always learning. Yes. Always learning as a feeding and swallowing therapist and always trying to gain that more knowledge. And I just. It was just a great approach, and every piece of information helped me in some way and changed how I do therapy.

So I love that. Amazing. So, okay, so you had a really great mentorship experience when you started out, right? So you got very lucky because I know that can be really hard to find. So you've had that mentorship. Now are you in a mentor position at this point? Like, do you mentor others or how does it work, like, where you are?

So I have the opportunity, when we do have schools contact, to mentor a student once they come in. So I definitely based on the experience that I had and just seeing how wonderful. I had the wonderful Shasha Cheryl Pelletier. I had her. She was beautiful and wonderful and great and positive, and just seeing and watching her mentor style, too, like, gave me some good tips and some confidence to feel like I can now take that role on definitely at my facility if the opportunity arises. So I'm very excited for that.

Yay. And I think that's so cool because I just feel like there's so much gatekeeping in the pediatric feeding world. It can be so hard to find mentors. And, you know, I was like, how do we infuse them with all the possible knowledge that we can possibly infuse them with and give them some, like, really amazing mentors who are experienced in the work that they're doing, but that also are. They're good mentors, right? Because, like, you need somebody who kind of understands what it is to mentor. And that's where I feel like we've had, you know, different. There's different people who have worked in my business, for example, who are really great with, you know, answering questions in a Facebook group, but maybe, like, they don't have the skill set to, like, mentor, you know, in a different way. And so we were really, like, looking for people. And I remember when Shasha and I recorded a podcast together, I was like, ah, all right, We. We need you. We need you. I don't know how, but, like, we need you infused into what we're doing, some in some way, shape or form. And I was just kind of telling her, yeah, we're creating this and we're thinking about that. And she was like, I would love to be a part of that. And I was like, okay, because she's definitely one of those, like, beautiful brains where, like, you say something and she's got, like, all these just therapy ideas, like, and she's, you know. But anyways, yeah, go listen to the podcast with Cheryl. She's amazing.

She is. She's wonderful.

She's just a ball of energy. Love her. But it's. It's really cool because there's different mentorship styles, too, and I think it's just a mat. But it's a matter of also, you know, not just having the experience, but understanding how to mentor somebody. And again, I just think it's so hard to find people even willing to mentor out in our field at times, so. So I love. I love that you had that when you started, and I love that it's kind of coming full circle for you too. Yeah.

She was amazing. And I will say, even from the first night of introductions, she made me feel welcome, all of us feel welcome, and just immediately was like, tell me what you're having difficulty with or give me one thing that you want me to help you with. So from right off the bat, she was ready to go and jump in and give guidance and support, and I appreciated that so much. So taking that time, not only to get to know each and every one of us in our backgrounds, but that's the great piece of the mentorship that this program offers is she not only listened to that, but she asked, okay, well, give me one thing. And then before we even got off the call, she was like, I'll have something for you before we meet again. So to even have that just. I was like, I'm supported. Yeah.

Yeah.

Yay.

I love that. I love that so much. And there's definitely, like, different shapes of, you know, support throughout this program and everything. But from, like, okay, so from, like, the knowledge that you're taking away, because you also mentioned that the courses, you feel like they. They gave you some new knowledge. Is there anything that, like, comes to mind where you're like, oh, that's like, a recent thing I did in a therapy session, or, oh, this gave me that idea. Like, was there anything that stands out to you as being, like, something you've added to your tool belt or. I don't know.

Well, definitely. Shasha did some food strategies for the kitchen strategies, and I took away a lot from that as to how to just integrate some of those ideas into my sessions. And then she talks a lot about scant flavors and all of these different ways to incorporate or change the food in different ways as well. That, I'll be honest, had never even crossed my mind. So. And just some food items too, that she was like, do you know that this is actually this kind of food and you can make it look this way and it can be. Then you can change it into this and the texture changing. And then this is why you can use this and that and just different perspectives and tools to use. I mean, she talked about using two small, shorter straws and different ways that you can incorporate those. And I will say I was like, wow, okay. I never even thought about that. I mean, I've taken some other feeding courses. I've taken sos and those give you great ideas too as well. Sorry if you hear bumping and clunking. I have a cat. She's excited to introduce herself today.

Cats are welcome.

But just giving those different perspectives. And I literally would leave after I watched that and then talk to her in my mentor sessions or hear her ideas, would leave and have something to implement the next day. Yeah. So just. It was just amazing to have that piece.

That's amazing. I love that. And then has. Have you connected like with others in the group? Do you feel like you'll stay connected with others in your group afterwards? Like any networking happening? What's happening? What's that look like?

Yes, I believe we're all. I actually created our group, a text message group for just our little small group. But we had all discussed, even in our big, large groups, how can we keep in touch? How can we continue to have a way to network with each other or contact each other? Because we're all going to have different experiences and approaches and just having that resource and that support. And I would say the ladies that are in my group, all the ladies in the course are wonderful. The ladies in my group are awesome. And we all come from different backgrounds and different settings. So I think we all feel like we have a good support right there too, just in our small group to lean on each other and to seek out more advice.

So I love that. That was one of our goals too. When we created this. We were like, we want everyone to find at least one other person that they can like get really close with, link arms with. And when you walk away and you probably remember me, I might have said this, like on our call when we were chatting, like, I want you to have that like feeding bestie where at any point you can text them after the eight months and you can just be like, hey, I got a case da Da, da, da, da. Like, I'm a little stuck. Or what do you think about this? Or any thoughts? Because it's like sometimes if we can just get out of our own heads and, like, have that chat with a colleague, it just kind of gets like the wheels turning again and we're like, oh, yeah, okay. Oh, great idea. Like, oh, and let me take, you know, great idea. And then now I have this idea. And so it's just being able to bounce ideas off of each other and talk about tricky cases or check in on certain things that, you know, that I. When I was going through a certification, my MYO cert, there was no support zero mentorship. It was promised. I got none. And I ended up linking up with Autumn Reed Henning, who teaches the TOTs training course, because we were going through it at the same time. And that's why she and I became like, besties. And so now it was like, I was like, I want that for everybody else. I want everybody else to have that person that's in their specialty that they can connect with whenever they need to. And so I'm like, like, so, so very happy because it sounds like everybody has found at least one other person, if not their entire small group to stay connected to. And so I love that for you guys.

And I love the opportunity too, that this offered. Like, in my group, my small group, it's not just speech therapists, it's OTs. So having that connection there with an OT as well, just having that variety and those networking opportunities, because we all have different perspectives and bring those different things to the table. So this course is definitely just given not only a lot of knowledge pieces, but a lot of connection pieces with other people. So, yeah, it's a great opportunity.

So awesome. So awesome. Is there anything else you can think of that you want to share with us either about the program, your experience, anything along those lines?

I will just say that it. For those that may listen and are questioning whether, should I do it, should I not do it, do it. It is worth it. And it will expand not only your knowledge, but just your support group and the mentorship. You can't get anything like that anywhere else. It is absolutely amazing. And to have that opportunity to discuss cases not only with your peers, but with that mentor who's been doing this for years upon years and get a different insight. I mean, it's. It's just an amazing experience and it's worth every bit of it, and I've truly enjoyed it and just see how much it's changed me as a clinician and helped me grow. So I'm very thankful for that and can't praise your program enough.

So thank you, Brittany, and congratulations because you guys are all like, officially graduating too. So this will. This will go out after you graduated. But. But we have a little. A little graduation party coming up on Monday night, the Monday after we're recording this. And I'm just excited to see y' all because it's like I talk to every single one of you before you ever enroll to help you kind of figure out like, is this the next best step for you? And now it's like, we've come full circle. We're on the other side of it. And I'm like, you guys did it. I feel proud.

Yay. We did it. And we were the first group. I'm going to wear that with a. With that's badge of honor right there is. We were the first group.

So, so good. And because you guys were the first group and we were like, be, you know, show us a little grace. We'll show you. Show you a little grace. Although I feel like on both sides it was smooth sailing and all things were wonderful. We as we've created additional courses. We told like the first group and we're telling the second group too, because we're still looking into whole, like, we're still working on the whole accreditation thing. And that is. That's going to be a couple year process that we're looking into. So we were like, for this first couple of groups, you guys are going to get like all the bonuses if there's like any additional things we throw in for future groups, like, we're just going to keep adding it to your. Your portal, like you're gonna do, you know, when. When those things get dropped in. If we create more courses, which we are creating more courses and the other bonuses, all that kind of stuff. So stay tuned for that. I'm actually creating this, like, a couple smaller things that I think would be beneficial for you all as well, because they're more like resource based, which will be like super cheap for the general public, like, to buy. But it's like such valuable resources. So those will probably be popped in there for you guys in the next couple weeks too, because they're. They're pretty much done. We just have to like wrap it up, tie it with a pretty bow, and I have to record a couple little videos to go with them. But yeah, so much more fun stuff coming.

Yay. I'm excited.

Well, thank you so much and yeah, congratulations.

Thank you.

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