Why Pediatric Feeding Therapy Feels So Hard and What’s Been Missing

I am sharing this knowledge no matter what. I will not going to keep it in my vest because it's the children and the babies that benefit from collaboration. I was so surprised that some of the leaders in the field were not willing to share their information with me. So basically trial and error. And I went to all the courses. You name them, I went to them.

Hi and welcome back to the Untethered Podcast. Today we have Cheryl Pelletier rejoining us. You are going to instantly love her if you've never encountered her, met her, been mentored by her before. Many of you know her is Shasha, a nickname that she earned 30 years ago from a child who was learning to speak and it stuck. But Shasha, or Cheryl, is a speech language pathologist with over 35 years of experience specializing in feeding and swallowing disorders across the lifespan. For more than two decades, she served as the lead feeding and swallowing specialist in an outpatient setting, working with babies, providing lactation coaching, supporting children of all ages, and treating neurologically diverse adults with developmental delays. In 2017, driven by what her own patients truly needed, she invented a completely new approach to therapeutic chewing and swallowing, which led to the creation of the Side Biter, a patented tool that uses real diced and frozen foods to support functional chewing and swallowing. The patent was officially granted between 2020 and 2023 and it has been an absolute game changer in the feeding world. So go check that out today. Cheryl also runs her own private practice, Nosh Inc. And she is a mentor inside of our programs Feed the Peds, the Pediatric Feeding Hub, and inside of the Certified Pediatric Feeding Therapist certification. So whether you're just starting in feeding or you are looking for certification, she is part of our programs and she is an incredible mentor. You are in for such a treat with this conversation, so let's dive in. Welcome to the Untethered Podcast.

I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the Orofacial myofunctional Therapy, Airway 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.

Cheryl, welcome back to the podcast.

Thank you for having me. Good to see you.

You too. I always love chatting with you. We've done a couple of these now, and you are obviously a very important and integral part of our Feed the Peeds and CPFT team and mentorship team and all the things. So I'm honored that you're taking some time out to hang with us today.

Well, it's a wonderful opportunity to be a facilitator as well as a coach, and it means a lot to me to be involved.

And just in case I default to Cheryl's nickname, if you hear me call her Shasha, I just want to put that out there. That is what we call her internally here. So it's Cheryl that I'm referring to if I say that. Okay, so mentorship is definitely not new to you. Basically, I feel like it's. It's almost who you are. Like, you're obviously a pediatric feeding therapist. You have a lot of experience. Experience. You've worked in a lot of settings, but I think throughout your entire career, you've shared that. You have basically always had students, newer clinicians, clinicians with less experience under your wing. And so it's. It seems like it's been a constant. I'm just curious to have you share with us just, you know, like, why that's mattered to you, why that's kind of been a part of who you are since. It sounds like almost since the beginning.

Well, it's a story because I have been there. I have been asked. Many years ago, I would say 25 years ago, I was asked to create a feeding and swallowing program in an outpatient facility associated with a Boston hospital and was ground zero. And I wanted to do it the right way. I started making protocols and collecting data about how to create a case history, policies and procedures, how to keep the facility clean and sanitary, how to create an assessment, how to build a team ot, pt, speech dietitian, gi. I felt very alone and very afraid. And I reached out to a lot of facilities close to me, thinking that I'm sure they're going to mentor me. I'm sure they're going to help me along because I want to do this thing. No, they had no obligation to me whatsoever. I was very nervous. I cried a lot. And I swore to myself, if I figure out just a little bit of knowledge, I am sharing this knowledge no matter what. I will not going to keep it in my vest because it's the children and the babies that benefit from collaboration I was so surprised that some of the leaders in the field were not willing to share their information with me. So basically trial and error. And I went to all the courses. You name them, I went to them. The problem with all the courses where that when you're looking at a child, they don't always fit into what you just learned at this course. And the, you know, the person behind the podium is not going to say to you, yeah, do this with this child, because they've never met the child before, right? So you have to then think on your feet and problem solve and be quick about it. And that is the reason why when I was in a position of supervisor or a mentor, I'm like, this is what I'm looking at and this is why it's important. Because I had no idea at the beginning and I was in the trenches, expected to know, and it was full on imposter syndrome. And I was petrified. And I don't want any clinician that we are lucky to have in our courses, the 12 week and the certification to feel like that ever again. I want them to be able to get the knowledge to problem solve with their peers, to have a facilitator that will draw. They know a lot. Everyone in our courses that we do together, Hallie, they've been through it and they know a lot. But there's still this hunger for knowledge. And we are always striving to be lifelong learners. But if you don't have a good mentor or facilitator or coach that walks alongside you, you can either get too frustrated or forever miss key elements that would have mattered for that child that has feeding and swallowing problems and their families. Because you're not just treating the patient, you're treating the whole entire family. And so that's why when I got this opportunity to use some of the things that I learned along the way and I learned alongside all of the participants because I love their questions. And I'm like, oh, well, let's figure it out. And like I said, the peers that are together with that clinician also have a set of skills that maybe I have not had. And so they come forward and it's such a dynamic way of learning. Very mature, very professional, very supportive, and I just love being a part of it because I feel like that when you train a clinician to the next level, you are helping thousands of children get off wait lists, get what they truly need, bring in collaborators, referral sources that they truly need, and then that's so important. Otherwise, if you're for Me, I was in an outpatient clinic, seeing clients one right after another, and the most I could probably see was, I mean, you know, 10 a day, which is a lot. But here we have the opportunity to spread far and wide and also be available for questions later. So they might not know what they don't know right now, but then they're like, okay, you know, what would a mentor do? Or what would Hallie do? Or what would Shasha do? So that's sort of how I became passionate about education. I did a lot of in services, a lot of training in the hospital settings, but it's very limited to your audience, you know, your lunch and learn. Here. I feel like we have this opportunity to grow, improve, do things that the participants want us, want to be learning. So we always throwing it out there. How can we help you the most in this case? What resources do you feel like you're lacking? So that's why I started when I had this opportunity. I was like, yeah, this is the part of my career that I really want to hone. And you have to really know your stuff, even if you don't know it at the time. When you get a question, you'll be like, I can find that out for you. Let me.

Let me think.

Let me use my mighty brain, or let me use Hallie's brain or one of the other mentors. And not everyone knows all the answers, and that's the beauty of it. And it means that you're growing in a mature, professional manner.

I love that. I love that. And you said something at the beginning that I think is so key. I struggled as a new clinician to find people to mentor me as well. And I offered to pay people both in feeding and myo. And it was like crickets. And it was wild. I mean, people didn't even say no. They just wouldn't respond to my emails or my calls. It was like, are we adults? Or. I mean, just tell me no, I'll go away. Give me a no. At least, like, have the respect and decency to say no. You know what I'm not interested in because I feel like you're competition or, I don't know, give me a reason. Give me something. Nothing. It was wild. But that also gave me the passion to learn and then want to share that knowledge. And that was a big thing in the beginning. I was like, no more gatekeeping. Gatekeeping only hurts the patients. Why are we so afraid? And not we, you and I, but just as a profession, why are some of the incredible, brilliant minds who are at the forefront of what is being taught here. So afraid to educate the next level and mentor the next level or the next, you know, the rising, you know, leaders of the future in this space. Do you feel like they're going to replace you and you won't be relevant anymore? Like there's enough of us to go around, there's enough patience to go around. I don't know where this fear based mindset comes from that we can't actually step out and, and mentor and educate fully, you know, those who are in our circles and those who reach out to us. And so that's like, like you said, I was like, I want to gain this knowledge so I can help others, I want, I can help other patients, I can help other clinicians. You know, gatekeeping, it is harmful. And there's just so much of that in our profession. I don't know why.

Well, I also just coming from a medical kind of standpoint, the administrators, I don't think knew how complex pediatric feeding and swallowing was and how detailed of an education the clinicians needed even back then, because in school we didn't get it. And so I think that there was a disconnect between what was needed educationally and then the time and the funds to take a person like me and give them administration time to make a curriculum, to actually teach the basics. Before we made some mistakes that were costly. I mean, this is really the only setting or sub category of speech therapy. Well, and occupational therapy too, where you could harm somebody, somebody could choke to death or aspirate or, or, you know, there could be consequences for what we don't know. And I struggled with that because I felt like that when people weren't getting the supervision. I was a supervisor, but I went above and beyond never PA for it just because ethically I knew it was the right thing to do. But there wasn't anything in place to educate people that wanted to learn. That came to me and said, shasha, I want to be on the feeding team. Like, yep.

What do you think that those newer clinicians struggle with the most when they start working? Is it what you just said? Is it that fear of like, I could actually do harm to these patients? And I know that's very different than everything else in the pediatric or in the pediatric world in general. Slp, ot, pt, you know, but the ability to potentially cause harm and you.

Need to know some basics. That's why I just love what you put together for the feed the peds 12 week and as well as the modules for certification because they're right there. There's time to review it. There's resources, there's websites, there's books, there's bonus items. And that's something that I just could not do as a supervisor and a mentor in a facility like that because I had my own caseload. So I sympathize with clinicians that are well seasoned, as we say, experienced in a setting. It's extremely difficult to balance unless you have time in your schedule to truly educate. So this fit in with my ethics and what I viewed myself in this second half of my career because I do know a lot of things that I can share that are functional and fun and helpful and effective and supports families. They're not, you know. So that's why I just think that what you've put together is so powerful because it's just a place, a safe, supportive place for clinicians that are new or maybe clinicians that want to learn more. We always can learn more.

Yeah, absolutely. Well, and I love that because I'm like we're all lifelong learners and I love highlighted that none of us know everything. And I think that's so important for us to say at this point of our careers because that imposter syndrome thing is real. And I know that there's people in the field till retirement that still feel like an imposter throughout their entire career, regardless of the level of their expertise. And so I love that you share that because it's real. It's. That's we're human, right? Like we all have our things, we all have our feelings and all the things. Anyways, I'm curious to know, like after supervising students for so many years, are there any patterns that you see in students who grow quickly versus students who stay stuck?

I think the students that can really see the full picture step outside of the case and get meta with it and look at true function and not expect say in their treatment plan that it would be quick because nothing that we do is really fast. If they're realistic and they go ahead and give themselves grace, they're open for changes. I think those open for suggestions. Clinicians that kind of think that they know it all right away are missing some opportunities to learn what this child's trying to tell them. So that's I think what I've noticed and I think that the clinicians that thrive with validation, which is what I love about these programs, is that sometimes you just need to say to somebody, you are so right. You that keep going. Just give it three more months instead of you know, oh, I tried it for a month and it's, it's the mother's fault or whatever. Like they're, they're not open to the fact that maybe what they're treating is not the actual problem.

If pediatric feeding cases make you think, where do I even start? This is for you. I created Screen the Peeds to feed the PEDs, a free three day training where I walk you step by step through how to screen pediatric feeding with confidence you'll learn what's typical, what's not, exactly what to do next. Join us for free at feedthepedes.com backslash.

Training to circle back and say, okay, what am I missing? What is it that is going on with this little human? Or what's the setting like? You know, looking at so many, it's so many details, but you get faster at it. And I think going at it in a strength based perspective and not like a lacking or, you know, disability based perspective is super helpful.

Yeah, I love that. That's always been like my M.O. is like, why don't we look at what they're good at and use that to help us work on the skill that we're trying to build. Like, how can we use that to kind of level up? Right. And so I really, I really, really love that. And you know, and so for anybody who's not aware, Cheryl is both a mentor inside Feed the Peds and also inside certified PDF. Well, actually you're in everything. Literally, you're in our pediatric feeding hub. You're in the certification, the cpft. And so for anyone who is maybe listening to this for the first, first time and not familiar with all of our programs, Feed the Peas is more of a like intro, comprehensive introductory pediatric feeding course that teaches, you know, typical development, assessment, treatment. You know, we dive into medical complexities and tevidural tissues and my own how to adapt that to the little ones. And then we have the pediatric feeding hub, which is really geared more towards people already working with pediatric feeding cases who want a community and mentorship. And then we've got the cpft, which is our certified pediatric feeding therapist certification program, which is a full program. It's got coursework and you're working with patients and you're presenting cases and you're writing reports and all these things Anyway, so, you know, I think it's really cool because you're a mentor across all of these programs. So I don't know if there's like a good answer for this or not, but I'm just kind of curious to Know from your perspective, like, how do you balance being supportive? Right. While still holding, like, high clinical standards? Because I feel like a big part of what we want to come out of our program are therapists who can become critical thinkers. They can think on their own two feet, but, like, they've been mentored to get there, right?

So one of the things that I really try to hone in on is taking a look at their patterns of looking at a child, taking data, and then pulling all the pieces together and analyzing it. Because we are good at being clinical investigators, right? So we're looking and we're watching, but pulling it together and making some clinical decisions based on a protocol that you're using, based on some testing tools, having a real kind of mindset of what does this all mean? How do I put it together? What diagnosis can I come up with? What are the rationales that I have for creating a functional, measurable treatment plan? How do I determine what referral sources I need to support this family and this child? I think doing that in a directed, cohesive way is what we can do to bring somebody to the next level. Sometimes we don't know what we're seeing. We're seeing something and we don't know exactly how to describe it. So bringing language to that, and it's great because, you know, we're in the therapy field where we're teaching vocabulary all the time. But sometimes when it comes to us on a report, what is it that we saw? How do we describe it? What does it mean? And can I label it? And then can I make a real skilled functional goal that goes with that? So it sounds, you know, simple, but it's really not. Because when you're new at it, you're just sort of, you know, you've got time constraints. You only saw the child for half an hour. Like, what can you do in a half an hour? That really pulls it all together and you can analyze it as a higher level clinician. So that's where walking alongside somebody and coaching them can help them open their eyes to, you know, what could this be? What does that mean? What did you do then? How did you cue them? And were there improvements? What facilitated them to improve in your assessment? What does that mean to you? Like, if you move their hips to the left and change their seating and put the spoon in the left hand instead of the right, what does that mean? So that's been exciting because some of the assessments that we go through, we're taught just to look at all these disabilities. This was wrong. That was wrong. This was wrong. That was wrong. But what are the diagnostic therapeutic strategies you can use to then say, but prognosis is really good because they responded to these cues. So that's a different level of assessment. We assess during every session, really. But if it's the initial visit with this family, how is it that you could, like you said, take this strengths and build on them and find out what are the compensations that this child is doing that's telling us a story. So when. When we're new at it and we just look at checking off the boxes, we don't see the full child. So I feel like in. In these courses that you offer, especially in the group discussions, that's where I think peer to peer and coach to peer and participant kind of helps to solidify all of those skills.

I love that. And it's. It's really cool to see everyone coming out of either feed the PEDs, the course, or the CPFT program, because we see clinicians, like, shift from, like, asking, like, am I right? Is this right? Is this how you would do this? What am I missing? To kind of going like, well, what is my clinical reasoning around this? Like, you're thinking you were, like, guiding them. Like, why are you doing this? Why is this important to you? Like, what is the reasoning behind this? And helping them? Right. Trust their observations and their own clinical instincts. And, you know, there's like, this real, like, clinical maturity, if you will, that I see that, like, grows in feed the peds and then just like, completely blossoms inside cpft, which is so, so very cool. And so I think it's. It's very exciting to see them go from, like, start to finish in both the course and the program. But what would you say? Like, so as a mentor, I'm just kind of curious in the program of. Because I'm thinking of conversations I've had with people, like, wondering if they should, you know, go into cpfd, if they should get certified as a pediatric feeding therapist. Are there certain, like, people that you feel like, yeah, this would be a really good, you know, opportunity or reason or, you know, example of somebody who should go through certification. Any. Any thoughts around that? Candidates for certification?

I feel like that the clinician that's been at it for a while, a good three to five years, who has a pretty full caseload of feeding and swallowing cases, who want to really either step out into private practice or really specialize, they really want to say, I'm a specialist. Because I think a lot of people will just name themselves a Specialist. I'm a specialist. I'll be honest, I never in my whole career told anyone I was a specialist. I was a feeding and swallowing therapist because at the time I had a full caseload of all clients that had those issues. But I never named myself as a specialist. And I think that if I had a certification and I think now I could say that because I have it, but I feel like that it sets you apart from somebody that sees clients now and then that have feeding issues or you're the go to person at your facility, but you haven't done it for a really long time. I really think that certification gives a leg up to that person to say, listen, this is who I am. I have learned through the school of hard knocks in three to five years. I am dedicated to this and I went through this certification and I've heard so many stories about people saying, yeah, now that I have this, I'm getting referrals from Ents and GI and they recognize me as a leader. So the 12 week is more of like, I, I'm doing it, but I'd like to kind of fill in the holes. And then going to the certification is the next really nice step because then you really, you really have credentials. You're credentialed. Yeah, that was my issue. I didn't feel confident because no one, you know, had a magic wand or dubbed me queen of a feeding is Wally program. I just tried my best, but I didn't, I never. Even on my business card, it never said specialist ever, because I just didn't, you know, I didn't, I don't know, I just, I didn't have the credentials yet. So that's where I think this is so, so wonderful. And I will also say that my small group that I worked with when we were doing some, we do a lot of assignments and exercises and homework. It's a lot of work, but worth it. They said to me at first we didn't know why that these certain things were important. For example, how to write certain things on your assessment report. And when I said, you know, you can now go anywhere, any setting, if your job at the school ended and you were then thrusted into inpatient or whatever, just across the board, your evaluations are stellar. A physician can look at them and exactly what your expertise is telling them and what your expertise is going to do about it. Because there was no more nebulous, you know, language. It was concise, direct, functional and supportive and family friendly. And so many people are like, I thought my reports were really Good. And I was very insulted. Now they're so good, and I get it. So that. That's really exciting. Back to like the clinician that gets stuck. If you're doing things the same way all the time, you're not growing.

Yes. And I love it because I've had. It's. It's so. It's been so interesting. There's some newer clinicians who have been in the field, you know, doing feeding for just a couple years that have gone through the program, and there's people who have been in the field for 35 years who have gone through the program, and everybody has gotten something out of it and feels like it completely changed things for them. And. And that's what's really incredible because, you know, it's like whenever I set out to set to create any of this, my goal was function. How do we make this functional? How do we create critical fingers? How do we help you as a clinician actually get out there and help your patients and feel good about the work that you're doing and that you're making progress and not just fill a CEU. Like, we can fill CEUs all day, every day. All kinds of these companies that sell you memberships for $100 a year or whatever. That's good and great if that's your goal is just filling CEUs. But I know for me, I was like, no, I'm looking for the thing that's going to actually help me improve and be a better therapist for my patients. And I just couldn't find that. I was like, I really had a hard time finding, like, the things that were out there too, at least in pediatric feeding were like, very specific to certain courses or programs, but they weren't like, comprehensive approaches. And I was like, you know, we have this like, board certified swallowing credential through asha, but it's really more adult geared. It's not really. There's not pediatrics, like, really embedded into it significantly. And, you know, I know people with. With those credentials that are working with solely pediatrics, and they were like, I don't think it was that beneficial to me. And it was not easy to get. So I was like, well, clearly we're missing the boat here. We got to fill this void. So it's been really, really cool. Like the things that you shared with some people, having all these exper. External referrals to them all of a sudden because they have the credentials. You know, I know a couple people have opened private practices and they're like, my schedule is full. I've just like the patients have flooded in because people recognize me as the expert clinicians, pediatricians, ENTs, you know, they're all referring to me because I have these credentials. And I'm like, it's wild. But that's also how the medical system works. When they see credentials, they know you're the person to send the patients to. And, and we can stand behind those credentials because we know the quality of what is coming out of the program. Like, people are the abilities they have to actually go out and help these kids. And so I think it's really incredible that this is out there now. And it's really exciting because again, my whole reason for doing all of this, back in 2019, when I decided I was diving in feet, you know, feet, I was like, feet first, jump in, go. Was get these kids off pediatric feeding wait lists. And then when I was like, okay, we're making, we're making a difference. There's thousands of clinicians trained now that weren't. But how do we make a difference faster? How do we dive deeper? How do we get more clinicians in, you know, their day to day work, feeling like they really excel at what they do and they can really help these patients. And you know, what if they don't know something, it's okay because nobody knows everything. And we have a community to go back to to then seek, you know, guidance from. Because one of the things I know we tell a lot of our graduates is, you know, we want you to link up. I'm pairing people with mentors and with clinicians in the certification so that you all are on a similar journey and the mentor you're paired with can actually help you based on the, your goals of going through this program. And when you come out, you have those fellow clinicians that you went through this with as a resource. And hopefully new friendships are born, new colleague, you know, relationships are born out of this. You can continue to have each other to lean on outside of the cpft because we all need, we all need those colleagues. And it's enough of us feeling like we're on like dysphagia island by ourselves with no ability to help.

I love that the SLPs and the OTs learned so much from their different disciplines. Constantly we were going back and forth, you know, look at it from the lens of an ot. What are you seeing? What are you sharing and what activities would you do? And the SLPs were like, oh my God, I just learned so much.

And then confidence in feeding therapy starts with screening. If you're an slp, OT or PT who wants clarity before diving into feeding cases. Join my free 3 day training. Screen the PEDs. To feed the PEDs, sign up at feedthepedes.com backslash training.

The OT is the same thing. I always knew about speech therapists, but I didn't really know exactly what they would do differently than me. And so if you're not in a setting where you, you're paired with another clinician that you get along with, because I know in certain, certain settings it's like turf wars, right? Whereas in these modules and the calls, there's no turf. It's, it's. We're all learning together, we're all playing nice in the sandbox, and we're all figuring it out together.

I love that and that's so important. I was, I was just having a conversation with someone earlier today who's in our MYO membership and they were like, I love the mentors in there because it's SLPs and RDHs. And I said, you know, there's such a turf war in the MYO space between those clinicians, kind of like in the feeding world between slp, OT and even pet, depending on who's in the nicu, who's an inpatient, who's an outpatient. It's different in every hospital. I feel like More commonly the OTs or the PTs are in the NICU than the SLPs. SLPs are like trying to fight their way in. I was talking to a hospital system where only the OTs do the outpatient feeding because the SLPs are so slammed and they have a space issue so they can't hire SLPs on and train them for feeding in their facility. And I was like, well, that's different. I don't hear that very often, you know, so it's like, it's so dependent on where you work. But also, like you said, it just, just there are these turf wars created because of how different systems and facilities do things. And it's just so nice when everybody, like you said, can come and play nicely together in the sandbox. Like we're all back in preschool and learning how to share our toys.

Yeah. So like OTs, OTS were completely trained differently than us. You know, they didn't have the training about, you know, velo pharyngeal port and like what happens after food goes through the lips. So this was a great way to support them. And some of the OTs in my group said, oh, I was watching this child and I was watching closely and the food is coming out of the nose. I don't know what that means. And this is in the certification class. Okay, so if they hadn't been here, they wouldn't have the peers to gather around. And I did a whole extra little talk about, okay, this is what happens when you. The tongue elevates and then, you know, the V lobe, pharyngeal port closes and it doesn't come. Not supposed to come out your. Of your nose. And she's like, what do I do about it? You know what I mean? So it was such a great moment because how else are you going to really learn it if you're in the trenches and swimming your way through these things that you don't, maybe you'll never see that, but here you are seeing it and you're supported in a group that can address it with you. Like, this is where you might refer this child to ent. And then why that would be. And it was really such a great teachable moment that had nothing to do with the curriculum. It just, it's so organic and so functional how it happens. I just love it.

I love that. And I think that's the beauty of having us all come together and why I try to marry the professions who both have the license to, you know, to do these things. Because, you know, similarly, ot's learn things in school that us as SLPs do not. And that tends to be more around maybe some of the sensory system, you know, based conversations and proprioception and all these terms that like SLPs are like, what does that mean? Like, what is that? Tell me more about. Right? And so, and positioning and seating and all these things that play into feeding that are critical but that, you know, a lot of us may learn on our own. I didn't learn any pediatric feeding grad school at all. So there's that. I only learned adult dysphasia, which is totally different than pediatric. But, you know, I think we all have a seat at the table and we all have different backgrounds and we all have different knowledge, and when we can all come together, we have so much to learn from each other. And so when you do have these, like, case questions pop up and these teachable moments, and you've got both professions in the room, right? It's like totally different lens through which you see the same patient case situation and, and the patients are better for it because then we have different conversations that allow us to bring different things back to the table. And when working with those patients, we're.

So lucky that in the 12 week feed the peds. We have Karen Howarth, who is gifted. She is our co presenter and she brings to the table so much knowledge. She's a skilled ot and we're just, just, it's a, it's a great team because where I end, she picks up and we just offer the participants a well rounded, you know, holistic view of situations and cases with a spin on the strength and building on those. So I really love that.

Yeah, yeah. And then we've got OTs who've created some additional coursework in the CPFT. And plus we've got Beth in there, our NICU OT. It's been, it's been so cool to like be able to bring in Karen and Beth and some of our course creators with that knowledge because I've learned from, you know, what a lot of they have, a lot of what they've either shared through courses or through mentorship. Again, totally different lens. Like have experience, you have experience, Nadine has experience, you know, but it's, it's different, you know, and I've worked with lots of kiddos who were on ot. I've co treated with ot, both pediatric feeding and non feeding cases and, and still it's like to have these conversations surrounding, you know, what we're talking about in Feed the Peeds and even cpft. It's just, it's, it's so well rounded and, and you don't know what, you don't know, you don't know what you're missing until all of a sudden this conversation happens and you're like, whoa, wasn't expecting that. So cool, so valuable. This is going to help me, this is going to help me help my patients, right? And help the families of these patients. And at the end of the day, that's, that's, that's the whole reason why I know a lot of us do what we do.

We had some good catches with some people's cases when they brought cases to the table. And like, I'm worried about this and that and through problem solving, made referrals or suggested referrals that really caught issues like endocrine, like metabolic stuff that, you know, oh, you think the child's small because they're not eating. But what if now they're eating or they have a G tube now and they're still not gaining weight? Why? What is the issue? And it could be an endocrinology issue or like I said, a metabolic condition that we, we didn't know about. And they were small because of that. And it wasn't necessarily that they weren't eating. Very interesting. So it's just been a wonderful growth experience for all.

Well, thank you, Sasha, for all of the work that you do with us and all of our programs and the course and the membership and the certification. We wholeheartedly value you. You. I know that everyone who has been in your group and even many who aren't talk, they just sing your praises. And for anyone who's not familiar with Cheryl, I just have to give her a little bit of a plug because she also has created this really cool feeding tool called the side Biter. And so you guys all need to go check that out. It's by Nosh. If you're looking at the screen and watching this, you can see G N O S H. It's on this little license plate up at the top of her screen. So cute. But Nosh feeding, and Cheryl has her own private practice and has just extensive, you know, experience in pediatric feeding. But that side Biter tool is really cool. And the one thing I want to point out about it is it's the only thing on the market that does what it does, in my experience, from different tools that we've used, because I know there's all kinds of, what do you call it, Cheryl? Like, they're gum line feeders is kind of what these other ones are. And that's a lot of those things that you'll see, like little, like toys, like little things that babies can, you know, experience before they have teeth, if you will. Right. They're the kind of, like, feeders that you can put little things into to squeeze a teeny bit out of maybe once the baby has teeth. And we're actually, like, using these tools and feeding therapy. There was nothing safe. And honestly, like, I don't want to get sued. I don't want to injure the child that I'm working with, like, major liability. Don't use those gum line feeders. You know, Cheryl created this tool that we needed that basically allows children to. And I. You have different levels and I don't have it with here. Maybe you have one on your desk. But, you know, there is the version or the part of it that doesn't have the holes. So you can put food in it and still like, like work with food present. But they don't actually experience the smell, the taste. They just visually see it inside of the side biter. And you can work on skills and then you, like, slowly, incrementally have the ability to add a teensy bit of more food. More food, more Food coming through the tiny little holes. And you can explain this better than I can, but I just think it's a really cool tool. I had to plug it because. And I'll let, Cheryl, I'll let you speak about it because I think it's really, really very cool. And I know when we first recorded you had the adult version, you then came out with the pediatric version. And so let me speak. I'm going to let you speak about your tool because everybody needs to know about this.

Well, basically there's five tools now, they're patented in the US there's five, because that's how my brain works. I was thinking about children because I kept getting medically involved children coming to me that were more and more medically involved and older. So as I said, I worked in a outpatient clinic and it wasn't just the, you know, the babies and 2 year olds that weren't chewing well, it was. And swallowing it was. There's seven, they've had multiple issues. They've been fed by G tube since birth. They're seven now. And feeding and swallowing therapy became this big buzzword. You know, all the doctors were hearing about, oh, well, maybe you need feeding therapy. And they would show up and the mother would be like, yes, we want Johnny to chew and swallow this pizza. And they would have pizza with them. I thought, okay, so we can modify it, we can puree it into Etsy, you know, level five. We could do, I could do a lot of things, but that those are consistencies that we don't chew. So of course, I was familiar with all the mesh feeders and the different things. And I was like, I need something that's linear, that's the shape of my finger because it was constantly putting food in the cheeks on the molars, trying to get that tongue to move laterally back and forth, rotation. It's like, I really need this tool and I need it to have a gradual ability to give food. So it would be safer and safer once the individual learned swallow activation. And I wanted it to be bouncy for proprioception. I wanted it to fit on the molars. So I came out with something that looks like this. This is linear. So on Sidebiter.com you'll see lots of videos on how to use it. So I also wanted one that was half the size, that was a mini. So the mini biter has six holes in it. So the larger ones hold 5mls of possible food that somebody could chew and swallow. And with that there's a ton of exercise so they are chewing and swallowing exercise tools. So believe me, I chew on them all the time because I want to know, oh, how does shrimp feel in there? How does you know a meatball feel? The only thing you can't put in there is nuts and seeds because it would break the silicone. But it's mouth safe silicone go in the dishwasher, it's easily cleaned. But what it does is it offers strengthening to all the 126 muscles that you use in your face and your throat to safely chew and swallow your food. And so I also wanted this to be in our toolbox. Because of home programs, some of the families I saw could only come one time a month if the child was sick or the older person. I was working with older adults with developmental challenges such as down syndrome and autism. And so they would come from a long way, they would come once a month, they would miss that, Then I wouldn't see them for two months. What we do in 45 minutes is not going to help them two months time. So I wanted to send something home with them that they could use to stimulate flavor, saliva production, saliva management, motivate them. Because, you know, motivating somebody that has a cognitive disability to have pureed foods sometimes doesn't go well. They don't want that. They want what they had before. So one of the clients that really spurred me on was an adult 67 year old man with down syndrome that had a stroke. Now he loved food and now he's got a feeding tube and it was, he could not understand why he couldn't have what he wanted to have, but he could have it in the side biter. So he was able to wean from the tube using that. And then like I said, the mini is also something that's great because it's designed for seven months and up. Good for, you know, babies that maybe had developed some teeth and missed the window of baby led weaning because, you know, you can't just hand them a turkey leg and hope for the best. So I was hoping that that's where, how it would be used. And it is. And it's something that has really taken off and is highly functional. So I appreciate this opportunity to talk about it. I do have a coupon if anyone wants to try it out. It's. It's Feed the PEDs, it's FTP. So if anyone who is following Holly and is involved with Feed the Peds or the certification, if you want to try them out, that's what you could use and share with your patients. And I also support, I do tons of chats and virtual trainings to support creative and effective use of all the tools. So that's what it is.

And I think it's important to share too because I'm a very crunchy mom for the other crunchy mamas out there who are like, where do these materials come from and is it is safe and all of that. Like I know Sasha has us produced in the United States, even the down to the cleaning tool where I know she like, she knows the quality of what she's giving you so it's safe and that nothing's going to decrease, degrade. And you know, it's not coming from China, which if you're not aware most of those baby feeders are coming from, from China. They're treated like toys. So they're not necessarily like food grade safe types of tools. So just know where your stuff is coming from and what you put in your baby's mouth because this is definitely safe and tried and true and tested and all the things. And I just wanted.

It can be frozen. The other thing is that they can be frozen or contain frozen foods, you know, put in the freezer overnight, you can put breast milk in them, you can put, you know, frozen yogurt. If you can't have a thin liquid, you can use pudding in there. Anything that would maintain viscosity for thermal stem, for awareness. And it can be actually, it is durable to 500 degrees. So it can go in the dishwasher at any commercial dishwasher, which is usually 185 to 200 degrees Fahrenheit. So there was a lot of thought and effort that went into creating them in a durable way in the shape and the size, that would be therapeutic. So it's definitely a medical tool.

Yeah. So if you're a therapist and you have never heard of this or you're not using them, what are you even doing? Like go get one right now. Okay. And Shasha, Cheryl obviously has a lot of ideas and, and she's got a great Instagram so you can follow her on there as well. Because like you do demonstrate even on your Instagram or Facebook. I know you're on LinkedIn, you're on all the places, but they can see the tool and they can see even you using the tool with kiddos or even families, I guess send videos too. So there's some really good demonstration demonstrations that, you know, I've seen you share on social media that can be beneficial for your.

It's specific to dysphagia. And some sensory delays as well. And I'll be honest, I don't use a lot of tools. But sometimes you have clients that need a bridge tool.

Yes.

And that's what this is. It's a bridge tool from. Because we don't choose purees. So it was really hard. I couldn't equate. I was having a hard time equating. You know, people would say, oh, I just dip a straw in yogurt and teach them to chew. That to me was not equating with pizza or a meatball. It just wasn't going fast enough for. But the gains that I found with using the prototype was just like, okay, this is cool.

You solved a problem that existed in the market for a long time that nobody else had figured out yet.

The problem was I didn't want a three part thing I didn't want to handle and then a tip and then a lock. I wanted one piece that wouldn't pop off.

Yeah.

So the way that it's designed is just, you know, it has like the plunger thing in it. You'll see in the videos. That is not a syringe. That is to anchor the food in the biting tip. Because if it's not anchored and somebody bites, all the food goes into the handle. And we want the food to go into the mouth.

Yeah, yeah. There's a lot of love and blood and sweat and tears and thought and brilliance and all the things wrapped up into this so much. And I mean, it's really commendable, Cheryl, because like, you figured out how to create something that is obviously so successful. I know you said it's really taken off. It's. People are realizing how helpful and functional of a tool this is. And so I'm just excited because, you know, if we can help kids and families get to their goal a little faster, a little safer and also, you know, get to that goal because a lot of these kids just weren't getting to the goal. Right. Or whatever the goal is that the parent has for that child. Like, that's. It's huge. You're really changing lives and also the quality of life.

Like there's some, you know, kiddos that I had that maybe had a condition that was progressive or they're really not a candidate to wean from a G tube. However, during Thanksgiving or holidays, Hanukkah, Christmas, there's certain foods that everyone's having and this child isn't. So it would be really nice to put, you know, turkey and stuffing or stuffing or, or a special, a birthday cake in the side biter and they can have the frosting on the outside and they can. The amount of work that it takes to get 5mls out of the side butter and 2.5mls out of the mini. There's so much work involved that kids have actually moved on pretty quickly to the actual food, which was the point. It's not to use that as a feeder. It's to gain control, interest. And a lot of those kids have never had the opportunity to taste a birthday cake because they were G2 fed. But they're safe in encapsulated in the fighters. So quality of life. And also just on the go, put a french fry in there. And mothers are like, this is a game changer. This is so good. We can go to the carnival or.

Go to the fair and you know, I mean, corn dog inside. A big part of what we do is, is eat right socially as humans. And so to be able to participate in that and to give them a safe way to do that is just, it's so cool. So cool.

Good job. Yeah, thank you. Thanks for the opportunity.

So, okay, so we'll, we'll, we'll wrap up here. But I just wanted to say thank you, Cheryl, so much because you're obviously a very valued member of our team, an integral part of our mentorship team across Feed the Peds, the Hub, and the certified pediatric feeding curriculum, all of which are opening soon. So, you know, we wanted to make sure we had an opportunity to chat about it and the importance of mentorship and creating critical thinkers and, you know, really truly getting out there and helping our patients, which at the end of the day is the end goal of it all. So thank you for everything that you do.

Thank you for having me.

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