EPISODE 258

[INTRODUCTION]

[0:00:00] MD: Y'all, today's gratitude entry, it is hard on my mommy's heart. Because today's episode is all about pediatric hearing loss. And I will be completely honest. I was not prepared for the amount of tears I shed in today's episode. 

With my entire heart, I am incredibly grateful for Dr. Regina Lemmon Bush, Dr. Angela McLeod, and Dr. Garner. Because those three people were instrumental in getting Bear on his path. And to our sweet friend, "The Brance", Miss Brantley Bonnet. Honey, we couldn't have done it without you. Getting us to Dr. Regina, getting us in with Angela, and being there through all the surgeries with Garner. From one very full mommy heart, I am thankful. Y'all enjoy today's episode.

[0:01:13] MD: Hi, folks, and welcome to First Bite: Fed, Fun, and Functional. A speech therapy podcast sponsored by speechtherapypd.com. I am your host on this nerd venture, Michelle Dawson, MS, CCC-SLP CLC. The All-Things PEDs SLP. I am a colleague in the trenches of home health and early intervention right there with you. I run my own private practice, Hartwood Speech Therapy, here in Col d' town, South Carolina. And I guest lecture nationwide on best practices for early intervention for the medically complex graduates. First BiteÕs mission is short and sweet; to bring light, hope, knowledge, and joy to the pediatric clinician, parent, or advocate.

[0:02:00] EF: By way of a nerdy conversation, so there's plenty of laughter, too.

[0:02:04] MD: In this podcast, we cover everything from AAC to breastfeeding.

[0:02:09] EF: Ethics on how to run a private practice.

[0:02:12] MD: Pediatric dysphagia to clinical supervision.

[0:02:15] EF: And all other topics in the role of pediatric speech pathology. Our goal is to bring evidence-based practice straight to you by interviewing subject matter experts.

[0:02:24] MD: To break down the communication barriers, so that we can access the knowledge of their fields.

[0:02:29] EF: Or, as a close friend says, ÒTo build the bridge.Ó

[0:02:33] MD: By bringing other professionals and experts in our field together, we hope to spark advocacy, joy, and passion for continuing to grow and advance care for our little ones.

[0:02:44] EF: Every fourth episode, I join. I'm Erin Forward, MSP, CCC-SLP, the Yankee by way of Rochester New York transplant who actually inspired this journey. I bring a different perspective, that of a new-ish clinician with experience in early intervention, pediatric acute care, and non-profit pediatric outpatient settings.

[0:03:06] MD: Sit back, relax, and watch out for all hearth growth and enjoy this geeky gig brought to you by speechtherapypd.com.

Hey, this is Michelle Dawson here. And I need to update my disclosure statements. My non-financial disclosures, I actively volunteer with Feeding Matters, National Foundation of Swallowing Disorders, NFOSD, Dysphagia Outreach Project, DOP. I am a former treasurer with the Council of State Association Presidents, CSAP. A past president of the South Carolina Speech-Language and Hearing Association, SCSHA. A current board of trustees member with the Communication Disorders Foundation of Virginia. And I am a current member of ASHA, ASHA SIG 13 SCSHA. The Speech-Language-Hearing Association of Virginia, SHAV. A member of the National Black Speech-Language-Hearing Association, NBSLA. And Dysphagia Research Society, DRS. 

Additionally, I volunteer with ASHA as the topic chair for the Pediatric Feeding Disorder Planning Committee for the ASHA 2023 Convention in Boston. And I hope you make it out there. 

My financial disclosures include receiving compensation for First Bite podcast from speechtherapypd.com as well as from additional webinars and for webinars associated with understanding dysphagia, which is also a podcast with speechtherapypd.com. 

And I currently receive a salary from the University of South Carolina in my work as adjunct professor and student services coordinator. And I receive royalties from the sale of my book, Chasing the Swallow: Truth, Science, and Hope for Pediatric Feeding and Swallowing Disorders. As well as compensation for the CEUs associated with it from speechtherapypd.com. 

Those are my current disclosure statements. Thanks, guys. 

[0:05:17] EF: The views and opinions expressed in today's podcast do not reflect the organizations associated with the speakers and are their views and opinions solely. 

[INTERVIEW]

[0:05:25] MD: Okay, everybody. I have an emotional treat for today. And when I say emotional, one, yesterday, on October 16th, our youngest, smelliest son, Boo Bear extreme Dawson turned nine years old, which that is amazing. Just bless. Amazing. 

But today's guest Ð and I'm already choking up. Today's guest had a journey that had Ð I shared some of the footsteps with once a long time ago. And I am talking about none other than the author, Valerie James Abbott. She's the author of Padapillo and a phenomenal guest speaker at universities, at conferences all about pediatric hearing loss. 

And it's her walk with her family and with her youngest. She has two girls to my two boys. And their journey. And this children's book is, one, beautifully Illustrated. Because I love a good story. You could tell I'm a ped's therapist, right? I love a good picture book. But I was not prepared when I read the book to be right back there as a mom learning and navigating that my son had a hearing loss. That we were going to need speech therapy. 

And it walked me through it, but from the lens of the big sister, which, honestly, I had until the moment I touched her book not truly given the thought of what Goose Danger went through as we were dragging his little brother through all of these appointments, and surgeries, and more therapy. And it is so beautiful and so impactful. 

One, I'm going to get a tissue box. And, two, you guys are going to go check out Padapillo and you're going to purchase it. Because it's just wonderful. I probably can't say that on an ASHA CEU. But bloody freaking hell, this is an amazing book. But, Valerie, thank you, thank you, thank you so much for coming on. Hi. I'm glad that I met you.

[0:07:49] VJA: I know. I know. Thank you.

[0:07:51] MD: Yes. Also, shout out to Renee for introducing us. Yay, Renee Garrett. But this, ma'am, is one heck of a mighty powerful story. And your bio reads like a who's who for pediatric hearing loss advocacy for the state of Virginia and the greater continental United States. 

Folks, I probably should have talked about those things before I got all choked up. She volunteers with the Virginia Early Hearing Detection Initiative, I think I got that right, Advisory Committee. She's the co-founder of the National Pediatric Late Onset Hearing Loss Awareness Campaign. She is employed with the Infant & Toddler Connection at Henrico, New Kent and Charles City counties. She's a children's author and just an advocate extraordinaire. But you were telling me beforehand, you started out in Corporate America banking. So, take me from the top. How did all this happen?

[0:08:52] VJA: Yes, I did. I did. I was very motivated after college to jump into Corporate America and climb that ladder. And so grateful that Bank of America gave me that chance way back when to do just that. And so, I did a lot of things at Bank of America. Ultimately, landing in some corporate communications roles. 

And it was during year 14 when my youngest child was a toddler that her preschool reached out to us and said, "Something is up. Something's up with your kid." And it was actually during a typical parent-teacher conference. And the teacher said, "Are you worried about your child's speech?" And my husband and I looked at each other and said, "No." Because we really weren't. And she said, "Really? Do you find her difficult to understand?" And we said, "Well, sure, sometimes. But she's two and a half." Aren't all two-and-a-half-year-olds hard to understand? 

So, she pointed out some behaviors that were atypical and concerning for her and she asked if we would consider having a speech evaluation. Started with a speech evaluation. Ta-da-da. In early intervention. We called the early intervention office, the one that I am literally sitting in right now. This is where we called. Talk about full circle. And said, "I don't know what we're supposed to do. Someone told us to call you." They came out. And within a few hours, it became abundantly clear we were probably looking at a hearing issue. And that was confirmed a few weeks later. 

And she was so off-track developmentally that I knew getting her back on track with support from early intervention and with support eventually from early childhood special education was not going to be the job of a nanny. That it was the job of parents. And so, I resigned even though I was on a great trajectory. There was a morning period of both mourning this, at the time, devastating news. No one could tell us how she lost her hearing. When? Why it happened? She was an incredibly healthy child. And, simultaneously, grieving the loss of a career that I had worked really hard on. 

And so, I clearly know now, the spiritual woman that I am, that this was part of the plan all along. Because I would never be able to be the advocate that I am or have written the book that I did without the previous experience in Corporate America.

[0:11:31] MD: Yes. It is very humbling to sit back and watch. And you all know, I'm a woman of faith and I'm a Christian. but for me, it's very humbling to sit back and watch God move before me in ways that I couldn't fathom. Yep. 

Also, I appreciate that you give permission to mourn the loss of a career while also giving permission to mourn the loss of your daughter's hearing. Because so many career women don't give ourselves the grace for that. When it's a huge part of your identity, that is very, very difficult. because, I mean, I had three months of bed rest with Bear. And then, just keeping me pregnant. Just to stay pregnant to get him here, this child. I should have known from the beginning he was going to be my wild card. And then stayed home. 

But to not work for six months was Ð and that's what I did. It was devastating, but I had to do what was right for him. And that was just to grow him. Get fat, be happy, eat all the cheeseburgers. That's literally what the job description was from my OB-GYN at the time. It worked. He was 35 weeks, 6 pounds, and 12 ounces. 

[0:12:55] VJA: Oh, that's awesome. 

[0:12:58] MD: Yes. But if he stayed in the whole time, they would have cut that sucker out. You walked this walk and then went through the journey. Can you kind of tell us a little bit about how she's doing now just so that folks can celebrate goodness in life?

[0:13:15] VJA: Yes. She was identified with her hearing loss at two and a half. And on June 6th of 2023, she graduated from high school. I know. She is now at Longwood University. And we couldn't be more excited or proud of her. The journey, the academic journey alone with 504 plans, and IEPs, and back and forth, and does she qualify? Does she not? What services and supports? And I'm tired. I'm tired. And I didn't realize just how tired I would be at the end of K through 12. But she is now 18 and in college.

[0:13:58] MD: Amazing. Also, I know some of the faculty at Longwood. And that's a beautiful school. And they will advocate and nourish her in this next step. I'd be remiss if I didn't share, once upon a time, I had a lovely student and a grad student. And she contracted a meningitis when she was a toddler and had to have hearing loss or had hearing loss. But has a cochlear implant. And she's the speech pathologist with a cochlear implant focusing on ped's feeding and swallowing. And crushing it. 

[0:14:30] VJA: Crushing it.

[0:14:31] MD: Crushing it. This concept Ð folks, if you're listening, we need to remember that these tiny humans that we've been called to serve are going to grow up and be colleagues one day. They may be our interprofessional practice partner. The therapist down the hall that we're pulling in for services. They may also be speech-language pathologists. 

And on that note, did you know that ASHA has a caucus for Ð is disability caucus for colleagues, audiologists, and speech-language pathologists that identify with a disability, including hearing loss. If you're not a member, I do recommend that. And if you identify within that category, I would recommend considering joining. Because they're there to advocate for you professionally. 

But take us back to itty-bitty. Not birdie. Bridey? 

[0:15:26] VJA: Bridey. It's the Irish nickname for Bridget. 

[0:15:29] MD: I didn't know that. 

[0:15:29] VJA: Yeah. Bridey is the Irish nickname for Bridget. It's very popular over in Ireland.

[0:15:34] MD: Really? Okay. Bridey. Because when I read it, my little brain read Birdie. And then when you said Bridey, I was like, "Oh, Michelle, you butchered your spelling there." 

[0:15:47] VJA: Yeah. She was a big baby. She was a big baby. She was almost nine pounds. Her older sister was also nine pounds. And she came into the world a happy, healthy, very hungry baby. And passed her newborn hearing screen. I have no memory of that experience. I don't know if that's because it was done back in the nursery or in our room. I don't know. 
But she passed. And we have the paper to prove it. 

And we do believe that she had typical hearing at birth. And she continued to be a super healthy, happy, hungry toddler. All of the milestones you would expect a child to meet, she was meeting them with the exception of communication. And that started to break down at some point, but we didn't notice it. Because we were a busy family of four and not professionally versed in child development and we'd already raised one kid and she was doing fine. 

Really, she was rarely at the pediatrician. Rarely. And I do remember the pediatrician at some point saying something like, "Do you have any concerns about her hearing?" And we said, "No." And that box was checked and then we kept moving on. It really was Ð it came as a shock when we realized, one, she was developmentally off track. But, two, that she developed a significant hearing loss, permanent, for no apparent reason out of nowhere. And I think that was part of the panic that we experienced as a family and the panic and guilt of how the hell did this happen. When did it happen? Why did it happen? How did we not notice? How did no one notice? And what are we going to do now? 

[0:17:30] MD: Yes. Oh, honey, how I was there. And then, add in the fact that I'm supposed to know this because I'm the speech pathologist. But I'm not that SLP. I'm not the hearing loss SLP. I am the, "Oh, I see a red flag." Because we may not be turning or alerting when we're working on bottle feeding. That I am that SLP. But the speech sounds, there is a difference. 

And, folks, Valerie and I were talking about this before we got started about how, even though that's my role as the feeding therapist, we still have the opportunity to make the referrals, to make the request. And when we get called in for feeding, there are some red flags that we should be aware of. 

A child that has a cleft to the lip and palate, that's one red flag. I mean, for me, that's Ð because that's normally when I get called in. For me, if I have a little one that I'm working with that has hemiparesis, lateral weakness, or a paralysis on one side, I start worrying about what's going on innervation. What's going on neurologically? Do we have an increased risk for our sensory neural hearing loss? Because of where was the bleed? Where was the anoxic event? What other red flags do you talk about that we should be aware of? 

[0:18:50] VJA: There are so many. There are so many. And I'm so glad that you've invited me to join you because this is where I think our worlds are far closer connected than we've ever realized when it comes to helping families of young children identify postnatal hearing loss faster, right? This is not going to come from some crazy legislation or some other technology. It's going to come from all of us paying attention in a different way. 

[0:19:14] MD: Yes. 

[0:19:15] VJA: How do we do that? We know that there are risk factors for postnatal hearing loss. The JCIH has a well-established long list of them. 

[0:19:25] MD: JCIH. Can you translate that? 

[0:19:28] VJA: Yes. The Joint Committee on Infant Hearing. And so, they have a list of known risk factors. One of them is any baby that has spent more than five days in a NICU is automatically, automatically at increased risk for postnatal hearing loss. There's a lot of different reasons for that. I'm not a medical professional.

[0:19:49] MD: All of my patients. Sorry.

[0:19:51] VJA: I know. Do you see what I mean? Do you see what I mean? Okay. What should be happening Ð this is just one category we're talking about. Any child who's been in NICU for greater than five days, they're going to be screened most of the time for hearing loss before hospital discharge. But they are flagged as pass with risk. Why? Because they were the NICU for greater than five days. There may be multiple other reasons. But if nothing else, if there's only one box checked, it's because they spent more than five days in a NICU. 

And so, what does that mean? That means that that child needs to have a formal assessment. Not a paper one. Saying, "Do you think the child can do this? Do you think the child can do this?" They need to have a formal reassessment between 12 and 24 months I believe is what the CDC currently recommends. 

And different states, Department of Health, they have different parameters. But, generally, it's somewhere, depending on what the risk factor is, between 12 and 24 months, or sooner if the parents have concern. The parents can always, always override that recommendation. There you go. Any child that's been in a NICU for greater than five days has an automatic risk factor for postnatal hearing loss. 

What are some of the others? Any child with suspected or confirmed CCMV, congenital cytomegalovirus. What the heck is that? 

[0:21:14] MD: Is that the cat kitty litter one? 

[0:21:16] VJA: No, it's not. Why do we know all about the kitty litter one? 

[0:21:20] MD: I know all about the kitty litter. Because when I was pregnant, they were like, "Do you have cats?" I was like, "No, I have dogs." And they're like, "Do you have any sandboxes outside that have dogs?" And I'm like Ð that. And don't eat turkey. The turkey deli meat. I know those two warnings. But like Ð okay. Continue.

[0:21:38] VJA: Congenital cytomegalovirus is the number one non-genetic cause of early childhood hearing loss in the United States above all other non-genetic causes. 

[0:21:50] MD: Oh, what is it? 

[0:21:51] VJA: Okay. It is a virus. That, for you and I, we have probably had it. People older than us have definitely had it. People younger than us might have had it. It's generally the sniffles, okay? For us, a healthy person, it is no big deal. The issue becomes if a woman is pregnant, has not been exposed to it, has not been infected with it, and becomes exposed and infected while pregnant. The impact on the fetus can be catastrophic. 

But sometimes it's not catastrophic. But the number one thing, the number one thing that it causes is sensory neural hearing loss. And in many cases, that child is asymptomatic at birth. They come out. They look fine. Sometimes they have a rash. Sometimes they have other things where like, "Oh, we need to do this test." But, frequently, they are asymptomatic. They come out, everything is fine. 

And they go home and sometime between birth and five, or six, or seven years of age, that child's hearing changes permanently. And we are not talking about this. We are not talking about this. 

Let's say, for example, that we have a child that is born with a congenital CMV. They appear asymptomatic. And then when they get home, there's some feeding issues. There's some swallowing issues. There's some other issues going on, okay? After 21 days of life, we can't test for congenital CMV. It's important that, if we're going to be screening, we're doing that. That's a whole other podcast. But what happens is Ð 

[0:23:26] MD: Wait. Not screening for this? 

[0:23:28] VJA: No. Here, I know you are a national/international podcast. I can tell you what we're doing in Virginia. I can tell you what we're doing in a couple of other states. In Virginia, starting in September of 2020, any child that fails the newborn hearing screen in the hospital is automatically tested for congenital CMV, CCMV, with a swab of the mouth. 

That test goes out. It comes back fairly quickly. Within a day or two. And we can confirm that CCMV was detected at birth. And then they have to go for a more extensive urine sample, I believe. And if we detect, it can confirm CCMV infection within the first 21 days of life, that family has some decisions to make. 

There are antivirals that can be offered. And they're strong. They're really strong. But they can improve the hearing outcome in many cases. But the thing is this, one if the child fails their newborn hearing screen. Okay? We need that to be accurate. But there's no global, universal screening for CCMV in Virginia yet. 

I think that's down the road, but not for a while. We now have, I think, one or two states in the United States that now have universal CCMV screening. Every baby that's born in the hospital, just like they get the heel prick, just like the hearing test. They will also get a CCMV screening. And again, that's especially important for those asymptomatic children. Because the parents have the option of considering antivirals to minimize the impact of the infection postnatally. 

[0:25:18] MD: Are you familiar with SHAV? 

[0:25:22] VJA: I am very familiar with SHAV. I'm hoping one day they'll make me like an honorary member as a parent advocate. Just put [inaudible 0:25:28].

[0:25:30] MD: Poor SCHSA. Man, I moved two states and now they're like, "Now Michelle's all up SHAVs butt." I'm past president of SCSHA. And I've got some girlfriends down there that I need to connect you to afterwards that head up some of the hearing loss initiatives in South Carolina. But I'm just thinking this is how Ð just how you connect them.

[0:25:55] VJA: Right. This is where we're talking about feeding issues, swallowing, all of these other things that are Ð they don't feel connected to pediatric hearing loss. But when we think about do we know the cause of why we're here in the first place? Do we know what caused the child's current condition that's requiring these therapies? If the answer is it could have been CMV, but we didn't test because we missed the 21-day window. Because he was asymptomatic at birth or whatever. If there's a chance that it could have been CMV, again, congenital, because CMV that's acquired after birth does not cause these issues, we need to be tracking those children's hearing annually for years. Not just 12 to 24 months, but for years. That's just one category. 

[0:26:43] MD: Yes. But also, if it's one swab, why are we not doing this? 

[0:26:49] VJA: Because it's expensive. 

[0:26:51] MD: Aye. But if we did many of them, the overall cost would go down. 

[0:26:57] VJA: Correct. But that's where legislation starts, right? In Virginia, we were able to get targeted CMV screening, targeted CCMV screening approved and blessed by the general assembly. We started there. And that's where many states start. But it's expensive. There was a time when universal newborn hearings greeting wasn't taking place and there were some places that were happening. And now we are doing it. I think CMV is going to be there someday. But we need a bunch of loud people out there demanding it. 

[0:27:33] MD: I am loud, joyfully so. Make a righteous noise. Weren't we commanded that? 

[0:27:39] VJA: Yes. 

[0:27:41] MD: Okay. Continue. Okay. On these list of things that are potential Ð 

[0:27:45] VJA: On these list of things. Right. 

[0:27:47] MD: Before we go down that rabbit hole further. 

[0:27:48] VJA: I know. That is a rabbit hole. It's a deep, deep, deep rabbit hole. We could spend a lot of time there. The other one is children with Down syndrome or other syndromes are at increased risk. Children of Hispanic descent. 

[0:28:05] MD: I didn't know that. 

[0:28:06] VJA: Mm-hmm. Any child who is of Hispanic descent is at an increased risk for early childhood hearing loss. And they're greater than any other community living in the United States. And there's a lot of different theories for that. But it's true. Data tells us that. It may not tell us the why, but it tells us the fact that it is more Ð there's a higher occurrence of it. 
There's one. 

Although that is not necessarily a JCIH risk factor, that is still a risk factor that we need to consider. Any child who has had chronic otitis media. You may have a child that you're dealing with, you're doing feeding therapy with them, and this kid is just Ð the ears are given the parents a time. 

And we have children who are tubes and all sorts of things. And how do we get the fluid out? And infection, after infection, after infection. And 18 months later, we still haven't retested the child's hearing. And, yet, we know that there's this chronic issue that the JCIH, again, lists as a risk factor for postnatal hearing loss.

[0:29:12] MD: Okay. Can I comment? Okay. Folks that do feeding, if you're listening, hang with me. Because interesting case studies that are my child and some of the patients that I have served. Bear had a very large palatine tonsils. Faucial pillar tonsils, the tonsils that are right there between the fascial pillars, those tonsils weren't large laterally. When you're looking at them, they didn't bulge out of the pillars when you do your oral mech exam. 

But his were large anterior posteriorly. When he laid down at night and went to sleep, they blocked and occluded his airway. Now if you have children that have larger tonsils here and or they have larger adenoid tissue, especially if it's low tone, what happens is it disrupts the normal arrow digestive tract. 

If that tissue mass causes enough of an occlusion when they go to inhale and bring it in, it's like the opposite of the Bernoulli effect and it can Ð disrupted aerodigestive tract process can actually pull the crico esophageal sphincter, the sphincter to your esophagus open. And that vacuum sucks up your gastric content. 

You may not have GERD during the day when you're up and running. But when you're down for a nap, when you're down asleep in your car seat, when you are down for the night in your crib, it may actually pull your gastric contents up. Well, your eustachian tubes run into your throat, right? They run into the back of the throat. That gastric contents can clog and occlude the eustachian tubes from the inside out. 

For us, we had chronic otitis media, but he kept getting junked up from an internal source because he just had great big adenoids and tonsils. Bless his heart. And it wasn't a tonal issue. I mean, that's my oldest. He has a different past medical history, right? But this is what it is. 

Now, for your patients that have a pediatric feeding disorder, sit back and look at how many of them are obligatory mouth breathers and how many of them have acid reflux. That can go hand-in-hand. It makes sense to me that we have chronic otitis media in conjunction with kids that have GERD. But are we having GERD in conjunction with the pediatric feeding disorder? Because PFD is a 1 in 37 prevalence for children under the age of five and a huge comorbidity of that is GERD. And GERD can trigger conductive hearing loss. There's an overlap here. Sorry. Continue.

[0:32:04] VJA: But see that this is exactly what I'm talking about, is we are more closely connected than we realize. These two, right? All of these different specialties and fields. Okay. A couple of other things. Head trauma is one. And it doesn't necessarily have to be a car accident. There's lots of different ways that infants and young children can experience head trauma. Chemotherapy. Any child that has been on chemotherapy. There are also other ototoxic drugs. 

And so, again, if you're working with a medically fragile or a medically complex child, knowing kind of are any of the medications that they have taken in the past ototoxic? And again, you can kind of just advocate for ongoing hearing health monitoring of those children.

[0:32:49] MD: Wait. Ototoxic medications cause damage to the auditory nerve. When you're thinking about like Ð 

[0:32:57] VJA: Not necessarily. Yeah. Not necessarily the auditory nerve. It could be the hair cells that are within. There's a lot of different Ð ototoxic chemicals can impact the ear in a couple of different ways. Not just the auditory nerve.

[0:33:12] MD: Thank you for correcting me. Yes.

[0:33:15] VJA: So then, the last one is family history of early childhood hearing loss. A lot of people never put two and two together. That Uncle Joe, who has a speech issue, because it wasn't addressed, has a hearing loss. But no one really knows about it or talks about it because his hearing loss is moderate. Ho he doesn't wear hearing aids or maybe he does. But there's a speech issue there. 

And why is there a speech issue? Because he had early childhood hearing loss that went unaddressed or unrecognized. Therefore, he didn't receive speech therapy. But no one's thinking about the fact that Uncle Joe is related to my children. And if he had early childhood hearing loss, okay, that could be caused by a lot of things. But it could also be genetic. 

In our case, we did not know any family members that had any early childhood hearing loss on either side of our family. And we can go back pretty far. However, when we did genetic testing, Bridey has connexin 26. What the heck is connexin 26? Connexin 26 is the number one genetic cause of hearing loss in infants and young children and it's not always present at birth. 

[0:34:33] MD: Can you spell this? Spell this word. 

[0:34:35] VJA: Yes. Connexin. C-O-N-N-E-X-I-N. Connexin. I hope that's how it's spelled. Yeah. C-O-N-N-E-X-I-N 26. It is the number one non-syndromic genetic cause of hearing loss of infants and young children in the United States. How do we not know this? No one's talking about this. And no one's talking about Ð 

[0:35:05] MD: I'm sorry. I've literally never heard of this before in my life. 

[0:35:08] VJA: Yes. And Bridey Ð we've met hundreds of families of children with connexin 26. Some of them were identified through the newborn hearing screening because their hearing loss was present when they were born. Sometimes it's mild. Starts as mild. Sometimes it's moderate. Sometimes it's moderate sloping to severe. Sometimes it's severe. Sometimes it's profound. Frequently, it's progressive. Not always. But not always is it detectable or present at birth. 

And so, in our case, we believe that Bridey had typical or as close to typical hearing as you can have, which is why she passed the newborn hearing screen and that she was probably somewhere in the 18-month-old age when her hearing status changed as a result of connexin 26. 

Again, she had a genetic predisposition and it took her hearing. It stole it from her. And we Ð that's a risk factor we didn't know about. So then, when we talk about risk factors, the JCIH risk factors, I like to highlight, there are the known and the unknown risk factors. Connexin 26 can be both known and unknown. Congenital CMV, CCMV can be both known and unknown. But it's the same thing. But do we know that it's there? 

And that's why we advocate for ongoing hearing health monitoring of all children between birth and school age. Because you know what? We don't screen children after the newborn hearing screen until they are five and if they're in public school. Children who are homeschooled, which there's a growing population there and children who are in private school, charter schools, private schools, they are frequently not screened the way that public school children are. There's a lot we can do to find these kids. 

And so, here's the other thing. Can I talk about some statistics that are kind of startling? 

[0:37:04] MD: Yes. 

[0:37:05] VJA: Are you ready? 

[0:37:06] MD: Wait. All of this is kind of startling. 

[0:37:09] VJA: I know. I've got a box Ð incidence of hearing loss doubles between birth and school age. In other words, the same number of children who are identified with congenital hearing loss when they're born, the same number lose their hearing between birth and school age. But we aren't finding them until that window of communication opportunity has passed. And so, we're finding them in kindergarten and first grade when they lost their hearing when they were one, or two, or three, or later. And CCMV is not helping us out at all. That's the one. Incidents of hearing loss doubles between birth and school age. 
 
The CDC estimates that 14.9% of students ages six through 19 have enough hearing loss to impact them academically. We only know about this many. And if we only know about this many, we know that less are receiving services that would support their academic success. 

We have to find these kids. We have to find them because the impact Ð the long-term impact on them academically, socially, emotionally, mental health, their ability to thrive in life is impacted by this one piece of them that no one is talking about, no one is diagnosing until you can't remedy the past. They've gotten past that part. 

And all of us, all of us can contribute to finding these kids sooner by just looking at the kids that we're working with differently. Just observing things with a different lens, with a different set of questions. And when we see something that we think, "You know what? Is there any possibility that this child's hearing could have changed? Is there any possibility?" When in doubt, let's check it out. We need to steer away from this pediatrician, "Well, let's wait and see." 

[0:39:13] MD: Oh, my God. If I hear another freaking pediatrician tell me let's wait and see Ð 

[0:39:17] VJA: Oh, he's a late talker. Oh, she shy because mom's shy. There's all of these reasons that families are dissuade away from a hearing evaluation and we need to turn the tide. We need to shift the mindset away from, "Let's wait and seeÓ to, "When in doubt, let's check it out." Because all the therapy in the world, especially when it comes to speech, and communication and language acquisition, all of that is not going to have nearly the impact at the prime time if the child can't hear. 

[0:39:55] MD: So, scary moment. My son's audiologist perforated his eardrums during an OAE because they didn't put the caps on. How they put the caps on? She's an audiologist and forgot to put the caps on. While she keeps pushing it in there and blood starts coming out of his ear, Michelle lost her professional Ð I'm a speech-language pathologist and may or may not have cornered the audiologist in the room who had six inches on me. And proceed to tell her what she could do with herself in her very poor skills. 

And then the ENT pulled me aside and said my son, who was hysterically crying because he just had his eardrum perforated, told me that your son has signs of the autism. He's inconsolable. We should probably refer him for the autism. Refer him to early intervention for the autism. 

Two things. One, this was our third trip to this audiologist. They should have automatically referred us to early intervention the first time he failed his hearing test. They should have referred us the second time for hearing loss. It's an automatic qualifier for early intervention under IDEA part C. I work in IDEA part C, but not that kind. So I didn't know. Right?

And I brought my grad student that day with me. Leslie, I will forever thank you for this. Because I wanted her to see what a hearing test looked like in the real world. I thought this would be a great learning opportunity. Bless Leslie. Leslie was like, "I thought you were going to murder her." I was like, "I thought I was going to murder her." But I didn't. There was no crimes committed. Thank you, Jesus. She ended up subsequently losing her job at that facility. But I didn't actually have much to do with that. That was me making one complaint. And apparently, others had made complaints. But popping people's eardrums is frowned upon, especially when you do it more than once. Just couldn't go out and say that. Anyways. 

[0:42:07] VJA: Well, I'm so glad you mentioned that. Because this is another thing that I want to mention to your listeners, is there is a difference between an audiologist, and a pediatric audiologist and an audiologist that is willing to see children. Okay? And we have too many audiologists that are willing to see children that are doing a disservice to children who are deaf and hard of hearing. 

[0:42:33] MD: Yes. It's not their scope. 

[0:42:35] VJA: It is different. It is completely different. And so, what we advocate for our family and most other families, and you are probably of that mindset, is children who are young, young children need to be seen by pediatric audiologists. They know which tests are best. How best to do them? When the environment Ð this is not going to work. We are not going to get good test results from here. The goal is to know the hearing status of the child. Not to finish the test. 

[0:43:11] MD: Yes. Beth at USC. Beth at the University of South Carolina, Dr. Beth, my experience with her has set the bar here. She met Ð Erin, the co-host of the podcast, this whole thing was her idea a lifetime ago. She was the grad student that was assigned. I met her when I was a complete basket case knowing this is going to be the third or fourth hearing test that we failed. Beth met me at the door and took my son and took Erin and she said, "I just want you to sit and relax. We've got this." 

And I got to watch them look like they were playing a game. He had never had any experiences Ð he was surrounded by beautiful graduate students. And his little two-and-a-half-year-old tiny man self was just like in hog heaven. Totally different experience. Because it was a true pediatric audiologist and not an audiologist who worked with kids who did not know what they were doing.

[0:44:10] VJA: That's right. That's right. And it's so unfortunate. Because there's so many audiologists out there. And I know after this I'm going to get some nasty grams. But here's so many Ð I know. But here's the thing, is it's true and they know it. And so, there is a difference between an audiologist who generally, sees the adult population. An audiologist that is a pediatric audiologist that their primary audience are infants and young children. And then there are audiologists that will see children. And those are the ones that I really worry about. 

Because, one, rarely have I heard of them actually diagnosing a child. When they see a child and they're like, "Oh, yeah. Yup. Hearing loss is present for sure." Frequently, they don't want to be the one to give the official diagnosis. They're going to refer to a larger clinic or to a university clinic anyway. 

[0:45:04] MD: So then, why did they do the eval in the first part? We said the exact same thing simultaneously. 

[0:45:12] VJA: What did you say? 

[0:45:12] MD: I said, so why they even go there at the Ð why they go there in the first place? 

[0:45:18] VJA: Because Uncle Joe goes to doctor so and so. And he's gone there all the time. Or because you live in a town where there isn't a pediatric audiologist, but there's an audiologist in the town and everybody who uses hearing aids goes to them. There are reasons why families go. I understand why families go. 

But as a professional, you can advocate for families like mine to say Ð if they're like, "Yeah. You know what? We're going to have the hearing tested." "Great where are you thinking of having that done?" And then when they say Joe's Audiology on Main Street. You look it up and see, "Yeah, there's no mention of children on there." To maybe tell the family, "Did you know that there are such things as pediatric audiologists and they specialize in testing children?" That's where, again, we are closer connected to this than we realize. 

And chances are, if you are working with a hundred children over the course of a few years, a handful of them, if that, will ultimately end up having some kind of hearing loss. And so, it's very small percentage of the practice for your listeners. But, God, is it important for the families that are having that experience? And every day, every day that we are closer to connecting that family to a diagnosis and, therefore, to services, will make the outcome that you're working on with that child better. 

[0:46:48] MD: This is akin to me giving the recommendation to see an ENT when I'm worried about a laryngeal cleft. And not all ENTs treat pediatrics. And not all pediatric ENTs treat laryngeal clefts. Because a level one laryngeal cleft can be very difficult to observe if you haven't seen it before. Or not all pediatric ETNs are Pediatric Sleep Board Certified. If they don't have that certification, they will not understand the nuances of the aerodigestive tract and the nuances of how obstructive sleep apnea can lead to ADD, ADHD, exacerbate GERD, and trigger all of these things. Because they just don't hold that advanced Ð it is a board cert that lasts for seven years. And then you have to reapply, resit. 

Folks, this is why we engage in interprofessional education. We are called to learn about our allied health, and medical, and community-based partners and what they bring to the table and their nuances so that we can advocate in those moments for IPP.

And I just Ð y'all, thank you. Because, I mean, good Lord, we do this like every single week. Or sometimes we miss a week or two and then drop like three at once. But life. But this is the why. Thank you for joining Erin, and I and Valerie on this crusade. 

Oh, my gosh. Okay. Wait. I thought of another risk factor. If a patient has hypoxic-ischemic encephalopathy Ð I can't ever say that last word. It's too many syllables. But if they go through the cooling protocol after birth Ð Rocky, I know you're listening and I know you know exactly the word I'm looking for. But it's where they take the blood out of their body and they run it through the room and then they put it back in in the carotid artery. And it's done in NICUs. If they go through that protocol, it drastically increases the likelihood of unilateral hearing loss on the side where they have it injected in their neck. I'm going cooling protocol for HIE. Have you heard of hypoxic-ischemic encephalopathy? 

[0:49:17] VJA: I have heard of it. And, again, just heard of it. I'm assuming those babies have spent more than five days in a NICU. Correct? 

[0:49:25] MD: ECMO. This is the procedure. Yes. Yes, they have. And it's the specific procedure. But I've treated patients that have had ECMO and they've had me coming in and doing the feeding. Because when they have the paralysis, it impacts the laryngeal nerves and we've got difficulty with dysphasia, the swallowing disorder, while there's also been teachers of the deaf and hard of hearing and speech pathologists that are like LSVT ABT, [inaudible 0:49:52] ABT certified. I mean, we've had all hands-on deck. But that's what it requires. Because we need all of these different outlets. 

I need to connect you to the executive director of HIE. Hope for HIE. We will do that afterwards. Oh, that would be fun. Y'all would get along like peanut butter jelly. Okay. Continue. 

[0:50:11] VJA: Okay. What you just described is another example of why they just say any baby who has spent more than five days in a NICU. We don't need the giant list of all the things, and the treatments, and the medicines and all Ð no. Just if your child spent more than five days in the NICU, they are at increased risk of early childhood hearing loss. Okay? 

We take all of the I need to know all the different terms out of it. It makes it easier for families. It makes it easier for professionals. You don't have to memorize the long list of if this happened, if this happened, if this happened. It's a blanket statement. And it's because there's so many contributing factors and things that happen to a child in a NICU that can contribute to permanent hearing loss. 

You also mentioned unilateral hearing loss. Let's talk about that for a second. Children with unilateral hearing loss, even if it's mild, are at increased risk of hearing loss developing in the other ear than their typical hearing peers. What does this mean? This means that if you are working with a baby and they are Ð again, we're talking about feeding as one example. And the family mentions something. Again, this is a medically fragile child or lots of other things going on. And they mention, yes, they failed or we know there's a mild loss in the left ear. But one ear is enough, which it's not. That's another topic. but it's only mild. So, we're not worried about speech and language at this point. 

Okay. Well, the family doesn't realize is that, one, that unilateral hearing loss could be progressive. So, that should be routinely monitored and evaluated to determine is it still mild or is it progressing? But the other ear has an increased risk of late-onset hearing loss because you already have one that has a hearing loss. 

And so, again, you might as a professional think, "Mild. All right. Fine. They don't need a hearing aid. Oh, okay. Fine. They might not need speech therapy." Whatever. But at a minimum, you should be advocating for ongoing hearing health monitoring of both of those ears during early childhood because of that increased risk factor. 

There's just a different Ð the more we know, both parents and professionals about late onset hearing loss, postnatal hearing loss, it goes by so many different names, delayed hearing loss, acquired hearing loss. The more we know about it, the more we can just be hypervigilant to notice things that we might not have noticed before and to recommend things that we might not have recommended before that maybe aren't within our professional, I'm accredited to talk about this. But as a professional, don't I have an obligation to share what I know with a family and then leave it up to them to decide what to do with that information? 

[0:53:00] MD: Yes. Okay. 

[0:53:05] VJA: Yep. 

[0:53:06] MD: I go back to if we all know this and I filter this through the lens of on past podcasts and on past advocacy initiatives, I am intimately aware the degree to which pediatricians' developmental training are inhibited, which is scary. They don't have time in their curriculum and practicums like the didactic components to learn all of these idiosyncrasies, right? Which I respect. Their job is to keep the tiny humans alive. But their job is also to be a generalist and a smashingly good generalist before we filter out into the specialist, right? 

One of my best friends is a pediatrician. And Tess is a hoot. She was like. ÒNo. Hell no. They didn't teach us this. I didn't learn any about this until I became a mother of a child with special needs. Then I learned everything." I mean, alas. Here we are. 

But if we know this and if we have these statistics, I jump into, "Well, why can't we Ð if we have to fill out all those ASQ screeners every single well visit, why can't we in conjunction with those well visits require mandatory hearing screens?" It seems logical to me that this would be embedded in part of just well care at least once a year for that birth to five population that you go for a well visit then you automatically have your hearing tested at one, at two, at three. Maybe not every Ð when you have a newborn and it's like every so many months. I can understand they're being pushed back on that. But at this moment, especially when they're so teeny tiny and you could do an ABR right there. 

[0:54:56] VJA: Well, ABR Ð as you probably know, ABR, it takes Ð you can't just Ð a pediatrician, generally speaking, doesn't have the training to do an ABR. 

[0:55:05] MD: But if they hired a pediatric audiologist Ð 

[0:55:07] VJA: Well, sure. But there's a shortage of pedia Ð already a shortage.

[0:55:10] MD: I know. We're dreaming big here, maybe. 

[0:55:13] VJA: I know. I know. If we're dreaming big. What I can tell you, I'm not even allowed to talk about this. No. I actually serve on a work group within the JCIH. I was asked as a parent advocate to serve on a work group that is currently doing some research on late-identified children and kind of to find some common threads on what are we missing? How are we missing these kids? How are they becoming late-identified? 

And it's hard to know the answer to that. Because some of these children just fell through the cracks through the newborn hearing screening program. Some of them were screened and passed when they shouldn't have. Late identification has really gray numbers. But the JCIH is now looking at that. 

And I anticipate Ð even though I'm not allowed to talk about it, I anticipate we will see in the future, and not in the far future, some changes in recommendations on how infants and young children are screened between birth and school age as a result of this very large scope research project that they're doing. 

It's a literature review. I've been part of it. I've seen some of the studies from all over the world that they're considering. And so, I think what you're describing is on the horizon. But it's probably first going to come from JCIH as a position statement. But I don't know when. 

Nobody. Please, if you're listening to this, don't reach out to them and say, "I just heard from Valerie Abbott." Because I'll get kicked off the committee and that would be bad. That would be bad. But I do think this is an example of how one person really can create change by being a woman on fire. And they heard what I had to say and they heard what parents like I had to say, which is we could have found our children sooner. How the hell do we go without doing that? 

And the time has come I think that the professionals who know the most on these subjects is asking that same question. They're all asking that same question. And I'm eager to see where this changes. Honestly, Michelle, I think when your children are having children and when my children are having children, the way and frequency that they are being screened between birth and school age will be different than the way that children are screened today. 

[0:57:34] MD: I love this. Thank you. Okay. Two thoughts. One, we need to do a panel discussion with the JCIH on a podcast episode. Because that would be amazing. 

[0:57:51] VJA: Oh, wait until Ð wait. Yeah, don't reach out to them.

[0:57:52] MD: No. But we could just talk about what are they working on as like a global topic? I'm just thinking a lot. Because I didn't know this thing existed and this is Ð cool.

[0:58:01] VJA: Yes. I do think having a better understanding of the JCIH. Who's made up of them? What do they do? Yes.

[0:58:10] MD: Yes. That would be cool. Please, let's spread the word. And then, two Ð oh, I had the thought. Bring it back. Got it. CDC. The CDC norms of two by two and the variety of words, 200 words, 200-word minimum, two-word combos by two. The CDC did not consult a single speech-language pathologist. And they only consulted pediatricians who boulder dash. I'm going to say boulder dash again because I can't say what I really want to say because they would cut that out. Came up with like complete crap of norms. So bad that ASHA turned around and wrote a position statement. 

But the damage that they did with OT, PT and speech norms were appalling because they did not reach out to the well-known, well-established national professions. And so, I just kind of wonder, as we're talking about like all this advocacy and education on like hearing norms, how much of this are pediatricians getting back on, "Oh, well, the CDC says this." But we need Ð nobody fact checked that. Nobody trusted but verified like Ð 

[0:59:27] VJA: I think what will happen is Ð this is not the CDC. But when JCIH eventually comes out with a position statement saying, "We recommend the following." The whole planet will listen. Because that's what they do. And protocols for early childhood hearing screening will change and, for example, the American Academy of Pediatrics would be listening. And they would be the ones saying, "All right. The way that we're supposed to be doing things needs to change." Because of the JCIH recommendation. Just like there's all sorts of recommendations from different senior groups on what we should be doing to treat, to diagnose, to evaluate, screen. I think the first step in terms of a large-scale shift is this JCIH work that they're doing. 

The CDC Ð I know. I know. When that came out, I feel like my Facebook blew up and was like, "I know you're a parent. But do you know what this means?" And I said, "I do. And I'm sorry. I do. And I'm sorry." 

But here's the thing, is what Ð and I think what from my perspective is that's one piece of a much bigger puzzle. Okay? Speech and language skills, milestones, that's one piece of the puzzle. So much of what my daughter demonstrated developmentally had nothing to do with words and had everything to do with behaviors. And that's where the CDC milestones, which is, yes, some of it is language-based and some of it is word-based. But some of it is behavior-based. 

And so, is your child doing this? Is your child responding in this way? Is your child acknowledging when someone comes into the room? And so, there are other ways of monitoring development that, "Yeah, I know. They screwed this up." And I'm so glad that ASHA spoke up and put out a position statement. 

But some of the other things that the CDC has put out in terms of monitoring milestones still Ð and that's one of the things as a parent that we didn't do. We did not monitor milestones except for weight. Is she gaining weight? If she's gaining weight and she's staying heal, then we're good.

[1:01:35] MD: Yeah. No. As working professionals, as a house of two careers, I understand that. Because this is Ð my youngest sister, Madison, is a cardiac ICU nurse. There's 12 years between us. Madison is wide open intense. She makes me look well-behaved and lady. No. I'm just kidding. She's a pistol and I love her to pieces. And I hold her in the utmost respect. 

But I will never forget, when she was 17, my dad took her for a tattoo. And I was like, "Dad, when I got my second hole pierced in my ear you told me I look like a lady of the evening." And he was like, "By the fifth, you're just glad she's not working in a pole somewhere." And I was like, "How is that good parenting?" 

But I say all of that because they had five children, two incredibly intense careers that kept them in different countries, different parts of the world. And they were just trying to survive. It doesn't make it right. It doesn't make it wrong. It's an acknowledgment of that. But also, our families that are coming at this with low socioeconomic status that may not have access to a solid internet, they may not have access to health literacy and how to navigate the world of medicine. Because that requires, like you were saying earlier, communication. That requires skills to know how to advocate. 

Those families may not know that any of those normative data are available or present to help guide. And that's where, as professionals, we get to advocate and support and connect. This is bloody brilliant. Will you please come back? 

[1:03:27] VJA: I'd love to come back. 

[1:03:30] MD: Because we barely scratched the surface. 

[1:03:32] VJA: I know. I know we did. There's so many pieces of this that we could dive deep on each of them. But I'm grateful that you saw the value in really revisiting this topic that sometimes is talked about in graduate school for about two minutes and it's a side bar and a textbook we don't open anymore. That's what I've been told. But we are all responsible for sharing what we know. 

And I'm a big, big promoter of you do not have to be an expert in this topic to be a champion for it. If some part of this has grabbed the attention of a listener and they're like, "You know what? I know about this. Or I want to learn more about this." Great. Then share what you've learned with others. That's how we're going to improve discovering these kids sooner is by all of us creating a buzz that doesn't last a day and doesn't last a year, but lasts our lifetime.

[1:04:25] MD: Okay. My brain is flying. I have so many ideas. Okay. Folks, I need to wrap us up so that her and I can proceed to have a sidebar conversation. But, one, I love you. I am so grateful. Renee doesn't Ð she's like, "Michelle, you need to meet this woman." Renee, again, thank you. 

Okay. If somebody is listening, how can they reach you when they have additional questions? 

[1:04:49] VJA: Sure. I encourage anyone who wants to connect with me directly to email me at valeriejamesabbott@gmail.com. I do get back with everybody fairly quickly. That's my personal email address. My website is valeriejamesabbott.com. And there's some information out there. 

And there's so much information on late-onset hearing loss. It's just you have to go looking for it. I hope this has inspired some people to just start going down a rabbit hole on their phone late at night like I do to learn a little bit more about this topic. Because you will. It will charge you. I hope it charges your listener to learn more about it. 

[1:05:36] MD: When I go down a rabbit hole in the middle of the night, we end up doing additional podcast, or a bedroom, or a room in the house turns a completely different color. And normally, it's varying shades of the original color. Just a shade or two lighter. Those rabbit holes can be dangerous. Also, Mr. Dawson, you are the most patient man that was ever created. And I love you dearly. And the basement will one day be done. 

Okay. Now my next question is, as grandma would say, if somebody has any love money lying around, what can they donate to? How can they tithe their time if they have time and not finances? I mean, we're knocking on the door for Christmas vacation here. 

[1:06:16] VJA: Yes. Yes. I'm so glad you asked that. Anyone can be an ambassador for this cause. You can take this information. And if you need a PowerPoint on it, you want to present on it, reach out to me and I'll send you something that I have and you can claim it as your own and slap yours on it. 

If you have some love money, there is a fund called the Listen Up Fund. It is run by a 501(c)(3) that is here in Virginia. And the funds are intended to be used for anyone who really wants to take this message forward but doesn't have the funding to do it. 

For example, if there's a group that wants to put up posters on the topic of late-onset hearing loss, we already have those available, but they don't have money for printing them. That's what this fund is for, is to make it possible to spread this message with the army of people who want to help. And the link for that can be found on my website.

[1:07:10] MD: Beautiful. Thank you so very much. Folks, if you're listening, I do have one request. We are about uh five weeks away from ASHA in Boston. And, you know, full disclosure, I'm topic chair for the Pediatric Feeding and Swallowing Disorder Committee for ASHA this year. 

But there is such an intimate overlap between PFD swallowing and those that are at risk for a hearing loss. Come to ASHA. Bome to Boston. Check out this amazing lineup that volunteers from across the globe have worked to put together. But, also, go check out some of the pediatric hearing loss courses. Go check out some of those early language courses and grow your evidence-based triangle. Because there's so much more that we can learn. 

Also, thank you again for taking a peek. Find us on First Bite podcast on Instagram, on the land of the Facebook. I do post on LinkedIn. But, I mean, I don't really understand LinkedIn so much. Just talk about what cool podcast episode is out this week. 

And as always, feel free to message us through the First Bite podcast. Because the emails will probably die in my inbox. I'll eventually get to them, but not in the timeliness with which Valerie does it. 

Valerie, thank you, with my whole heart, for coming on. 

[1:08:34] VJA: Thank you for the invitation. This has been great. 

[1:08:36] MD: Awesome. Thanks, hon. 

[OUTRO]

[1:08:39] MD: Feeding Matters. Guide system-wide changes by uniting caregivers, professionals and community partners under the Pediatric Feeding Disorder Alliance. 

So, what is this alliance? The alliance is an open-access collaborative community focused on achieving strategic goals within three focus areas; education, advocacy and research. So, who is the Alliance? It's you. The Alliance is open to any person passionate about improving care for children with a pediatric feeding disorder. 

To date, 187 professionals, caregivers and partners have joined the alliance. You can join today by visiting the Feeding Matters website at www.feedingmatters.org. Click on PFD Alliance tab and sign up today. Change is possible when we work together. 

That's a wrap, folks. Once again, thank you for listening to First Bite: Fed, Fun and Functional. I'm your humble but, yet, sassy host, Michelle Dawson, The All Things PEDÕs SLP. This podcast is part of a course offered for continuing education through speechtherapypd.com. Please check out the website if you'd like to learn more about CEU opportunities for this episode, as well as the ones that are archived. And as always, remember, feed your mind, feed your soul, be kind and feed those babies.

[END]




FBP 258		Transcript

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