Tag Archive for: speech-language pathology

Inclusion, Diversity, and Belonging

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In September 2021, Tx:Team launched a formal Inclusion, Diversity, and Belonging (IDB) Initiative. This initiative came out of a question we asked our leadership team: how do our associates and patients experience Tx:Team?

Our mission is to provide everyone with the opportunity to live the healthiest life possible. Diversity of background, experience, identity, ethnicity, race, sexual identity and orientation, and perspective improves the creativity, innovation, quality, and effectiveness of the therapy we provide.

On October 28th and 29th, 2021, we convened a meeting of Tx:Team’s IDB workgroup comprised of associates from around the country and members of our home office, along with guests from the Indiana University Schools of Physical Therapy and Occupational Therapy. Facilitated by Rob Shook and Bill Kirst, our workshop generated five specific initiatives that Tx:Team has adopted and will execute in 2022 and 2023:

  1. Develop an authentic and clearly articulated statement of Tx:Team’s IDB philosophy.
  2. Establish safe spaces for associates to be themselves, talk openly about key issues, and seek guidance from easily identifiable allies/mentors.
  3. Incorporate IDB into Tx:Team’s internal and external marketing and communication platforms and materials.
  4. Create a one-year fellowship for new Physical and Occupational Therapy, and Speech Language Pathology graduates with a specific focus on engaging therapists from groups that are historically underrepresented in our profession.
  5. Target groups in schools and organizations that are historically underrepresented in our industry and provide education, opportunities for shadowing, and other exposure to possible career paths in the rehab profession.

One of Tx:Team’s core identifying characteristics is authenticity, and we take this very seriously. Our intent was to clearly and publicly state who we are and what we believe, and then put those beliefs into action. To broaden our reach and better reflect the diversity found in our communities, we are creating opportunities for historically underrepresented groups to access the education, experience, and support necessary to join the therapy profession.

Tx:Team is a place for anyone with a passion for healing and a desire to change the world, and we are committed to fostering an environment where each associate can be included, valued, and seen. We want everyone who walks through our doors to feel safe and comfortable just being themselves.

Baby-Led Weaning A Developmental Perspective

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Baby-led weaning.  Every parent has experienced the scenario. Seated comfortably at dinner with their six-month old baby in his high chair, a mother and father look over to see the face of an infant who wants nothing to do with his puréed carrots. He wants only one thing: their grilled chicken and steamed green beans. So, what’s a parent to do? The infant is at an age when pediatricians say that parents can start to offer smooth, blended (puréed) foods as a way to introduce different flavors. Yet some parents feel that, if their infant shows interest in solid foods, he or she must be ready for those foods.

baby-led weaning

Does your baby show interest in a new food?

Baby-led weaning (BLW) is an infant-driven feeding approach in which the parent offers the infant any food in which he or she shows interest. This could include, but is certainly not limited to, raw apples, french fries, potato chips, fish sticks, pieces of grilled chicken, and carrot sticks. Many parents report success with BLW, though studies have demonstrated an increased risk of choking using this approach. But why?

 

Each parent has to decide what works best for their child. (Parenting seems to be an endless series of decisions, does it not?) As with all decisions in parenting – bottle vs. breast, pacifier vs. no pacifier, co-sleeping vs. separate crib, Baby- Led Weaning vs. progressive textures – it’s important to have the facts. Once we have the facts, we as parents can make educated decisions about what’s best for our family and our little ones.

When deciding if BLW is right for your infant, there are many points about normal development that are important to consider. A large number of developmental factors play a role in an infant’s feeding progression. These include: vision (the infant’s ability to see the food), sensory input (the infant’s ability to distinguish different colors, tastes, smells, and textures of various foods), trunk control (the infant’s ability to sit up and support himself, promoting a safe, upright position for eating solid foods), and fine motor skills (the infant’s ability to hold a piece of food in his hand and bring it to his mouth).

While  all of these are important, some of the most critical developmental milestones to be aware of when considering BLW are those associated with the progression of oral motor functions. In order to safely chew and swallow foods, a person’s oral motor skills must be refined about to be able to 1) keep the food in his mouth, 2) move the food forward and backward, as well as side to side using his tongue, 3) chew the foods in a rotary pattern (this is a circular chewing pattern, like a cow chewing cud, not just munching or smashing the foods against the roof of the mouth), and 4) be able to purposely move the food backward in the mouth using the tongue.

Below are the milestones related to oral motor development that are important for readiness for solid foods (not just liquids or purées):

  • 0-4 months: During this time, infants continue to develop reflexes that protect their airway and prevent choking. They are able to coordinate two to three sucks from a nipple or bottle prior to swallowing, and respond with consistency to stimulation provided around the mouth (for example, a pacifier or toys).
  • 4-6 months: Infants continue to develop the ability to move liquid and watery purees backward in the mouth with their tongues, though these textures continue to move backward primarily through pressure within the mouth when the lips are closed. The tongue begins to move items back and forth (but not yet from side to side, which is important for being able to effectively chew.) Around six months, a primitive “munching” pattern may begin to emerge. This marks the first step toward a rotary chewing pattern.
  • 6-9 months: This is when developmentally mature movement of a bite of food from side to side in the mouth occurs. Infants are able to transition slightly more textured foods forward and backward, side to side in the mouth, and demonstrate emerging ability to chew these foods. Infants continue to move food to the back of the throat to swallow primarily via pressure within the mouth, rather than coordinated tongue movement. The primitive munch continues to be refined.
  • 10-12 months: Infants develop the ability to lick food off their lips effectively. Biting becomes more isolated, which is important in development of rotary chewing. Rotary chewing begins to emerge toward the end of this timeframe, but continues to be refined from 12-24 months. By this age, infants demonstrate the ability to move foods from side to side in their mouths without difficulty.
  • 14-16 months: Infants are able to chew and move firmer and more textured bites of the food throughout the mouth. By this age, they are able to reliably keep a bite of food in the mouth (hooray for no more bibs!)

All of these abilities (containment of a bite in the mouth, moving a bite forward and backward, moving a bite side to side, rotary chewing, active rather than passive movement of a bite backward to swallow) should be present for chewing and swallowing of solid foods to be considered safe.

You know your baby best. You are also in the best position to make the safest choice based on his or her abilities and whether BLW is right for your infant. If you have any questions, consult with your trusted medical provider.

Lauren Most, CCC-SLP, is a speech-language pathologist for Tx:Team partnered with Frederick Regional Health System. She received her Bachelor’s degree in speech-language pathology from Loyola University in Maryland, and her Master’s degree from the University of Maryland, College Park. Her work includes providing services to infants and toddlers in the neonatal intensive care unit and the community who have difficulty with feeding and/or swallowing.

Playing with Purpose: A Pediatric Speech Therapist’s Perspective

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With holidays and birthdays, come many toys that cycle in and out of your home. They come in many different brands and styles but all have the same underlying potential for developing your child’s communication skills. Here are just a few commonly found toys that I use as a Pediatric Speech Therapist with the children I work with in order to develop and expand their speech and language abilities.

 

toy farmToy Farm: This toy is loaded with opportunities for you to model early developing speech sounds to your child. Some of the first sounds acquired by infants and toddlers are made with their lips such as “b” “p” and “m”. When playing with this toy with your child, exaggerate these target sounds while modeling animal names and noises.  Some of the target words I use include: “baaa”, “moo”, “pig” with exaggerating the initial sound of each word. Try to have your child watch your mouth while you are saying these words. Allow wait time after saying a target word to give your child an opportunity for imitation.

Cause and Effect Toys: These toys come in many varieties but all have the same underlying theme.popup They are toys that allow a child to “cause” an event to occur. In the case of the pictured toy, when your child pushes a button, the window opens and an animal appears. Communication is founded in cause-effect. Even before a child learns to speak, they understand that when they cry, it results in an event. This event can be a diaper change, a feeding, or attention from their caregiver. When a child understands this relationship, the door for purposeful communication is opened.

Kitchen Set: Pretend play is a huge component of a child’s language development. It is their way of taking scenes from their environment and re-enacting them using language they hear daily. When you listen to your child play, you may hear some familiar phrases!

Kitchen play

This is a great toy for children of all ages. When playing with this toy, help your child to pretend. Model actions such as: stirring with a spoon, putting food in the oven, or turning the sink on and off. While performing these tasks, keep your language SIMPLE.  Phrases such as “too hot”, “all done”, “more please”, and “all gone” are simple beginning phrases that can be used in many situations throughout the day.

While these are just a few suggestions for your holiday and birthday gift list, there are many other options of toys and play that stimulate communication. Any toy that encourages an opportunity for interaction between you and your child is a learning opportunity!

When you go shopping, look for toys that encompass interaction. Although there are several toys on the market that light up or make noise, many of these toys only have a visual component, but do not allow your child to manipulate or physically engage in active play. Much of our early language consists of “active” words that rely on motion or position. Some of the best toys set the scene for using words such as “go”, “stop”, “up”, “down”, “in”, “out”, “on” and “off”.

Why is this type of play important? Young children understand much more than they can verbally express. Even before your child says their first word, they are acquiring and understanding of multiple vocabulary terms daily. By the age of 2, a typical child understands 200-300 vocabulary terms! This makes your task of modeling these early vocabulary terms during play that much more meaningful.

If you are concerned about your child’s speech and language development, below are a few warning signs that may warrant assessment by a Speech Language Pathologist:

  • reduced eye contact
  • disinterest for communication
  • does not respond to their name or sounds in their environment
  • frequent ear infections
  • limited babbling or verbal output
  • difficulty understanding simple commands
  • For toddlers who have speech that is very difficult to understand, resulting in frequent anger outbursts and temper tantrums

There is no “right” age for seeking help for your child’s speech and language. Speech and language development varies for every child. A child who is behind may catch up on their own without intervention, especially when developing their speech sounds. With that being said, do not ignore your parental instincts. It never hurts to seek assistance or an expert opinion.

Michelle Keenan, SLP-CCC is a Tx:Team Speech Language Pathologist treating the Pediatric population at FMH Rose Hill Outpatient Clinic. You may contact Michelle at 240-566-3132 or find out more about Speech Language Therapy go to www.fmh.org/Rehabilitation

 

Tag Archive for: speech-language pathology