5 Signs Your Picky Child Isn’t Getting Enough Nutrients & You Need To See A Doc

By Jacqueline Burt Cote

There’s a reason why foods like buttered noodles and chicken fingers are clichéd children’s menu staples: Lots of kids aren’t particularly open-minded when it comes to eating, and some of them are downright picky. But as common as this behavior can be, it’s also a little scary for parents. After all, frozen waffles and cheese sticks don’t exactly constitute a “balanced diet.” A child whose daily meals revolve around five foods can’t possibly be getting all the nutrition she needs for proper growth, can she? So what are some signs your picky kid isn’t getting enough nutrients?

Read more on ROMPER >>

7 Red Flags Your Child Is More Than Just A Picky Eater & Trying To Tell You Something’s Up

By Jacqueline Burt Cote

At some point or another, nearly every kid will exhibit behavior that falls into the “picky eating” category — and if you’ve ever had a toddler who refuses to eat anything not served in her Peppa Pig bowl or a preschooler who insists on dipping literally everything in ketchup, then you know what I’m talking about. As insanely frustrating as this can be, it’s usually a normal and temporary part of your child’s development. But in some cases, it’s not so normal. So what are some red flags that could mean your child is more than just a picky eater?

Read more on ROMPER >>

Tongue Tie: Why I Can’t Wait for the Research

By Melanie Potock, MA, CCC-SLP

I’m in the trenches. I’m the one holding a mom’s hands while she tears up and asks me why her baby can’t eat solid foods after the GI test results can’t pinpoint a problem. I’m having delicate, respectful discussions with physicians, but who insist that “If the baby can bottle feed with that tongue, then they can learn to eat solids with that tongue” or worse, “Don’t worry if he can’t breast feed, he’ll be eating solids soon and won’t need the breast.”  I’ve had preschoolers finally end up on my caseload after seeing several different medical professionals (including geneticists), but never a feeding professional. It’s what spurred me on to write three articles for the American Speech Language Hearing Association – Just Flip the Lip and Tip Back the Tongue. Later, I shared my clinical observations in the article Three Structures in A Child’s Mouth that Can Cause Picky Eating.

From my perspective, I can’t wait for the research on ankyloglossia (tongue-tie) in order to further determine how tethered oral tissues might be impacting an individual child’s functional skills for feeding. As a professional, I have the utmost respect for evidence based practice.  If I child can’t move his tongue adequately for safe chewing and swallowing, it’s my job to determine why, with or without a study. Problem is, that child can’t wait for multiple studies to support what I see in plain sight as an experienced clinician. I’m going to consider all the possibilities impacting a child’s ability to eat in an age-appropriate manner using my differential diagnosis skills. I don’t see tethered oral tissues in all my clients, but the ones that are clearly tied can’t manipulate food safely.  It may not be the only culprit, but I’m not going to ignore what’s right in front of me.

Would we question an occupational therapist’s clinical observations if they reported that a child’s fine motor skills were delayed due to syndactyly (webbing of the fingers)?  Would we expect that OT to provide months of therapy to rule out other causes for the child’s motor challenges before discussing their clinical observations with the pediatrician, hand surgeon or other members of that child’s team? Would we question a physical therapist’s clinical observations if they reported that a child’s gross motor delay was related to progressive heel-cord contractures?  At some point, it comes down to clinical experience and knowledgeable assessment skills, an understanding of typical development, a respect for the family’s concerns and frankly, decent eyesight.

On one hand, I can’t wait for the research!  I want to learn more! We need it, but for now, I’m in the trenches.

In short, I can’t wait for the research because it’s not fair to these families.  My job is to assess function for feeding.  It’s pretty clear to me when I’m evaluating a child’s oral motor skills and her tongue has limited range of movement because of a tie.  As a feeding specialist, I know the range of movement necessary for safe and comfortable eating.  I can’t wait for the research and I think that’s enough of a reason to speak up and help these kids.


To learn what research we do have, and what we know so far, check out this post on the Talk Tools website, as well as their new book being released soon!

Functional Assessment of Feeding Challenges in Children with Ankyloglossia by Robyn Merkel-Walsh, MA, CCC-SLP & Lori Overland, MS, CCC-SLP, C/NDT, CLC.  In this excellent article highlighting Walsh and Overland’s presentation at the 2017 American Speech Language Hearing Association, the following references were provided:

References:

American Academy of Breastfeeding Medicine (AABM). (2016). Protocol # 11: Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad. Retrieved from: http://www.bfmed.org/Media/Files/Protocols/ankyloglossia.pdf

Amir, L.H., James, J.P. & Donath, S.M. (2006). Reliability of the Hazelbaker assessment tool for lingual frenulum function. International Breastfeeding Journal, 1(3).

American Speech-Language-Hearing Association (2015). ICD-10-CM Diagnosis Codes for Audiology and Speech-Language Pathology Preparing for Implementation. Retrieved from: http://www.asha.org/Practice/reimbursement/coding/ICD-10/

Boyd, K. (2014). Impact of tongue-tie over a lifetime: an anthropological perspective. Presentation at the IATP 2nd World Summit. Montreal, Quebec.

de Castro Martinelli, R.L., Marchesan, I.Q., Gusmao, R.J., de Castro Rodrigues, A. & Berretin-Felix, G. (2014). Histological characteristics of altered human lingual frenulum. International Journal of Pediatrics and Child Health, 2, 5-9.

Ferres-Amat, E., Pastor-Vera, T., Ferres-Amat, E., Mareque-Bueno, J., Prats-Armengol, J. & Ferres-Padro, E. (2016). Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol. Journal of Oral Medicine and Pathology, 1:21 (1):39-47

Francis, D.O., Chinnadurai, S., Morad, A., Epstein, R.A., Kohanim, S., Krishnaswami, S., Sathe, N.A. & McPheeters, M.L. (2015). Treatments for ankyloglossia and ankyloglossia with concomitant lip-tie. Comparative Effectiveness Reviews, No. 149. Agency for Healthcare Research and Quality. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK299120/.

International Affiliation of Tongue-Tie Professionals (2016). Classification. Retrieved from: http://tonguetieprofessionals.org/about/assessment/classification/

Kummer, A. (2016). To clip or not to clip? That’s the question. Presented at the annual convention of The American Speech-Language-Hearing Association. Philadelphia, PA.

Martinelli, R.L., Marchesan, I.Q., & Berretin-Felix, G. (2012). Lingual Frenulum Protocol with Scores for Infants. International Journal of Orofacial Myology, 38, 104-113.

Merdad, H. & Mascarenhas, A.K. (2010). Ankyloglossia may cause breastfeeding, tongue mobility, and speech difficulties, with inconclusive results on treatment choices. Journal of Evidence-Based Dental Practice, 10(3):152-3.

Messner, A.H. & Lalakea, M.L. (2000). Ankyloglossia: controversies in management. International Journal of Pediatric Otorhinolaryngology, 54(2):123-31.

Overland, L. & Merkel-Walsh, R. (2013). A sensory-motor approach to feeding. Charleston, SC: TalkTools.

Sethi N., Smith D., Kortequee S., Ward V.M. & Clarke S. (2013). Benefits of frenulotomy in infants with ankyloglossia. International Journal of Pediatric Otorhinolaryngology, 77(5): 762-5.

Head’s UP! I just pre-ordered the new book by Walsh and Overland: Functional Assessment and Remediation of TOTs.  You can order it here for the pre-sale price, as of today, for 50% off, on the Talk Tools website.

 

 

 

Why Is My Baby Pulling At Their Ears? They’re Trying To Tell You Something

By Shannon Evans

When it comes to infants, parents can drive themselves crazy reading into every nonverbal cue they give. You’re constantly on the lookout for common ailments like ear infections, so when you see tiny hands heading towards those ears, your antennae prick up. But are infections always the culprit? When parents ask, “why is my baby pulling at their ears?” they’re likely to come across a large spectrum of explanations.

Read more on ROMPER >>

Iron Chef, Dysphagia Style

By Melanie Potock

Picadillo ground beef from the Dining With Dysphagia cookbook.

What do a coconut-milk-infused shake, spicy risotto, and macaroni and cheese have in common? They are just a few examples of the winning recipes from a cooking competition created for people who have difficulty swallowing. Sampled by professional and celebrity chefs in New York City, these culinary creations were developed by students taking Interdisciplinary Care-Based Management of Dysphagia.

Read more on the ASHA LEADER BLOG >>

Sippy Cups: 3 Reasons to Skip Them and What to Offer Instead

By Melanie Potock

In the article Step Away from the Sippy Cup, I discussed how the sippy cup was invented for parents, not for kids. An engineer got fed up with his toddler spilling juice on the carpet and the rest is history. Today, sippy cups are marketed to parents as a vital piece of feeding equipment, causing parents to consider sippy cups an essential part of a baby’s development. As a speech-language pathologist and feeding specialist, I beg to differ on this point. Here’s why:

Read More on ASHA Leader >>

21 Tips for Navigating the NICU

By Michelle Crouch

The odds are on your side that your child will be born full-term and perfectly healthy. Still, about one in 13 babies in the United States spends some time in the Neonatal Intensive Care Unit (NICU). And a recent study by The Dartmouth Institute for Health Policy and Clinical Practice and the Geisel School of Medicine found that 43 percent of these infants are not even premature—they are full-term babies who need more care. For new parents, having a newborn in the NICU can feel scary and overwhelming, so we asked top medical professionals, as well as moms who’ve been there, for their best coping strategies.

Read more at FITPREGNANCY.COM >>

12 Foods & Drinks That Will Help Your Kids Poop

By Liz Alterman

Here’s an unpleasant truth: Kids get constipated. For a variety of reasons that range from diet to just not wanting to stop playing and take the time to poop, little guys and gals can end up going days without taking a number two — which becomes uncomfortable for everyone. We asked parents, pediatricians, and nutritionists to share the foods they’ve found help keep kids regular.

Read more on cafemom.com >>

Study Up on PANDAS: A Little-Known Disorder With Big Effects

By Melanie Potock

Tomorrow—October 9—is PANDAS/PANS Awareness Day. Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) includes a little-known set of symptoms that occur when strep creates inflammation in a child’s brain. According to the PANDAS network, the child then “quickly begins to exhibit life-changing symptoms such as OCD [obsessive-compulsive disorder], anxiety, tics, personality changes, decline in math and handwriting abilities, sensory sensitivities, restrictive eating and more.” PANS—Pediatric Acute-Onset Neuropsychiatric Syndromes— might result from a different bacterial infection, virus or an environmental trigger.

Read More on The ASHA Leader Blog >>