Screen the Peds to Feed the Peds

Your— that window. Hmm. Hmm. Okay. Wait, how do I move to the— I'm in a practice session. Alright, hello everybody. We're gonna give everybody a chance to join us. I see everybody entering the room. Okay, I'm gonna go ahead and pin my video. Yay! Say hello in the chat. Just as a side note, only myself and my team will be able to see the chat. So you're not going to see each other, but you'll see notes from us. Good morning. Hello, everyone. Tell us where you're joining from and let us know what your profession is. Do we have SLP, SLPA, OT, CODA, PT? Hi, Kristen and Tricia, Deepa, Danielle, Corey, Karina. Kara, Laura, Lynette, Samantha, Hannah, Jesse, Michelle, Tina. Oh my gosh, I could read all of your names all day long, but that will take a while. All right, I still see some of you rolling in, so we're going to give it just one more minute and then we'll get started. But continue to share with us where you're from, your profession, say hello. Oh, I love seeing we've got people from Canada, all over the US. Amazing, amazing, amazing. Okay. Okay. Looks like we still have a few people rolling in. There's over 400 of you here so far. Exciting. Love this. One more minute and we have a Q&A at the bottom. Hello, everybody. Yes, so make sure that you're saying hi in the webinar chat. So we've got 2 different areas. There's the webinar chat, and then there is the Q&A. We're going to use the Q&A as well for some Q&A after. So if you have questions that come up during that you want me to answer after, happy to do that. Side note, we can't dive too deep into cases for various reasons, um, because there is over 400 of you here. But make sure you're, you're, um, not going to the where it says Q&A at the bottom, but you're actually going to the webinar chat where it says chat. So click on chat and say hello there. Okay. Oh my gosh, you guys are still rolling in, so I'm gonna give it one more minute and then I promise we're going to join— or join— get started. Happy Monday. All right, I'm going to close the Q&A for now. Perfection. All right, so I'm going to invite you all to drop your thoughts in the chat as we go today because I am watching and what you share actually directly shapes what I'm going to dive deeper into this week. Okay. So what I want you all to realize is this is not like a one-way lecture. Okay. I am teaching you. I am here on the screen, but we're interactive. I want you all participating. I'm going to be teaching based on what you're actually seeing and needing as far as like mentorship goes right now. Okay. So you're in the right place if you are an SLP, an SLPA, OT, CODA, PT, or related provider, and you want to confidently, right, Screen your first pediatric feeding patient. We're going to do that today, and you'll be able to go and do this for homework with a patient of your own. Um, and if you're ready to have a little fun and you just want to feel good, you want some empowering, uplifting, um, you know, community here, that you're in the right place. Okay, you're going to have a 3-day info-packed experience, and I just welcome you to be open to everything that we're going to share and be, you know, hang out with us here in the chat. Um, I am Hallie Bulkin. I probably should introduce myself before we go any further. I am a speech-language pathologist, I'm a certified pediatric feeding therapist, and a certified myofunctional therapist. I'm also a podcast host, founder of Feed the Peeds, and mama of 2, plus I've got my fur baby. Um, but honestly, before all those fancy letters and certifications, um, all those titles and everything, right, I'm just a clinician who spent way too long about like being scared of feeding cases. And honestly, I was afraid that I was gonna do the wrong thing, right? And I'm guessing some of you know that feeling. And here's the thing, I look at this group of— how many of you are here? Almost 500 of you, or 494. Wow. And you know, you all showed up live today, and I know you're not here because your schedule was wide open. You're here because there is a kid on your mind. Maybe it's your own child, maybe it's someone on your caseload, um, maybe somebody referred feeding case and you, you wanted to say yes, but you didn't feel ready. Maybe you've been avoiding it for months, or maybe you're just tired of feeling like feeding is this mysterious thing that only the specialists can touch. Okay, I get it, I was there. Um, but over the next 3 days, we are going to change that, not just for you, but for all of the, the kids and their caregivers, their families who need us to step up, right? Because here's what I know: there aren't enough feeding therapists out there, and the kids who need us, they just, they can't wait for all of us to feel like 100% ready, right? So I am inviting you to do this with this community. Let's do this together. You, me, this amazing group of clinicians that are here who are brave enough to show up and learn. All right, does that sound good? Okay, let's, let's dive in. We're gonna go over a few housekeeping things first because it's day one. Um, the team is going to drop any links that you need into the chat as we go through today, but I'm also to walk through a couple of details here that I think are pretty important, okay? We are using our free pediatric feeding screening packet that has been downloaded over 122,000, like, like 122,040+ times. Crazy, absolutely insane, and I love it because that means that more of us know that we need to help these children, right? You're going to need it for the training starting today. Okay. So what I'm going to do is screen share real fast with you where you can get it. And if you don't have, if for some reason you're like, I can't access that, or you're just having trouble accessing it, we're going to drop a phone number that you can text and the team is going to personally message it to you right now. Hopefully this is not crazy town because there's over 500 of you on this training, but you can text 207-481-4413. All right, and the team will send you a copy. Now I'm gonna, like I said, I'm gonna screen share real fast so you can see which page you need to access it. Okay, so this is the page you're going to want to have on your desktop all week long. Um, you're going to want to make sure that you have— okay, so as we go through here, right here's access to the private podcast series. Now we're actually dropping some extra bonus episodes for you on this, so pay attention to it this week. Um, we started with just 5 short episodes, but we're gonna drop a couple extra bonus episodes for y'all. Um, so just be aware of that, but you're gonna be able— and inside the screener, and the reason why you want this screener, okay, this is the one, if you can see in my window, that I'm talking about. You're gonna want that because it gives you access to the milestone chart that we're gonna go over today, as well as the other pages that we're gonna go over the rest of the week. And again, you can download that here. Let me find where it is. We have it available in multiple languages. Do, do I scroll? Scrolled right past it. Okay, so here's your screener packet. Okay, you can get it in English, Spanish, French, Portuguese, Russian, and there are more coming, so stay tuned for more. There's also on this page scholarship opportunity information down at the bottom and all the details on how to enter that before Thursday at 1 PM. We have needs-based and non-needs-based, so just stay tuned. We will definitely go over— I'll go over some of those details with you shortly, but I just wanted to make sure that you all knew where to find that. Okay. All right, so go ahead and type a yes or a no in the chat if you have or have not downloaded that screener. Now that we've given you all access to do so, I'm just curious to know who has it. Okay, lots of yeses, a couple of not yet. All right, so one more time, you can go to this right here. The team will link this for you in the chat, feedthepeds.com/screenthepeds. Sometimes you need a www in front of it, the internet gets a little funny. Um, So make sure you've got that and the text message again in case you need that is 207-481-4413 and the team will send it right to you. Okay. All right. So the other thing I want to do is I want to invite you to join us in our Facebook community. The team is going to drop the link for you in the chat as well. Hannah, I'm glad you got it. Yay! So many of you also, just as a side note, have grabbed the VIP option, which I believe Oh, well, the team's going to instruct you on how you can get that. Oh, here we go. Right here in the middle. I was like, I know it's on this page somewhere. It's such a silly low price, but this is— this just covers the expenses so that we can make sure that you all can have lifetime access. Okay. For those of you who want lifetime access to this week's training, you can still access that. But we are— this price is going to basically— and this option is going to disappear today. So make sure you get it if you still want it. You'll get access to today, tomorrow, and Wednesday's trainings. And real quick, as a bonus for those of you who showed up live today, I'm going to pop out of the share so I can see you all again. Um, I am going to do a quick little giveaway right now. So I want you to tell us in the chat which of the following trainings you want in on. Okay. And we're going to randomly choose a winner. If for some reason you get the one that you already have, because I know some of you already have some of these trainings, then you'll get the other one. No big deal. Um, so type a 1 for Tongue-Tie Bootcamp and type a 2 for Quick start feeding? Ooh, so many. All right. So the team is going to pull a name and let me know. We're going to give you all a moment because like I said, there are now, there's like 573 of you here. So we're going to give you a moment to all enter. And by the way, if you guys stay until 1:00 PM today, you're also going to get the bonus that we promised you when you signed up for the training, which is my recommended feeding tools guide. You're going to get that for free as well. Okay. So lots of goodness and tons of bonuses just because we all, We like to love on you guys. All right. So as that's coming through and as we wait for the team to draw a winner, let's recap. And team, can you guys check the Q&A as well and make sure that we move any— you guys are already doing that. I don't even tell you. Okay, I can see. I can see you're on it. All right. So just getting some of my electrolytes over here. All right. We're going to take a peek at the page that I just unshared, which I'm going to actually want to pull back up the two videos because I just want to remind everybody where to find this as well. And I know I personally was in the DMs with quite a few of you going through like, hey, you know, welcome. Did you get access to this page? Have you watched the two videos yet? Great. Have you seen the private podcast? That was me in my Instagram DMs. I wanted to actually make sure that you guys got it because in the past sometimes people were like, oh, I didn't have time to watch the video. So just a little extra encouragement so that you're ready to go today. Um, because in video 1, so if you're like, what videos are you talking about? Right? All week long, the recordings are going to be up here and they're going to stay up here through May 10th. Okay. May 10th, Sunday. Then if you want the lifetime access, they disappear and you need to get on that today because that option is going away soon as well. We will put all of the recordings right here on this page. So this page has every single thing you need for this week. Okay. So to watch video 1 and 2 that was already released, we click that button, it pops us down to it. And right here you can see the first video, which I'm not going to play through, but you do see the screening with Mia, right? And so you watched me screen her, a typically developing kiddo with pretty Typical feeding skills, right? And so we then moved on to the next video where— whoopsies, hold on, it just went full throttle on my page here— where you watched Lily. And I'm just going to play through Lily for a second so you guys can observe a little bit of her screening. We're going to be using this, this all week, Lily screening, right? And you saw her eat part of her dinner. You were invited to use a screening packet to screen her to your best of your ability, because I know this is new for many of you. And this is a video, like I said, that we're going to refer to all week, okay? If you haven't watched it, please watch it today, tonight, whenever you get a chance before tomorrow. And I want to just put out a reminder, when you do an actual screening, it takes a couple of minutes. We're using these longer videos. We're doing a longer training for teaching and learning and application purposes. But in real life, this takes like 2 to 3 minutes max. Okay. All right. The last thing I will say, because I always get questions about it and I don't want to waste our time on Q&A later about scholarships, but if you look here at the bottom, you can click through to read about the scholarship that actually ended today. That was on Instagram. Anybody not on Instagram, no worries. We've got scholarships 2 and 3, and they are partially needs-based as well, but everybody has to participate. Okay, we will announce the winner for this first one later today, so stay tuned for that. 2 and 3 You'll collect 3 hashtags. You're gonna get one per day today, tomorrow, and Wednesday during the training. You're gonna collect those. You're gonna complete the screening packet, and you're gonna submit the 3 hashtags, the screening packet, through a link that we're gonna drop to you on Wednesday at 1:00 PM when we're all wrapped up with the 3-day training. Okay? Thursday at 1:00 PM, the submissions close. So it's 24-hour window only. Okay, so again, to qualify, attend all 3 days, Monday, Tuesday, Wednesday, or watch the recordings. Grab your, your hashtags, submit that along with your completed screener. Okay, and then for needs-based, you also have the opportunity to demonstrate financial need. So please read through all of this. I'm not going to read it here, but read through it and submit everything that we're requesting. Otherwise, we cannot consider you for needs-based if we don't get everything that is listed in the instructions. All right. Um, okay. And all that information lives right here on this link, the feedthepeds.com/screenthepeds page. So if you need anything at all, it's right here. All right, so let's pop back out of here. So we're going to share the screener in a few moments, but first I just want to talk to y'all for a few moments. I got such great feedback from these videos, right, on Instagram, and some of you who are talking to me in the DMs. Um, you guys have been a little bit quieter inside the Facebook group. That's okay. Uh, but there are a lot of ahas shared, and it really seems that the incidence and prevalence of feeding disorders from that first video that you watched in our developmentally delayed kiddos came as a big surprise. Um, others shared how simple and quick this screener is and how awesome it is to have a milestone chart, which we're going to go over soon as it relates to Lily. Um, and, and I still have her video playing here. Hold on, let me just pause that because I squirrel distractions. Okay. Um, what was I saying? You guys, some of you shared how simple the screener is, how quick it is, how it's awesome to have this milestone chart. And somebody pointed out that they really like this to be able to share it with families. And yes, my friends, that is the entire goal, right? And so when I say the milestone chart, I'm talking about this one now. In yours because we've updated it, it's going to be a little bit bluer. There's not going to be any green on it anymore. But the beautiful thing about this is like, let's say that you're working with a 12-month-old, and this could be a kid who's adjusted to 12 months because maybe they're 18 months, but— or not 18 months, they— let's say they're, they're, um, actually 14 months old, but they were born 2 months early. Their skills are actually at a 12-month-old level. We would still adjust there. Or they're actually 12 months and functioning at a 12-month-old level chronologically. Cognitively, right? So we look at where they would— where we would expect them to be around 12 months, and I fold it in half and I say, you see this? This is what we're looking at for your kiddo. You see all this? Ignore that. It's such a great visual to have, and you can laminate it and just use another piece of paper to just, you know, kind of COVID it up. So I share that because this tool is something that I personally use in practice all the time. And I think, again, it's something you should laminate and stick on your wall. Okay, you're welcome. Um, another thing that has been shared is that some of you didn't realize how much of a lack of feeding therapists there are out there, and that how this population is majorly underserved. And that is why my mission in the beginning was to get kids off of pediatric feeding waitlists. I was like, there are just too many kids waiting and they don't have the time to wait, right? So Anyways, before we go further, I also know from speaking with some of you that there have been some barriers to entering the pediatric feeding world. So I want to put up a quick poll. And in doing that, let me just find that here to share. Hold on. Where is my poll, guys? All right, Fiona, are you able to put up the poll because I don't see it. Where's my chat? Oh, thank you. There it is. It disappeared for me. Usually I can launch them. So what has been your biggest barrier, right, into entering this world of pediatric feeding? Is it lack of time or mentorship, or fear of getting it wrong, accessing the right tools, not enough clinical experience? Go ahead and vote. I'm not going to be able to see the results, so I'll have the team share them in a moment. But, um, Team, once we get— usually I try to get everybody to vote, but once we get at least like 80% of the people that are here voting, then we can close it out. I'm going to continue until we get all of your responses and the team will let me know. Oh, well, while we're doing that, I can announce our winner from our giveaway. So Jennifer Smith, you are our winner. And yes, Chrissy, this is a free training. There is, there is no fee for this 3-day training in particular. Monday, Tuesday, Wednesday, completely free. If you want to upgrade to the, um, the VIP, which gives you lifetime access to this particular training, then you can pay a fee, but you don't have to. That's totally up to you. You are so welcome. And there will be some sensory in here as well, Lynn. Okay. So each training is technically 12 to 1 PM each day, but I do stay after to answer questions after 1 PM. But if you're just looking for the actual training itself, I keep it between 12 to 1 so that you all, if you have to hop off for sessions, you can go, and everybody else is welcome to stay if you don't, if you don't want to hop off. All right, we're at 70% complete, so stay tuned here. Oh, here we go. Okay, so the team is going to go ahead and— oh, you didn't see the poll. That happens sometimes. Okay, so the other thing, um, Fiona, because we only got like 440 people, so I think Fiona might be doing it on my team. Um, next time, can we share— there's a way to share like a link or like a QR code that they can screen in the chat. I've had to do that in the past. Um, I don't know why, for some reason it doesn't show up all the time, but okay. So interesting. Lack of time, 17%. Mentorship, 41%. Fear of getting it wrong, 39%. Access to the right tools, 31%. Not enough clinical experience, 55%. Okay, well, I have to like— let me, let me like reformat my brain for a second because I was going to talk to y'all about Time, but only, only a portion of you feel like time is the issue here. All right. While we do that, we're all going to center ourselves. I want to give you guys a tool first before we pivot our little chat. And this is something we call— I call it smell the soup, cool the soup. And it's a breathwork exercise. This is really great for you, but it's also really great for feeding sessions because it's going to connect your breathing with oral motor awareness. And I, as we go on this week, you're going to learn I'm a big proponent of nasal breathing and not so much mouth breathing. But there are times where we want to off-gas, like, right? It's okay to go to let air out of our mouth, and it also brings awareness. So because it's purposeful, it's not something I use all the time or all session long, but I might do it like once with a kid. Okay, um, all right, so 60 seconds to calm our nervous system so that we're learning from a place of focus and not frazzle. So I want you to put your hand in front of your mouth like you're holding a warm bowl of soup, and I want you to inhale slowly. I'm going to demonstrate, and then we're going to do it 3 times together. I want you to inhale slowly through your nose like you're smelling the soup, and I'm going to count to 3. We're going to go, and then we're going to exhale gently through our mouth like we're cooling the soup. On a count of 4. Okay, we're gonna do 3 rounds together. You ready? Okay, so inhale slowly through your nose like you're smelling the soup. 1, 2, 3. Exhale gently through your mouth like you're cooling the soup. 1, 2, 3, 4. 2 more times. Inhale slowly through your nose, 1, 2, 3. Exhale out, 1, 2, 3, 4. One more time. Inhale, 1, 2, 3. Exhale, 1, 2, 3, 4. Okay, so this is just a quick, playful an evidence-based exercise that you can use with the kids who are struggling with feeding or even knowing where their mouth, their tongue, their lips, their jaw exists, right? Where is it on their face? Um, because this pairs with regulation and it pairs with oral awareness, and it's also a really great reset in your own day when you're jumping between sessions. Right. If you could just do this between kids, like as you're— maybe you're walking to go and get the next child that you're going to treat in the waiting room at school, in your home office, maybe you're in the car driving to them. This is— you can have your eyes open, right? So this is something you can do while you're walking, while you're driving. You just— okay. So I want you to go ahead and just type a little yes. In the chat if you feel even 1% calmer. Yes. Amazing. Is that a great way to start a Monday? I love this. Okay. So before we dive into Lilly's milestone chart today, we're going to spend a few minutes on something that I think is just as important as clinical content. Like I told you guys, I was, I was going to talk about time and how we don't have a lot of time and how we have to make time. But I'm going to change that because I want to talk about what you all are telling me is the biggest concern, and that's your level of clinical experience. Okay. And I want you to be honest with me here. What's the hardest part about feeding cases for you right now? I want you just to drop one word in the chat. What is the hardest part? Like, I know some of you said sensory. Um, I see knowledge. It could be oral motor. It could be babies, like working with babies. Like, what is that thing? Okay, parent co— vomiting. Yeah, oral motor, babies, scope of practice, sensory, parent buy-in, time. Okay, time and preparation, safety, access to care team, G-tube and avoidance, fear of choking, refusal. Yeah, sequencing the treatment plan. Okay. Yeah. Amazing scope. Okay. Link with oral motor difficulties and avoidance of variety of foods. All of the above. Yes. Okay. Amazing. I want to call it what it is. Okay. It's not that y'all don't care, right? It's not that you're not trying. A lot of you don't— are basically telling me you don't feel like you've had enough real experience with these things to be confident and feel like like, okay, I feel safe in my own body to go and help these— in my knowledge, right? And in how I feel to go and help these children. So when I paint a picture for you, let's say you finish today's training and you're like, okay, that makes sense. But then you get that real patient sitting in front of you and now you're second-guessing, right? Wait, is it sensory? Is it motor? Is it both? Am I missing something? Should I refer out? What do I— what if I do the wrong thing? So you go to Google, you ask in the Facebook groups, maybe you're even opening ChatGPT. Be careful, it hallucinates. We can't really trust everything on there. But let's say you do all those things and you still fully don't trust the answer. Now fast forward a year, same questions, same hesitation, same feeling of, I feel like I should know this by now. Like, which version of you do you want, right? Because here's what most people won't say out loud. You don't need a ton of more information, right? A lot of you need that clinical guidance, that guided clinical experience. That's the difference. And obviously we need some information, right? Information is still very helpful. Um, but if we just consume and consume and consume more and more and more information, without someone to help us apply it, without that mentorship, without getting the clinical experience, without the community, without being a part of the movement towards helping these kids and their families and our communities, right? Yeah, it doesn't— the needle doesn't move forward. That's, that's the difference. I took 10 years to feel truly confident in doing all of this work. Please don't do that. Don't be me. Don't be me. I took a decade and that was between 2009 and like 2019. And why was it that long? Because even though I was out there and I was becoming specialized, I was still questioning myself. And it's not that I wasn't learning, but I was still piecing things together. And that's the point where I, I finally was like, I got it. I figured this out. And this was really hard and I don't want other people to have to experience this. So because it took me that long to feel like I pieced everything together and I was like, oh, one course here and a random CEU there and trying to apply it on my own. Right. I just, I didn't have a clear path. That's what I realized. And I had no real-time feedback. I tried to pay local therapists to help mentor me and like crickets, nobody, nobody would help. Like what is with the gatekeeping in this space? That goes away. No more of that. Right. I had nobody telling me or saying like, yes, this is it. Like you're on the right track. Hey, have you considered this? What about that? Right. So the confidence took years for me to build. And here's what I realized. The confidence didn't come from like watching more trainings and taking more notes, which is what I was basically doing. And which is basically how education happens. It came from doing the work. With support, right? So what would it feel like to actually know what you're doing? Not guessing, not hoping, but walking into a session and thinking like, I've seen this before. I know what to look for. I know what my next step is. Or, you know what, I think I'm going to try this. Maybe I'm not sure 100%, but like, I'm going to try this because I have enough knowing to know that like, okay, I've got some tools in my tool belt. Like, let's give something a try. Let's give it a go. Right. That's not talent. That's not everybody knowing more than you do, right? It's actually developing pattern recognition that is built through experience, which is what you all are telling me is like the number one thing that's holding y'all back. And that is exactly what most clinicians here appear to be missing. So if you had the right mentorship and hands-on guidance, what would change for you clinically? I want you to drop that for me in the chat. With the right mentorship and hands-on guidance, what would change for you clinically? Comfort, confidence. Okay. Better real-life examples, build confidence, feel more comfortable trying. Yeah. I'm seeing a ton of confidence, reduce anxiety. Yeah. How would— yeah. Okay. And how would this make you guys feel if you felt more confident? I know confidence kind of seems like a feeling, but like, um, like when you're working with these kids, like we want to feel confident, but like is there another feeling that comes up? Less stress. Yeah, like you offer your families, families more. So much lighter. You'd be a well-rounded therapist. Well, you're— Mariah, you're gonna include feeding screenings in your screening and your sessions and your assessments this week. It's gonna happen. Calmer, happier, relieved, less anxious, capable and making a difference, valid in what I teach to parents. Oh, you guys, this gives me chills. Empowered, like you're making a true impact. Like, I'm getting a little teared up here. Like, this is useful, like a true expert. I love this. There's 57 more that I haven't even read yet. I'm gonna read them all later. I absolutely love this. Because here's the shift: you don't become confident before you start. You become confident because you start with the right support, with the right people, right? With the right community. And that's what's missing so deeply in all the work that we do, the community. And that's what we've been creating here for the past, like, 5 and a half years. The clinicians who I see actually grow, they decide, I am done figuring this out alone. I'm ready to be guided. I'm done with guessing. And it's like, guys, it's okay to guess once in a while. You're taking like educated, right? Moves forward, but you're not like out there on Dysphagia Island by yourself. And they also decide a lot of times, like, I want to collapse years into months. Like, that's what I wanted to do. It took me 10 years. And I have figured out a way to help condense that for you all into like 10 weeks. Insane. We'll talk more about that later this week. So ask yourself, where will you be a year from now if nothing changes, right? You're still going to be learning, but not doing. So I want you to picture this instead. You're the go-to feeding therapist in your area where you work. I don't know if that's a school, if that's an outpatient center, rehab, private practice, um, you're home-based, you're in early intervention, or like wherever you might be located, you are the go-to feeding therapist in your area. You trust your clinical decisions. You're not crowdsourcing every case anymore. You still have community, you still have people to talk to and fall back on, but you're not having to ask every single thing to a Google or a ChatGPT, right? Or a random Facebook group that you don't know, like who's in that group, right? And if they can actually help you, um, because you didn't just learn, right? You got the experience, the experience that you were missing, the experience that I wish I had back in 2009, 2007 to 2009, when I was in grad school. And this, this is your invitation into that next level. Okay. We're going to keep building this together over the next few days. But just know this, the clinicians who succeed, they stop waiting to feel ready and they start building experience on purpose. Okay. So what we're going to get into now for the rest of today is the— and oh, I have to give you guys a hashtag. So I had one that I was going to give you, but we just pivoted. So let me think, let me think about what the hashtag is going to be. And I'm gonna have to write it down so that I remember this. It's right. Well, the team will write it down. Forget I got the team here. While I'm thinking about that, we're gonna jump into choosing ourselves today and not a year from now. Okay, let me give you the hashtag so we can move on, 'cause we're gonna jump right into the milestone chart and I don't wanna forget about it, especially for those of you who have to like leave right at 1:00 PM. How about— I was trying to think of something with the word movement. Let's just do #LetsMove, hashtag let's move, because I want to invite you all to be a part of this movement. And so together we're going to move, we're going to move forward today and we're going to talk more about this movement. So the hashtag is #LetsMove. Okay, team, grab that for me. So I remember later in this week what came through my brain at this moment. I can't tell you why that came through really. That's just the hashtag. All right. And you all are worth that, right? You are worth investing in yourself time-wise, right? To, cause I know some of you are struggling with time to be a part of a movement that helps both you and the patients you work with and the families you're working with and the community. That you're in, right? It's what it's all about. Okay, let's pivot. Let's move to the milestone chart. I'm going to dive in. We're going to review Lily's developmental and feeding history. Now, you're not always going to have all of this information. Um, video— that video that was there, that is the one that, uh, I showed you before, if you remember, with Lily's screening. That's the one we're gonna be talking about. We're gonna match what you all saw to the milestone chart, okay? I'm not going to show you mine. I should not do that because give all the answers away before you have a time opportunity to, uh, interact here. Um, if you have to go at 1, I just want to give you real quick, and I'll review this again at the end, but real quick, your homework if you have to go at 1, and we'll be wrapping up like with the, the clinical side then, is to complete Lily's screening packet. Okay, take notes on what you see, what's standing out to you, what needs further evaluation. How do her jaw, her lips, her tongue, her cheeks and the sensory processing that you're observing, how does that all impact her feeding? Okay, I have a bonus challenge for you guys too. If you apply this in real life and you go screen a kiddo even though you haven't learned everything yet, you'll get entered into a bonus giveaway this week. Okay, um, so don't worry about the details on that, more to come, but I just wanted to really encourage you all to go out and Complete the packet for Lily, right? Fill out the screener for Lily tonight. And then if not today, Tuesday or Wednesday, you're going to go out and you're going to screen a kiddo. Definitely tomorrow by 1 PM, you'll be ready to go into a screening. Okay. We're going to make sense of all of it on Wednesday. But the screening part, you're going to know how to do by 1 PM tomorrow. Okay. So quick. Well, I'll tell you guys this later. Well, I'll tell you a quick story. It's coming up for me. And then we're going to jump to Lily's case history. Last time I ran this challenge, I had an OT message me after day 1. It just like was popping into my mind, so I want to share this. And they shared, I've been avoiding feeding cases for months because I didn't feel ready. And after just going through the milestone chart they were about to go through, she screened her very first kiddo. She said it was so much easier than she thought, and she was like, I can't believe I waited this long to start doing this, right? So that's the kind of like movement we have going here. That's kind of momentum I want for you. This isn't about adding more work. It's about giving you the tools that make your work faster, like more efficient and clearer and more impactful. And it's something you can build into the time that you're already spending with your patients, whether you're assessing or treating. Okay. All right. So a little background on Lily's case history. And again, you're not always going to know this information ahead of time. Um, And don't forget, if any questions pop up into your head as we go, you can drop them in the chat. If it's something not directly related to this though, go ahead and put in the Q&A and the team will save those Q&As for me to stay and answer after 1 PM. Okay, I am really curious though, and it's totally okay if your answer is not yet. Have you screened Lily using the screening packet, the video, video 2? Type yes or not yet in the chat just so I can see where we're at. Okay. I've got a mixture, a lot of yeses, a lot of not yet. Okay. I don't know if this is 50/50, but that's kind of what it's looking. Okay. So amazing. Super. All right. Beautiful. Here's the background. Not a full eval reminder. We usually get this in a full eval, but I'm going to give it to you since we're doing a training. And because Lily is actually my daughter, I can give you the full scoop. So she was 4 in the video that you guys watched, and she's now 10 and a half years old. Yay! So I know all the things about her, and I keep using her case because it's just, it's a good one. And that's why I love using it as a learning tool. So her journey starts in utero. I was being monitored really closely by maternal fetal medicine. So we had lots of sonograms. They told me I had a heart-shaped uterus. Yay! And they were actually concerned that I was not going to go full term with her. They kept saying that they wanted my cervix to stay like long and strong, which it did. Funny story. When I talk about tongue ties and like healing post-frenectomy, my patients have no idea about the backstory, but I always go like, I want you guys to heal long and strong. And I always giggle a little in my head, but they don't, they don't know the background before, between, you know, or behind that. Anyways, it did stay long and strong and Lily was in no rush to leave the womb despite all of the best, the best efforts to induce labor. She was super comfy in there. I decided I was never inducing labor again after that and didn't with my second one, went into labor naturally. Whole nother conversation for another day. But man, if anybody wants to talk about that in the Instagram DMs, feel free to DM me because that was a whole experience in and of itself. Anyways, they nearly induced her early because her brain was absorbing all of the nutrients and her belly was not growing as expected. And she was fine. She ended up being fine. But to this day, she's like just a kid with a tiny waist. Right? And as an infant and toddler, I could barely keep leggings on her. I think the Cat and Jack brand from Target, like, that was all, that was all that worked at the time. And if you guys remember, this was 10 and a half years ago. So our options were kind of limited. A lot more options now. Labor and delivery took about 24 hours from induction to birth, but she arrived healthy. We had breastfeeding challenges from day one. Okay, she struggled to latch. I was in a lot of pain. With nursing, hospital lactation came. I even went to an IBCLC at my pediatrician's office. Everyone told me it was normal. It was not. Things got concerning kind of fast because she dropped a significant amount of weight while we were still in the hospital and we had to go straight to the pediatrician the day we got home for a weight check. And they told me to supplement with formula until my milk came in. Here's the kicker. My milk was in, but I didn't know. And Lily just really was not able to latch or suck. Effectively. So I gave her one bottle of the ready-to-feed Similac that night, which turned into what feels like one of the worst nights of my life. Like, it is still etched in my brain. She was screaming in pain. I can barely, barely move from birth, um, in my own healing, and I was bouncing around trying to soothe her, sobbing alongside of her. My mom was like, I don't know how to help you guys. And I was like, I don't know how to help us either. We called the pediatrician in the morning and they're like, oh, 'Let's try Gerber Good Start because that has just one milk protein and the Similac has three.' But I was done. I was like, 'Nope, the formula is not working for me. I'm going to figure out how to pump and feed her if I have to and breastfeed her.' And I just was not willing to feed her more of something that had her up screaming for like 3 hours straight. It was exhausting and very sad. So I donated the formula and I decided We're going to make breastfeeding work because I'm stubborn and I really didn't have a lot of support. And that was just the decision I made. So I pumped and I nursed and I pumped again and triple feeding and all that fun stuff, right? The milk bar was always open. She would feed on one side while I pumped on the other. Like, it just was constant. Eventually she accepted the bottle, but only for me, not my nanny. And that was stressful because I, you know, I had a private practice and built this practice so I could be around for my children. And so I made very flexible work hours work. Seeing patients so that I could feed her. Um, but get this, she never grew over the first percentile her entire first year of life. And the pediatrician said it was okay because she was staying on her own growth curve. I also saw another lactation consultant who repositioned her into like a football hold and voilà, she fed beautifully once in the office. It's like when you take your car to the shop, right? And that mystery noise just stops. When the mechanic starts testing it or driving it, and then you drive back off the lot or out of that mechanic's, you know, place, and there is a noise again, but they didn't see it or hear it. Yeah, they also told me to, um, strip her naked and spritz water on her, and I was like, we're done, no thank you. So fun. Anyways, at this point I usually have people telling me, and I see this here, like, that's exactly what happened to me, I— from Sarah, that is, and Tricia. Yeah, I see some of you. Yeah, I see some of you sharing this. This is usually the point where I go, I have some mama therapists in here being like, same, same. And I just want to tell you all, this is not typical and you are not alone. Okay? This is part of my mission is like to have people realize this is not helping anybody. This is not, it's not helpful to tell parents this is a normal part of breastfeeding. It's not. It's not. Anyways, so we started solid foods. We went to purees. We progressed to the family foods we're all eating. She was doing great eating what we ate in toddler-appropriate shapes, forms, sizes, everything, right? But then at 15 months, she had 5 vaccines in one day and she had a terrifying reaction. We don't know which one she reacted to, but she vomited like violently in her sleep all over her crib and her wall. It was kind of horrifying. She had had baked chicken and baked fish. Fish that day, and she refused. To this day, she still refuses baked fish, but we have her eating chicken again, or any type of fish really. Um, so I don't know whether it was a trauma response or a change in taste or GI sensitivity. I don't know, but everything changed after that. Okay, have you guys seen this happen? Like, have you seen a kid stop eating a food due to a traumatic experience like vomiting or choking, right? What was the trigger? Like, share if you're comfortable. I'm seeing yes, lots of yeses. Yep, lots of yeses. Yeah, choking incident. Yeah, vomiting in their sleep. Yeah, yep, vomiting, choking, NICU stay. Yeah, there's a ton of things that can lead to this. That was you as a kid. Yeah, so you get it. Yes. Yeah. Anyways, let's keep going. So she was a belly sleeper, often with her butt in the air, which we know to be a red flag for tethered oral tissues like tongue tie, lip ties, and airway. Hello. Hello, tripod sleepers. Um, basically she's opening up her airway and I can answer questions about that later. But you know, the video that you watched, that was only the second ever like chicken tender that she ate since that 15-month-old. Experience. And she still avoids most chicken. She'll eat some today, but she had had one a couple of days before and I kind of bribed her. I was like, can you show other kids how you eat your chicken tenders? We can make a video about it. Like hashtag mom bribes. It's not actually your hashtag. Sorry, don't use that. I was like, it's for the other kids. And she was like, yeah, like very into making videos at age 4. Anyway, so fast forward to 2017, took my first Intro to Mayo course, learned about tongue ties, raced home, checked Lily's mouth, Boom, posterior and anterior tongue tie. One of the worst lip ties I'd seen attaching like deep into the alveolar ridge. Have you guys had a moment where you go to like a course, you have this like aha moment, right? Where you're like, ooh, this client, or maybe your own child, just say aha in the chat. It's not a chicken tender, it's a chicken nugget. Yes. Yes. Thank you for that reminder. Yes. Lily was very sure to remind me of that. Anyways, we went to the ENT who refused to treat her because she wasn't nursing anymore, and that experience was super frustrating, but also eye-opening. Hi, I know who you're referring to. Um, it gave me a lot of insight into what a lot of parents go through when they're finally seeking help and then they get dismissed, right? So then we went to see the oral surgeon. He agreed the tongue needed to be released but not the lip. And at 18 months, she couldn't drink from an open cup. So I was like, haha, joke's on me, feeding therapist mom. Yay! Um, but she could drink from a straw, so she primarily drank from a straw cup until we finally mastered open cup skills and stopped dumping it all over ourselves. Age 4, she started in an ALF appliance, which is an Alternative Light Wire Functionals, and I can share that with you guys this week as well. She had it both top and bottom arches for a slow expansion. She did really great. It's a gentler form of expansion that keeps the palate open, which is also nice for like keeping the tongue up in the roof of the mouth where it's supposed to live. We'll talk about that too. She wore that just until after her 5th birthday. And so if you notice something in her mouth in the video, that's That's what it was. Okay. Her before and after pics are amazing and I've actually shared them over on my Instagram. So if you go to my Instagram, you check out like the Lily TOTS and the Airway highlights there. It's under all of them. Um, anyways, if we have time later, remind me and I will pull up the CBCT, which is the CT scan where you can see her before and after from expansion. It's really cool. All right. So that was a lot. Now that you know Lily's backstory, I want you to sit with something for a second before we go over this. And this part does doesn't take a ton of time. Um, I'm a feeding therapist, right? I know the red flags, I have the language, I have access to providers. And even with all of that, it took years to connect the dots for my own child and get her the support she needed. So that's my experience. What's happening to the parents who don't have this training, who don't know what questions to ask, who are told like, let's wait and see, right? They're told that one more time and one more time and one more time, right? That's why we're here. Every time you screen a kid, every time you trust your gut and you recommend further evaluation, every time you advocate for a family, you're filling a gap that shouldn't exist, but it does. And the kids, they can't wait for the system to fix itself. Okay, so here's what we're going to do with all this. I mentioned your homework, right, already, and we're going to review that first. We're going to go through the milestone chart, and then we will come back into, um, the homework. All right, so let's go through it. Pull this milestone chart out. I'm going to pull it up and screen share on the screen in case any— I know some of you said you were having trouble finding it, you're getting it, the team can help you with that. Here it is, and let me see if I can make it, yeah, a tiny bit smaller so we can see the whole thing. Beautiful. All right, so who is not familiar with what these different jaw movements are? The phasic bite, the munch chew, the diagonal chew. Anybody here know what it is or not? Let me find my chat again. Hold on, I am like a bunch of messages away from the bottom here. Okay. All right. So I have my little mouth model that I'm going to show you. So hopefully you guys can still see me as well. I'm pinned, so I should be up there. Okay, cool. So the phasic bite is basically if you think of like an up and down, you get a little, little guy here. Okay, so I'm going to put this in front of my face. It's a bit bigger. Phasic bite is that up and down rhythmic motion. It's reflective. It's that vertical pattern. Okay. And it's when the jaw movement is driven. Sorry, guys, I'm just moving the chat over for a second. It's when the jaw movement is just primarily open, close, open, close, open, close. Okay, so it's that primitive reflexive pattern that babies have at birth. We don't see any lateral movement, we don't see any cross, you know, crossing the midline or anything like that. We see it in early feeders, kids, sometimes kids with oral motor delays. We'll talk about sensory-driven biting patterns, but, you know, maybe they're chomping on utensils, right? But really, that phasic bite, we should only see it between 0 to 6-ish months of life, which is then we move into the munch-chew. It's still vertical, but now it's more controlled and intentional. And this is the same time that we introduce solids. So this is very intentional as to why 6 months is the recommended time in addition to other skills that we want them to have, right? So this is more like voluntary, more rhythmic, and it's the beginning of true like chewing development. Okay. We might see a little lateralization, but not typically. Sometimes the jaw is staying here. Sometimes it's moving with the tongue. We might see it move around a little bit. Um, but typically the primary pattern is that up and down movement. Okay, so toddlers that are learning to chew sometimes are still doing that. And if you look here, the diagonal chew should start to develop around, uh, like it's really around 9-ish, 9 to 12 months. Okay, we sometimes see it a little bit earlier, but 9 to 12 months. Some kids skip over diagonal, go straight to circular rotary, which is the next thing that we're going to talk about. So the diagonal chew is we just go down to one side and back to midline. We do not cross over. That's it, right? Otherwise, we move into the circular where the jaw is actually making a circle, right? So we're going down, around— sorry, we're going down to the side and then across midline, right? And we've got an actual circular rotary. Just kind of means circular, right? So circular rotary too. Does that make sense? Type yes or yes. No, let me know in the chat. Awesome. Okay, so diagonal. Someone said, can you say, can you explain diagonal? Down, over, and back up to midline. So they're kind of going to the diagonal, to like one side, after they open the jaw, but they're staying on one side. We could do the same thing to the other side, right? So the diagonal is literally just go down and then across and back up on a diagonal. Okay, so it's basically almost like a half of the chew, but not like we're not crossing the line, and we're chewing just on one side. We've had a lot of one-sided chewers, but Most of them tend to munch on one side. They're not really doing a diagonal. So that rotary chew starts to develop between like 9 to 12-ish months of age. And then we really expect them to have it mastered by 3 years, by 36 months of age. Okay, that's a really big window for them to be developing that. Some kids skip over that diagonal and go straight from a munch to a circular rotary, and that's okay. We don't like them always skipping skills everywhere, but that in this case, it's fine. Okay, let's move on to the lips. So, so if you're chewing gum and you're just chewing it in a munch, someone said, is that like an adult chewing gum? Depends how you chew. Some people move in a circle, some people go up and down, right? The circular one is basically just, right, you're going across midline, right? Maybe you start going down, you open, and then you go to the side and you cross over. Right. But you're literally making a circle and you're crossing midline. The midline is that like imaginary line down the center, right? You're crossing over that line, whereas with the diagonal, you're not. You're stopping. You stop when everything comes back together. You go down, you know, down, out and back up, down, out and back up. We're never crossing over to the other side. Okay. That's the difference. All right. You are so welcome. That's an important one to spend a few minutes on because everyone kind of gets a little— Okay. Now the lips. The lips are a little bit easier to explain without so much demonstration, but we basically expect the lips to seal at birth around breast or bottle nipple. We need them functioning, you know, and closing, and it's going to move as one unit, meaning it moves together with the tongue, the cheeks, the palate, right? So the lips are, they're all working together for breast or bottle feeding for the first 6 months of life. And then we start to see more active lip movements, meaning like we might see like, ooh, or, you know, they'll move from like a, like smacking the lips together to pursing the lips a little bit or even using the lips. Like, watch this on my model here. Which comes next? Stripping food from the spoon, right? 9 to 12 months-ish, we go like this. And that spoon, just so you know, when we're feeding babies, we should never feed up and Swipe, we should be feeding in and out, right? So the lips are going to close, help clear the spoon, spoon comes out. Okay, so the lips are meant to clear the spoon. They're supposed to help with that. And we start to have improved lip closure around 12 months of age, right? And when I'm talking about that is like more improved lip closure if they're like taking a bite, they're clearing the spoon as we know, Maybe it's around a fork, maybe it's around a straw, right? That's when we also see straw drinking develop better. And then around 12 to 18 months of age, we expect the jaw-lip-tongue dissociation to happen. What is that? That is where our jaw, our lips, and our tongue start to work independently of each other, right? So for example, I will ask a kid who's a little bit older to lateralize their tongue. And when I ask them to come touch the corner of their lips, watch what happens. They go like this. See how my jaw is moving with my tongue instead of holding it still? And the only thing moving is my tongue. That's dissociation, right? So we actually expect that around 18 months of age. I can tell you most of the kids we work with do not have that. We'll talk more about that this week as well. Um, okay, chewing with lips closed starts to develop around 18 months of age, and we actually expect kids to have that by 24 months of age, but most of them are not doing it until well past 3 years. So I'm a little bit— if that's like the only thing they're not doing, I'm looking at why, but I'm not gonna just put a kid into therapy just because they're not chewing with their lips closed. Um, but I'm also looking into mouth breathing and other things that might be happening as well that could be preventing that. And we're going to talk more about that this week too. Tomorrow, especially, we're going to spend a lot of time on our checklist tomorrow. All right. Let's talk about our tongue before some of you have to hop off at 1 o'clock. So the cupping, right? So the tongue cups. What do we mean by that? Look at the shape of the tongue here. Do you see how it's kind of like a, like, think about like a taco tongue, right? When you guys ever, anybody ever do that where you made like a taco shape, that's like cupping and babies need to be able to do that for the breast or the bottle nipple. Let me grab a bottle and show you. For the breast or bottle nipple to actually fit right around the nipple. So I'm showing you guys here on the screen, right? That way the tongue can help to pull the milk from the breast or bottle nipple. It's that simple. Okay, we have to be able to do that from birth and really it continues onward, but we just kind of ended it. It doesn't end at 6 months. Anybody breast or bottle feeding is going to continue to have that skill. Um, protrusion and retraction. So we expect the tongue to start pushing forward and retracting back, right? By 6 months of age, that starts. They really, they really get that, you know, around 9-ish months or so. Um, it's really nicely mastered. And then around 12 months of age, that's when we expect that tongue to start lateralizing and moving side to side. Okay, so left and right, right? Like I was showing you before. But a lot of times it's okay. They're going to move their jaw and their lips. Everything's going to move together as one unit. Okay. We don't expect kids to sweep food from their lips and like truly clear their lips until they're about 18 months of age. And it's like 18 to 24 months or so. And then the proper way to swallow is to have our— and we're going to talk more about this too. And I got my big ol' mouth model here to show you guys. Okay. We want to swallow with our tongue up. Right. Lips together. Lips are obviously not together here, but tongue should be up. And that means our tongue tip is up during the swallow. And why is that important? We have to seal everything off. So if you can, like, suction your tongue to the roof of your mouth, you do what we call— we're creating negative pressure. Negative pressure is mandatory. It's required for us to swallow. Properly, or swallow it all really, right? So we can do that with our mouth open. If you're able to suction your tongue, you get a little saliva on your tongue, you suction your tongue to the roof of your mouth. I have an appliance in my mouth, so it's hard for me to do this, but you should be able to do that with your mouth open. Now we're not asking the kids to do that, but I'm just proving a point here. A lot of our kids are not doing this. They're pushing their tongue between the teeth, against the teeth, or between the lips to close the space, create that negative pressure to properly swallow back, because their tongue is not up on the roof of their mouth. Where it's supposed to be. Okay. So for those of you who have to jump off real quick, let me pop out of here. And I promise we will dive really deep into all the symptoms that you guys see on the, the checklist. You get the checklist and show you. So I just popped out of the screen share. Oh, well, I don't know where it went. Okay, well, I put it somewhere else, but I'm not going to show you this one because this one has all the, all the answers on it for what we're going to do tomorrow. But the next page has the 50 most common symptoms, and that is what we are going to be going over tomorrow. So get excited and stay tuned for that. All right. So let me see where we were at. We— I was giving you guys the homework, right? Just to review really fast, your homework is to— oh, and I guess team, go ahead and drop for everybody the giveaway for everybody who stayed the whole time. For anybody who has to go, it is my favorite like feeding tools guide. So enjoy that. We love it. We love it. We love it. And then your other homework, as I shared for you, is basically to go finish Green Lily if you haven't done it already. Okay. And, um, yeah, if you're feeling ambitious, go ahead and screen another kiddo that you're working with. Um, no pressure though, but would love for you guys to do that. Okay. Let me— and here's the bonus challenge, because I know I say that and a lot of you are not going to do it. Before you go to sleep tonight, I want you to think about just one kid that's on your caseload. And just one kid that you could help. Pull that milestone chart out and just think about where they're at. What matches? What feels off, right? We're not writing a full eval. You don't need all the answers yet, or at all, really. Just start noticing things differently than you did this morning before we went through that, that milestone chart, okay? Because the therapists who succeed are the ones who are taking action right away That's us. That's all of us here in this collective movement, this collective whole. I am having so much fun with you all. You all showed up today with questions and energy and willingness to learn, even when it feels uncomfortable or like you don't have all the experience. And that is what makes us all great clinicians. So before we close out, we're going to put one more poll up because I would love to know, like, what's been your favorite part of Day 1 so far? Is it that clinical experience? Segment that we basically just kind of went through, and we're going to do more of each day. And I promise we're going to spend way more time on the clinical stuff over the next 2 days. Today's a lighter day so we can go through some housekeeping stuff, right? Learning Lily's story, getting to use a milestone chart, feeling seen and supported, the smell, the soup, cool the soup, breath technique. Go ahead and, um, share that, and we'll leave the poll open for a moment. Um, team, if there's a way to drop the link there's a link that they could click on possibly, or a QR code or something that I've shared in the past to the chat, so that if they can't see the poll popping up, say, like, maybe have like a screen blocker or something, I know they're able to access it another way. We will be going into World Highs. Yes. All right, so that poll is there and going. And one last pop-up prize today, as I mentioned, is for everybody, right? So again, if you're here, you're going to get access to my favorite feeding tools. Yeah. Okay. So before you go and before— like, I'm going to stay for Q&A, but before you all go, if you need to hop off again, videos come down Sunday at May 10th at 12 noon Eastern time. Get the VIP upgrade if you want to keep all these trainings for the next— this today's and the next 2 days. The screener and milestone chart is at that feedthepeds.com/screenthepeds page, which the team just shared in the chat. If you showed up live, or if you show up live, I should say, all 3 days, um, and you show need— there's both need and non-need-based scholarships— you're qualified to apply for the scholarship. Um, you'll submit your screener, the 3 hashtags, and they have the completed screener and the 3 hashtags, and you have to be participating, right? Um, Thursday 1 PM is when that is going to— we'll open it Wednesday 1 PM, it closes Thursday at 1 PM, um, and then we will announce the Instagram scholarship winner later today, and this week's scholarship winners will be announced Thursday afternoon, both, um, on Instagram and via email. Okay, and if we have your phone number, we might text you as well. Um, I know we've been communicating with a lot of you over text. Tomorrow we're diving deeper. Get ready. Thank you guys so much for showing up today, not just for yourself but for all of the kids and the families and this community and your community where you live. Um, because they all need you. They need you. All right. See you guys the same time tomorrow. I'm excited. Keep— Kristen messaged Team Hallie. Can you help Kristen Bertolone? Bertolone? Bertolone? She's getting an error for the screening milestone chart. If you could help her access that, that would be amazing. Anna is saying the screening is not coming up for her either. Okay. If you guys are getting— that's really strange. Okay. There must be something. Must be broken. I guess we broke the internet. So It was working at some point because like I shared over 122,000 people, I think, or 120, whatever number it's at now, have downloaded it. We will make sure you guys all will email. I think we're going to— oh, I don't want to say that. Are we emailing out the guide team? Hold on, let me check with the team. Okay, the QR is not working for some reason for the poll, so Sorry if you got it, go ahead and type in the chat if you want for the poll. But if you're not able to comment on the second poll here, no worries. You can, you can share in the chat with us. You will get a certificate of completion on Wednesday when we finalize the 3-day training. Yes. If you want the screener texted to your phone, send the word screener and text 207-481-4413. Team Hallie put that in the chat for you guys. So if you can't get the screener, please do it that way. And then the favorite feeder, the favorite feeding tools link, guys, I think that's maybe not working for some people. The team will make sure you guys get it. You can also message Team Hallie and let them know you're having trouble and they will guide you. Okay, amazing. All right, so I'm gonna go pivot to the Q&A box and answer some questions. I am just— I'm just making sure that I didn't have a message from my sitter because I've got one kid at school and one kid homesick on the couch. Um, just, just checking in on mommy stuff. Okay, let's dive in. Okay, so this is a great question. So I'm an early childhood educator, um, Gwyneth, supporting families, so I'm not going to assess myself, but would Oh, I guess I closed out the poll by sharing that. Sorry, y'all. Um, I'm not gonna assess myself, but I would— I want to know like when to refer. Yes, amazing. Okay, so can you hang with us tomorrow? Because this is also something that I would love for our clinicians to do, our SLPs, our OTs, slippas, codas, PTs. Go out and like educate the educators, right? Educate the teachers. You guys are our first line defense to finding these kids a lot of times. And so I used to— my— not used to it, well, I'm not going into the private schools anymore, but I used to go into private preschools. My, my team still does. And honestly, that's how we found some of the kids that we need to screen further. We're like seeing them during nap time when dropping off another kid. And so it's one of those things where if you say tomorrow you're gonna have a whole host of symptoms and signs to look for So join us tomorrow, please, because then I think you'll know exactly when to refer. You're going to start noticing these things and be like, hmm, this kid needs screening, right? Okay. What conference do you mean? Like what training? Maybe what conference do you offer for treatment, not just screening, specifically what to do with 11 to 18 month olds who don't chew? They don't let you in their mouth. That some people call that no man's land. They are a tricky little bunch, aren't they? Those cute little toddlers. Um, Feed the Peets. So this is Screen the Peets. I actually do have a course, it's a 10-week course called Feed the Peets. We'll talk more about it the next 2 days. Um, we're actually going to give early access to those of you that are here if you want to jump in to secure your spot. So stay tuned for that tomorrow. But we dive into like full-on assessment because this is just screening and we need to also know how to Assess and diagnose and treatment plan and then treat, right? And so that is Feed the Peeds, um, and we'll share more about that. That is opening soon, um, and we go birth to 5 generally because that's, you know, where like that's the time frame that we expect all these skills to develop. And really any kid who's older who does not have those skills, it still applies to them because these foundational skills basically are what we need to address in feeding therapy. Um, so we got you. That's coming. All right. I'm interested to hear more about the sleeping position related to tongue and lip tie. Didn't know that was a thing. Oh yeah. So where do we begin? We're going to talk a bit more about airway with the symptoms tomorrow. And what ends up happening is if the jaw is a little recessed, right, the jaw sitting a little further backwards. So if you look here, the jaw's should match. The jaw is slightly back, right? You see how it's not completely lined up? Guess what happens? It pushes into the airway, which is back here. They, you know, your nasopharynx, the nasal region to the throat region. And what ends up happening is we can't breathe as well. And so the child will do things to try and advance the jaw forward. So if we put a baby on their back Guess what happens if they already have a recessed jaw and the jaw is— the mouth is open, they're mouth breathing, and the jaw falls further back? We have an airway issue. If we, if we don't have that issue and our tongue is suctioned up in our mouth lightly and our lips are closed, we're breathing through our nose, oftentimes the jaw will hold. And so sleeping on the back is not an issue. But in our airway kiddos, it is an issue. And so a lot of them will flip to their bellies earlier than you expect them to, number one. Number two, they will also position themselves in a tripod with their hands on their head, and then they'll have like their, um, their booties up because that naturally opens up the airway more. Thumb sucking, nail biting, sucking on clothing— there could be a sensory component, but it could be airway. As etiology. So just some food for thought. We'll talk more about this. Um, okay, so this came through. Not only that, but there's a ton of pushback from providers about tongue ties as a whole. I requested the procedure with 3 different providers before finally getting a referral. Frustrating. And I advocate other families take the doctor's answer and let it go and quit asking. Yes, it is frustrating because we know as providers, especially if you're in this space, how beneficial these procedures can be. Obviously, we need pre- and post-op therapy. Again, we can talk more about that later. Um, but a lot of providers don't actually know how to assess for function. And so we're looking at, is there a functional impact? Okay, we see tight tissue, but is it impacting sleep, breathing, feeding, speaking? And sometimes kids who get a lot of dental caries, like cavities, they're mouth breathers. It's not because they're eating too much sugar, the parents are not brushing their teeth well enough. So stay tuned for the mouth breathing conversation tomorrow. It is frustrating, I feel you. Um, okay, uh, let's see. For a kiddo with this diminished— sorry— lip closure, would you still not support by using an upward motion for spoon clearance? So that question is related to when I demonstrated this. Now I'm saying the spoon should go in and out, and she's saying, well, what if their lips are not like closed all the way? So in that case, what I'm going to do is I'm going to support the lips and then with the jaw. Okay, so I'll put the spoon in. Oftentimes it's more of a jaw issue than a lip issue. Now if there's like a lip tying, lip sitting too high, you can also support the lips. Okay, so it depends on the presentation, um, but We're not spoon scraping. Great question. Love it. Okay. Why no up and down the spoon? We just answered that. Love it. This was like such a question today. Fantastic. What age should a child drink? So most babies have water introduction somewhere around like maybe 6 months, but they don't really need it if they're on breast milk or bottle milk because they're getting the hydration they need. So some families will even wait till 12 months. Right. So I'm just telling you, like, what's happening out there based on what's shared, um, by pediatricians, etc. That said, oh, I didn't click to do this. Um, straw drinking generally— so my kids for straw drinking, like, at 7 months. My, uh, some of my peers will recommend 9 months, some will recommend 12 months. It depends on the kid's oral motor skills. Do they have the ability to round their lips. So adults, hi, we should— a lot of us bite down on our straw. And what you're actually doing is fixing your jaw. You're supporting your jaw. We should not use our teeth. It should— the straw should always be in front of the teeth with the lips rounding around it. I see a lot of adults going this. Hold on, that was really exaggerated. They don't have their tongue out. They go their tongue comes forward, that it rests on either their teeth or tongue, the straw does. And so what I want you to realize is a lot of kids are going to start doing that. Okay, um, we want to support them in moving beyond that. And so we'll often— and this is more treatment-based— but we'll often— I like short angled straws. Um, this is just like— this one's called MiniWare. This is one example where it's angled towards them. So if the straw was like this, they're going to have to dip their head down or they're going to tip the cup, right? If the straw is angled, they can bring it right to their mouth. Right. And so for me, you see me drinking out of my roommate here and I'm going— I'm actually having to— Okay, so do what I say, not what I do. This one brings it right to their mouth. They can drink through it, right? They can pull the liquid without having to tip their head, which is fantastic, especially for airway. And also this one's a little long, but we can— you can always cut it in silicone. Um, it's fine. There's other ones that are too long, but you can always get a Lip Blok, right? Because you want them learning how to use their lips to drink. So that's going back to the milestone chart. And the lips, right? We want the lips that improve closure happening by like 12 months, 9 to 12 months or so. So that's why people will say like 9 months for straw drinking. My kids, again, were doing it at 7 months. All right. What about finger suckers who can only move their tongue laterally to one side and cannot move their tongue up at all? Well, I would be looking to see, do we have a restriction under the tongue in that case? Finger sucking is also another habit that advances the jaw forward. So that tells me there is an airway thing that we might want to look into, number one. Number two, moving the tongue only to one side, right? And, or maybe sometimes I'll ask kids to chew on one side and you see they have an overdeveloped masseter muscle because they're chewing primarily on one side. That happens a lot. Um, yeah, I would be working. So I might do something like, and I don't like to go into too much treatment on here because I don't really know the cases and the kiddos you're talking about, but I'll tell you one thing. I would, if they're chewing primarily on this side, I would start— see what happens to my tongue? My tongue is naturally moving toward the side that I'm chewing on. So I would start doing some bite blocks on the other side. Free tip for you. But also like, let's do an assessment, a full feeding assessment. And like, as part of that assessment, we look into tethered oral tissues and see if there's tongue, lip, cheek ties, anything, or just some other tension. It might not be ties, but we don't know until we roll it out. "How can a child chew at 6 to 8 months if they cannot lateralize their tongue to form a bolus to swallow?" So first, let's think about this. Okay, so there's a whole like baby-led weaning movement, then there's like the puree movement, and then there's the combination of the two. I believe in a modified baby-led weaning. I believe we should combine the two. One, culturally, some parents want to be able to feed their child purees on a spoon. That's you. That's fantastic. Listen, we eat purees as adults, so I don't know why people are so anti-babies learning to eat purees. It's a sensory motor experience that they need to have. Okay, so now that I got that off my chest, um, that's number one. Number two, I also believe that babies and children should chew on hard things. Okay, so if you give them a hard celery stick or carrot stick or a bone, yes, that's okay. Or like a wooden spoon or whatever. That's good for jaw development. Obviously monitor them, make sure they're not breaking off anything and that they're not, you know, whatever, if you give them something wooden, it's not splintering. But we have moved so far away from supporting jaw development into like eating mushy foods that like only doing puree is problematic. Okay. And getting, 'cause a lot of kids get stuck there. So we need to be introducing the harder things, the harder solids and things earlier on. Okay. But you don't need teeth to do that. Yay! Because we have our jaw and that's bone. Yay! Um, and if they cannot lateralize their tongue yet, that a lot of them, what's end— what's happening, sorry, is they are putting food in and they're— a lot of them are mashing, right? Or that munch that's happening, remember? And they're gonna start to move from a munch pattern over. Now a lot of these kids in therapy don't move from the munch and they're 3, 4 years of age. So let's ask, Well, how do you do a munch chew with no lateralization and still form a bolus to swallow? They don't. Most of the time they don't. It's all over the place, right? Around 6 months of age is when we should start to be able to develop it. They'll chew on their sides of their mouth. It will kind of fall into their tongue. It might not be a perfectly formed bolus. They don't have all that control yet. That's okay. And they swallow. By 9 months of age though, they should have that. So just a side note there. Okay, um, so the lateralization really helps. That's also where we start to get into harder foods to eat, right? Uh, so hopefully that answers the question. It's a really good— I really like how you guys are thinking. Okay, you want to see, you want to see the CBC? All right, so let me— we answered this one with the spoon feeding, so I'm gonna Go to the next one. These screening videos can be found on feedthepeeps.com/screenthepeeps. The team can definitely link that in the chat, and I think they have, so definitely check the chat for that. Um, I need some good info to get the local ENT and orthodontist on board for the importance of nasal breathing. I have a family dentist on board 100%, just need the rest. Okay, so a dentist is probably half your battle, honestly, because there are some areas where we can't find ENTs or orthos. Yay. Does the dentist do airway expansion with like appliance work? Would be my first question. And then the way that we start to go out and have these conversations. So I look to see if there are any orthodontists who are promoting like airway screenings. Sometimes they do and they're not actually doing airway treatment. But a really great person to follow is my ortho, Dr. Koval. Koval. She's on Instagram. Um, her name's, uh, I think it's Koval Orthodontics or something. Um, but she— if you start to see what she's talking about, then you can start to see what other orthos are talking about. You can, you know, maybe share that with the local ortho and be like, hey, would you use any of these? Any chance to use any of these appliances that she's talking about, right? Or you do any of this work? Um, because it is really nice when you have an ortho who understands, oh hey, we're not just looking for lateral growth, We're oftentimes looking to grow the jaws forward and bring the palate down. We want to grow in 3 dimensions, open the airway. When we grow forward, we open the airway. So that's really important. It's not just about straight teeth, which is traditional orthodontics. It's really about opening the airway. And then by means of doing that, we can also work towards straight teeth with an appliance. And it can either be like an appliance, like a Rapid Palatal Expander and braces, but different than what a traditional ortho does. Or it could be that expander plus like Invisalign, which is what my kids are doing. And I can talk more about that this weekend. As well. Um, ENT is also a little bit tricky. First of all, there are not as many pediatric ENTs as you would think out there, and then the ones who are tend to be very— so I'm actually going to have an ENT on the podcast soon who's here in South Florida, Dr. Grobman. Um, we were talking about— I kind of grilled him. I was actually presenting at a conference locally and he was on an ENT panel right after I spoke. And I said, listen, you know, we send our families to the ENT and they get sent away all the time. And here's the deal and here's my questions and here's why families are frustrated. And he basically explained to me like, we have certain criteria to take out tonsils and adenoids. We have certain criteria for this, this, and this. I'm like, I get it, I do. But nobody explains that to families. And if we as therapists can have a better understanding, then we can also set families up to understand you might be turned away and told like, your kid's fine or there's nothing more to do or we're gonna monitor. And if that happens, here's the game plan, right? So that parents don't come away frustrated. I think a lot of it is like positioning to understand, one, what the ENTs are looking for, what they require to move forward with either medication or surgery, and then also being able to support our families beyond that. And yes, unfortunately, that falls on us to do that, even though it shouldn't. It does, because they're coming back to us and not going back to the ENT in a lot of those situations. Um, I will say though, a lot of families these days no longer want to have surgery done. They rather go through expansion with like an airway dentist or airway ortho and avoid taking out the tonsils and adenoids if they can because it's part of the immune system. So we can talk more about that as well. Um, I did not have to actually get Lily's, um, tonsils out. They were almost kissing. So I'll show you that in a moment. Um, how to check for a tongue tie— that is like, uh, it's more than just checking and exposing the tissue. It's an entire functional evaluation. So we We'll talk a little bit more about that this week, but the full thing is actually inside feed the peas. So that's not a quick, easy answer. Child cups her tongue when drinking from a straw, otherwise she eats well. Is this a problem? No, it's not necessarily a problem. You mean like she's just kind of going like— I would just make sure the tongue is— I don't know how old your kiddo is, but I would just make sure the tongue is not like out past the lips and it's staying behind the teeth. Um, and if you can support her to start learning how to drink just with her lips, that would be awesome. But beyond that, I don't have other details, so I can't really advise further. Um, how much am I looking at the children's grip on the utensils? So that is more of like a fine motor OT task, right? Um, we're often collaborating. I'm an SLP by trade, and we do— so in my course, for example, we have SLP and OT. So we're talking about all of it. But when I'm screening, I'm screening for feeding. I'm not screening for like the fine motor side. So that, like, if we had an OT doing this, the OT would definitely be screening for, you know, utensil grasp, all of that, and how they're stabbing the food and how they're bringing it to their face. We talk about all that in the course, so it's important. But on the screener, I'm typically looking more at the oral motor skills specifically, if that helps. Okay. Uh-uh. Okay. So discussing food textures and sizes by age is like a very deep dive into like getting ready for treatment. So we're not going to be talking about that here this week, but we do have all that covered inside the full course. Sorry guys, some of these things are like 30-minute conversations. So the questions have to be quick. They have to be something I can answer in a couple of minutes. "At 6 to 9 months, how far should they be protruding the tongue?" So the tongue should be able to go like just like really not far, like just to the lips. They don't even have to go past lips. They can, but we're just looking like, can they protrude? Like as an adult, obviously I can get my tongue pretty far out. We really don't need our tongue too far out other than, you know, licking an ice cream cone or something like that. Like how often are you sticking your tongue out at somebody? Like how often are we getting our tongue beyond the lips? Right? Licking the lips. They just, they need to be able to like clear their lips of food. So I look at the function to kind of figure out, is that far enough? And also at 6 to 9 months, right, they're not clearing their lips yet, but they will be doing that around 18 months or so. But just, you know, can they stick their tongue out? Because sometimes babies will smile and the tongue will come out and you're like, oh, that's so cute, right? That's functional. That's part of development. Can we do that? Um, okay. Can you discuss when a child should be receiving the majority of their nutrition from table food and not bottle? So 12 months is typically when we phase out a bottle and we move them to a straw cup and open cup. Now you can do straw cup earlier, like we talked about. Open cup can be done at any age. Open cup feeding, if for babies who cannot breast or bottle feed, is actually a tool that we use from birth. So you can, once the child is actually able to sit up on their own, even with like maybe a little support, but like they can sit up on their own, at least with like a tripod seating where they're like kind of supporting themselves with like their hands or just like one hand and you can move to a high chair and you can work on like open cup drinking, that's fine. And so let's say 6 months on average for that, where they're actually supporting themselves and learning to open cup drink and you're not just feeding them from an open cup. Like from birth, from as a feeding strategy. But as far as nutrition goes, by 12 months of age, that's when we're pivoting, like where food becomes a larger source of nutrition. Now listen, some people breastfeed until 4 years, right? Some people breastfeed beyond that. Culturally, it's different all around the world. And so kids are still getting a good amount of nutrition, but we do— there is a time and a place for food to be also a primary source of nutrition. And not have that as a primary source anymore, but still be offering that as an additional, you know, support, support, support, an additional type of nutrition. I don't know what word I was trying to say there. Um, okay, so hopefully that helps as well. Love to know more about how to go through with treatment plan for feeding after evaluation, get stuck creating goals and then progressing the plan. So we are talking screening this week. So anything like treatment and treatment planning, that's all going to be in Feed the Peeds, and I'll talk more about that. As well. Um, I'm grandma, my granddaughter feeding was a problem due to she is nasal fed. When can we do feed salt? So solid feeds, you'd have to talk to her team. That's not something, something I can guide on, especially if she was on like an NG tube or anything. Um, do you have specific courses for infants 6 months plus? So Feed the Peets covers that. Yes. Do you have 3 quick tips on how to break the news to parents that their child needs to be screened by an SLP when working with them in an early an early education, early childhood education environment, like preschool, nanny, caregiver. Yeah, I would just maybe say something like, hey, you know, when we're eating snack, I've noticed that they're doing this. And I can just say, I was, you know, I was trained on how to screen for pediatric feeding. And I've just noticed that they're not doing this, or I'm seeing this. They seem to really struggle with X, you know, either a certain type of food, or I'm noticing that the food's falling out of their mouth, like describe what you're seeing. Seeing and what your concern is, because most parents are not going to discount that. And you might say like, I would really love to recommend like a screening with an actual like SLP or OT or, you know, to the PT so that they can determine if there's like more going on that we maybe can help the kid with. So I'd like to really like sandwich it around like, oh, this is something really positive. Okay, here's what I'm seeing that I'm concerned about. You know, I was trained on how to screen for, you know, for pediatric feeding to know when to refer. And I would really, I just, I think I think it would be a really great idea if we could make a referral to, you know, have a feeding screening for this reason, right? Because a parent knows there's an issue, they're typically not going to ignore it. But also it's like they're kind of like, well, why do we need to do this? Right? So it's like you're telling them why, because I saw this and this was concerning and I want to make sure we can best support your child. So, right. If you have safety concerns, I would highlight that especially. Hopefully that helps. Let me know if that's helpful or if you still have more questions. Yes, the sleeping position is connected to mouth breathing. Yep. Okay. I have, I have both heard of the Replenish straw that trains tongue positioning and I have them. They sent them to me. They've also been on my podcast. I think in theory and in practice, it's a good idea. That said, I think it needs to be done under the clinical guidance of a trained pediatric feeding or myofunctional therapist, depending on the age of the child. Mio is 4+ cognitively. Feeding is basically anywhere across the lifespan, but especially under that 4 or 5-year-old age range. Why? Because I have seen so many children and adults use it incorrectly, create new compensations, create really weird like muscle patterns and straining on their muscles. So with the proper guidance, it's not easy to use. It's very hard and you need proper guidance so you're not compensating and using it wrong and doing the complete opposite of what it's intended for. So again, do I think it's a good tool? Yes, with a caveat, with the proper guidance. Any suggestions for ASD kiddos? I don't know what you have in general, like a more specific question for the ASD kiddos, because all of this applies to them too. When do you recommend introducing harder foods like carrots or celery? So we talked a little bit about that where you can definitely introduce them at 6 months for them to like build jaw development, then you could also be steaming them to make them softer for them to actually consume them, to like mash, munch, you know, swallow them. And then, you know, once you'll— I'm going to stop there because I don't want to get into like a whole like timeline. But like, that's how I would introduce because you asked about introducing harder foods. I would actually use it for jaw development first on like an actual stick, and then I would move into making it a little bit softer for feeding initially to introduce them until they're able to move towards eating them in their raw format. Okay, the dentist's IG, it's Dr. Cobal. I don't have it pulled up in front of me, but if you DM me on Instagram, I can send it to you. How to address tongue thrusting in babies with Down syndrome? Oh, I love this. So sensory oral motor intervention from birth. We can do this from birth. We can actually work with them to not thrust the tongue the same way we work with other children who are thrusting their tongue, and little ones where the therapy is more passive when they're younger. And you said babies, that's why I'm focusing on that. We do teach this inside Feed the Peeps, and I have a really, really amazing case of this 2-year-old who I worked with who was tongue-tied. He has Down syndrome. Oh my gosh. He like, he just knew me as like tongue clicks basically. So he would see me and go, he'd just start clicking his tongue because we always worked on getting that tongue up to the roof of the mouth. They imitate really well sometimes. And so that's something you can even do this with babies. Tongue clicks, start there. I would start there. Start getting those motor patterns built where there's like la la la. Because we get a lot of the mirror neurons that happen. My youngest, my youngest one, Mia, was imitating me at 2 months old, clicking my tongue. She started to click her tongue because I was doing that and play with her. And I have evidence because I was presenting at a conference and I had her there and she was like on a table and there were a bunch of SLPs standing around and I was like, and she started clicking her tongue and everyone was like, oh my gosh. This was like back in 2018. She was literally 2 months old. They're like, she just started copying you. She's clicking her tongue. 2-month-old can do that? It was a whole discussion. So anyways, I share that because what we can do with them, what we can do with a lot of others. A lot of times they don't actually have a tongue that's too big. They just have a tongue that's too big for their current jaw. And so they may also need expansion and some other interventions and everything, but that's true for a lot of our kiddos too. Um, if they do truly have macroglossia, that's a different discussion because they're going to have a really hard time, right? And the tongue is going to come forward more. Um, but but a lot of these kiddos can make such beautiful progress, and their faces can really develop the same way as their, their peers, right? Um, okay. Oops. I work with the Down syndrome community in Portland, Oregon. There are many teens with Down syndrome that do not eat solids. How do we get parents and our teens to buy in and understand they need to work on feeding therapy and work towards eating solids. Well, they're teens and they're parents, so we can educate as much as we want. But at the end of the day, it's truly up to them, right? We can't force anybody to do anything or come for therapy that they don't want. So if you're just trying to see if you can get them on board and you're not like, oh, I'm not forcing them, like, I'm not saying that you are, but I just like to remember— remind everybody, like, we're working with humans. We know textbook-wise what we think is the best option. It's not always what's best for the patient. It's also not always the goal of the family or the patient. Right. And so just keep that in mind because sometimes it might frustrate you and you're like, I just want to help them, but they don't want that help. Right. So we got to meet them where they're at and find out what their goals are. So that's number one. Number two, if it is the goal or you think it's, you want to educate them on it, I would just educate them on, hey, you know, you could go out with friends and you could eat pizza. You could do, you know, you could go have this or have that. And You know, see what their interest is and see if you can get them bought in and share with them like, this is something I can help you with. You know, do you want help with that? Honestly, that's probably the first angle I would take because getting the buy-in from someone who's not interested, you're not going to. And sometimes also if you have somebody that you've worked with, um, or another team that has developed those skills and they can talk to the same age peers, that can be really beneficial cuz they can also help educate. And it's not just like us as the professional educating. That's really cool. Um, all right. Is it normal for a 2 to 3 year old kid to chew longer and spit on meat and veggies? Well, it does take more effort and time to chew like grilled meat, right? Or baked meats even. It's something falling off the bone, maybe not as much. Um, it's like braised or it's like short ribs or something like that, but like It can take a bit longer. That is definitely harder. But spitting, spitting is not typically something that we see. So that kind of begs the question as to how long are they taking to do everything? Are they chewing and just holding in their mouth? Are they chewing it for like 5 minutes? Are they just chewing it like 20 times before they swallow? Right. But the spitting, that has me kind of going, hmm, there's something, there might be something going on, you know, that we want to address. Do you also work with psychologists specialized in feeding when it comes to kids whose aversion is extremely strong and are very resistant? Yeah, for sure. I mean, there's also some, some speech pathologists who specialize in like ARFID, right? Which is that more anxiety avoidant-based type of feeding restrictive disorder, which I'm totally messing up the name, but it's avoidant restrictive feeding, right? Anyways, ARFID. Um, so yes, we do collaborate with them totally, and we do get like referrals and everything for that as well. Um, so really anybody on the team who's going to be beneficial to that kid is a professional we're going to work with for sure. Um, how do you get a child with ASD to sit up instead of laying down when drinking milk from a sippy cup? There are so many things I don't know about this kid, so it's not necessarily something I can comment on. So guys, if you have like very specific case-based things and I'm concerned that there could be a safety component, I'm not going to answer because I would need the whole case and we can't— there's just not enough time to dive into all these individual cases. So if it's like a really quick question related to like the screening, then I can answer it. If it's like super specific, like a one sentence super specific question, that would be awesome. Um, all right, kiddo on the spectrum, 5 years old, only drinking out of a bottle and baby food added in to the bottle. Doctor said reflux ABA has been tracking us, actually sensory related. As the OT, I'm thinking it's not only sensory, also very sensory avoidant and sensory sensitive. I think you're on to something. This kid, it sounds like this kid is in like fight or flight potentially. And since you're like saying, I think it's not just sensory, yeah, most, most of the time it's not just sensory. Sensory is a very big part of what we do. And what I like to explain is like there's motor and there's sensory, but they're intertwined in the body and we can't truly separate them. But everybody teaches them and talks about them in silos. So like, we need the sensory stuff and we need the motor stuff, and we need to understand both, and we need to treat them both. And that's why SLPs and OTs and SLPA and CODAs— like, we all really need to come together because we all really benefit the child in such beautiful ways when we integrate the work that we're doing. Um, yes, Arfid, thank you. Okay, discussion of lip blocks, not tilting head, and different types of straws. Yes, we answered that. Um, Avoidant restrictive food intake disorder. Thank you, Abby. That is not clearly my specialty since I couldn't even come up with the full name. That would be my team. They have training and specialize in that. That— I'm, I'm not working on that so much. Um, appreciate you all. Okay, let me see. Okay, so we're gonna wrap this up by 2. Um, but let me see if I can pull up the CBCT. I'm just sharing that just so that we get to whatever questions come through. Let me see if this is Lily's CBCT or mine. Oh, that was easy! Yay, we got it! Oh my gosh, so good. I love when the universe is just like, here, that's what you need. Let me pull that up as the first option on your, um, on your Adobe PDF. Does not usually happen that way. Okay, so this is what we're going to answer live. So Share. Nervous. Okay. All right. So just kind of scrolling down. So this was the bottom of 2019. The top was 2021. Lily had her expansion fall of 2019 into fall of 2020. And then we are summer of 2020, fall, summer. Yes. August of 2020. She got it all for her 5th birthday. So she in the 2021, so like this is a year-ish, maybe just under a year later before we moved. Let me see if it's— the date is there. Oh no, this was January 2021. Okay. Sorry, guys. So it was January 2021. So this was about 5 months after she got her appliance off or out of her mouth. So this was before. And what's interesting is you see how like there What dentists tend to do is they tend to draw a straight line across, look like this, and you can see how her teeth are not all lining up. So her jaw was higher and more narrow and things were sitting kind of funny. They weren't all coming together properly. And then you can also see that there's crowding down here and up here. There's all this crowding of the teeth, whereas here, right? Do you see that straight line? Oops. See how there's like a straight line? It's almost like she's biting down on a straight line and everything's just aligned beautifully on this top image. So that's a dentition, and now she's got more space for her teeth to actually grow in, um, from the teeth that are below and above, right? Do you see how much wider the teeth appear? And we do have some teeth coming through that were not present on this first one, but when you really start to look at it, you go, oh wow, like she is— and you can see it in the shape of her jaw that it's wider than it was here. See, it's more like pointed down here and it's a little it's less pointed up here. So that's the jaw. Now what I'd really like to show you guys is this. Look right here on the right side. You barely see the swirly things, right? Those are our turbinates. Barely see that. Plus these like big black pools on the left and the right, those are our sinus cavities. You barely see them over here. Okay, she was very full. This kid could not breathe when she started in August 2019. She— her turbinates were full. This is the septum down the center here. You could barely see the septum. You could see the, like, a little portion of it here, but couldn't really see the rest of it because it's filled with fluid and inflammation. This is what we want to see over here on the left, okay? These are her maxillary sinuses. If we have a kid that is so stuffed up— and these— this is a jaw down here, or the, the temporomandibular joint. But if we have a kid that is so stuffed up that they cannot breathe How do we expect them to learn how to nasal breathe and how to close their mouth when they get the tongue up in their mouth? This is why airway is so important, and it's important from birth, and we will talk more about it this week. Down here you can also see her cervical spine. So do you see how her head was like more— her head and her neck are sitting more forward in this image versus this one? This is the tongue here. This is the tongue here. You can see down here there's more opening in the airway. This, her head was pushing forward to try and open the airway, but it was still very narrow down here, right? So it's thicker when she's in the proper position with her jaw and her tongue in the right place. Okay, and so again, you can see on this diagonal versus this rectangle that her head was just pushing, and you can see the curvature of the spine here as well on the right side. That was before her appliance therapy versus the spine here on the left, which is post-therapy. So it makes a huge difference. And this is not what traditional orthos or dentists are looking at. So I really like to share that because I think it's super important. I'm going to leave that open and just stop the screen share, stop share, because I'm sure that we'll— I'm going to want to show that again this week. Okay. All right, so let me see what other questions we have before we wrap up. So there's a question about using the Duo Spoons in therapy from The Feeding Tools. Um, I mean, you can put a little puree on them. What's really nice is that there, there's, um both sides of the spoon can be used, right? So you can just flip around, use one side, flip around, use the other side. It's going to give different sensory input, and that's what I really like about them. Um, so, you know, give it to the kid, let them play with it. You can also give it to the kid and have them just explore and see what they do with it before you ever put food on it. That's okay too. Um, okay, so question about the journey with Alf. Daughter had an upper for about a year. We had a poor experience with the dental provider. We stop. She's 8 and has MARPI because we waited too long. They put MARPI in at 8? My 8-year-old did not. I have MARPI, and my, um, 8-year-old went in, and my 8-year-old and 10-year-old both went into a different rapid palatal expander with our airway ortho. Seems like Lily and my daughter have had a similar experience. Feel like, yeah, you are in the right place. Love that you're here. Love that you're here. What age do you recommend for airway dentist or ENT? Which one first? Depends on the kid, depends on the concern. Um, kids should start going to the dentist in general, just like for regular dental cleanings, by like a year, just so they get familiar with the dentist. But if you have concerns about airway, I would be starting with the eval that we do, the one that we teach inside Feed the Peeds. And from there, then you figure out like who else should we be referring to, unless you're like have such a grave concern about airway that you're referring somebody onward because of, um You know, you don't think this kid is safe to sleep on their back, or they're rolling over and they feel like they're trying to open their airway, like then I might be going to an ENT first. But again, it's going to depend on the kid, the case, the age, all the things. Um, okay, let's see, we'll take a couple more questions and then we will wrap up. Um, all right, let me see if this is something I can answer quickly or not. Kid— my kid is deaf, has poor balance coordination, eats and drinks through a syringe. Noted to put his fingers in his mouth, causing more drooling. Since therapy has ability to identify food around his mouth, can only swallow easy melting food. We started biting on easy melting crackers like breadsticks and small pieces, or he would spit it out. Also chokes, um, when drinking water. Am I on the right track? I'm not helping him swallow thick liquids like pureed fruits, which mother reported. Oh, so this is not your child, this is a child you're treating. Got it. I'm now helping him swallow thick liquids like pureed Fruits, which mom reported he just started sucking on the bottle. So again, there's so many nuances here, and for safety reasons, I can't really comment on the case without knowing it super well. If you feel like you're making progress and he's safe to do what you're recommending in therapy, by all means, keep going. Right. But for direct case support, like, we can always dive into it. But this is like a sometimes a 30-minute conversation. So for direct support with your own cases, if you want somebody We do have mentors on our team that could do like a mentor session with you. So you can email us about that if you're curious. Um, but also if you wanna learn more, Feed the Peeds is a really great place to do that. We've been working on tongue clicks, but my 8-year-old cannot get the mid tongue to elevate. I'm not comfortable yet saying he has TOT, but he does. Are you gonna talk about how to improve that? Because I've done all I know. Um, we do talk about tendinobranchial tissues in both of my courses. So I have a pediatric feeding course, Feed the Peeds, and I have a myofunctional therapy course, um, the Myo Method. We dive into it in both of them. We'll definitely talk more about tethered oral tissues this week, though, during the screening, especially tomorrow. So join me tomorrow. Would Lily take a paci or too congested to like it? So she wasn't that congested as a baby. That image you saw was when she was 4, but she would not take a paci. But it was because she had a tongue tie. She couldn't— a lot of tongue-tied babies have a hard time holding a pacifier in their mouth. So just some food for thought. All right. We answered 51 questions. We had 162 others. It looks like they came through that were not questions, but just comments. Amazing. Oh, she has RPE, not an RPE. Okay, that makes more sense, Jessica. All right. I was like, oh, that seems intensive. Okay. Yeah. So she's got rapid palate expansion. Yes. That's what my girls had, followed by Invisalign. So, and Lily's had 3 rounds of expansion. She had her ALF, her ALF that I mentioned, which is what the before and after results were that I just showed you. Then she had a rapid palate expander with a forward growth component customized to it. It was a Hyrax with forward growth component customized with one airway dentist. Then we found Dr. Cobal, who's an airway ortho, who's 10 minutes from our house. And she put them into— she said it's basically like a modified Haas appliance for anybody who wants to look that up. Um, H— I think it's H-A-A-S. And that grew them the rest of the way that they needed. And now they're in their Invisalign, and they had upper and lower appliances. Um, my younger one did the same, the second one and the third one that Lily did. So she went into the Rapid Pal expansion with 4-growth component because she was— even though she was a great feeder at age age 24 to 36— no, age 36 months, like her third year of life, basically. She had croup 9 times, and so she was constantly on steroids. And I— anyways, that's a whole other conversation for another day. I was like, something's got to give. We got— we need a different treatment plan. And so she went into airway expansion because she was like an airway crisis kiddo, and that helped her. She stopped getting croup. Um, but then we— she needed another round of expansion, and that's when we ended up at the Airway Ortho here in Boca, Dr. Koval. So amazing results there. She's also in Invisalign now. She is 8. My older one, Lily, is— that we're using this week, she's 10 and a half going on 11. Okay, so the VIP access is the question about that. That just gets you the recording. We don't have like additional sessions on like treatment and feeding. That is a whole separate course. So there is a course available. I will talk— there's a lot of questions about it, so I'm going to talk about it tomorrow. And as I mentioned earlier, we will give you guys early access to jump into that and even start with some of the early modules if you really want to, because there seems to be a lot of interest. But that's a whole separate thing. So stay tuned. We'll talk about tomorrow. Um, well, I talk about methods that avoid removing the tonsils and adenoids before choosing surgery as the last option. So what I can say is that's out of scope. I can't say yes or no, a kid needs surgery or they don't need surgery. But as I shared, we have a lot of holistic parents coming to us who are saying, I don't want to put my kid through surgery. What else can we do? And that's when I then refer them to an airway-centric orthodontist or dentist who has a growth appliance that they can use to help open the airway, grow the face forward, bring the jaws in alignment. And by nature of doing that and get correct spacing between the teeth, because children, babies should have babies and children should have equal spacing between their teeth so they have room for their adult teeth to grow in. When they don't have that, that's when we haven't— we start to have issues of the high— and we'll talk about this tomorrow— but the high narrow palates, the tongue is sitting low and forward, it can't sit up on the roof of the mouth, right? And so that, that begs the question of, well, one, can they nasal breathe? Two, do we need to go into an appliance first before this type of therapy? Could we do both at the same time, right? It's going to depend on the case and everything. So yes, if you're looking to avoid that, there are other things you can do first. And typically it's going to look like expansion. Some, some providers will start as young as 2 years of age. Some will start around 4. We don't want to have to wait that long. So we'll do behavioral things like in our therapy sessions. Right. And when I say behavioral, I don't mean like how they're behaving. I'm talking about like feeding therapy, myo, depending on their age. Right. Seeing if we can figure out ways to help them clear the nasal cavity to the nasal breathe and get that tongue up, lips closed, teeth together, breathing through your nose, right? That's a little Mayo mantra. And we do that. I, inside Feed the Peas, I do what I call, I call it feeding with a twist of TOTS and Mayo because we teach tongue ties and we teach Mayo and we teach how it adapts to the birth to 5-year-olds who are too young for traditional myofunctional therapy. Because no, there's no such thing as baby Mayo or Toddlers Myo or Mini Myo. Um, there's feeding therapy and then there's Myo 4 to 5 years plus. And like everything we do in Myo basically is what we do in pediatric feeding. It's just adapted. It's just looks a little different, but it falls under the license of an SLP or OT or like a SLPA, COTA, right? Who's treating these things. Okay. Or PT even who's super specialized. All right. That is all of our questions for today. Thank you guys so much for joining me. That was so much fun. I'll be back here, same place, same time tomorrow. So until then, I hope everybody has a great Monday, and I'll see you guys tomorrow at noon. Bye, everybody. You are so welcome.