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Welcome to the Swall Your Pride podcast. I'm

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your host, Theresa Richard. I'm a board certified

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specialist in swallowing and swallowing disorders, a mobile

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fees business owner, and founder of the MedSLP

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Collective.

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This podcast is all about delivering the latest

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evidence based practice to medical SLPs everywhere.

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Whether you're a new clinician seeking tangible tools

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for treatment or a seasoned vet stuck in

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a rut, my goal is to help ditch

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the old school ways of the past that

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no longer serve you or your patients, to

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reinvigorate your passion for our field, to broaden

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your knowledge about our scope of practice, and

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to inspire you to practice at the top

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of your license. So if you're listening, I

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encourage you to swallow your pride, be open

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and willing to learn because let's face it,

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your patients deserve that kind of care. With

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that, let's dive right in.

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Just a quick disclaimer that all statements and

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opinions expressed in this episode do not reflect

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on the organizations associated with the speakers and

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are their own opinions solely. Alright. Hello, Amy.

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Thank you so much for joining me. Thank

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you for having me. I'm a pleasure to

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be here. Yeah. And welcome back, everyone, to

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the Swallow Your Pride podcast.

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Today's guest is doctor Amy Delaney. She's an

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assistant professor in speech pathology and audiology at

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Marquette University.

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She's the director of the neurodevelopmental

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feeding and swallowing lab focusing on the identification

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of a norm reference for feeding development aligned

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with the diagnostic criteria for pediatric feeding disorders

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and development of assessment tools for the early

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and accurate diagnosis.

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Recent publications of her research highlight preliminary data

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for feeding expectations in a development texture framework,

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texture progression,

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oral feeding skill assessment, and bite acceptance. She

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recently was awarded an ASHA Foundation Research Grant

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to support further standardization of feeding skill development.

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Doctor. Delaney worked at Children's Hospital of Wisconsin

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for twenty years in advanced diagnostics and intervention

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of PFD

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and pediatric dysphagia in medically complex children.

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She is a founding medical professional council member

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and outgoing educational pillar chair for feeding matters.

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She coauthored the infant and child feeding questionnaire

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and PFD consensus paper by Godet et al

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in 2019.

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Alright. So welcome to the show, Amy. So

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let's let's start with the scoping review. So,

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you know, share with us, if you can,

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a little, you know, background. Where did this

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come from come from? What were you hoping

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to find? Yeah. Good question.

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So,

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you in

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the midst of your dissertation can fully appreciate,

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the scoping review from the perspective of I'm

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actually redoing my dissertation that I finished in

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2010.

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So,

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when I finished my,

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PhD, I went back to the hospital full

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time,

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and just, you know, was having a hard

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time balancing,

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trying to publish plus patient care. And so

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I never ended up publishing at that point

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on my dissertation

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and and that work. And

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over the time, I wanted to

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do so, but, you know, we needed to

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update the literature review. And,

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and then at that point, you know, long

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ago,

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scoping reviews weren't the standard in

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in this kind of work. So we kinda

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went back to start over,

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which, you know, for anybody that's on a

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dissertation, that's really

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stressful

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and,

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frustrating. But in the end, it's it was

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the right choice and,

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really pleased with with the outcomes.

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So,

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we have a two part scoping review. There

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are two standalone papers,

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that have come out of,

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this work in,

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AJSLP.

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And, ultimately,

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what we were interested in is kind of

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the state of the state of

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clinically observable

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oral feeding skills and the norms around that.

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So what are we basing our clinical observations

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on at this point?

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There's been plenty of,

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work and literature out there stating that we

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just don't have a standard

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clinical tool that we can use,

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for pediatrics.

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We have checklists. We have some, you know,

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PROMS,

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measures that,

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are wonderful.

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But, you know, where where did the data

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where have they come from? Where are the

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gaps? Where do we need to go from

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here?

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The result of my,

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dissertation

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was actually developing an observational feeding scale on

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the oral movements

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that we observe during a feeding. So I

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was very much interested in updating that,

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through this more rigorous process,

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or formal standard process.

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And then,

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you know, this is where it ages to

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me and my time,

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where now technology is a benefit to us

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where we can do

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consensus ratings, you know,

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digitally and more easily than,

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what we could have in the past to,

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further validate the scale that we had originally

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developed. So I have a bunch of data

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that we've used,

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for the scale, but I haven't wanted to

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publish it because I knew I needed to

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update it. So here we are in 2025.

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So,

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the scoping review,

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the interest of that was,

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infants that have moved beyond

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liquid only diet. So, you know, kind of

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four to six months,

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through early childhood.

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And any

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literature that was out there on,

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the methodology,

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the population studied,

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that have worked to establish some of our

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foundation,

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norms that we use as clinicians

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ultimately.

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So,

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you know, our criteria

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were,

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that the participants had to be observed.

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They could be video recorded, but ultimately, the

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observations and the,

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measures that we were taking were primarily with

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our eyes, which is our primary clinical,

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particularly in pediatrics,

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not instrumental,

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but that they needed to be also doing

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some,

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observations of something other than liquids.

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And in the general category, we're gonna say

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solids,

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and,

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that they needed to provide the, you know,

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the specific skills that they were measuring.

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And,

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yeah. So we, you know, we did that

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that lit search. We worked with one of

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our librarians at the university.

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And, of course, with all of

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the vetting that you do of keywords and

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the process in your searches, you still end

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up with, you know, 20 some thousand articles

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that you have to go and lead through,

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to get down to, you know, a core

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set of

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of articles that we actually were going to

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use to analyze. So,

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ultimately, we,

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ended up with a core set of,

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articles

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that,

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four 14 of them out of a whole

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bed,

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that really met our criteria. So, you know,

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we know that we don't have a lot

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of norms

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for developmental,

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you know, feeding skill progression.

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We know that there's gaps,

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but we haven't

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really dove we had no. Nobody's really, dove

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into exactly what are those gaps and and

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what what do we know. So that was

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the goal of the part one

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paper. So,

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we were able to look at, you know,

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how are how are participants being participants being

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fed? What are the settings that they're in

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for this work?

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What textures are they reported to be observing?

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And utensils,

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what specific areas of oral feeding skills are

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they really looking at?

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How are they quantifying this? So,

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so we went back through that whole process,

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to and following, you know, the,

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the PRISMA,

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guidelines for scoping review.

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So that's a very structured

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process,

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that you can follow. So,

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you know, it was just really interesting to

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see,

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you know, the breadth of what's out there,

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you know, how much, you know, gap there

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really is. So where,

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there's a lot of work in slightly older

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kids and less work in that four to

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six months to 24,

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which is when all of that development is

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really being established.

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It's really critical times where we wanna be

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able to catch kids early, or

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there's gaps in, you know, individuals studying one

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aspect of the feeding process. So it might

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just be chewing. It might just be acceptance

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of the bite.

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It might be just concerns.

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So,

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there are, you know, again, a lot of

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gaps in, looking at the entire process. So,

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you know, I think of feeding across the

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phases of swallowing. We need to be accounting

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for all of those observations,

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when we're watching a child eat. And,

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so

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yeah. So that scoping part one is really

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about those methodologies,

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you know, who we are,

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studying,

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and in general, what some of the the

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data are that that have come out of

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that thus far. So where so so share

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with me, you know, where where where did

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this this lead you? I I feel like

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a lot of times this leads to more

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Yeah. Than answers. Yeah. Yeah. So the part

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one was really about

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what's the work that's come right before us.

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And part of that process then was to

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pull out all of these specific observations that

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have been made. The part two of the

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scoping review was then to take those 107

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different observations

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that,

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have been in the literature

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and then analyze those. So my hypothesis has

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always been, we don't have a 107

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oral movements that we're observing.

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You know, people

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report on similar observations that have it worded

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slightly differently or maybe have a slightly different

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operational definition,

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or the way that they're measuring it might

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be a little different.

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They might have skills that are specific to

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different textures. So it might be the same

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skill, but they're reporting it for puree versus

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a solid.

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So we have this kind of inflation

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of observations, which makes it very hard clinically

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to know what to exactly observe, what's important

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to observe,

280
00:10:36,579 --> 00:10:39,879
what will help us define age appropriate feeding

281
00:10:40,179 --> 00:10:41,240
so that we can

282
00:10:41,620 --> 00:10:44,980
use that, you know, benchmark to identify when

283
00:10:44,980 --> 00:10:47,294
kids are faltering so we can address that

284
00:10:47,294 --> 00:10:47,794
sooner.

285
00:10:48,414 --> 00:10:50,815
So, so we took the 107

286
00:10:50,815 --> 00:10:53,714
skills, and then we analyzed them. So

287
00:10:54,095 --> 00:10:56,334
we sorted all of these skills based on

288
00:10:56,334 --> 00:10:57,954
the texture that the,

289
00:10:58,975 --> 00:11:00,595
study had looked at. We

290
00:11:01,049 --> 00:11:03,289
coded each of the textures by which phase

291
00:11:03,289 --> 00:11:06,330
of swallowing is this really attached to. And

292
00:11:06,330 --> 00:11:06,830
then,

293
00:11:07,850 --> 00:11:10,429
you know, what structures are we really observing?

294
00:11:10,730 --> 00:11:12,509
Because we know we need to be accounting

295
00:11:12,570 --> 00:11:14,110
for all of those features.

296
00:11:15,370 --> 00:11:15,870
So

297
00:11:16,535 --> 00:11:18,455
we coded all of these skills in all

298
00:11:18,455 --> 00:11:20,535
of these different ways and then sorted and

299
00:11:20,535 --> 00:11:22,235
analyzed and looked at them,

300
00:11:23,095 --> 00:11:25,254
in a variety of different ways. And and

301
00:11:25,254 --> 00:11:27,434
essentially are are proposing that,

302
00:11:27,735 --> 00:11:30,634
any feeding skill measure needs to account for

303
00:11:30,959 --> 00:11:32,419
multiple textures, certainly.

304
00:11:32,799 --> 00:11:34,000
We need to account for,

305
00:11:34,879 --> 00:11:35,379
physiologic

306
00:11:35,679 --> 00:11:38,079
timing, so cross spaces of swallow in our

307
00:11:38,079 --> 00:11:38,579
observations,

308
00:11:39,519 --> 00:11:40,259
to be comprehensive.

309
00:11:41,439 --> 00:11:42,879
And then a lot of the skills that

310
00:11:42,879 --> 00:11:45,860
are out there are really subjective. So,

311
00:11:46,335 --> 00:11:48,735
you know, what is my definition of smooth

312
00:11:48,735 --> 00:11:50,035
movement or,

313
00:11:51,535 --> 00:11:52,035
strong

314
00:11:52,415 --> 00:11:55,554
closure? You know? So there's things that without

315
00:11:55,615 --> 00:11:56,115
instrumentation,

316
00:11:56,495 --> 00:11:59,394
we can't, you know, truly measure. So,

317
00:12:00,080 --> 00:12:03,040
to what extent do skills meet some sort

318
00:12:03,040 --> 00:12:06,800
of objective criteria that we could truly see

319
00:12:06,800 --> 00:12:08,899
and be reliable on versus

320
00:12:09,279 --> 00:12:11,940
maybe they need to be reworded slightly differently.

321
00:12:14,254 --> 00:12:17,215
And, and, ultimately, when we started looking at

322
00:12:17,215 --> 00:12:19,455
all the skills across the textures, we we

323
00:12:19,455 --> 00:12:23,315
could identify core skills that really applied regardless

324
00:12:23,375 --> 00:12:25,134
of the texture. So we don't need all

325
00:12:25,134 --> 00:12:28,549
of these texture specific lists of skills, you

326
00:12:28,549 --> 00:12:30,649
know, outside of maybe sucking

327
00:12:31,429 --> 00:12:34,490
or, you know, biting and, you know, those

328
00:12:34,789 --> 00:12:36,949
specific chewing motions, but a lot of those

329
00:12:36,949 --> 00:12:38,949
motions we still see, you know, with other

330
00:12:38,949 --> 00:12:39,990
textures. So,

331
00:12:40,774 --> 00:12:43,254
so we really propose that, you know, future

332
00:12:43,254 --> 00:12:45,575
work needs to consider these features when we're

333
00:12:45,575 --> 00:12:46,075
developing

334
00:12:46,695 --> 00:12:49,355
a measure, ultimately. Alright. Awesome.

335
00:12:49,894 --> 00:12:51,815
Let let's so let's talk a little bit

336
00:12:51,815 --> 00:12:54,134
about the other study that you guys just

337
00:12:54,134 --> 00:12:55,289
published in the other measure.

338
00:12:56,009 --> 00:12:58,649
Also the developmental texture framework? Yes. Is that

339
00:12:58,730 --> 00:13:00,029
yes. Yes. So,

340
00:13:01,449 --> 00:13:02,909
we had a paper,

341
00:13:03,850 --> 00:13:06,190
published a couple months ago in the journal

342
00:13:06,250 --> 00:13:07,629
of texture studies,

343
00:13:08,009 --> 00:13:09,949
and it is a

344
00:13:10,424 --> 00:13:12,044
developmental texture framework,

345
00:13:13,144 --> 00:13:13,644
that

346
00:13:14,024 --> 00:13:14,524
is,

347
00:13:15,865 --> 00:13:17,865
based in food science. We had a food

348
00:13:17,865 --> 00:13:18,365
scientist,

349
00:13:19,144 --> 00:13:19,965
on the paper,

350
00:13:20,504 --> 00:13:21,644
as well as a dietitian,

351
00:13:22,345 --> 00:13:22,845
myself

352
00:13:23,225 --> 00:13:26,070
and Suzanne Evans Morris. Who had some very

353
00:13:26,070 --> 00:13:27,529
foundational work in,

354
00:13:28,230 --> 00:13:30,730
eating skill development, and then doctor Gaudet,

355
00:13:31,190 --> 00:13:33,750
who was our primary author on the consensus

356
00:13:33,750 --> 00:13:35,509
as well and a previous colleague of mine

357
00:13:35,509 --> 00:13:36,169
at children's.

358
00:13:37,190 --> 00:13:38,009
And so

359
00:13:38,414 --> 00:13:41,455
what we had intended to do was we

360
00:13:41,455 --> 00:13:41,774
had,

361
00:13:42,414 --> 00:13:45,615
reached out to Nestle Research, and they do

362
00:13:45,615 --> 00:13:47,855
a fit study every eight years. So every

363
00:13:47,855 --> 00:13:49,634
eight years, they do a national survey

364
00:13:50,014 --> 00:13:52,274
on collecting twenty four hour diet recalls

365
00:13:52,620 --> 00:13:53,120
on,

366
00:13:53,660 --> 00:13:56,620
healthy kids from birth to 48 of age,

367
00:13:56,620 --> 00:14:00,240
and they do all kinds of nutritional analysis

368
00:14:00,940 --> 00:14:02,320
on these diet recalls.

369
00:14:03,100 --> 00:14:03,600
And

370
00:14:03,980 --> 00:14:05,980
so from our paper that we published in

371
00:14:05,980 --> 00:14:06,879
'21

372
00:14:06,940 --> 00:14:08,000
where we present,

373
00:14:09,154 --> 00:14:11,014
this concept of a texture analysis,

374
00:14:12,274 --> 00:14:14,914
we wanted to get access to code those

375
00:14:14,914 --> 00:14:16,134
data. We were given,

376
00:14:16,754 --> 00:14:17,894
access to the datasets,

377
00:14:18,995 --> 00:14:20,754
which is about 2,700

378
00:14:20,754 --> 00:14:21,254
kids,

379
00:14:22,434 --> 00:14:22,934
and

380
00:14:23,315 --> 00:14:23,815
code

381
00:14:24,170 --> 00:14:27,129
the diet records for texture and then redo

382
00:14:27,129 --> 00:14:29,050
the analysis. So we can see what textures

383
00:14:29,050 --> 00:14:30,970
are present in the diet at different ages,

384
00:14:30,970 --> 00:14:32,350
how often are kids

385
00:14:32,970 --> 00:14:35,930
consuming foods by these textures, and then how

386
00:14:35,930 --> 00:14:38,090
much of their nutrition is finds some different

387
00:14:38,090 --> 00:14:39,870
textures. Because that's really

388
00:14:40,225 --> 00:14:41,684
in the general

389
00:14:42,144 --> 00:14:45,904
population. That is probably the most obvious visible

390
00:14:45,904 --> 00:14:48,965
marker of feeding development as my trial developed

391
00:14:49,024 --> 00:14:49,524
from,

392
00:14:51,184 --> 00:14:52,644
you know, nipple feeding

393
00:14:53,419 --> 00:14:55,259
to solids, which is really the kind of

394
00:14:55,259 --> 00:14:57,179
hallmark is if somebody's like, oh, yes. They've

395
00:14:57,179 --> 00:14:59,100
started solids, but we all know that solids

396
00:14:59,100 --> 00:14:59,919
are very different.

397
00:15:01,100 --> 00:15:03,419
And, you know, at what point do they

398
00:15:03,419 --> 00:15:04,159
go from

399
00:15:04,539 --> 00:15:07,605
practicing with their first solids to eating like

400
00:15:07,605 --> 00:15:09,945
the family? And we know those transitions occur

401
00:15:10,485 --> 00:15:12,565
really within just those first couple years of

402
00:15:12,565 --> 00:15:14,425
life and very, very rapidly.

403
00:15:14,884 --> 00:15:17,065
So there's a lot of moving pieces there.

404
00:15:17,205 --> 00:15:17,705
And,

405
00:15:18,245 --> 00:15:18,745
so

406
00:15:20,209 --> 00:15:21,909
the the kind of texture consumption

407
00:15:22,370 --> 00:15:24,769
analysis that we do is looking at those

408
00:15:24,769 --> 00:15:26,870
kind of in this three pronged way.

409
00:15:27,409 --> 00:15:29,009
You can have a texture in your diet,

410
00:15:29,009 --> 00:15:30,610
but that doesn't mean you have good skills

411
00:15:30,610 --> 00:15:32,289
for it or that you can consume your

412
00:15:32,289 --> 00:15:35,934
nutrition by it. So presence is important, but

413
00:15:35,934 --> 00:15:37,154
it's not the full story.

414
00:15:37,855 --> 00:15:38,995
You can be offered

415
00:15:39,375 --> 00:15:41,294
a lot of different types of textures and

416
00:15:41,294 --> 00:15:43,855
foods frequently throughout the day, and that's great

417
00:15:43,855 --> 00:15:45,934
if your family feels like that's appropriate. But

418
00:15:45,934 --> 00:15:47,455
that doesn't mean you're consuming a lot of

419
00:15:47,455 --> 00:15:50,320
your nutrition by those textures. So, you know,

420
00:15:50,320 --> 00:15:51,779
if I have a two year old

421
00:15:52,159 --> 00:15:54,799
that has, you know, all a variety of

422
00:15:54,799 --> 00:15:57,279
textures in their diet, they're offered it every

423
00:15:57,279 --> 00:15:59,279
day at multiple meals, but they take one

424
00:15:59,279 --> 00:16:01,039
bite of each of those, and the most

425
00:16:01,039 --> 00:16:03,440
of their nutrition is by liquids, that's a

426
00:16:03,440 --> 00:16:04,179
very different

427
00:16:04,554 --> 00:16:05,054
profile

428
00:16:05,434 --> 00:16:05,934
than

429
00:16:06,235 --> 00:16:08,394
a child that is consuming the majority of

430
00:16:08,394 --> 00:16:10,795
their nutrition by, you know, like a a

431
00:16:10,795 --> 00:16:11,295
nonformula

432
00:16:11,675 --> 00:16:14,554
liquid beverage and the majority of their calories

433
00:16:14,554 --> 00:16:16,575
from chewable solids in the family

434
00:16:16,955 --> 00:16:17,455
foods

435
00:16:18,059 --> 00:16:19,740
during the day and their three meals and

436
00:16:19,740 --> 00:16:21,519
two to three snacks. Right? So,

437
00:16:22,460 --> 00:16:25,440
so what we are doing is now analyzing

438
00:16:25,500 --> 00:16:28,620
beans' diet records from a national sample in

439
00:16:28,620 --> 00:16:30,960
this way so that we can, as

440
00:16:31,414 --> 00:16:31,914
clinicians,

441
00:16:32,294 --> 00:16:32,794
understand

442
00:16:33,254 --> 00:16:35,495
when does it seem feasible to have textures

443
00:16:35,495 --> 00:16:37,975
in your diet and offer them often and

444
00:16:37,975 --> 00:16:39,194
then ultimately

445
00:16:39,735 --> 00:16:42,054
consume your nutrition by them. And I envision

446
00:16:42,054 --> 00:16:43,914
this to look like a growth curve ultimately

447
00:16:44,134 --> 00:16:44,954
so we could

448
00:16:45,360 --> 00:16:47,360
ultimately kind of plot our kids and have

449
00:16:47,360 --> 00:16:49,860
something measurable to do when we're assessing

450
00:16:50,240 --> 00:16:51,700
our kids and really identify

451
00:16:52,159 --> 00:16:54,320
when they might just be not progressing in

452
00:16:54,320 --> 00:16:56,399
the same way. So, you know, we say

453
00:16:56,399 --> 00:16:58,159
we wanna advance diet. We have a child

454
00:16:58,159 --> 00:17:00,320
that has delayed advance of diet, which is

455
00:17:00,320 --> 00:17:03,115
kind of like classic hallmark of identification,

456
00:17:04,214 --> 00:17:06,234
that we could actually put some quantification

457
00:17:06,535 --> 00:17:08,775
to that. That's that's amazing that you were

458
00:17:08,775 --> 00:17:10,794
able to get your hands on that large

459
00:17:10,934 --> 00:17:11,434
dataset.

460
00:17:12,375 --> 00:17:14,480
Yeah. Yeah. It's it's an honor to be

461
00:17:14,480 --> 00:17:16,879
able to to have that. I think it

462
00:17:16,879 --> 00:17:18,740
can be some really powerful data.

463
00:17:20,240 --> 00:17:22,639
Certainly, you know, we we need to vet

464
00:17:22,639 --> 00:17:25,139
all of that then with feeding skill observation.

465
00:17:25,200 --> 00:17:26,799
What are the skills then that

466
00:17:27,424 --> 00:17:29,424
Yep. We are required to support that? So

467
00:17:29,424 --> 00:17:31,585
we have these kind of two arms of

468
00:17:31,585 --> 00:17:33,664
the research program that are right now working

469
00:17:33,664 --> 00:17:35,825
in parallel, which, you know, with our current

470
00:17:35,825 --> 00:17:38,464
data collection, we're we're bringing together. So we

471
00:17:38,464 --> 00:17:39,765
gather the same data

472
00:17:40,200 --> 00:17:41,019
and observations

473
00:17:41,559 --> 00:17:43,960
with the standard textures, in our current data

474
00:17:43,960 --> 00:17:46,059
collection. So then now we can say,

475
00:17:46,440 --> 00:17:49,319
yes. We have this texture consumption profile, and

476
00:17:49,319 --> 00:17:51,799
here are their oral feeding skills that they

477
00:17:51,799 --> 00:17:52,554
are using

478
00:17:52,855 --> 00:17:55,035
so we can start to to match that,

479
00:17:55,734 --> 00:17:56,234
for,

480
00:17:56,694 --> 00:18:00,134
some benchmarks for Estesan. Awesome. Awesome. So where

481
00:18:00,134 --> 00:18:01,494
are you now, Amy? Where where

482
00:18:02,934 --> 00:18:03,595
Yeah. Yeah.

483
00:18:04,375 --> 00:18:06,694
So we're actually in the process of the

484
00:18:06,694 --> 00:18:07,194
analysis

485
00:18:08,240 --> 00:18:09,619
of that large dataset,

486
00:18:11,119 --> 00:18:13,679
which you can imagine is super huge. Yeah.

487
00:18:14,159 --> 00:18:15,940
And but it's that's really exciting.

488
00:18:16,399 --> 00:18:18,480
And preliminary data have come out of that

489
00:18:18,480 --> 00:18:19,460
is just really

490
00:18:19,839 --> 00:18:20,355
cool to

491
00:18:21,954 --> 00:18:23,575
see, different developmental trends,

492
00:18:24,355 --> 00:18:27,154
in presence and frequency for sure where we

493
00:18:27,234 --> 00:18:29,634
where we're really starting to see different feeding

494
00:18:29,634 --> 00:18:30,134
stages

495
00:18:30,674 --> 00:18:31,174
that,

496
00:18:32,194 --> 00:18:35,255
are different than our well child visit schedule.

497
00:18:36,670 --> 00:18:38,589
So that it's not start solid at six

498
00:18:38,589 --> 00:18:40,190
months, and by 12, you should be on,

499
00:18:40,190 --> 00:18:42,029
like, family food. But what does that really

500
00:18:42,029 --> 00:18:44,529
mean? And right. That's a big window.

501
00:18:46,109 --> 00:18:46,609
So

502
00:18:46,910 --> 00:18:48,130
I'm hoping to,

503
00:18:48,830 --> 00:18:51,650
establish different feeding stages and milestones,

504
00:18:53,204 --> 00:18:56,164
and then be able to have primary care

505
00:18:56,164 --> 00:19:00,005
providers and caregivers really assess that from home.

506
00:19:00,005 --> 00:19:01,704
This is kind of a home friendly,

507
00:19:02,325 --> 00:19:04,565
way to think about it. So, hopefully, we

508
00:19:04,565 --> 00:19:06,509
can really prevent some of TF data from

509
00:19:06,509 --> 00:19:08,750
happening because we're catching it so much earlier

510
00:19:08,750 --> 00:19:10,049
and it just differences.

511
00:19:10,430 --> 00:19:10,830
Yeah.

512
00:19:11,710 --> 00:19:14,430
And then if not, we are able to

513
00:19:14,430 --> 00:19:15,890
then measure changes

514
00:19:16,350 --> 00:19:17,009
in therapy

515
00:19:17,309 --> 00:19:19,470
because we can redo that analysis at any

516
00:19:19,470 --> 00:19:19,970
time,

517
00:19:20,509 --> 00:19:23,775
and look for measurable changes, you know, across

518
00:19:23,775 --> 00:19:26,015
time. So, you know, that'll be the work

519
00:19:26,015 --> 00:19:28,174
in the background. So it's it's always twofold.

520
00:19:28,174 --> 00:19:30,894
It's, you know, selfishly as a clinician, what

521
00:19:30,894 --> 00:19:32,335
can I get so that I can do

522
00:19:32,335 --> 00:19:34,595
my job better? Yeah. But

523
00:19:34,930 --> 00:19:37,330
what kind of information can I put in

524
00:19:37,330 --> 00:19:38,230
the hands of caregivers

525
00:19:38,529 --> 00:19:40,150
and frontline providers

526
00:19:40,609 --> 00:19:42,849
Yep? Before they ever see us? Right? To

527
00:19:42,849 --> 00:19:44,609
have seen to get to see us, there's

528
00:19:44,609 --> 00:19:46,930
gotta be something pretty much going on. So

529
00:19:46,930 --> 00:19:48,875
could we, you know, address that earlier and

530
00:19:48,875 --> 00:19:50,634
maybe somebody else could address it before they

531
00:19:50,634 --> 00:19:52,315
actually need to see us? Yeah.

532
00:19:52,714 --> 00:19:54,335
Yeah. So that's kind of that goal.

533
00:19:54,954 --> 00:19:56,894
So that'll be, you know, in the process,

534
00:19:57,274 --> 00:19:58,894
during the analysis as well.

535
00:19:59,994 --> 00:20:01,835
And then for the other arm with the

536
00:20:01,835 --> 00:20:04,509
feeding scale, we're actually just getting ready to,

537
00:20:05,450 --> 00:20:05,950
invite

538
00:20:06,250 --> 00:20:06,750
some

539
00:20:07,130 --> 00:20:10,750
people, to Adelphi consensus rating study. So,

540
00:20:11,130 --> 00:20:12,809
we're taking those 107

541
00:20:12,809 --> 00:20:15,210
feeding skills that we identified, and we're gonna

542
00:20:15,210 --> 00:20:16,029
have raters

543
00:20:16,730 --> 00:20:17,230
rate,

544
00:20:17,984 --> 00:20:19,904
the importance of these skills. Do you feel

545
00:20:19,904 --> 00:20:21,664
like these skills are important and to what

546
00:20:21,664 --> 00:20:22,164
extent,

547
00:20:22,945 --> 00:20:24,884
for feeding assessments and establishing

548
00:20:25,265 --> 00:20:25,765
benchmarks,

549
00:20:26,865 --> 00:20:28,565
for development? And then

550
00:20:29,105 --> 00:20:30,805
those skills that

551
00:20:32,130 --> 00:20:35,170
meet consensus, we'll do another round of surveys

552
00:20:35,170 --> 00:20:37,490
of now what do we actually think we

553
00:20:37,490 --> 00:20:39,109
could observe reliably.

554
00:20:40,450 --> 00:20:42,450
And that's essentially how we had done the,

555
00:20:42,850 --> 00:20:43,990
setup for my dissertation.

556
00:20:44,444 --> 00:20:46,765
So we're repeating that, but at a larger

557
00:20:46,765 --> 00:20:47,265
scale.

558
00:20:48,125 --> 00:20:50,204
And this time, instead of just having speech

559
00:20:50,204 --> 00:20:52,544
pathology, we're also doing OT and psych,

560
00:20:53,005 --> 00:20:55,565
part of that process. So anybody that really

561
00:20:55,565 --> 00:20:56,704
observes and assesses

562
00:20:57,085 --> 00:20:57,585
children,

563
00:20:58,660 --> 00:21:00,920
while they're eating clinically. So,

564
00:21:01,380 --> 00:21:03,140
and then we'll do some focus groups after

565
00:21:03,140 --> 00:21:05,079
that and essentially try to reestablish

566
00:21:05,380 --> 00:21:08,180
the scale that we had with whatever now

567
00:21:08,180 --> 00:21:09,960
new vetted skills and movements,

568
00:21:11,299 --> 00:21:13,480
that make it through that process. So,

569
00:21:14,099 --> 00:21:15,294
that's kind of that

570
00:21:15,755 --> 00:21:17,755
next stage now. Some of the scoping review

571
00:21:17,755 --> 00:21:20,154
is to do that. And then once we

572
00:21:20,154 --> 00:21:22,075
establish the scale, then we can start putting

573
00:21:22,075 --> 00:21:23,535
out the data on the actual,

574
00:21:24,714 --> 00:21:27,460
skills that we're observing in in typical kids.

575
00:21:27,460 --> 00:21:30,500
That's awesome. This this is really commendable, Amy.

576
00:21:30,500 --> 00:21:32,200
I I mean, this is Thank you.

577
00:21:32,819 --> 00:21:34,980
I commend you for having such a big

578
00:21:34,980 --> 00:21:37,880
vision to tackle such a big but important

579
00:21:38,179 --> 00:21:38,679
thing.

580
00:21:39,234 --> 00:21:40,994
Yeah. Thank you. A lot of time. Yeah.

581
00:21:40,994 --> 00:21:42,835
I I mean, it's so it's so needed

582
00:21:42,835 --> 00:21:44,835
in in our field. It's so needed for

583
00:21:44,835 --> 00:21:47,494
moms, for parents, for kids, for pediatricians.

584
00:21:48,434 --> 00:21:49,634
But let let me do I'd love to

585
00:21:49,634 --> 00:21:51,394
ask you just, like, a personal question. Is

586
00:21:51,394 --> 00:21:54,490
this you you worked clinically for forever until

587
00:21:54,490 --> 00:21:56,649
you got into this work. Had this had

588
00:21:56,649 --> 00:21:58,250
this always been sort of a thing in

589
00:21:58,250 --> 00:22:00,569
the back of your mind, like, I really

590
00:22:00,569 --> 00:22:02,009
wanna get to the bottom of this, or

591
00:22:02,009 --> 00:22:04,329
I really wanna study this more. How how

592
00:22:04,329 --> 00:22:06,514
did this all come? Yeah.

593
00:22:07,615 --> 00:22:09,694
Yeah. Getting my PhD and doing research was

594
00:22:09,694 --> 00:22:11,454
never on my radar. I avoided that at

595
00:22:11,454 --> 00:22:12,194
all cost.

596
00:22:13,934 --> 00:22:14,434
And,

597
00:22:15,134 --> 00:22:16,894
you know, I really landed my dream job

598
00:22:16,894 --> 00:22:18,194
right out of grad school.

599
00:22:19,130 --> 00:22:20,909
I started as a CF at Children's.

600
00:22:21,609 --> 00:22:23,849
So I was, you know, exposed to just

601
00:22:23,849 --> 00:22:26,909
a wide range of of children and ages

602
00:22:26,970 --> 00:22:29,529
and and diagnoses and disorders. And,

603
00:22:30,409 --> 00:22:32,589
so I I ventured first into

604
00:22:33,245 --> 00:22:35,164
motor speech. So I worked with Ray Kent

605
00:22:35,164 --> 00:22:36,384
initially on my dissertation,

606
00:22:37,005 --> 00:22:38,924
who is, you know, icon in motors it's

607
00:22:38,924 --> 00:22:40,865
motor speech world, and then

608
00:22:41,245 --> 00:22:42,365
transitioned to,

609
00:22:42,765 --> 00:22:44,684
Katie Houston, who was doing a lot of

610
00:22:44,684 --> 00:22:45,184
work,

611
00:22:45,805 --> 00:22:46,465
in speech

612
00:22:46,829 --> 00:22:47,329
intelligibility

613
00:22:47,630 --> 00:22:48,130
norms

614
00:22:48,509 --> 00:22:49,009
and,

615
00:22:49,710 --> 00:22:52,349
and developing some of those benchmarks. So, you

616
00:22:52,349 --> 00:22:54,609
know, so that was always the motor aspect.

617
00:22:55,150 --> 00:22:58,190
The movement physiology aspect has always been of

618
00:22:58,190 --> 00:23:00,505
interest to me. How does the body work?

619
00:23:00,505 --> 00:23:02,505
How does it work to produce speech sounds?

620
00:23:02,505 --> 00:23:04,904
How does it work to chew and to

621
00:23:04,904 --> 00:23:08,184
swallow? And when I went to the hospital,

622
00:23:08,184 --> 00:23:10,765
I was, you know, immediately exposed to,

623
00:23:11,705 --> 00:23:14,605
training on swallow studies and fees and

624
00:23:15,140 --> 00:23:16,039
clinical assessment,

625
00:23:18,100 --> 00:23:21,059
had the opportunity to join the interdisciplinary feeding

626
00:23:21,059 --> 00:23:22,840
team. So I was exposed to

627
00:23:23,220 --> 00:23:26,420
GI and nutrition and psychology and nursing and

628
00:23:26,420 --> 00:23:28,515
all of those right off the bat,

629
00:23:28,974 --> 00:23:31,615
where you're working. And it's children's in in

630
00:23:31,615 --> 00:23:33,154
Milwaukee is truly an interdisciplinary.

631
00:23:33,855 --> 00:23:36,654
So you work side by side evaluating and

632
00:23:36,654 --> 00:23:38,894
assessing and asking questions. So you learn just

633
00:23:38,894 --> 00:23:40,335
a ton. And that's where the whole texture

634
00:23:40,335 --> 00:23:42,320
analysis came from, was sitting next to the

635
00:23:42,320 --> 00:23:44,400
dietitian who's taking the twenty four hour and

636
00:23:44,400 --> 00:23:46,720
crunching their nutrition numbers and just being super

637
00:23:46,720 --> 00:23:48,799
jealous that they had ways to do that.

638
00:23:48,799 --> 00:23:50,799
Yeah. Yeah. And I'm like, oh, I could

639
00:23:50,799 --> 00:23:52,480
do something similar to that, and that just

640
00:23:52,480 --> 00:23:55,085
kind of evolved over time. Yeah. Yeah. And

641
00:23:55,085 --> 00:23:57,005
now I've entered it into something more formal.

642
00:23:57,005 --> 00:23:57,505
But,

643
00:23:59,325 --> 00:24:02,144
so, yeah, I started venturing into feeding, swallowing.

644
00:24:02,285 --> 00:24:02,785
And,

645
00:24:03,244 --> 00:24:04,684
you know, as I started saying, okay. I

646
00:24:04,684 --> 00:24:06,960
need to assess these kids and identify if

647
00:24:07,039 --> 00:24:07,940
they need therapy.

648
00:24:08,319 --> 00:24:09,759
What do we have out there to help

649
00:24:09,759 --> 00:24:10,259
me

650
00:24:10,640 --> 00:24:11,279
with that?

651
00:24:11,759 --> 00:24:13,599
And really at that time, because this was

652
00:24:13,599 --> 00:24:14,980
really taking us back,

653
00:24:15,919 --> 00:24:18,339
because I started my PhD in 02/2002,

654
00:24:18,960 --> 00:24:21,039
the pre feeding skills checklist was, you know,

655
00:24:21,039 --> 00:24:23,494
still pretty much what people use. And even

656
00:24:23,494 --> 00:24:25,255
still today, a lot of people still use

657
00:24:25,255 --> 00:24:27,734
that by Suzanne and Morris, and she published

658
00:24:27,734 --> 00:24:29,835
that in the pre feeding skills book,

659
00:24:30,294 --> 00:24:31,355
with Marsha Duncline.

660
00:24:32,855 --> 00:24:35,015
And when you dive into that, and Suzanne

661
00:24:35,015 --> 00:24:37,000
and I talked about this on multiple occasions,

662
00:24:37,700 --> 00:24:39,539
you know, she based it on six kids,

663
00:24:39,539 --> 00:24:41,960
and she had, you know, really in-depth observations

664
00:24:42,099 --> 00:24:43,240
and video analysis,

665
00:24:43,859 --> 00:24:46,019
and looked at when skills kind of emerge

666
00:24:46,019 --> 00:24:47,480
and seem to be mastered.

667
00:24:48,654 --> 00:24:50,494
But, you know, I always knew that, clearly,

668
00:24:50,494 --> 00:24:52,815
we needed many more kits to be able

669
00:24:52,815 --> 00:24:55,315
to establish this as normative benchmarks.

670
00:24:56,015 --> 00:24:58,894
But it's really it's it's complicated and time

671
00:24:58,894 --> 00:24:59,394
consuming,

672
00:24:59,855 --> 00:25:00,835
you know, to

673
00:25:01,279 --> 00:25:03,119
to do the video analysis and establish those

674
00:25:03,119 --> 00:25:05,440
things. And so at that point, I was

675
00:25:05,440 --> 00:25:05,940
encouraged

676
00:25:06,240 --> 00:25:08,399
to, well, maybe go back for your PhD.

677
00:25:08,399 --> 00:25:09,460
You got these questions,

678
00:25:09,839 --> 00:25:12,079
you know. Why don't you do that? I'm

679
00:25:12,079 --> 00:25:13,380
like, oh, okay.

680
00:25:13,759 --> 00:25:15,974
Yeah. So, but yeah. So just out of

681
00:25:15,974 --> 00:25:18,934
those clinical questions, you know, developed this kind

682
00:25:18,934 --> 00:25:21,575
of desire to answer them. Yep. And I

683
00:25:21,575 --> 00:25:23,035
just, you know, I had opportunities

684
00:25:23,335 --> 00:25:25,575
that I took and I I worked really

685
00:25:25,575 --> 00:25:27,595
hard at to to make those things happen.

686
00:25:28,455 --> 00:25:28,955
And,

687
00:25:29,460 --> 00:25:31,460
you know, I worked at the hospital throughout

688
00:25:31,460 --> 00:25:33,000
my entire PhD program.

689
00:25:34,099 --> 00:25:36,500
You know, so you're constantly double dipping, and

690
00:25:36,500 --> 00:25:38,339
it's you know, it takes it took me

691
00:25:38,339 --> 00:25:38,839
longer.

692
00:25:39,779 --> 00:25:41,480
And then I chose to do

693
00:25:41,785 --> 00:25:45,065
a project that was my own, ultimately, that

694
00:25:45,065 --> 00:25:47,384
I could continue. So that was a bigger

695
00:25:47,384 --> 00:25:50,585
project than probably necessary, so that took longer

696
00:25:50,585 --> 00:25:52,904
too. And you know? But it's established my

697
00:25:52,904 --> 00:25:55,000
research program. So it was you know, the

698
00:25:55,000 --> 00:25:56,200
time was worth it, and it was more

699
00:25:56,200 --> 00:25:57,799
meaning it was meaningful to me. That's what

700
00:25:57,799 --> 00:25:58,460
I needed,

701
00:25:59,480 --> 00:26:02,039
in that moment to kinda push forward and

702
00:26:02,039 --> 00:26:02,539
persevere,

703
00:26:03,000 --> 00:26:05,000
you know, through the program and, you know,

704
00:26:05,000 --> 00:26:06,759
come out on the other side. Yeah. Yeah.

705
00:26:06,759 --> 00:26:08,804
No. I I I love that just as

706
00:26:08,804 --> 00:26:11,204
a clinician, but also as a someone that's

707
00:26:11,204 --> 00:26:13,204
in the throes of dissertation work right now.

708
00:26:13,204 --> 00:26:13,444
It's it's

709
00:26:14,164 --> 00:26:15,605
you know, I think sometimes when we're working

710
00:26:15,605 --> 00:26:16,105
clinically,

711
00:26:16,484 --> 00:26:18,484
we just have all these questions, and it's

712
00:26:18,484 --> 00:26:20,724
like, am I just not a good clinician

713
00:26:20,724 --> 00:26:22,890
because I don't know these answers, or do

714
00:26:22,890 --> 00:26:24,570
they just not accept? You know, I think

715
00:26:24,570 --> 00:26:26,809
we Yeah. Throw ourselves to the wolves and

716
00:26:27,049 --> 00:26:27,549
Absolutely.

717
00:26:27,930 --> 00:26:29,529
Yeah. And, you know, I know a lot

718
00:26:29,529 --> 00:26:30,890
of times I'm like, am I just not

719
00:26:30,890 --> 00:26:33,049
smart enough? Did I just learn this? Like,

720
00:26:33,049 --> 00:26:34,269
where is this information?

721
00:26:34,650 --> 00:26:36,089
And the reality is is that a lot

722
00:26:36,089 --> 00:26:38,269
of times it just doesn't exist and nobody's

723
00:26:38,884 --> 00:26:42,244
uncovered yet. And Yeah. Absolutely. And yeah. As,

724
00:26:42,244 --> 00:26:44,984
you know, as clinicians particularly in this area,

725
00:26:46,404 --> 00:26:48,325
we're really in our infancy still in the

726
00:26:48,325 --> 00:26:49,304
literature and

727
00:26:49,605 --> 00:26:50,904
in in this work.

728
00:26:51,365 --> 00:26:53,365
And there's a lot of great work out

729
00:26:53,365 --> 00:26:54,940
there, and it's pieces

730
00:26:55,319 --> 00:26:56,859
of the puzzle. Mhmm.

731
00:26:57,799 --> 00:26:59,480
And that's where kind of the scoping reviews

732
00:26:59,480 --> 00:27:01,079
look at. Yeah. Oh, they're looking at that,

733
00:27:01,079 --> 00:27:02,440
and they're looking at that, and that's great.

734
00:27:02,440 --> 00:27:04,039
And they're looking at that, or they're looking

735
00:27:04,039 --> 00:27:06,039
at this age, but we need to we

736
00:27:06,039 --> 00:27:07,799
need to fill in those gaps. We need

737
00:27:07,799 --> 00:27:09,305
to look at, you know, each of these

738
00:27:09,305 --> 00:27:11,305
kids as a as a whole because what

739
00:27:11,305 --> 00:27:12,365
else is influencing

740
00:27:13,144 --> 00:27:15,244
those individual things that we're looking at.

741
00:27:15,625 --> 00:27:18,045
That certainly makes projects more complicated

742
00:27:18,585 --> 00:27:20,744
and, you know, a little bit harder to

743
00:27:20,744 --> 00:27:21,244
manage.

744
00:27:21,944 --> 00:27:22,444
So,

745
00:27:23,269 --> 00:27:25,450
but, you know, that's just my direction,

746
00:27:26,069 --> 00:27:27,750
is to look at them all of those

747
00:27:27,750 --> 00:27:29,750
pieces. Yep. Yeah. And I think as a

748
00:27:29,750 --> 00:27:31,690
clinician too, it's so helpful because,

749
00:27:32,069 --> 00:27:33,269
like I mentioned, I was part of a

750
00:27:33,269 --> 00:27:35,509
scoping review, gosh, maybe three, four years ago.

751
00:27:35,509 --> 00:27:36,789
I can't even remember how long ago it

752
00:27:36,789 --> 00:27:38,535
was now. But it was so interesting to

753
00:27:38,615 --> 00:27:40,615
to realize that so much literature had been

754
00:27:40,695 --> 00:27:42,535
so much research had been done in certain

755
00:27:42,535 --> 00:27:45,335
areas, and and so little had been done

756
00:27:45,335 --> 00:27:47,414
in other areas. And it's an addition that

757
00:27:47,414 --> 00:27:49,255
takes the pressure off of us to say,

758
00:27:49,255 --> 00:27:51,654
okay. I'm not crazy. I didn't just not

759
00:27:51,654 --> 00:27:53,880
learn this stuff. Like, there just really isn't

760
00:27:53,880 --> 00:27:55,559
a lot to know or, you know, there

761
00:27:55,559 --> 00:27:57,579
isn't a lot that we know yet

762
00:27:58,039 --> 00:28:00,359
in specific areas. And I just think that's

763
00:28:00,359 --> 00:28:03,559
very encouraging for, you know, clinicians that do

764
00:28:03,559 --> 00:28:05,865
wanna go back and get their PhD maybe

765
00:28:05,865 --> 00:28:07,785
later in their career. And I was I

766
00:28:07,785 --> 00:28:09,225
was kinda the opposite of you. I was

767
00:28:09,225 --> 00:28:11,065
someone that I wanted to get my PhD

768
00:28:11,065 --> 00:28:12,664
right out of grad school. And I had

769
00:28:12,664 --> 00:28:14,744
a I did a a master's thesis, and

770
00:28:14,744 --> 00:28:16,205
I had the most amazing,

771
00:28:16,849 --> 00:28:17,750
master's mentor,

772
00:28:18,369 --> 00:28:20,130
thesis mentor, and she just said, no, Teresa.

773
00:28:20,130 --> 00:28:22,289
I really encourage you to go work for

774
00:28:22,289 --> 00:28:24,289
a while before you get your PhD, before

775
00:28:24,289 --> 00:28:26,049
you start your PhD, because it'll just give

776
00:28:26,049 --> 00:28:28,369
you you'll know what you wanna study at

777
00:28:28,369 --> 00:28:30,644
that point. Sure. Yep. And, you know, naive

778
00:28:30,724 --> 00:28:32,404
little grad school, Teresa, was like, no. I

779
00:28:32,404 --> 00:28:33,924
want I know what I want to study

780
00:28:33,924 --> 00:28:36,325
yet. And, you know, fortunately, life took me

781
00:28:36,325 --> 00:28:37,845
in other directions, and I you know, it

782
00:28:37,845 --> 00:28:40,244
was fifteen years before I went back. But

783
00:28:40,244 --> 00:28:42,565
now Yeah. I'm like, gosh. I'm so passionate

784
00:28:42,565 --> 00:28:44,244
about what I wanna study, and I know

785
00:28:44,244 --> 00:28:44,744
exactly,

786
00:28:45,079 --> 00:28:45,740
you know,

787
00:28:46,039 --> 00:28:47,900
where the gaps are and what we need

788
00:28:48,119 --> 00:28:49,880
to to look for and find. And and

789
00:28:49,880 --> 00:28:51,400
so she was 100%

790
00:28:51,400 --> 00:28:52,700
right, and I will know. Yeah.

791
00:28:54,279 --> 00:28:54,940
Yeah. Exactly.

792
00:28:55,640 --> 00:28:57,480
Yeah. Yeah. But I think there's just so

793
00:28:57,480 --> 00:28:59,714
much you learn clinically about what what we

794
00:28:59,714 --> 00:29:01,634
don't know, and it's it's not a personal

795
00:29:01,634 --> 00:29:03,954
attack. It's a crud. We just need to

796
00:29:03,954 --> 00:29:04,855
know more of that.

797
00:29:05,154 --> 00:29:06,934
Yeah. And I yeah. And I think,

798
00:29:07,714 --> 00:29:08,934
you know, from a clinician

799
00:29:09,234 --> 00:29:11,554
perspective, you see, like, oh, I'm not doing

800
00:29:11,554 --> 00:29:13,654
research. I don't know anything, which is baloney

801
00:29:13,875 --> 00:29:14,375
because

802
00:29:15,190 --> 00:29:15,930
as a clinician,

803
00:29:16,390 --> 00:29:18,470
we know what's out there. We just don't

804
00:29:18,470 --> 00:29:21,049
have the capacity in that current role to

805
00:29:21,109 --> 00:29:23,269
generally answer some of those questions, definitely some

806
00:29:23,269 --> 00:29:23,769
questions,

807
00:29:24,230 --> 00:29:25,750
and to participate. But,

808
00:29:26,230 --> 00:29:27,509
no. We do the best that we can

809
00:29:27,509 --> 00:29:29,335
as clinicians. We have to see our patients.

810
00:29:29,335 --> 00:29:30,454
We can't say, well, I don't have a

811
00:29:30,454 --> 00:29:32,375
norm on that, so I'm just gonna, you

812
00:29:32,375 --> 00:29:33,275
know, see you.

813
00:29:34,054 --> 00:29:37,095
You know, we have norms. They're just maybe

814
00:29:37,095 --> 00:29:38,795
big age ranges. So,

815
00:29:40,134 --> 00:29:42,855
they're just not sensitive enough to identify kids

816
00:29:42,855 --> 00:29:43,355
earlier,

817
00:29:43,789 --> 00:29:46,450
and that's and that's really a focus. So,

818
00:29:47,230 --> 00:29:49,390
you know, we do go and and present

819
00:29:49,390 --> 00:29:50,589
and, like, well, how do you know this

820
00:29:50,589 --> 00:29:52,190
kid's typical if there's no norms? Like, I

821
00:29:52,190 --> 00:29:54,029
get that question all the time. Well, yeah,

822
00:29:54,029 --> 00:29:55,869
we have to vet it against their medical

823
00:29:55,869 --> 00:29:57,649
status and, you know,

824
00:29:58,755 --> 00:29:59,894
their general development

825
00:30:00,275 --> 00:30:02,195
and, you know, etcetera, and the norms that

826
00:30:02,195 --> 00:30:03,654
we do have so,

827
00:30:04,355 --> 00:30:06,355
so that we can continue to refine that,

828
00:30:06,355 --> 00:30:08,755
you know, over time. Yeah. That's that's a

829
00:30:08,755 --> 00:30:10,674
tough thing that we always experience with my

830
00:30:10,674 --> 00:30:13,200
son too was that there's so many scales

831
00:30:13,200 --> 00:30:14,799
and measures and things that he is not

832
00:30:14,799 --> 00:30:16,400
even on. You know? He's not even on

833
00:30:16,400 --> 00:30:18,960
the normal developmental growth chart. But then you

834
00:30:18,960 --> 00:30:21,599
look at other medical conditions, and he doesn't

835
00:30:21,599 --> 00:30:23,619
have any. You know? So it's it it

836
00:30:23,759 --> 00:30:26,000
seems like to be a disconnect because according

837
00:30:26,000 --> 00:30:28,705
to some scales Yeah. He's way off them,

838
00:30:28,705 --> 00:30:30,705
and then according to some, he is he's

839
00:30:30,705 --> 00:30:32,865
right on. So it's it's really tricky for

840
00:30:32,865 --> 00:30:35,445
some of these kids that have multiple complexities,

841
00:30:35,664 --> 00:30:37,984
and and it's it's hard to piece them

842
00:30:37,984 --> 00:30:39,299
out. You know? That's why it's just so

843
00:30:39,299 --> 00:30:41,059
important to look at the whole big picture

844
00:30:41,059 --> 00:30:42,740
and, you know, okay. How is this kid

845
00:30:42,740 --> 00:30:44,179
doing as a whole? What are all these

846
00:30:44,179 --> 00:30:46,740
other classes that fit into the puzzle? And,

847
00:30:46,740 --> 00:30:47,940
you know, I think we're getting to this

848
00:30:47,940 --> 00:30:50,259
point in speech pathology that we're appreciating that

849
00:30:50,259 --> 00:30:52,464
a lot. We're appreciating the big picture. As

850
00:30:52,464 --> 00:30:54,384
you mentioned, you had, you know, dietitian and

851
00:30:54,384 --> 00:30:56,644
and other colleagues other interdisciplinary

852
00:30:56,944 --> 00:30:59,605
colleagues on your papers too, and I'm I'm

853
00:30:59,664 --> 00:31:02,065
loving seeing that more now because it just

854
00:31:02,065 --> 00:31:04,625
just gives us a much more bigger picture

855
00:31:04,625 --> 00:31:05,524
of the kid.

856
00:31:06,400 --> 00:31:08,240
It sure does. And, you know, and based

857
00:31:08,240 --> 00:31:10,240
on your experience too, I mean, it really

858
00:31:10,240 --> 00:31:12,480
shows that there's just not one thing that

859
00:31:12,480 --> 00:31:15,200
we can use Yep. To identify kids. It

860
00:31:15,279 --> 00:31:16,660
it's going to be multiple

861
00:31:17,119 --> 00:31:17,619
pronged

862
00:31:18,160 --> 00:31:18,980
in the approach

863
00:31:19,555 --> 00:31:21,234
to and not just, you know, a nutrition

864
00:31:21,474 --> 00:31:24,134
having to have other disciplines, but even within

865
00:31:24,755 --> 00:31:27,474
our scope that it's just not one measure

866
00:31:27,474 --> 00:31:29,715
that's gonna answer all those questions. Yep.

867
00:31:30,275 --> 00:31:32,195
So we do have to have, you know,

868
00:31:32,195 --> 00:31:32,695
multiple

869
00:31:33,340 --> 00:31:35,820
multiple measures in our arsenal that we are

870
00:31:35,820 --> 00:31:37,500
using, and we use that to the best

871
00:31:37,500 --> 00:31:39,740
of the current state of knowledge. And we

872
00:31:39,740 --> 00:31:41,420
refine that as we go. So in our

873
00:31:41,420 --> 00:31:43,420
clinical practice and our standards, we just need

874
00:31:43,420 --> 00:31:46,080
to be fluid and open to

875
00:31:46,615 --> 00:31:48,855
those changes, which sometimes can be hard. You

876
00:31:48,855 --> 00:31:50,214
know? We got our rhythm, and we know

877
00:31:50,214 --> 00:31:51,835
what we're doing. And now

878
00:31:52,214 --> 00:31:54,934
introducing something new can, you know, make things

879
00:31:54,934 --> 00:31:56,394
a little bit more complicated.

880
00:31:56,694 --> 00:31:57,194
And,

881
00:31:57,815 --> 00:31:59,829
you know, but in everything, we just have

882
00:31:59,829 --> 00:32:02,149
to be open to that new data that's

883
00:32:02,149 --> 00:32:04,710
coming out with your new process and, you

884
00:32:04,710 --> 00:32:06,789
know, it's to help the kids. Yeah. Yeah.

885
00:32:06,789 --> 00:32:08,230
Yeah. And and I really appreciate what you're

886
00:32:08,230 --> 00:32:09,589
doing with your work too because I think

887
00:32:09,589 --> 00:32:11,450
it'll help so many, you know, pediatricians

888
00:32:11,750 --> 00:32:13,714
too. It's you know, I I know for

889
00:32:13,714 --> 00:32:15,634
my son, we go we have about three

890
00:32:15,634 --> 00:32:18,755
different pediatricians for just different things that we

891
00:32:18,755 --> 00:32:21,095
go to, you know, but it's interesting. I

892
00:32:21,234 --> 00:32:23,394
I love and appreciate all of them for

893
00:32:23,394 --> 00:32:24,774
their different expertise,

894
00:32:25,075 --> 00:32:27,400
but what's interesting is, you know, one will

895
00:32:27,400 --> 00:32:29,000
say, oh, you know, no. They're right on

896
00:32:29,000 --> 00:32:30,600
track. Or one will say, no. This is

897
00:32:30,600 --> 00:32:32,200
really delayed. We need to get some help.

898
00:32:32,200 --> 00:32:33,880
And Right. And and it's tough. You don't

899
00:32:33,880 --> 00:32:36,279
wanna undermine any of their expertise, but they're

900
00:32:36,279 --> 00:32:38,775
all going based on different things. So,

901
00:32:39,734 --> 00:32:41,815
hopefully, your, you know, your your feeding scales

902
00:32:41,815 --> 00:32:43,914
and and frameworks will help to

903
00:32:44,455 --> 00:32:46,775
sort of get everyone on on the same

904
00:32:46,775 --> 00:32:49,015
page a little bit more. Yeah. I I

905
00:32:49,015 --> 00:32:51,255
hope so. And and, yeah, you know, everybody

906
00:32:51,255 --> 00:32:54,150
has a different perspective based on their discipline,

907
00:32:54,210 --> 00:32:57,490
where they've trained the exposure to different populations

908
00:32:57,490 --> 00:32:59,490
of kids and disorders that they've worked with.

909
00:32:59,490 --> 00:33:02,450
You know, what's one perspective of maybe not

910
00:33:02,450 --> 00:33:04,529
growing so well versus another? You know, some

911
00:33:04,529 --> 00:33:07,329
are gonna be super sensitive to changes in

912
00:33:07,329 --> 00:33:08,230
growth or,

913
00:33:08,804 --> 00:33:11,444
differences in, you know, what they're seeing based

914
00:33:11,444 --> 00:33:13,625
on who they've treated in the past.

915
00:33:14,404 --> 00:33:17,605
So I think it's really important for not

916
00:33:17,605 --> 00:33:20,804
only for other providers when you're working together

917
00:33:20,804 --> 00:33:22,980
on a patient, but for caregivers to know

918
00:33:23,220 --> 00:33:25,619
that different providers with different backgrounds are gonna

919
00:33:25,619 --> 00:33:26,519
look at it differently.

920
00:33:27,059 --> 00:33:29,299
It doesn't mean one's right or wrong. It's

921
00:33:29,299 --> 00:33:31,940
just a different perspective, and you have to

922
00:33:31,940 --> 00:33:34,980
pull those pieces together Yeah. For your child.

923
00:33:34,980 --> 00:33:37,355
And that's it's hard. Right? That's hard. Yep.

924
00:33:37,355 --> 00:33:39,195
Yep. Yeah. Awesome. Well, thank you so much.

925
00:33:39,195 --> 00:33:41,275
I mean, this has been just a awesome

926
00:33:41,275 --> 00:33:43,355
conversation. Is there any anything else that you

927
00:33:43,355 --> 00:33:45,695
like to share, or did we cover everything?

928
00:33:46,075 --> 00:33:47,695
No. You know? We could talk forever.

929
00:33:48,075 --> 00:33:49,934
No. I think I think that's,

930
00:33:50,634 --> 00:33:52,235
I think that really covers, you know, kind

931
00:33:52,235 --> 00:33:54,369
of the current work that we're doing.

932
00:33:55,170 --> 00:33:56,150
We are expanding

933
00:33:56,450 --> 00:33:56,950
to,

934
00:33:58,049 --> 00:33:59,750
children with PFD and dysphasia,

935
00:34:00,289 --> 00:34:02,150
in our data collection because, ultimately,

936
00:34:02,609 --> 00:34:04,289
I want to be able to profile these

937
00:34:04,289 --> 00:34:06,194
kids in all of these ways so we

938
00:34:06,194 --> 00:34:08,675
can better predict. If you have a specific

939
00:34:08,675 --> 00:34:10,695
diagnosis that has a little bit more

940
00:34:11,074 --> 00:34:11,574
consistency

941
00:34:11,954 --> 00:34:12,934
to expectations,

942
00:34:13,394 --> 00:34:14,454
can we provide

943
00:34:14,914 --> 00:34:17,655
caregivers with better kind of predictive information?

944
00:34:18,599 --> 00:34:19,099
Right?

945
00:34:19,559 --> 00:34:22,059
So, yep, we know from

946
00:34:22,440 --> 00:34:24,599
the literature that your child is going to

947
00:34:24,599 --> 00:34:26,680
be behind in learning to eat, but they're

948
00:34:26,680 --> 00:34:28,519
gonna learn kind of in the same order.

949
00:34:28,519 --> 00:34:30,840
It's just gonna be delayed. So, right, you're

950
00:34:30,840 --> 00:34:32,539
gonna do a little bit more texture modification

951
00:34:32,840 --> 00:34:34,155
or give, you know, give them a little

952
00:34:34,155 --> 00:34:36,815
bit more grace and what your expectations are.

953
00:34:37,275 --> 00:34:37,775
Or,

954
00:34:38,235 --> 00:34:39,835
no. If we can get your child in

955
00:34:39,835 --> 00:34:41,994
and get some pretty intensive intervention, we think

956
00:34:41,994 --> 00:34:43,835
we could, you know, resolve this quickly based

957
00:34:43,835 --> 00:34:45,594
on what we know. So that's that's in

958
00:34:45,594 --> 00:34:47,835
parallel while we're developing some of the norms,

959
00:34:47,835 --> 00:34:50,750
really trying to establish the same profilings

960
00:34:51,210 --> 00:34:52,910
to children with different diagnoses,

961
00:34:54,170 --> 00:34:57,070
so that we can identify risk Yep. Earlier.

962
00:34:58,250 --> 00:34:58,650
So,

963
00:34:59,449 --> 00:35:00,829
cohort is that we,

964
00:35:01,130 --> 00:35:02,910
have studied. Now we have two papers,

965
00:35:03,224 --> 00:35:05,465
also coming out that aren't out yet, in

966
00:35:05,465 --> 00:35:07,785
congenital heart. Oh, wow. So which is really

967
00:35:07,864 --> 00:35:10,265
while congenital heart in and of itself is,

968
00:35:10,265 --> 00:35:12,585
you know, a big diagnosis, it's a it's

969
00:35:12,585 --> 00:35:14,204
a diverse group of kids.

970
00:35:14,825 --> 00:35:16,364
So but really interesting,

971
00:35:17,690 --> 00:35:20,489
in how their feeding develops, what their outcomes

972
00:35:20,489 --> 00:35:21,150
look like,

973
00:35:21,849 --> 00:35:24,329
and why I like this group a lot

974
00:35:24,329 --> 00:35:27,230
is when we look at different developmental domains,

975
00:35:27,610 --> 00:35:30,430
kids with congenital heart really have scattered developmental

976
00:35:30,650 --> 00:35:33,150
profiles. It's not just a global delay.

977
00:35:34,474 --> 00:35:36,875
It's not, you know, only a delay in

978
00:35:36,875 --> 00:35:38,715
one area. We have some kids that have

979
00:35:38,715 --> 00:35:41,035
no developmental delays. We have kids that have

980
00:35:41,035 --> 00:35:42,235
global, and then we have kids that have

981
00:35:42,235 --> 00:35:44,074
very specific, just a motor delay or just

982
00:35:44,074 --> 00:35:44,954
a, you know, whatever.

983
00:35:45,275 --> 00:35:48,255
So we're using that to help us understand,

984
00:35:49,309 --> 00:35:50,610
how different developmental

985
00:35:51,230 --> 00:35:54,130
aspects of a child drive feeding. You know?

986
00:35:54,269 --> 00:35:56,530
Is it mostly motor? Is it mostly cognition?

987
00:35:58,030 --> 00:36:00,750
Which ones drive it differently at different ages

988
00:36:01,295 --> 00:36:01,614
Yeah.

989
00:36:02,175 --> 00:36:04,414
Or a combination of things. So so that

990
00:36:04,414 --> 00:36:04,894
is,

991
00:36:05,215 --> 00:36:06,675
a group of kids that,

992
00:36:07,535 --> 00:36:08,675
we have been studying,

993
00:36:09,454 --> 00:36:09,954
in,

994
00:36:10,894 --> 00:36:12,974
certain ways, and then we are working right

995
00:36:12,974 --> 00:36:13,715
now towards

996
00:36:14,255 --> 00:36:15,715
writing a grant so we can,

997
00:36:16,190 --> 00:36:18,430
do longitudinal studies in case of the congenital

998
00:36:18,430 --> 00:36:20,190
heart as well as typical. So we can

999
00:36:20,190 --> 00:36:21,090
really understand

1000
00:36:21,390 --> 00:36:23,789
how this feeding developed. Yep. Why does it

1001
00:36:23,789 --> 00:36:25,809
go well? Why doesn't it go well?

1002
00:36:26,750 --> 00:36:28,510
Because we really need to know that, you

1003
00:36:28,510 --> 00:36:30,025
know, as as so,

1004
00:36:30,644 --> 00:36:32,644
yeah. So that's, you know, that's kind of

1005
00:36:32,644 --> 00:36:34,644
some of our next steps as we as

1006
00:36:34,644 --> 00:36:36,025
we move forward and,

1007
00:36:36,485 --> 00:36:38,085
yeah, kind of expand out on our data

1008
00:36:38,085 --> 00:36:40,724
collection. Yeah. It it's super fascinating too. Right?

1009
00:36:40,724 --> 00:36:42,164
There's just so much I've learned with my

1010
00:36:42,164 --> 00:36:44,369
son in the last few years. Yeah.

1011
00:36:44,909 --> 00:36:47,389
About, you know, he he it takes him

1012
00:36:47,389 --> 00:36:49,089
a long time to eat by mouth.

1013
00:36:49,550 --> 00:36:51,550
And what we're realizing is, you know, physical

1014
00:36:51,550 --> 00:36:53,469
therapy and occupational therapy are saying, you know,

1015
00:36:53,469 --> 00:36:55,469
he's using so much of his strength and

1016
00:36:55,469 --> 00:36:57,949
his energy and his calories in trying to

1017
00:36:57,949 --> 00:37:00,664
eat Yeah. That he's really not

1018
00:37:00,965 --> 00:37:01,465
retaining

1019
00:37:01,765 --> 00:37:04,485
many calories because he's burning them all. So

1020
00:37:04,485 --> 00:37:06,405
then when it comes to muscle building during

1021
00:37:06,405 --> 00:37:08,505
actual PT time, he's wiped.

1022
00:37:08,805 --> 00:37:10,965
Yeah. So these are the conversations that we're

1023
00:37:10,965 --> 00:37:12,565
having, you know, okay. So then do we

1024
00:37:12,565 --> 00:37:14,164
give him a tube feeding so that he's

1025
00:37:14,164 --> 00:37:15,839
got some energy to then

1026
00:37:16,139 --> 00:37:18,480
go hopefully do some walking and PT?

1027
00:37:18,940 --> 00:37:21,339
And there's just so many pieces to that

1028
00:37:21,339 --> 00:37:23,339
puzzle of, you know, like you said, is

1029
00:37:23,339 --> 00:37:25,839
it motor? Is it cognitive? Is it sensory?

1030
00:37:25,980 --> 00:37:27,675
Is it, you know, he's got all sorts

1031
00:37:27,675 --> 00:37:29,914
of different issues going on and, you know,

1032
00:37:29,914 --> 00:37:31,695
we just don't know the answer sometimes.

1033
00:37:31,994 --> 00:37:34,394
But No. For sure. But we do know

1034
00:37:34,394 --> 00:37:36,255
that, you know, nutrition

1035
00:37:36,555 --> 00:37:37,695
and being nourished

1036
00:37:38,074 --> 00:37:39,295
is nonnegotiable.

1037
00:37:39,994 --> 00:37:42,940
Right? Top priority. Yeah. Top priority,

1038
00:37:43,319 --> 00:37:44,219
and it drives

1039
00:37:45,079 --> 00:37:47,880
development, and it obviously drives growth, but it

1040
00:37:47,880 --> 00:37:48,779
drives opportunity.

1041
00:37:49,319 --> 00:37:52,519
Yep. And there's enough literature that when kids

1042
00:37:52,519 --> 00:37:54,599
aren't nourished and growing well in the first

1043
00:37:54,599 --> 00:37:57,164
one thousand days, that they are higher have

1044
00:37:57,164 --> 00:37:59,744
higher risk for neurodevelopmental delay later.

1045
00:38:00,605 --> 00:38:02,304
So it's so critical

1046
00:38:02,925 --> 00:38:05,184
to do that. But when we don't have

1047
00:38:05,324 --> 00:38:08,204
sensitive enough expectations in those first one thousand

1048
00:38:08,204 --> 00:38:10,730
days, we're we're doing a disservice to the

1049
00:38:10,730 --> 00:38:12,570
kids because we're not Yeah. We don't wanna

1050
00:38:12,570 --> 00:38:14,730
be alarmists and say, oh, we need to,

1051
00:38:14,730 --> 00:38:17,050
you know, treat everybody or get everybody in,

1052
00:38:17,050 --> 00:38:19,609
but we do need to, I think, be

1053
00:38:19,609 --> 00:38:21,210
a little bit more of an alarmist in

1054
00:38:21,210 --> 00:38:22,775
those first, you know, phases.

1055
00:38:23,315 --> 00:38:24,674
And then there's a lot of ways to

1056
00:38:24,674 --> 00:38:27,554
do something like tooth feeding. That was something

1057
00:38:27,554 --> 00:38:29,474
that we managed a ton on our on

1058
00:38:29,474 --> 00:38:30,214
our team

1059
00:38:30,594 --> 00:38:33,795
because there's GI complications and nutrition complications. And

1060
00:38:33,795 --> 00:38:35,875
then, you know, the dietitian can make a

1061
00:38:35,875 --> 00:38:37,494
great plan, but then

1062
00:38:38,030 --> 00:38:39,789
the psychologist has to say, well, yep. But

1063
00:38:39,789 --> 00:38:41,309
what's the form of that food and how

1064
00:38:41,309 --> 00:38:43,230
much are you expecting? And because it's gonna

1065
00:38:43,230 --> 00:38:44,989
take them too long to consume it, they're

1066
00:38:44,989 --> 00:38:46,449
gonna burn too much calories

1067
00:38:46,829 --> 00:38:49,309
to get the benefit from that. You know?

1068
00:38:49,309 --> 00:38:51,215
They don't have the GI tolerance to that.

1069
00:38:51,215 --> 00:38:53,295
They're resistant to eating. You know? All of

1070
00:38:53,295 --> 00:38:54,594
those pieces play

1071
00:38:54,974 --> 00:38:55,954
a huge role.

1072
00:38:56,815 --> 00:38:58,974
And, yeah, you know, deciding on using a

1073
00:38:58,974 --> 00:39:00,835
feeding tube is a is a big decision.

1074
00:39:02,015 --> 00:39:04,094
And I you know, in the pediatric world,

1075
00:39:04,094 --> 00:39:05,614
and I I was listening to your,

1076
00:39:06,015 --> 00:39:08,470
more recent podcast podcast about your experience over

1077
00:39:08,470 --> 00:39:10,650
the summer and making those decisions. And

1078
00:39:10,950 --> 00:39:12,869
it is a really hard decision, you know,

1079
00:39:12,869 --> 00:39:14,869
in the adult world. Like you guys kinda

1080
00:39:14,869 --> 00:39:17,369
said, it's it's thought of as, oh gosh,

1081
00:39:17,430 --> 00:39:19,510
avoid the tube at all costs. Yeah. Yeah.

1082
00:39:19,510 --> 00:39:21,349
You know? And in the pediatric realm, we're

1083
00:39:21,349 --> 00:39:22,864
like, it is such a tool,

1084
00:39:23,244 --> 00:39:25,405
and it's Yep. A a safety net, and

1085
00:39:25,405 --> 00:39:28,465
it allows a child and a family to,

1086
00:39:28,605 --> 00:39:31,164
you know, have positive experiences to have room

1087
00:39:31,164 --> 00:39:33,585
to grow and develop and gain skill.

1088
00:39:34,364 --> 00:39:36,385
So it is just a it's an interesting,

1089
00:39:36,950 --> 00:39:39,050
you know, kind of difference in in philosophy

1090
00:39:39,430 --> 00:39:39,930
almost.

1091
00:39:40,789 --> 00:39:42,630
And yeah. But there's also so many different

1092
00:39:42,630 --> 00:39:44,789
ways to to manage that. Right? To not,

1093
00:39:44,789 --> 00:39:45,849
you know, inhibit

1094
00:39:46,390 --> 00:39:48,470
still desire to eat, but getting enough to

1095
00:39:48,470 --> 00:39:50,550
nourish and not be feeding all day long.

1096
00:39:50,550 --> 00:39:52,309
You know, all of those things. So it

1097
00:39:52,309 --> 00:39:53,824
is it's a really complicated,

1098
00:39:54,525 --> 00:39:56,445
process, and you need multiple people on your

1099
00:39:56,445 --> 00:39:58,764
team to help you manage manage that. Yeah.

1100
00:39:58,764 --> 00:40:00,284
Thank you for sharing that about the first

1101
00:40:00,284 --> 00:40:02,284
thousand days. I had never heard that before,

1102
00:40:02,284 --> 00:40:03,804
but it makes you know, I try to

1103
00:40:03,804 --> 00:40:06,099
give myself grace with how how I navigate

1104
00:40:06,159 --> 00:40:07,300
my thud when it was

1105
00:40:07,920 --> 00:40:09,519
fresh out of the NICU. But, you know,

1106
00:40:09,519 --> 00:40:11,519
not you know, it's been ten years, and

1107
00:40:11,519 --> 00:40:13,119
I've you know, we learned a lot more

1108
00:40:13,119 --> 00:40:14,980
now than we knew ten years ago. But

1109
00:40:15,280 --> 00:40:16,019
it's it's

1110
00:40:16,480 --> 00:40:18,014
crazy to me now now to think back

1111
00:40:18,014 --> 00:40:19,694
of they just kept saying, oh, he'll just

1112
00:40:19,694 --> 00:40:21,375
figure it out. He'll just figure it out.

1113
00:40:21,375 --> 00:40:23,375
He'll just figure it out. And, you know,

1114
00:40:23,375 --> 00:40:25,135
I was just like, no. Like, he's not

1115
00:40:25,135 --> 00:40:26,835
gonna figure it out. Like,

1116
00:40:27,214 --> 00:40:28,275
we need help.

1117
00:40:28,655 --> 00:40:31,269
Yeah. So Yeah. And you know what? Caregivers

1118
00:40:31,289 --> 00:40:33,829
know. They know when they're stressed, it shouldn't

1119
00:40:33,969 --> 00:40:35,969
be that stressful to feed a a baby

1120
00:40:35,969 --> 00:40:37,089
or a child. Right.

1121
00:40:37,569 --> 00:40:38,069
And

1122
00:40:38,369 --> 00:40:40,469
that's one of the markers

1123
00:40:40,849 --> 00:40:42,449
of a child struggling to eat is when

1124
00:40:42,449 --> 00:40:45,574
a caregiver is actually stressed and expressing concern.

1125
00:40:45,715 --> 00:40:46,534
Yep. Overwhelmingly,

1126
00:40:47,394 --> 00:40:50,355
beyond any of those other intricate sensitive measures

1127
00:40:50,355 --> 00:40:51,335
that we can

1128
00:40:51,715 --> 00:40:52,215
establish,

1129
00:40:53,155 --> 00:40:55,795
where the disconnect has been is then what

1130
00:40:55,795 --> 00:40:57,554
do we do with that? And that's where

1131
00:40:57,554 --> 00:41:00,869
the primary providers hadn't had enough exposure, and

1132
00:41:00,869 --> 00:41:02,150
they're the first to say we don't get

1133
00:41:02,150 --> 00:41:03,909
a lot of education in feeding and feeding

1134
00:41:03,909 --> 00:41:06,469
developments. Growth, growth charts. Yeah. So when a

1135
00:41:06,469 --> 00:41:08,389
family comes to us, we're not really sure

1136
00:41:08,389 --> 00:41:09,210
what to do.

1137
00:41:09,989 --> 00:41:10,969
You know, overwhelmingly,

1138
00:41:11,349 --> 00:41:13,385
they will refer to speech. So we're often

1139
00:41:13,385 --> 00:41:14,925
the first to get a child,

1140
00:41:15,945 --> 00:41:18,184
when they're struggling. And so it's up to

1141
00:41:18,184 --> 00:41:20,505
us often to figure it out, figure out

1142
00:41:20,505 --> 00:41:22,344
what's going on. Yep. Is this the feeding

1143
00:41:22,344 --> 00:41:24,505
skill problem? Is there something else going on?

1144
00:41:24,505 --> 00:41:26,204
Who else needs to be on that team?

1145
00:41:26,344 --> 00:41:26,744
Yep.

1146
00:41:27,304 --> 00:41:29,039
So, you know, all of this is, you

1147
00:41:29,039 --> 00:41:31,280
know, to help everybody in the process. So,

1148
00:41:31,280 --> 00:41:33,039
you know, what the heck to do Yeah.

1149
00:41:33,199 --> 00:41:33,699
Ultimately.

1150
00:41:34,000 --> 00:41:35,599
Yeah. But it's interesting that, you know, just

1151
00:41:35,599 --> 00:41:38,239
when I just in conversation with people, you

1152
00:41:38,239 --> 00:41:39,519
know, people like, oh, what are you doing?

1153
00:41:39,519 --> 00:41:40,820
I'm like, oh, I'm a scariatologist.

1154
00:41:41,119 --> 00:41:43,380
I, you know, work with swallowing disorders. And,

1155
00:41:43,394 --> 00:41:44,914
know, it's like if you talk to, you

1156
00:41:44,914 --> 00:41:45,735
know, pediatricians

1157
00:41:46,675 --> 00:41:48,835
or nurse pediatric nurses or they're like, oh

1158
00:41:48,835 --> 00:41:50,034
my gosh. Can I get your card? Like,

1159
00:41:50,034 --> 00:41:51,315
we never know what to do with these

1160
00:41:51,315 --> 00:41:53,315
kids. And I'm like Yeah. Yeah. I don't

1161
00:41:53,315 --> 00:41:54,835
work with kids, but, yes, I will find

1162
00:41:54,835 --> 00:41:56,855
you someone that can. But it always surprises

1163
00:41:56,914 --> 00:41:58,980
me when, you know, I've had that happen

1164
00:41:58,980 --> 00:42:00,420
a few times just in the last few

1165
00:42:00,420 --> 00:42:01,940
months, and I'm just like, oh my goodness.

1166
00:42:01,940 --> 00:42:04,440
Like, it pains me that, you know, pediatricians

1167
00:42:04,579 --> 00:42:06,179
don't feel like they know what to do

1168
00:42:06,179 --> 00:42:07,940
with it. You know, they're like Absolutely. They're

1169
00:42:07,940 --> 00:42:09,780
having trouble eating. They're not on the growth

1170
00:42:09,780 --> 00:42:11,380
curve, but I just don't know where to

1171
00:42:11,380 --> 00:42:13,844
even send them or what to do. So,

1172
00:42:13,844 --> 00:42:16,164
you know, this Well, you know, like me

1173
00:42:16,485 --> 00:42:19,785
SLPs to market themselves better. Exactly. Exactly.

1174
00:42:20,164 --> 00:42:21,224
Well, and the other,

1175
00:42:22,324 --> 00:42:24,644
if everybody out there has heard about Feeding

1176
00:42:24,644 --> 00:42:27,000
Matters, which is, you know, the

1177
00:42:27,880 --> 00:42:29,800
organization that I've been a part of for

1178
00:42:29,800 --> 00:42:31,159
a really long time and a lot of

1179
00:42:31,159 --> 00:42:32,059
people out there.

1180
00:42:33,400 --> 00:42:36,219
But, you know, they they are a vetted

1181
00:42:36,679 --> 00:42:40,699
awesome resource and support for not only caregivers

1182
00:42:40,760 --> 00:42:43,914
and families but providers, especially providers that are

1183
00:42:43,914 --> 00:42:45,994
are getting more of these types of kids

1184
00:42:45,994 --> 00:42:46,655
and questions.

1185
00:42:46,954 --> 00:42:47,454
And,

1186
00:42:48,714 --> 00:42:51,614
there's good resources. There's a provider directory

1187
00:42:52,155 --> 00:42:53,054
on the website.

1188
00:42:54,394 --> 00:42:54,894
There's

1189
00:42:55,329 --> 00:42:57,829
programs for families to connect with other families

1190
00:42:58,049 --> 00:42:58,549
to,

1191
00:42:59,409 --> 00:43:00,710
you know, have shared experiences

1192
00:43:01,089 --> 00:43:01,909
and and

1193
00:43:02,210 --> 00:43:05,030
some mentoring. So, you know, that is definitely

1194
00:43:05,089 --> 00:43:05,589
growing.

1195
00:43:06,690 --> 00:43:07,190
And,

1196
00:43:08,234 --> 00:43:10,394
we are starting in a new initiative where

1197
00:43:10,394 --> 00:43:12,494
we're really trying to push feeding development

1198
00:43:12,875 --> 00:43:16,894
as its own developmental domain Yeah. In policy.

1199
00:43:17,194 --> 00:43:17,694
So,

1200
00:43:18,074 --> 00:43:20,014
that's really one of the new initiatives

1201
00:43:20,554 --> 00:43:21,054
that,

1202
00:43:21,594 --> 00:43:23,940
that we're working on through feeding matters and

1203
00:43:24,079 --> 00:43:25,679
to really push it out there in the

1204
00:43:25,679 --> 00:43:28,000
forefront that it's not embedded in all the

1205
00:43:28,000 --> 00:43:30,640
other developmental domains. It's its own. Yep. And

1206
00:43:30,640 --> 00:43:32,660
then, hopefully, that will start to establish

1207
00:43:33,039 --> 00:43:33,940
better education,

1208
00:43:34,640 --> 00:43:35,140
expectations,

1209
00:43:35,679 --> 00:43:36,660
and and awareness.

1210
00:43:37,055 --> 00:43:39,775
Yep. Awesome. Yes. For sure. Awesome. For sure.

1211
00:43:39,775 --> 00:43:41,375
I think that's a great point to end

1212
00:43:41,375 --> 00:43:43,695
on. Yeah. Thank you so much for you're

1213
00:43:43,695 --> 00:43:45,535
just a wolf of knowledge in all of

1214
00:43:45,535 --> 00:43:47,614
these areas and all of your clinical work

1215
00:43:47,614 --> 00:43:49,454
that you did, and and I just I

1216
00:43:49,454 --> 00:43:50,989
think it's so awesome to hear how you

1217
00:43:50,989 --> 00:43:53,869
transformed into this researcher, and and now you're

1218
00:43:53,869 --> 00:43:55,789
doing all this great work too. So I

1219
00:43:55,789 --> 00:43:58,349
hope it's inspirational to any SLPs out there

1220
00:43:58,349 --> 00:44:00,589
that, you know, may have this research itch

1221
00:44:00,589 --> 00:44:02,510
that they don't wanna scratch, but go do

1222
00:44:02,510 --> 00:44:02,909
it. So

1223
00:44:03,565 --> 00:44:05,344
go do it or, you know, partner,

1224
00:44:06,364 --> 00:44:07,344
check this out.

1225
00:44:08,125 --> 00:44:10,605
Yeah. There's just there's lots of great stuff

1226
00:44:10,605 --> 00:44:11,105
happening

1227
00:44:11,485 --> 00:44:14,285
in pediatric feeding as a whole. So lots

1228
00:44:14,285 --> 00:44:16,525
of exciting things to come. Awesome. Thank you

1229
00:44:16,525 --> 00:44:18,605
so much again, Amy. Thanks for having me.

1230
00:44:18,605 --> 00:44:21,400
Yeah. And that's a wrap for this episode.

1231
00:44:21,699 --> 00:44:23,960
As always, thank you so much for listening.

1232
00:44:24,260 --> 00:44:25,619
And if you'd like to download the show

1233
00:44:25,619 --> 00:44:29,799
notes from this episode, please visit swallowyourpridepodcast.com.

1234
00:44:29,940 --> 00:44:31,539
There, you can also sign up for our

1235
00:44:31,539 --> 00:44:33,460
email list so that you'll never miss another

1236
00:44:33,460 --> 00:44:33,960
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1237
00:44:34,414 --> 00:44:36,175
If you do like what you hear, then

1238
00:44:36,175 --> 00:44:38,755
please subscribe and leave a review on iTunes

1239
00:44:39,295 --> 00:44:41,054
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1240
00:44:41,054 --> 00:44:43,295
friends and colleagues because that is what keeps

1241
00:44:43,295 --> 00:44:44,675
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1242
00:44:45,135 --> 00:44:46,949
If you'd like to be a guest, share

1243
00:44:46,949 --> 00:44:49,590
feedback, or request a topic to be discussed

1244
00:44:49,590 --> 00:44:54,070
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1245
00:44:54,070 --> 00:44:56,070
Thank you so much for listening, and we'll

1246
00:44:56,070 --> 00:44:57,289
catch you next week.