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Lindsey

Feeding, For Parents, Little Friends

Why Babies Need to Mouth and How We Can Encourage Them to Continue

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“Did your child mouth as an infant?”

I ask this question all the time to the parents of kiddos with severe speech delays, picky eating habits, and other oral motor deficits.
More often than not, the answer is “not very much” or a flat out “no.”

Sounds like a dream, right? A baby who isn’t liable to choke on any little piece of who-knows-what lying on the floor? Jackpot!?

F A L S E

Why Mouthing Is Important:

Mouthing helps babies explore their world from a sensory and oral motor standpoint. They are learning about textures, tastes, and temperatures that will provide them with a solid foundation to move on from purees to solid foods (get it?) and avoid a picky eating rut. Additionally, they will begin to move their tongue and jaw in new, fun, and interesting ways. These movements will later develop into a mature chewing pattern that will allow them to eat a healthy variety of solid foods and help them produce lovely consonant sounds. As if all that wasn’t enough reason to encourage mouthing… it also helps the baby’s gag reflex move from the front to the back of their mouths.

Mouthing starts with the rooting reflex. This reflex is innate from birth and allows an infant to turn and attempt to suckle anything  that touches its face. The rooting reflex begins to diminish around the age of 4 months. At this same time, babies begin to gain the ability to bring their hands to their mouth. This is the opening of our mouthing window.

While it may be extremely convenient to not fear for your child’s safety due to the little babe putting ev.ery.thing. in his or her mouth… it may bite you later.

So what can we do?

  1. Provide lots of safe toys to mouth and gnaw on. You may even go as far as modeling what to do with these objects. That’s correct, adult reading this. I want you to put baby toys in your mouth. Lick and chew and move them around. Let that baby watch what to do.
  2. Make it a game. Think “puppy dog” and be silly so baby laugh and think its a fun game. Maybe they’ll be more willing to join in.
  3. Add some flavor. Try dipping an easy-to-wash toy in a juice or favorite puree to increase interest for the child.
  4. Make it cold. Place a toy in the freezer and see if it makes it more enjoyable. Again, we’re thinking about increasing sensory information.
  5. Provide texture. (sensory sensory sensory) We want bumpy toys. Soft toys. Squishy toys. ALL the toys! Bonus points for the language opportunities here.
  6. When your baby explores (safe) objects with their mouth, give praise. Make it a pleasurable experience and they are more likely to repeat their actions.

 

 

Some great options for mouthing can be found at your local retailers:

 

The Boon PULP Silicone Teething Feeder allows you to place a variety of flavors for your baby to safely explore and enjoy. Perhaps a juicy piece of watermelon or a frozen peeled grape? Yum!

 

 

 

A cute teething necklace like this one by BEBE by Me is another great option – you can’t lose it!

 

 

 

This nuby Banana NanaNubs gum massager is another adorable way to get your baby mouthing and ready for tooth-brushing. Here is the texture we’re looking for!

 

 


Perhaps my favorite is a good ol’ fashioned hard munchable. The key here, and this is very important, is that this is something the baby CANNOT chew or break off yet. The purpose at this point is only for sensory and oral motor exploration. Celery sticks work great too!

 

 

A few things to remember…

We never want to force, but we do want to encourage. A cry or a cold shoulder today could be a timid attempt to mouth tomorrow. Keep exposing the child to mouthing and be patient. Keep an eye out for little signs that they are becoming interested and try again soon.

If you are a parent reading this, it is always a good idea to reach out to a local Speech Language Pathologist for any concerns you may have with your child’s speech, language, and/or feeding. For more information, you may be interested in these parent handouts for late talkers.

 

Of course, safety is always first.

Please be sure that an adult is always present and watching closely as these options are explored. Use good common sense, folks. But we DO need that baby to learn all the awesome things their little mouth can do when it gets movin’!

 

Happy Mouthing, Speechy Friends!

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Articulation Therapy, Feeding

Whole-Child Speech Therapy for Treating Frontal Lisps

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We can talk about “hiding our tongue” and keeping “tight teeth” ’til we’re blue in the face… but for some kiddos it seems that pesky frontal lisp just WILL. NOT. GENERALIZE. into a crisp, beautiful /s/. Why? Because the way the tongue of many frontal lispers moves is different and, to be honest, disordered all day every day. Often times, they have an immature swallow pattern. If you watch them eat, you will see that little tongue peep out more than it should.

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We see a huge correlation between frontal lisps and kiddos who have (or had) prolonged usage of sippy cups, pacifiers, and thumb-sucking. Their swallowing pattern got stuck a little too close to the suckle stage and they continue to use a tongue-thrust pattern to swallow. We swallow about 600 times a day. That means every time our kiddos clear their saliva they are reinforcing their frontal lisp.
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Furthermore, you will notice our kiddos have a low at-rest posture for their tongue. I like to joke that my superpower is being able to identify people who used to have a lisp just by watching them speak for a few seconds. Lispers tongues hang low in their mouth – you can check out what I mean by watching THIS video.

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SO WHAT CAN WE DO ABOUT IT?

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Before I start articulation therapy with any of my frontal lispers… we do a few things.

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1. Nose Breathing

Ensure that your kiddo is a nose breather. Perform an oral mech and check for enlarged tonsils. Ask about seasonal allergies. Refer accordingly. Mouth-breathing promotes a low, forward resting posture of the tongue.

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2. No more sippy cups

Or thumb sucking. Or pacifiers. Or finger sucking. Cup drinking and straw drinking only, please.

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3. Make sure their tongue tip can elevate to their alveolar ridge.

Some kiddos just haven’t figured this out yet. If you need some help getting tongue-jaw dissociation, take the jaw out of the equation by having them bite down on something that well help prop open their mouth. (My favorite is to stack a few popsicle sticks and tape the together. It’s cheap and easy to replicate at home.) This will stabilize their jaw and allow them to put all their focus on getting that tongue in position. You can always add a tactile cue by putting some sour spray or ice cream on their alveolar ridge. I find kiddos don’t need these cues for very long once they figure out where their tongue should be. We need to be able to elevate our tongue tip to swallow properly, to produce appropriate alveolar phonemes, and even to get a good clear /s/.

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4. Tongue checks.

Have the kiddo engage in a silent activity- be it iPad time, coloring, building blocks, or anything in between. Periodically do a “tongue check” to see that they are keeping their tongue tip elevated to their alveolar ridge. We are trying to change the resting posture of their tongue here. For a tongue check freebie, click here.

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5. Feeding therapy.

If you watch a frontal lisper eat, you will likely see that tongue sneak out during or after their swallow on most food consistencies (liquid, puree, crunchy, etc). They will tell you they are just licking their lips- nope. Target a mature swallow in feeding therapy- and consider referring out if you are not trained in feeding. Again, we swallow 600 times each day!

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6. Look beyond the /s/

Watch their tongue on all alveolar sounds. There is an awfully good chance that if they are lisping on /s,z/ sh, ch, j… that /t,d,n.l/ aren’t correct either. Watch close and remember to follow a developmental pattern when targeting phonemes.

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7. Consider an appliance.

If you are signed up for our newsletter then you have already heard about these awesome appliances. Think of it as a tiny speech therapist in their mouth 24/7. The idea is that they receive speech and feeding therapy to learn how to place their tongue at the alveolar ridge for their swallow and for all alveolar sounds. This little bead serves as a warning that their tongue is going too far forward.

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And there ya go!
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Just some food for thought, friends. There may be so much more going on than just that pesky /s/ sound. We want to be sure to treat the whole child and hopefully this post will shine some light on your students. Once  you’ve addressed these concerns, you’ll be ready to kick some articulation booty and get them cookin’ with some drill work and generalization activities. Have fun, speechy friends! Conquer the frontal lisp!

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(puppy photo credit: Marion Michele via unsplash.com)

 

Generally SpeechyThings, Personal

Advice for SLP Interns When Your Clinical Fellowship Year Gets Hard

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You just graduated. You are burning bright with a fiery passion to change lives and start your career as a speech therapist! You go girl/guy! Now bookmark this post and set an alert for yourself to check back here in one month. Your CFY is a magical time but it is gonna get rough. You are not alone!

This blog post is for you when you are in the thick of it. Because there will be a day where you feel down and worn out.

I am offering you some advice. I just know as a CF, there were a few times I was feeling overwhelmed and went looking for a blog post like this to no avail. This is definitely one of those times where you can take what you like (or what you need) and leave the rest. Here are just a few things to keep in mind as you navigate this incredibly exciting and challenging new adventure:

 

15. Connect with your tribe.

There is a facebook group called Speech Pathologists at Large. Go find it.

 

14. “Comparison is the thief of joy.” -Theodore Roosevelt

Don’t compare yourself to other therapists. Everyone has their strengths and weaknesses.

 

13. If you make something – LAMINATE IT.

And if you’re using velcro- put the rough side on the pictures so it can be used on felt boards letter if you want.

 

12. ASK QUESTIONS.

You are clinical fellow. You should have a bajillion questions every day and that’s normal. It’s almost a guarantee that no matter what walks through that door… you’ve never treated a kid just like that before. Try to find the answer yourself but if you can’t, ASK!

 

11. “She made a promise to herself to hold her own well-being sacred.” -unknown

Try not to take your work home. You need to relax. Your brain is going to be a big puddle of mush for the better part of this experience (and beyond) so let yourself binge on Netflix now and again (and again).

 

10. Your best is enough.

All you need to do to be successful each day is make this session a little better than the last. If you can do that, you can be proud of yourself. I often wondered how much more progress my patient might make with a more experienced therapist. We will never know. But as long as you give that kid 100%- you are doing your job.

 

9. Grad school introduces you to the tip of the iceberg.

It does not (and cannot) adequately prepare you to meet the needs of every kid on your caseload and it’s no one’s fault. Birth by fire is necessary. Do your best to fill in the gaps.

 

8. Write it down.

Write down the things you’re learning. It helps you process and encode. You can look back later to see how far you’ve come.

 

7. “If your compassion does not include yourself, it is incomplete.” – Jack Kornfield

You are most likely going to have a family complain about you. It happens to everyone. But you will also have families who LOVE you. Learn from them both and don’t take the first one personally. Their child is the most precious thing in the world to them- it’s not meant to hurt you. We can’t all be perfect matches for every kid. 

 

6. Think outside the box.

If after a few sessions with a really tough kiddo you are still having a difficult time- figure out what kind of support they need from you that they are not getting. Maybe they need visual supports. Maybe they need some sensory input so they can organize. Talk to your supervisor.

 

5. “You is kind. You is SMART. You is important.” -“The Help”

Just remember that there was a day when the words “speech hierarchy” and “Brown’s Stages” meant nothing to you. You are smart. You know LOTS. Don’t forget that. Most of your families are totally unaware of what’s fully going on with their kid, so you at least know more than them and can help guide them through it.

 

4. Fake it ’til you make it. (Your confidence, that is.)

If you don’t feel confident in your answer to something- don’t keep talking in circles around it. Make your point quickly and, if needed, let the person know that you are going to look into it and get back to them. Also, try to remember that not everyone is a naturally friendly person. It doesn’t mean they think critically of you. It literally might just be their face. Be confident in your response and don’t let it get to you.

 

3. You will have ups and downs.

Even therapists I work with that have been at it for 15 years (and who are AMAZING) go through slumps where they feel ineffective. Just make note of the ups so you can remember those happy feelings. It will get tough at times but remember another peak is around the corner where something will click for your kiddo and your heart will explode with joy.

 

2. “Living is like tearing through a museum. Not until later do you really start absorbing what you saw, thinking about it, looking it up in a book, and remembering…” -Audrey Hepburn

Know that the more kids you treat, the more you will see patterns and get a sense of the “big picture.” It’s okay to feel lost. Trust your training and lean on your colleagues to be sure you are on the right track. You will navigate these waters together. You’ve got to work on faith for a while until you are backed by experience.  Everything is scary until you have a few under your belt. (During my CFY I was terrified of treating R and now I’m like “pffft” no problem- here is some help if you need it.) You’ve got this!

 

1. You can do this.

Remember the thousands of therapist who have been where you are right now. Your CF supervisor? She’s been here. Barbara Hodson? EVEN SHE’S BEEN HERE. Everyone was once brand new. Everyone, at one time, didn’t have a clue what they were doing. But they learned from their mistakes, sought answers, perservered, and got better and better until they got great. That will be you too.

 

 

There you have it. My best advice and a big ol’ virtual hug.

The paperwork sucks. Sometimes the parents are difficult to deal with. Sometimes the kids spit at you and hit you. So of course there are bad days but overall- I love my job and cannot imagine a more amazing career. How many people go to work and actually experience *joy*? Not just being happy at work- but feeling heart-warming joy?

 

You are making your debut in the BEST profession on the planet. It will be really hard some days, and then it will get easier. Then it will get hard again. Just know that eventually the hard days get less frequent and less intense- so push through! You’ve got this!

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