What’s Really Driving the Feeding Challenge? Looking Beyond the Symptoms

I did not want to be that person without training, and I did not have the training. I went from a speech therapist who did feeding to a feeding therapist. I really didn't start seeing infants until after the CPFT last year, and now that's 90% of my caseload. My goal as a therapist is to be the person I wish I would've had 10 years ago.

Welcome to the Untethered Podcast. I am your host, Hallie Bulkin. I'm a certified myo- I'm Hallie Bulkin, myofunctional therapist, feeding specialist, podcaster, business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up-to-date information in the orofacial myofunctional therapy, airway, tethered oral tissue, and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct Oral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Hi, and welcome back to the Untethered Podcast. Today we have Shae Bohlman joining us. Shae is a licensed speech-language pathologist with 7 years in outpatient pediatrics specializing in feeding and swallowing. She's a certified pediatric feeding therapist, a certified lactation counselor, and holds an interdisciplinary autism certification. Her passion is infant feeding and walking families through what is often a complex and deeply personal feeding journey. Her approach is responsive, family-centered, and focused on the whole child with a real emphasis on giving caregivers strategies that actually work in real life. She's also a wife and a mom to 2 strong-willed girls, and in her free time, she's usually reading or picking up a new craft she fully intends to master before abandoning it forever. Our guest today is 7 years into the outpatient pediatric space, and then you're in the middle of building your own practice. And so we're gonna talk a bit today about like what changed to make that possible and a whole lot about infant feeding along the way. So I would love to start with the change, right? You said that the CPFT, Certified Pediatric Feeding Therapist certification, changed your career. Tell me what it was like before certification.

So I did Feed the Peds Intro directly before CPFT. I was very lucky that I was in a cohort that ended right before CPFT began, so it kind of all happened for me at once. But before that, I was picking and choosing based on the clients that I had at the time, what courses to take. I really didn't have a broad scope of understanding feeding or where to really get all those basics. I mean, grad school is wonderful, but it doesn't set us up for pediatric therapy. I had one class and was told, you'll probably never see this, don't worry about it. Now it's all I do every day, so I'm glad that was wrong because I love it. But I've taken several courses. Feed the Peeds really started it off for me though, to see kids in a more broad picture and understand development going into all the way where certain breakdowns in development happen and what that can cause in feeding. Sometimes it's from birth, sometimes it's a little bit later on, and understanding more so about how to assess a child just overall and understand where that breakdown happened. Because if we don't understand where the breakdown happens, we can't really meet them on how to grow. Yes, the parents may want 10 more foods in their diet, but what's causing them to have difficulty getting those foods? Do we have trouble chewing? Does our tongue have trouble bringing the food to the back of our mouth? Like, we have to understand the child. We have to understand oral motor, sensory, the whole picture, medical, to fully understand where to go. We can't just be like, okay, 10 foods, that's our goal. Here we go. Because it's not gonna get you very far. And then CPFT, got into that. It really shaped assessment more than anything. It taught me how to really do an eval, a true eval, start to finish, deep dive into that, learning the difference between this is objectively what I'm seeing and what is my assessment? What's my bread and butter? What am I bringing to this? Because yes, I can tell you their tongue didn't lateralize and there's my objective picture, but what does it mean? It means that we couldn't bring the food to the side to masticate the bolus. We're not going to have a good mature rotary pattern if we can't even lateralize our tongue to bring that food over to the side. So it really helped me fully see a full picture of a child, bring in all the domains. And that got me into where I was submitting evals to doctors and local children's hospitals. And my evals were getting noticed, was getting more and more referrals back to me. And even the local children's hospital near me, they started calling. We want them on Shay's team. I saw Shay's evals. We have a client who sees Shay, and we have these other clients that we want to see Shay. So that alone, it really, it just, it shifted my career in a whole new direction. I went from a speech therapist who did feeding to a feeding therapist.

I love all of this. There was like so much you said in here where I was just like cheering you on in my head. I was like, yes, yes, yes. It's incredible because I think like you pointed out, like we really don't receive this education in our graduate program and If people are lucky, they might get a course or a one-day lecture on it. I got nothing. And so, you know, I'm like, hopefully we move in the opposite direction. And we start to get more education on pediatric feeding and swallowing in the grad school program, because it's such a prevalent component of the work that we do. And it's like you've said, everything is so highly integrated, like the sensory system and the motor system. And, you know, even if you're not doing feeding, I still feel like we have a due diligence and like ethical responsibility to know when there's a problem, even if we're not going to assess it further or treat it, we need to know who to refer to and when. But then I was like, when you were talking about the reports getting noticed and them noticing the work you were doing with your patients and being like, okay, she's seeing this patient, but we want— she's seeing these patients. I was like, oh my gosh. I mean, it is so validating when you're like, okay, I feel more confident and competent, but then other people start noticing it and they as a result start like referring to you and recognizing you as That expert, if you will, like that person who really takes a holistic approach. You're talking about like root cause medicine, not just knowing what do I see objectively, but like, why is that happening and how, like, what are we going to address? Well, if we know ultimately why we think this is happening, now we know how to address it, right? And so there was just so many gold nuggets. I don't think everyone understands like how many gold nuggets you just dropped in that answering that one question. That was so good. But anyways, all that to say, were you working with infants when you, like before Feed the Peas? even the CPFT, or is that newer for you?

No, I did not. It's not that I didn't trust myself to touch infants. It's because I'm a mother of 2. I've fed 2 babies. I've gone through the struggles of feeding 2 babies. My oldest put me through the wringer, and that's actually one of the reasons I got into watching your podcasts and learning all about Feed the Peeds, because my girls are Beautifully tongue-tied. Not anymore, but they were. Had the airway things. Yeah, I was like, oh my goodness, her Lily and my Lily sound just alike.

So funny. I'm like, and it's funny too, because I'm like, I can't tell you how many people, like when I do the free 3-day training before Feed the Peas, they're like, oh my gosh, that was my experience, we're living parallel lives. But then I remember you being like, wait, I have a Lily who also— and I was like, okay, this is getting really like very real now.

Yep. But no, I never treated other people's babies. I always say like my girls were my guinea pigs. They helped me understand how difficult it is, which helps me meet people in those hard moments because you have to have empathy when a new mama is coming in your office and that baby won't eat because that is one of the hardest things a new parent can be going through because that's supposed to be the easy thing, right? We just want our babies to be fed. We want them to grow. We want to do whatever we can to keep them happy and healthy. And for one of those pieces to be failing, those parents are distraught. So we have to meet them with so much empathy and really know what we're doing. So I did not want to be that person without training, and I did not have the training in my own head. I did not have the training to be an infant feeding therapist. I did older kid therapy way longer than I've done infant feeding because I needed to be more specialized in my head. I needed to understand this more. I needed to be more than just a mom who had been through it and someone who had read a few books. I really didn't start seeing infants until after the CPFT last year. And now That's 90% of my caseload.

So it's your real passion now.

It, I love all my babies. I get a new baby on schedule and I get so excited and I'm even building a team around that. So I'm still in an outpatient clinic and I'm only part-time through that. So I'm doing part-time in an outpatient clinic and I'm doing it part-time so I can start my own because I also believe that it's so important to meet people where they're at and not be another doctor's office. I wanna reach out to be in their space and bring it to them as well. And so I'm working through that and I have an OT who's collaborating with me because she was like, wow, you're doing such amazing things. And she works very closely with torticollis. Well, so many torticollis babies—

Well, and are tongue-tied.

Tongue-tied babies. And tongue-tied babies have those feeding issues. Breastfeeding's more difficult, bottle feeding's more difficult. So we're really trying to build that team and pull it all together. But no, I didn't see any of those until I felt confident enough myself. And that wasn't until after the CPFT.

It's fascinating to me because I also had that same experience where I was like, well, I was working with like the older kids. And by older, I mean like toddler on up. And it wasn't until I had my Lily, right, 11 years ago, that threw me into the deep end with pediatric feeding, like on the infant side, that I was like, wait a second, I need to know how to work with these babies. And it was after her that I then also became more skilled in working with infants, but also felt like there really isn't a lot of great education or mentorship or support around working with these kiddos, especially if you're like— and I was in private practice at the time, just felt like I was out on my own. And I was like, how do we help these parents? Like, I don't want any other mom and baby to experience what we experienced. Like, it was not a good experience. 13 months of painful breastfeeding, being told it was normal, being like, I'm the one who I feel like should have access to the resources. I have the education to a certain degree. Like, if I have all of this, what about all the parents that don't? Like, how are they figuring out what's typical, what's not typical, what's common, what's normal, what they should be getting help with? And, you know, my experience was not a great one. I was gaslit. I was turned away. I was told things were normal, which I now know are all not true, right? But I was like, these parents can't possibly— like, they're just gonna take someone's word for it because that's— they got vulnerable, they asked for help, and this was the response they got. Now I think parents are getting savvier, you know, like 10 years, 11 years down the road. I think there's a lot more access to better information online, although it's like, who do you even listen to these days? And I think parents have become way more savvy in doing the research, learning to trust their gut. They've got a lot of us advocating behind the scenes going, okay guys, trust your gut. If you think something is off, it is definitely worth exploring and don't take no for an answer. But to that extent, I think a lot of therapists still get very stuck with pediatric feeding in general, but especially the infants. I think it's a little more intimidating to work with the infant population. So do you find, because you said you're kind of building a team and, you know, I don't know how many others are doing like infant feeding around the work that you're doing, but do you find that like therapists tend to get like stuck in certain places when it comes to just infant or even just pediatric feeding in general?

I definitely feel like working alongside other therapists, the biggest roadblock I'm finding currently is infant Feeding refusal. It's, well, we don't know why they're refusing to eat. They ate in the beginning, they ate the first month or 2, now they're not eating at all. They won't eat the breast, they won't take the bottle, they're hungry, they're crying, they're now going down on their weight charts, their percentiles are dropping, they're going to be labeled failure to thrive. The doctor put a feeding tube in over the weekend. What do we do? And a lot of therapists feel very stuck there. I know I did. Felt very stuck. And I scoured the internet for these resources. Like you said, like I'm the one who should have this information. So scouring the internet, finding any book that I could. And I did read Rowena Bennett's approach. And honestly, I don't know if you've read Rowena Bennett's approach. Fantastic laid out. It can be a very scary program to follow. Especially when you present it to the parents. And so I think too, with the information I learned from the CPFT and Feed the Peds and understanding infant development and understanding babies holistically, like understanding regulation on top of oral motor, on top of positioning and understanding how to pace feed a baby who doesn't want you to feed them in that nice sideline position, right? They don't want to be in that position. And I need specialized positioning. I don't want you to be in front of me. I'm going to refuse if the environment isn't perfect. Can be very hard to figure out. It's a big place to get stuck. And so I feel like we have to help foster not hunger per se, but we have to create the opportunity to want to eat without making them overly hungry, using responsive feeding techniques, all of these things. It's not just responsive feeding with our toddlers. We have to be very responsive with our infants and understand where the breakdown happened and why it happened. But I do feel like feeding refusal, not just bottle refusal, but feeding refusal is a place that a lot of people are getting stuck right now.

Yeah. Yeah. I think that's always been one of the big places that it seems like everyone kind of gets stuck. And it's like, I don't want to make things worse. But I'm also not sure how to make things better. You know, it's like I hear that a lot from some of the clinicians that I've mentored in the past. Also a CLC. When did you get your CLC? Was that before or after your feeding certification?

I did them at the same time.

Wait a second. Actually, we talked about this and I'm feeling like you've been doing it at the same time, which was really very ambitious of you.

It was, it was so ambitious of me and I wish I would've done them back to back.

Do you feel like, so I mean, obviously it's a certified lactation counselor, right? So CLC for anybody who's not familiar. What did that add to your like feeding lens, if you will, outside of, you know, what we do as the pediatric feeding therapist as an SLP, for example? Because I know that adds another layer to the eval and the treatment.

So overall, as an SLP who has gotten the background in all the infant feeding, do I think it's necessary for an SLP with these trainings to be a CLC? No. However, I may feel that way because I have breastfed 2 children, 2 children who've had feeding difficulties. And so maybe I feel like maybe that wasn't necessary for me. However, the program was a great refresher and did give me a lot of insights. And it talked about the way we can meet parents with different levels of empathy and different levels of teaching. To help them take the information a little bit better. The 4 types of learners, I don't know if we've gone over that, but we have to meet parents where they're at. It was great for helping understand the difference between breast and bottle again, because they're very different mechanics. And a lot of feeding courses that are targeted for SLPs, OTs, and feeding therapists in general are very focused on bottle feeding. There are some great courses out there. And if I remember correctly, even the CPFT had a great breastfeeding resource module along with a bottle feeding module. Doing those at the same time, it was helping me put the pieces all together. I was like, okay, so when I do this, like I have to remember this mechanic. So I was a little bit all over the place.

It's okay, it all came together in the end.

I think being a CLC and a CPFT has been helpful in my actual sessions and also in marketing of myself because I get doctors call, well, who do you recommend for lactation? Well, I do lactation. They're like, you do lactation, but you're a speech therapist. And I'm like, I'm also a lactation counselor. They're like, oh, well, wonderful. Well, they can just come your way.

I'm like, great.

And a lot of the times I'll get local IBCLCs in my area from the hospitals. They will reach out and just be like, hey, we did our role in this. We talked about positioning and trying to get a better latch, but baby really just can't. No matter what position we put this baby in, they just, their mouth won't do it. So I will say being a CLC and a feeding therapist, I can see where that breakdown is. Is the position— is— do we need to present that breast in a different way? Do we need to have those hips flexed? Are we in midline? So that's where the CLC portion of me comes in. But then the feeding therapist in me is like, can they open their mouth that wide? Can that tongue protrude? Can they cup and keep that tongue elevated? Because the CLC didn't teach me how to fix those things. The CLC taught me we need somebody else. And so being— it's been great because I'm like, oh, this is where the breakdown is. I am that somebody else.

Yeah, that's awesome. It like really gives you that differential diagnosis, if you will, to figure out how do we want to proceed. And then that kind of also like ties into my next thought is like with tethered oral tissues, right? Because now you've got the mother-infant dyad. You like, you can talk about things from different angles. But it probably also maybe makes it a little bit easier to figure out like if a tetheral tissue may be at play, because you can really holistically assess like all sides of the situation, which is really cool. So how are you working with that when you do get these like tongue-tied infants, or you suspect there might be tetheral tissues, tongue or lip ties, or even cheek ties? Do you push for referrals? Are you kind of just like working through what's there? Like, what does that look like for you?

So I've done a couple of the TOTS courses. I'm TOTS certified, but of course I cannot diagnose a lip tie, tongue tie, cheek tie. That's outside of my scope, but I can notice those red flags, right? So when a baby comes in and we hear some of those red flag words— they're just chomping at the breast, they won't open their mouth very wide, If I go to rub their face, they're so tight. Oh yeah, they're going to PT for torticollis. Okay, so I go in already being like, I need to get under that tongue, I need to check in those cheeks, I need to see if there's any tethering. However, just because I find it doesn't mean I send them out that day. I see, okay, this is my structure. Is there clenching? Is it Where's the insertion points? How much function do I have with the structure that's present? How much tension is present in that baby's body? If they're so tense and they're in this extensor pattern all the time, or on the opposite, they're always in this flex pattern, they won't bring their head up, I know I need to open up a lot before I really know, do I want to send them to a referral? Or do we need to really get down into the bodywork of all this, get some function moving through? And then I'm like, okay, how far can we get function before we hit a roadblock? And when I get to that roadblock, and that might be 2 weeks, depends on how good that home carryover is, right? Might be 2 weeks. I'm like, okay, then I'm not really seeing the tension anymore, but this structure really isn't getting us very far. Or it might be 4 weeks of the manual therapies, working through the body, doing the feeding work, the suck training, and I'm like, all right, it's time. Like, we need to have that conversation again of— I know in the beginning I mentioned this was very tight, this is anterior, I showed you the tissue. Mm-hmm. Look at how far we've come. This is about as far as we're gonna get. So if we're still having difficulty, it's time to, time to go to that pediatric dentist or ENT depending on what the family would prefer. I work alongside some really fantastic pediatric dentists, beautiful releases, and they will get people who come to their clinic and say, I want, I want released. And our dentist will see them and they're like, okay, I see tethering, but we're gonna have you go see Ms. Shea first and she's gonna tell us what she thinks. She's gonna tell us how long until you can get this released. And parents are like, well, I'll just get it done today. And I have that relationship with my dentist of, we're not doing this today. We need, we need that pre-work. We need optimal healing, we need to make sure because just because you release it doesn't mean the tongue is going to know what to do once it has the range of motion. Like, we're still going to do that same pattern. Just because we can move doesn't mean we're going to change our pattern. So my dentists know that, and they're like, Shay will tell us when you're ready.

I love that. I love that. And I feel like that's been one of our biggest hurdles in certain communities and certain, you know, so we obviously talked to a lot of therapists across The US, even in Canada and Europe, even like we've expanded, right? And one of the biggest challenges is one, finding those professionals to refer to, and two, getting them on the same page where they understand like a release is not just a release. Like we need to properly prep that child and really the family, right? Whoever the caregivers are that are going to be working with that child at home, outside of any follow-up sessions, your pre and post-op, like we need everybody on board. Everyone's got to feel really good about the work we're about to do together, you know? And then make sure, like you said, that it's optimal timing for release, that it's optimal, you know, the child's body is optimized for that release. So they actually truly benefit from it. Because as you said, like, if you release that tongue and the child's not ready, where's the tongue going? It could actually cause greater issues, right? And be falling back in the mouth or causing other feeding issues, making things worse rather than improving. And listen, even when you do pre-op, sometimes things get harder after and before they get better and easier. And, you know, that's not to say don't do it, but like— when you're working with a provider like yourself who can help prep that child and that family and say, okay, green light, I sign off on this. Yes, if the dentist is saying you need a release, I feel like you're ready for that release. That just, I've seen the differences. I've seen the change in the children who have had the pre-op versus not because early on in my career I did not refer for pre-op and then I learned and then we started changing things. And let me tell you, those kids that then got the pre and post-op that weren't getting it, All the— even just pre-op, like, was missing before. Oh my gosh, night and day. Night and day results after release. Such a huge difference. And a lot of it ties into like, what does the nervous system look like? Are we actually not just physically ready, but like nervous system-wise? Is our body— is our mind— is the relationship between the mom and the baby, especially if there is like a feeding dyad there with breastfeeding? Like, there's just so many nuances and variables to consider in this. And I think parents don't realize that because Facebook groups can be both a blessing and a curse. Like, oh my gosh, my child had a tongue tie release and then everything got better. It did it? Or was there like a whole host of other things that happened surrounding that we're leaving out and not realizing those things were just as important as the procedure itself, right? So I love that you highlighted that because that's definitely one of those things that like, I like to really drill in and make sure everybody understands and fully knows. Like, if you're going to a provider who's just going to release your tongue and send you on your way, or your lip, Don't go to that provider. Sorry, sorry, not sorry. Like, you need to go to someone who's working with the team and understands that whole pre-op, post-op process because that's— it's a process. It's not just a singular procedure. Yeah.

And I've had to have that conversation with an ENT who was like, you know, I've done tongue ties and I don't see the benefit. Like, nothing changes. And I'm like, okay, let's talk about that. Did we do therapy? Well, no. Okay.

You just answered my question. Here we go.

These are our kiddos who have had the procedure, pre-op, post-op care. They're done so much quicker. We don't come into those like later issues where it's still going on. We still have reflux. We Still are uncomfortable. We've worked through the body. We've, like you said, the nervous system regulation in general. Like, I don't just work on the mouth. I— that whole baby in front of me, I gotta look at everything. And parents are always blown away by that. I put that baby on a yoga ball, they're like, why is my baby on a yoga ball? Well, we're working the digestive system. We're getting this neck open, these shoulders back. We're Working everything through, and they always crack up. They're like, "Wow, you just spend your whole day getting tooted on and pooped on," and I'm like, "Yes, yes, I do." You gotta work it all out. Yeah, yeah, I love it.

It's so funny. Like everybody, I kind of joke my kids are disgusting at the dinner table because my conversations are all about like gas, bloating. You know, did you poop today? Like that is our normal dinner conversation, and I'm like, guys, maybe keep it down when we're in a restaurant. Nobody else really wants to hear about this. But it's one of those things where when when normal digestion becomes like. Such a part, and then like your gut health, and becomes such a part of like your everyday conversation, it's sort of like no big deal, right? Until you're around other people. But no, it's something people don't really realize is so highly interconnected, and it's important. And so it's very cool like to hear when you really are taking that full-body approach. And we have to, because feeding is a full-body activity, and I don't think people realize that. They just see the mouth and the weight charts, right? And that's pretty much where it gets left. And we're like, that's just— those are 2 pieces of a very large puzzle. Here. And so very big pieces.

Yes. Like when I have a feeding kiddo come in and mom's like, they haven't eaten in 3 days, and I have to ask, when, when was their last big poop? Have they been straining all week? Well, they don't feel hungry. We have to help that hunger. And that goes for our babies. Our babies are not going to want to eat well if their belly's off, they haven't pooped, they're gonna have arching and crying. Our toddlers don't eat well. They become little birds, right? Grazing through the day, top off, top off. We never truly get that full hunger when our digestion, our digestion's off, our body's off, we're not pooping, we don't feel good, we're not gonna eat. So we really truly have to look at a whole child and ask some really crazy questions like, well, do you have a picture of what their poop typically looks like?

Like, here's the Bristol stool chart, pick. What does it look like? Do you know?

Which one would you say?

My kids love that stuff. Okay, so let's talk early solids then, right? So we've been talking a lot about infants. Obviously, this is still an infant conversation. We'll pivot to toddlers in a little. Do you see any big misconceptions around early solids when you're chatting with these families and they're working towards either that transition to solids or maybe they're already in that phase? Anything that you see come up a lot?

Really, I see a lot of questions about, well, everyone's saying baby-led weaning is the way to go. So do I never give them a puree? Do I never give them a spoon-fed food? Do I just shove them a whole piece of food or whatever I'm having at the dinner table? And I'm like, no. I think Solid Starts is a really great resource. I wish that would have been around for my oldest when I was in the midst of all this 10 years ago and was like, how can I make this? Is this food safe? And I'm reaching out to other parents in the Facebook mommy groups. And trying to read on little mommy blogs. And now it's there in a great place, right? And they have pictures. It's wonderful. But I'm not a one or the other. And so I feel like people are always shocked when I tell them that. I'm like, we need a mix because purees teach us how to swallow our food and purees help us get volume. Not that volume's needed before 1, really. But it helps. And then baby-led weaning, those solids, they need to be offered in certain ways, in a certain pattern, progression style, to get the skills. Because if we don't do any solids before 1, yes, solids aren't necessary before 1, but if we don't do it, then we're gonna have a 1-year-old that doesn't know how to do anything except for bottle feed, spoon feed, and They don't know how to eat the chunks that end up in their mouth. We have so much gagging, and that's a big misconception too. I get parents who call in, my child chokes at every meal, they're choking. And I'm like, okay, can you tell me what that looks like? Well, they put the food in and it comes right out. They choked on it.

Okay.

And so I get my little— I have a little chart, a little laminated chart, gag versus choke. Oh, that's great. We don't want too much gagging, but a choke is silent, right? We're gonna have color change, we're gonna have just this like open mouth, like wide-eyed look. Mostly we're seeing gagging. So that's a big misconception to the difference in a gag or a choke.

Absolutely. That's, you know, interestingly enough, that's a big educational point when I do my 3-day training with therapists, because a lot of therapists see a gag and think that there's choking. And I have to explain the same thing you just explained where Nope. If you're choking, like, there is an obstruction of the airway. You'll see like maybe color changes in the skin. It's silent. You don't hear them. If you can hear them crying, coughing, trying to expel it out of their airway, or it actually has come out already, they're not choking. They were gagging. And like you said, we don't want too much gagging, but we also never want to get rid of the gag because it's a protective mechanism, right? And that's the other thing people are like, we need to eliminate gagging. I'm like, no, we don't want to eliminate it. Maybe we don't want the child gagging all the time, but that's— A whole nother conversation. It's still protective.

We don't want their gag reflex to be up here by the dental bridge.

Yes, like this.

Like we need a gag.

Move it back. We want it towards the back of the throat so that it stays there as a protective mechanism in the future in case we ever need it, but we don't want it on a regular basis, you know. We don't want that happening every time the child sees the food or touches their lips or comes towards the front, like, third or half of their tongue. So that's always— I love that conversation though because it's— you just see these light bulbs go off, even with therapists. No one's ever taught them that, so I'm like, how would parents be expected to know, you know? And then I think the other thing That's so fascinating to me about solids, like early solids. We as adults like forget that we eat puree. Like we eat pureed soups, we eat sauces that are more pureed forms. You know, we eat purees as adults. It's not just baby food. So it's one of those things where it's so funny to me that people get so like stringent against like, against purees. Oh, if we start purees, they're never going to learn how to eat. No, like I'm like you. No, we need it all. We need— And listen, culturally, right? Sometimes parents want to spoon-feed their child, or maybe it's not even a cultural thing, it's just a preference by that family. Great, do it. You know, you do what you wanna do. I'm here to support you, but I also like to educate, like you're saying, where, okay, yes, we need purees, but we also need those harder foods, right? That baby-led weaning side of things where we're developing the, you know, oral motor chew patterns and the sensory system around it. It's also interconnected. So I love how you shared that because I'm 100% on board with that same approach. that's like the mixture of all the things. And, you know, I used to say like food before 1 is just for fun. And then I became a feeding therapist and realized it's like you said, we don't calorically necessarily need it because they should be getting their calories from breast milk or bottle milk, you know, or formula. It's there, it's necessary to develop our other skills. And so while we're not like super concerned on volume of the solids in the beginning, like we do need to develop all of those skills. So I love how you just kind of like hit the nail on the head with all of those different points. Because again, so many golden nuggets here that Even 11 years ago, working with my infant, my child, I didn't know all these things. I was like you. I was, I don't know. I'm like, I work with like 12 to 24 month old up crowd. Like, what do I do with a 6 month old? Like, do I, okay, I'm ready to start feeding her solids. So let's try, you know, some veggies pureed first. Like that seems, and then we'll do the fruit. I mean, I literally had no clue what to do with a 6 month old.

And you were like, oh man, this is messy.

Yeah, like I know what to do with a 12-month-old, and honestly it was like almost not even that different because some of our kids are delayed and I just wasn't giving myself enough credit. But like you said, like resources like Solid Starts and some of those things just weren't out there 11 years ago, and I wish I had things like that because that would have made my life so much easier. So anywho, let's talk a little bit about the older kids. Like when I say older, I mean like the kids who can actually decide if they want to be compliant or not, like the toddlers who really have an opinion, you know, they kind of go Ooh, autonomy. Like, I can say no, whether I want, you know, whether I'm okay with this or not, I still can say no. You talk a bit about like, for, you know, fostering intrinsic motivation. Can you tell us like, what does that mean in a feeding session?

So I truly believe like in responsive feeding. But responsive feeding is not passive feeding. When we think about that division of responsibility, Our parent decides what we eat, when we eat, where we eat. The child decides if they eat and how much they eat. But if we just stop there and we don't look at all those factors that go into setting up the right environment and making it intrinsically motivating, a child just may decide not to eat or eat one bite and be done. And then parents are like, well, that didn't work. Well, how did we set up that environment for them? Are we scheduling mealtimes in a way to foster that sense of hunger, foster that sense of, whoo, I feel that in my sensory system. I'm feeling rumbles and grumbles. Obviously I need to eat because if I'm walking around grazing all day, I don't really ever feel that. I don't get that true hunger sense. And those will be our kids that will sit down, they eat one bite, 2 bites, 3 bites, and they're like, okay, I'm done. And parents are like, well, I did what you said. I sat them down, they decided how much to eat, and I— this time I didn't say just take one more bite, right? And that's great. We don't want the just one more bite, 2 more bites and you can have a lollipop, 2 more bites and you can have your ice cream for tonight. I'm personally a fan of dessert at the same time as dinner. Like, it's All right there, a little bit on the tray. I don't mind. Sometimes we have dessert before dinner. It is what it is. We'll see how we're feeling. Maybe the cookies are baking while we're eating dinner. I don't know. Depends on the night. But it's not the reward for eating. Eating is the reward. I feel hungry. I eat my food. I feel better. That's the reward. And we have to help foster that. And it goes past our little toddlers, but it starts in infanthood and toddlerhood. We don't want to wait till a baby's way over hungry and screaming, crying to eat. They just get a little too upset, and then sometimes their bellies hurt because they cried so much and they took in too much air, and that's not motivating. They learned, well, I cried and I ate and then my belly hurt. Or If we have things like allergies, something like that, those kiddos end up our feeding refusal kiddos, end up our picky kids. And also in toddlers too. I eat something, my belly hurts. I ate too much candy, maybe. My belly hurts. I don't want to do that. I'm just going to take a couple bites here and there. I never really truly get hungry. And the less hunger we feel, it's going to keep compiling. Like, if I learn I don't need a full meal, I'm never Going to actually be hungry for a full meal. I'm going to go around in grades. I kind of just talked in a circle here, but I think—

No, it's good.

It's very important all throughout the stages, foster that intrinsic motivation. And I'm not saying we should be starving our kids out. Not at all. I'm saying let's schedule mealtimes. Let's foster the development of hunger to a point. So that's every 2 to 3 hours we should be getting something. I don't want to make them overly hungry. Because I don't know about you, but if I get overly hungry, I get nauseous and I end up not eating.

Yeah.

Our kids feel the same things that we do as adults. And I think as adults, we forget that sometimes. We're like, oh, well, they haven't eaten in hours. They should have eaten dinner. You can't have a snack today 'cause you didn't finish your dinner last night. And I'm not doing this. You need to eat your dinner. But then we end up with kids who are starving at bedtime because guess what? They probably still didn't eat that whole dinner that you wanted them to. We need those small meal times throughout the day. And it even goes to like our tube-fed kiddos. Like if we are getting continuous bolus feeds throughout the day, we're never feeling hunger. Those continuous feeds, not bolus feeds, but continuous feeds throughout the day, we're not feeling hunger. So we gotta work with GIs, we gotta work with nutrition. And I'll even send my toddlers who don't have tubes to nutrition and GI. How many calories a day should they be having? Are there some allergies we're missing? How can we help their gut and help foster these intrinsic motivators to feel better? How can I pass my stool so I can feel hungry? How can I eat enough calories that tomorrow my body's gonna want that many calories again? Like, how can we get more calories? How can we get more volume? By pacing out our food and making it motivating internally.

I love that, and I think it's something that's really important for us to keep in mind because even as an adult, right? I'll go all day sometimes and just be busy with work, and it'll be two or three p.m., and I'm like, oh my gosh! I didn't eat all day. Like I ate breakfast at like nine a.m., and now it's three, and the amount of energy that tanks in my body to the point where I'm like, oh my gosh! My brain is not functioning. Like I can't think. My head feels heavy.

I'm exhausted.

Like, I'm just tired. And if we can just remember that, like, there are other things that happen in our little ones when they are not consuming enough calories throughout the day to support their little bodies, and they need a lot more than we do usually. And so, you know, I think that you made a lot of really good points here. And, you know, even going back to your point of like, oh, well, you didn't eat your dinner last night, so we're not going to have a snack today because I want you to eat your dinner tonight. Well, maybe they need those calories right now. Like, maybe we can't wait till— Or maybe we should break it up into smaller little bits because that's what supports them at the moment. Not supporting grazing per se, not saying leave snacks out all day, but like have, like you said, those defined times where we, where food is available to them so that they can then choose like what they're gonna eat in that moment based on what they need. I just, I love that. I think that was so beautiful that you shared that. You know, there was another thought that I had too, the whole dessert with dinner thing. I am very big on like not criminalizing food, right?

Right.

Food is energy. It's calories are energy. And I think children also learn there's certain type of calories or energy that make me feel like really energized or really good. And maybe there's some that don't. And that could be different for different kids, the things that make one feel better and one feel worse, right? So it's like we— I just think as adults, so many of us grew up in very certain ways or experiences where we may have our own stories around foods and how foods, you know, healthy foods and not healthy foods. And I'm like, I always like to encourage families, let's not label a food one way or the other. Let's talk about its color, its shape, how it crunches, or how it, you know, oh, this one feels fun in my mouth. Oh, that one's really crunchy. You know, what are you feeling? You know, talking about the characteristics of the physical food versus like assigning a label to it, like healthy, unhealthy, fattening, you know, whatever. Because for kids, they're going to attach whatever label you've given them to that food, and it's going to create stories for them. And it's— I'm kind of laughing in Right now it's like laughing, not laughing, because there's this whole Oreo gate thing going around Instagram. I don't know if you've seen Oreo gate.

I have not.

And I'm like still undecided on if it's real or if it's completely made up. But it's like this WhatsApp group mom chat that back to school like recently happened. And this one mom basically says my kid came home upset because another kid had an Oreo in her lunchbox. And we don't allow that in our house. And it's this whole thing that's now like gone into a 7, 8 part series of ridiculousness of, you know, but they, all the other parents are correct in saying like, you cannot control what I put in my child's lunchbox. And they clarified immediately, is this an allergy issue? And we can't have this present in the classroom? And the mom said, no, it's just, it's basically, we don't allow that in our house. Okay. Well, you're not giving us any other information. Listen, like, I respect you not putting it in your kid's lunchbox, but I control what goes in mine. And that's the whole, it just kind of brings it back to, you know, the school, then the mom contacts, the school sends out an email basically saying, yes, we encourage healthy snacks and you know, choices and lunchbox, but it's ultimately up to every parent what they feed their child, right? And so I just thought it was a very interesting conversation because now every account is creating memes and jokes around it. And then you've got the feeding accounts that are talking about like division of responsibility, like you were talking about, and who gets to choose what goes on the plate and the child getting to choose what they want to eat from it and all that. And I'm like, look, I'm sitting over here as someone who We have like gluten-free versions of Oreos, not the Oreo brand, but a different one. And like, I probably consume a box of those like a week sometimes, like full stop. Like I will fully own that. I love them. It's like my, it's my go-to. But I'm also a house where like we are like pasture-raised, organic, holistic, like straight from the farm, like as much as I can for the most part. But I'm also like, I believe in like 80/20, 70/30, like when we got—

Variation.

We go out, we eat, we enjoy life. My kids go to a friend's house, they eat, they're allowed to have what the friend offers them, you know, or if they don't want it, they can say no thank you, right? But it's one of those things too where my kids now come home because I've educated them, and this happened when they were like 4, right? And these are 5-year-olds that we were talking about in Oreo Gate, but at 4 they came home and they'd be like, Mama, I got this candy, can I trade you for a different snack? I don't want to eat this because it has food dyes. Because they started to learn how they felt When they ate it. Not that I criminalized it, even though I think they're toxic, right? That's my opinion. I'm not gonna push that on anybody else. Everybody else is welcome to eat whatever they want. But in my house, my kid went absolutely crazy when she would have like red dyes and blue dyes. And so we eliminated them from our household, and I really prefer she not have it when she's out. But if she does, life happens, you know? So anyways, it was just a very interesting, semi-comical, cuz they've turned it into like a music, like a song basically when you see the text on the screen and then there's like a song and like an audio tune that's been put to it with the words. It's just such an interesting thing. And you're like, you know, these conversations go on and happen. And there's just so much stress around food these days and chemicals in our foods and all the things. And it's all that to say, it's just a whole nother level when your child physically can't even eat the foods, you know? And so anyways, I just, I don't even know how I got on that tangent, but it's—

Oreo gate.

Yeah. I'm like, by the time this actually airs, Oreo gate will probably be behind us, but that's fine. Everyone will maybe know what I'm talking about at that point. I just think it goes back to like, yes, we can definitely advocate for what we want and our kids. But I think also just keeping in mind, like, you're only in charge of your own child. You know, you see some of these things happen in these classrooms where, you know, you— there was one conversation around this too, where they said, oh, this happened with a child, and they ended up taking the child and putting that child where the parent didn't want them exposed to all these other foods into the principal's office. to eat every day. And now he basically gets to pick one kid to go eat with him. And I was just thinking like, how isolating, because the parent didn't want the kid around it. How about we teach our kids like what we feel is going to be supportive for them? And maybe if we have certain beliefs— anyways, it's just like this very toxic food culture. And I'm on a whole tangent.

I think it really truly connects back to responsive feeding. Because We teach our kiddos in the beginning, like they get this, we're choosing at this point what to feed them, but they're deciding if they're eating it. We've set up that motivation to want to eat it. So we are growing these little intuitive eaters. Responsive feeding turns into intuitive eating later on. And as an adult, that is something I had to work through.

Right.

And so many people I know. Say, like, I was not an intuitive eater. I would do so good all week and then Friday night eat a whole bag of Oreos, eat a whole bag of chips. Why? Because I didn't let myself have these little bits. I was too stringent and I didn't listen to what my body needed. And then I just craved it. And when we crave it, then we overeat it. So truly the work we're doing, starting from infanthood, going through toddlerhood, all the way through adolescence, we're raising intuitive eaters to the end. We're raising adults who can listen to their body, who can feed themselves well, and who can move forward and teach those skills to their children.

Yeah, absolutely. Thank you for tying that up and putting a pretty little bow on that for me. I was like, I know I was going somewhere with this. So you made it so succinctly, beautifully tied up with that pretty little bow.

Anyways.

So yes, and I think it's a really, it's just a fascinating conversation because it is so highly relevant to the work we do. And, you know, we get all kinds of families that have different foods that they consume and different preferences. And, you know, there could be cultural, it could just be preferences. And it's very interesting because, you know, I, like I shared, like in my household, like we eat a certain way, but being respectful of others, how they choose to eat, while also making sure that we are not putting our beliefs on someone else. They're not putting their beliefs on us. Everyone's choosing the best path forward for themselves, their family, their kids. But I do think that it's like you said, it's so beautifully said that it really comes back to teaching us how to even approach food, right? Because I'm being that intuitive eater, because like you, I was not when I was little. And now I can almost look at a food and be like, I know how I'm gonna feel when I eat that. So do we want that right now? Or do we maybe want that later? Do we just, you know, want to eat something completely different altogether?

Or maybe I only want one or two bites of it. Exactly, and that's because I know if I eat too much, I'll just feel sluggish.

Yeah, I'm like that brownie looks great, but it's three p.m., and if I eat that now, I'm gonna zonk out by dinner. Like, I have a bite or two. Like, that's fine. I just want a little sweet something, you know? And so it's. But again, that was a learned skill. That's not something I was taught. It wasn't something that I had as a child or even a teenager or when I was in college. It was. Something as an adult that basically I learned myself. And that's why, you know, I feel so strongly about it too, because now I can teach these things to my kids. And again, I just think it's one of those areas of experience that is not very well known, understood, or practiced. And so I love that you were highlighting that here. Okay, let's talk about like advocating for our clients on the team, because, you know, advocating— we've talked already about how there's specialists referring and maybe pediatricians involved and the families and everything, but we need to talk, I think, about that advocacy side, right? Advocating for our actual clients with these specialists and pediatricians at times. And I know you've got some fabulous ones on your team, so I'm not necessarily saying them, but why is this something that you think is a sticking point? Like, I feel like we talk a lot about team alignment and I just think it's not something that is well achieved in most areas yet.

I think it takes work on our part. To have team alignment. I don't think any of us are quite lucky enough to just walk into an area and start seeing kiddos and specialists take your word as gold. We really have to reach out. And maybe it's the tube-fed kiddo that you're seeing at this time and you're noticing, wow, their overnight feeds are really heavy and they're just not eating in the day. But the GI said only do tube feeds in the night to try to get them to eat in the day. And you're like, okay, well, they're not hungry. So reaching out to GI, getting nutritionists on board, and really advocating for that piece of, hey, let's look at them as a 24-hour period, right? Maybe we do bring back tube feeds in the daytime. Alongside of meals and talking to them and bouncing ideas back and forth. And not every doctor is okay with you coming with an opinion, and that's okay because as long as you have a reason for your opinion and your opinion makes sense, it's okay to have an opinion someone doesn't agree with. That's where advocacy comes in. You're coming to a doctor who may have a different opinion and you're giving that evidence and that Reasoning of why we should consider it. Again, it might not always go well.

Never know.

It's our job as therapists and parents to do it. Reaching out to pediatricians, maybe the pediatrician saying this isn't really a concern, because I'll see things all the time and I'm like, I really want a referral for this. I think it is a roadblock that we're having, especially like Sending off to GI or maybe allergy testing. Like, they're throwing up 2, 3 times a week. You're noticing it's around meal times, an hour, maybe 2 hours after meal times. Let's get an allergist on board or a GI on board. They go see pediatrician. Pediatrician says, I just don't think it's a great— it's like really necessary. Like, we'll just watch what they eat. Okay, but we were already watching what they ate. So we're not gonna get anywhere. We still have this roadblock. So then we have to advocate, right? We have to step up again and talk to them and be like, parent has been logging food. Parent is coming to me. This is happening quite often. Sometimes are worse than others. I really truly believe we need this referral. So being that advocate, and should we have to advocate as much as we do?

No.

But also like, it's our calling. That's what we do. That's why a lot of us got into this. We love the children that we work with. We love our clients. And advocacy is part of that, right? Even advocating for parents sometimes, helping parents find resources, helping parents find other families to connect with, and being like, you're not alone in this. So I think the advocacy part of our field goes very far and Really goes into every portion of our clients' lives.

Absolutely, completely agree with that. It's interesting, I really felt like I fell into advocacy really deeply when I had my own private practice and working with those patients, and even when I worked in the schools. But then when I was on the other side of the table, I'm like, I know how they do things over here, and I can help you get what you need on your kid's IEP. And, you know, with them, like, in private services too, but it was like a whole turn of the tables. Anyways, so let's talk about that. Let's, like, wrap our convo today talking about what you're building, because you're building your own thing. You're in the middle of, you know, your practice that you were talking about. You work part-time still in the clinic, but you're also building your own thing on the side. So tell us more about that.

So it's still very new and doesn't have much root to it just yet, getting everything put together. But I know that it's going to start. I really want to be a consult for a lot of families. So given courses, I want to be a consult where people can reach out with any questions they may have, and not just therapy, because I feel like sometimes parents are like, it's not bad enough to seek out therapy yet. But then they don't feel comfortable enough finding resources and people to help them just with some questions they may have. Well, how do I start solids? Breast isn't really going too great. What do— or maybe breastfeeding's been going great. When do I start a bottle? All of these things, and there maybe they didn't get enough information from their pediatrician, or maybe their pediatrician is like, oh well, go find the lactation consultant. So my goal is to really be a big area of consultation. So I want to offer the resources of— you have some questions about early development, early feeding, breastfeeding, bottle feeding, early solids, all those things. Let's chat. Let's have chats.

That's awesome.

I want to be somebody who— okay, I hear that you're having trouble with this. Let's find you somewhere that you need to go. Maybe you're seeking out and you don't know who to talk to about this. Well, this is my resource list. This is who's available in the area. And then on top of that, I also want to bring more to the in-home, bringing that feeding therapy to in-home and being able to meet kids where they're at. And maybe even like mommy and me courses where we're like, it's not necessarily therapy, right? But Moms and their toddlers coming in and we're all getting messy and it's a great time and we have a great theme. And even talking to parents a little bit before and after of like sensory aspects to feeding and we're gonna get messy here and it's okay, please don't wipe them till the end, all of that. So I really want it to be kind of diverse. I don't want to be just— Okay, so you're offering feeding therapy in the home. Like, I really want to be multifactorial in what I make this, and I'm very excited for where it's going to go.

Well, congratulations. That is so exciting. And I think that in-home therapy in the natural environment sometimes, especially for certain families, is so helpful because it's like they see it happen at their own kitchen table or, you know, wherever their child eats. And I think that can be so helpful. The getting messy, oh my gosh, like to do the sensory feeding or even just sensory play types of interactions with moms who are very like anxious about letting their kids get messy and really understanding, like learning the importance of it. Like, yes, please, that and more. And then, you know, the thing that you mentioned at first with doing like the consults, I think that's one of the biggest things that's still missing out there is just the ability to talk to a professional in this space who really understands what might be necessary. Maybe they can refer you to a provider if it's someone in your area. And it's almost like the beginning of the case management, if you will, you know what I mean? Like trying to figure out who do we talk to? Where do we go next? What am I even asking them or looking for in a provider? What am I asking about my child? I I think so many families just need that direction and they're left to case manage everything on their own. And so if they can at least feel confident about like where they're starting and where they're going next, I think that would just help on the trajectory of like this entire process because it is a process, it's a journey, right? And, you know, feeding therapy is a journey. Wherever you are in that process, it is a journey. And sometimes just knowing someone's in your corner can be so helpful. And so I think offering a service like that is just such a beautiful thing because parents don't, they don't know what they don't know. We didn't know what we didn't know. Right before we just kept diving deeper and deeper down this rabbit hole of all things feeding. So I love that. I'm excited for you, and I know you'll keep us posted. And just tell us where can they find you online right now if they do want to enlist in your services?

So nothing is up and running quite yet, but if you want to contact me, you can find me on Instagram or Facebook under Shay Bolman, S-H-A-Y B-O-L-L-M-A-N, and just send me a DM and get started. Websites will be up and going soon, and so when they are, those will be linked to my private accounts as well. But in the end, I just— my goal as a therapist is to be the person I wish I would have had 10 years ago. And so that's where I hope life takes me. And that's where the CPFT and Feed the Peeps has started taking me. It's really turned me into who I needed. And so I'm forever thankful for the resources you have started and the way that you have guided my So I'm so grateful we got to have this chat and talk about it all because it's been a few years of just being truly grateful for Feed the Peeds in general. And so it's changed my life and I hope lots of other SLPs get to experience that too because it really was worth it for me.

Oh, you're gonna make me cry. I'm like, it's— I received that and, you know, and it was just like I said, like I experienced this with my own kid too, right? And so it was like, can I provide these resources not just for the families through my private practice, but then for the other therapists? Because I was like, I just, I would, I want the training that I wish existed. I want the training I wish I had to help my own kid, and then I wish other therapists had to help my kid, you know? And so here we are, here we are now, you know, many years later. And it just really, you know, is very fulfilling on my end to be able to provide this to you all. And to— But I'm very grateful on my end too, because it takes therapists wanting this information and wanting to help the kids and wanting to make this like your life mission to basically provide these kinds of interventions, resources, you know, consults, like all the things for the families. And at the end of the day, I'm like, can we just clone you like 1,000 times over, please? Because we just need more Shanes in the world.

I appreciate that.

Well, thank you, Shane, so much for joining me today. This was awesome.

Thank you so much.

Quick disclaimer, all information, content, and material of this podcast are the opinions of the speakers and serves as informational purposes only and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these myotats, airway, and feeding-related episodes, be sure to leave a review on Apple podcasts and share this episode on your social media platforms. You can access free resources and all I offer at halliebulkin.com or pop over to @halliebulkin on Instagram to get all the latest updates.