EPISODE 249

[INTRODUCTION]

[0:00:14] 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 Ped's 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.

[0:01:02] EF: By way of a nerdy conversation, so there's plenty of laughter, too.

[0:01:05] MD: In this podcast, we cover everything from AAC to breastfeeding.

[0:01:09] EF: Ethics on how to run a private practice.

[0:01:12] MD: Pediatric dysphagia to clinical supervision.

[0:01:15] 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.

[0:01:25] MD: To break down the communication barriers, so that we can access the knowledge of their fields.

[0:01:30] EF: Or, as a close friend says, ÒTo build the bridge.Ó

[0:01:34] 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.

[0:01:45] 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.

[0:02:06] MD: Sit back, relax and watch out for all hearth growth and enjoy this geeky gig brought to you by speechtherapypd.com.

In today's gratitude entry, I am grateful for the random cat that has adopted our family. And I know that sounds weird. But we moved into this house, everything was a total train wreck. The former owners abandoned three bunny rabbits. Apparently, three cats. And my husband is deathly allergic to cats. But this one outdoor cat who we have renamed Purpudykins Dawson, go figure, has adopted us. 

And I know it's absurd, but this little, angry orange ball fluff that will bite you after three pets. I don't know why three is the magical number for this cat. Has Ð I don't know. It's just kind of been this symbol of patience. Also, I really, really love cats. And the cat gets to live outside and is perfectly content to live outside as long as he doesn't murder the neighbor's chickens. And this is debatable. It might not be Purpudykins Dawson. It could be the other orange tabbies that the other neighbor adopted. We don't know. But it is happy chaos and a little present in our lives that kind of filled the void after Chewbacca left. 

If you've ever lost a fluffy animal to only be adopted by a kind of aggressive, mean, angry one that loves you for the first two pets, but again not on the third, then you'll get that. Dear Purpudykins Dawson, honey, I'm grateful for you. I don't know if you're a boy or a girl. But we're grateful for you. 

Also, fun fact. Y'all, on Sunday, October 22nd from 7:00 pm to 8:30 pm, our very own Erin Forward will be presenting Connecting Through Play and Feeding Therapy: The Impact of Building Trust for Pediatric Feeding Disorders on the DIRFloortime virtual conference. Please, if you haven't signed up yet or taken a peek at it, we recommend that you check out the DIRFloortime Conference and then enroll for Erin Ð or for the whole conference. But tune in for Erin's course. There are some amazing, dynamic speakers. Hers is for 90 minutes. But I believe the early bird rate 129 bucks and it covers 0.6 ASHA CEUs. There it is. Y'all, have a good one. 

Hey. This is Michelle Dawson. And I need to update my disclosure statements. My non-financial disclosures, I actively volunteer with Feeding Matters, the National Foundation of Swallowing Disorders, NFOSD, the 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. 

[0:06:37] Announcer: 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. 

[EPISODE]

[0:06:45] MD: All right, everybody. I owe y'all a formal apology for the duration of time it has taken us to get our lives together to do the recording. This is not Erin. This is Peck Dawson chaos. Erin, bless heart, has been the most patient podcast co-host ever since the beginning of time. Because this is supposed to come out in August and it's now October. We're fine. But, yeah. It was me. Erin, thank you for being so patient while life was chaotic. 

[0:07:22] EF: We made it, people. We made it. 

[0:07:26] MD: We made it. 

[0:07:29] EF: This has been 14 reschedules, but we did it. We pinned her down.

[0:07:34] MD: Yes. So, life updates. Because I always feel like we have fantastic life updates. This morning, I got to take Bluebear Dawson's bunk bed to the Goodwill to donate. And he is officially in a big boy-size full bed and out of a booster seat. And to all the moms that have been there, done that, what the hell? That sucks. My heart was not prepared for this. Oh. It was like nobody preps you for when you cross the aisle from the toddler clothes to the little boy clothes. Because that's like such a Ð they're growing up aha moment. And that was the same moment when I dropped off the bed frame. It was like, "Okay. Here we are. He's officially a grown-ish man cup." Cue the waterworks. But you have Cola Kitty. Cola Kitty's back home. 

[0:08:28] EF: She's back home. She's decided that she likes to knock over her water bowl. So that's fun. But my floors are definitely like the fakest of fake wood because she'll have spilled the water a while ago and it's just like a puddle sitting on the floor. That's good. Yeah. I'm trying to think. Oh, ASHA is almost here. 

[0:08:46] MD: Yes.

[0:08:46] EF: By the time you guys get to listen to this episode.

[0:08:49] MD: I'm so sorry. I love you. Wait. And on that note, do you have your talks pulled up? The ones that you're giving? 

[0:08:57] EF: I have them in my brain. I don't know when they are. We'll make a post on when. I know I have a lecture at least every day. Because whoever made the schedules, it just happened.

[0:09:09] MD: I can tell you, the schedules were Ð 

[0:09:11] EF: It's difficult. Yeah. Yeah. I mean, I have four lectures. You're not going to make them all on the same day. 

[0:09:15] MD: No. But it is so complicated. Folks, on that note, let me tell you how this shakes out. ASHA sets up designated topic chairs. This year, I had the opportunity as serving as topic chair for pediatric feeding and swallowing disorders. And I'm serving again for next year for 2024 in Seattle as topic chair for PFD and swallowing disorders. 

And there's over 30 different topic chairs. And each topic chair is tasked with setting up committees. The committees are predicated on how many submissions are for each category. The PFD committee this year had 25, 26 volunteers. Next year will be the same. But smaller committees like neurovestibular for auditory processing, that committee only has like eight or nine people. 

In total, it can be upwards of to 300 volunteers that are tasked with reviewing call for papers. Making sure that they're evidence-based. Making sure that they meet minimal requirements by ASHA. And then the next step is that the ASHA convention chairs this year, it's Kelly Farquharson representing the SLP track. And Dr. Kelly Farquharson, who's also getting an ASHA fellow this year. Dr. Jennifer Simpson from Purdue who's representing the audiology. Those are the overarching convention chairs. 

They then create a final committee out of topic chairs, and volunteers to actually go through and set the schedule up. And that is you're literally scheduling hundreds if not a thousand different sessions that are running concurrently and overlapping. It is absolutely mindboggling to pour over that many spreadsheets. But please know that ASHA and the volunteers listen when they say, "Hey, can you not Ð" we went through systematically. Because I served on that final committee this year. We went through systematically to make sure that like a PFD under cleft palet overlap didn't overlap with an invited call for papers for the PFD committee. I mean, it's down to those nuances. 

But this is all run by volunteers. When you go, kind critique. But also, say thank you. And buy those people a cup of coffee because they need it. But on that note, Erin is giving Ð I always wanted to know what happened. How does this Ð it's literally all volunteers. But Erin has four presentations and one of them was designated a change-maker session, which is incredibly exciting. Can you tell us the title of your change-maker session? 

[0:11:55] EF: I think it's called something like Connecting Through Play and Feeding Therapy: Building Trust for PFD. I mean, it's a pretty nuanced title. You'll find it. That'll be streamed live. And then Karen and I Saturday morning, my OT partner in crime, are doing an embodied cognition lecture that's going to be available on the ASHA learning pass for like five years I think. And that's really talking about the multi-sensory experiences and how we use play for building language in practices and all those things. I'm really excited about that. 

And then I have a lecture on trauma-informed care with Renee Garrett, who does the Ð what's her podcast called? The Brainstorming Ð her new podcast? She has a new podcast of SpeechTherapyPD for adults. We're going to do trauma-informed care through the continuum. Pediatrics to adults. 

And then Dr. Jean Marshall and I are doing a caregiver coaching for PFD lecture as well, which I'm really excited about. Because we really go through kind of breaking down very functional before, during, after, in sessions. What to do? What strategies to use? How to build your coaching? Because coaching, I think, it comes naturally. I fortunately think Ð I mean, with my psych degree, I feel like the coaching component and the counseling component come pretty naturally to me. So it was difficult at first to be able to break it down for people when I was mentoring them. 

And she has so much research and has written so much about caregiver coaching and teletherapy. A lot of the research we pull is hers. That's really cool to be able to talk with her about all of that.

[0:13:46] MD: I love this. Renee's new podcast is called Brainstorms: Functional Neuro-Rehab for SLPs. And it is housed within the SLP learning series by SpeechTherapyPD, which is the reason this episode and all episodes of First Bite, with the exception of two, count for ASHA CEUs. I would definitely check hers out. 

And then in the ASHA app, your episode Ð it just rebooted. Is number 1172 Connecting Through Play and Feeding Therapy: The Impact of Building Trust for Pediatric Feeding Disorders. It's Thursday, November 16th at 2:30. The Trauma-Informed Care Across the Lifespan with Renee is Thursday, November 16th at 5 5:30. 

And How to Start That Conversation Caregiver Coaching with Jean Marshall is on Friday, November 17th at 5:30. And Embodied Cognition and Language Development, the one she's talking about with Karen, is on Saturday at 8:30 in the morning. Come join all of us bright and early. But those are your episodes. And I'm very Ð or your presentations.

[0:14:54] EF: What ones are you doing, Michelle? I forget. 

[0:14:56] MD: I only gave myself one this year. I only put in for one. I said gave myself one. That was incorrect. I only applied for one as a co-presenter because the topic chair stuff is all-consuming. But we have a talk from the cradle to the classroom into professional practice for PFD. It's Friday at 8:30 in the morning. And presenting with Carl Larson from Boston Children's Hospital, Emily Justice from Spalding Rehab. Emily is a hoot. Dr. Tessa Gonzalez, one of my very dear friends who's a pediatrician and a caregiver. As well as Dr. Andrew Scott from Tufts Medical Center. And Rachel Rosen from Boston Children's Hospital.

And we're going to, in short, talk about why PFD is inner professional practice at its core in order to do the diagnosis and comprehensive treatment. But it covers three different case studies from NICU to school age. And I'm very excited to be presenting with them. 

Also, when you submit for call for papers and you're a topic chair, you have to have the folks from ASHA actually review to make sure that your topic meets muster. And then it's only accepted if it meets all necessary requirements and scores high enough. Please know that if you are attending a talk by another topic chair, we had to apply for the talk to be accepted just like everybody else. But I only applied one as a committee because that's Ð we're going to be busy that week.

Yes. Okay. But now that we've talked all things ASHA, let's get started with our topic at hand. Are you good with that? Hi, Cola Kitty. 

[0:16:44] EF: Hello. She is needy.

[0:16:46] MD: Yes. Okay. We are today talking all things neurodiversity-affirming feeding. And I always feel like it's important that we start with what does neurodiversity-affirming therapy Ð actually, what is it at its core? Erin, you want to take us off from there? 

[0:17:06] EF: Well, and I hope that if you've listened to this podcast, you guys are on the neurodiversity-affirming train. I mean Ð and sure. And I think the best way to explain it is it's the mentality that brains are just different. And there's no moral value put on any brain versus another. 

Neurodivergence is the idea that brains are different. Michelle and I both have our own neurodivergence in the forms of ADHD, OCD, and anxiety, which I think there's so many strings to different forms of neurodivergence. It's rare to meet someone that's fully neurotypical. My uncle is one of the only people I've met that's fully neurotypical. And I just really struggle to understand him sometimes honestly. The level that that man is just so chill about things, I'm like I don't know how you function like this. 

And with that, it's shifted a lot of our practice specifically as SLPs, especially in regards to social communication and how we teach social skills. I use that in quotes. I find that floortime is a really great model for implementing neurodiversity-affirming practice. Because a huge part of that DIR, developmental individual differences, and relationships is focusing on a child's own individual differences and what makes them and taking the time to get to know them. As opposed to what we had done in the past, which was trying to make a child more neurotypical. 

And I used a metaphor that I came up with in regards to a tree. And I explain it in the way of you can't turn an apple tree into a cherry tree. But a lot of what we were doing in therapy before was trying to turn an apple tree into a cherry tree. And what's so cool about working with kids is that, unless you're like an arborist, you don't always know what type of tree it's going to be once it's planted in the ground. And it's our job to learn about that tree, that child, and figure out how much water, how much sunlight, how much fertilizer, what type of fertilizer it needs. And those are all supports for their individual differences. 

And I equate the individual difference of trauma to the rings of a tree. Because you can't see them. We may never see them. We may never be told what trauma a child's been through. But we have to assume that they're there. We have to know they make up who they are. 

And not every tree is planted in the best environment for it. If you saw a palm tree in New York, you'd be like that's going to have difficulty surviving here. And so, we don't look at it as like you're wrong. It's, "Okay. Maybe you weren't born into the family that has the same individual differences as you. Maybe society hasn't quite caught up yet to providing the supports that we needed to for our neurodivergent patients. 

And so, it's our job then to provide those supports. And that's okay. Some trees need more sunlight than others. Some trees need more water than others. They need different fertilizer. And you have to take the time to figure that out. That's the best way I found to explain it to people. 

And there's a big push for neurodiversity-affirming care, which I'm so grateful for. But I think there's just so many people that are talking about this. Sometimes it's hard to find the right information. And I always encourage people to listen to autistic speech pathologists and autistic individuals. Two Sides of the Spectrum has really great episodes where they bring in autistic researchers. 

I just did an interview with Ð let me find her. Because she's wonderful. She's an autistic SLP and has a podcast. And those are the people that we need to listen to. Emily Starling. She's wonderful. She has a podcast called Neurotwist. And so, that's what we need to start doing. 

And from a feeding therapy standpoint it I think has shifted a lot of our perspectives and how we need to view how we do feeding therapy. Because a lot of feeding therapy in the past was very behavioral. And the issue that comes with very strict behavioral strategies both with feeding and with language therapy from a neurodiversity-affirming perspective is that it's trying to change a behavior. But behavior is communication. 

Unless we understand Ð or it's information. It may not always be communication. But behavior is information. And so, if we don't take the time and the effort to understand why that is happening, why we're refusing foods, Michelle is the person I have learned so much from about chasing that swallow of a medical ideology. We need to make sure we chase that part of it. We can't negate that in neurodiversity-affirming therapy either because that may be an individual difference that they are not aware of. We need to make sure we're chasing to figure out what the medical individual differences are to inform our plan of care. 

But if we don't work to understand the why also behind the behavior, then we're just shutting down their experiences. And that can make a child feel that how they experience the world isn't valid. And so, I forget. And I will remember who have used it before this quote. And I will find it. And I will post it to give them credit for it. But the goal isn't to make a neurodivergent child neurotypical. The goal is to make a neurodivergent child a neurodivergent child who doesn't struggle in the environment that they're in. 

And feeding is tricky because it can be so medical. The thought of neurodiversity-affirming care is that it's a social model. You're not trying to fix them. But we have to acknowledge that there may still be these medical diagnoses going on that we can help support them with so they don't struggle as much. That's where I think some people struggle too, is like how do I use a social model when I have to be medical about feeding? Feeding is medical. If you listen to this podcast, you know that. But we have to view that medical as an individual difference and not necessarily Ð and we have to honor that too. Because we have to know if they have these medical diagnoses that might impact the way they want to eat. We get that. But then what about their sensory experience? Their social skills? All the things that encompass a meal. 

[0:23:34] MD: The things that have gone on behind the scenes is Peck Dawson. What you're saying hits home on a very personal deep level, right? You all know, I'm pretty much an open book. But I have had some things going on that we've had to try to figure out what's happening with my body. 

I've had a bunch of labs pulled. I do not have celiac disease. My iron's still in the toilet even after numerous supplements. Current working theory is does Michelle have a bleeding ulcer or a low-volume internal bleed, which is resulting in lethargy and a feeling of depletion? Which we'll find out after a colonoscopy and an endoscopy. I'll let you know how that turns out. 

Also, can I just say, I dragged my feet in doing all of this. And I'm always the person that's the proponent for everybody else to take care of themselves. And I am the worst patient in the history of patients. Erin is like not in fervent agreement over here. But it has changed my relationship with food. Because of whatever is going on with my body, if I eat some of my favorite foods, which to be fair I don't have a gallbladder. I have a hepatic hemangioma the size of a freaking softball in my liver. And so, I already at baseline have difficulty processing certain things because I'm missing the organ and my other organs compromise for digestive enzymes, right? 

But it's a Ð if I eat certain foods, it's a 50/50 shot whether or not I'm going to be running to the bathroom or having like a reaction, right? And as an adult that has not really had these problems up until like the last couple of years, it has changed my relationship with food. It gives me insight into how our tiny humans that have undiagnosed ideologies how they must feel. The fear that I have and I at least can filter it through a lens of the knowledge that I have garnered thus far through my work with PFD. But it's scary to be truthful. Because I want to be able to break bread with friends and not have to like embarrassingly run to the bathroom and blow the toilet up as Goose would say. 

But also, I mean, we know my children are also neurodivergent. I mean, it is what it is. It runs in our family and we thrive in this. But teaching the social cues to Goose Danger that I know you love the guacamole at the Mexican restaurant. However, it is not socially acceptable. 

[0:26:09] EF: You cannot put your hand in the guacamole. 

[0:26:13] MD: Oh, my God. Every time we turn around. If we are not watching the Goose, he is straight up like scooping the guac out with his hand at like almost 11. I'm like, "Honey, we cannot do this." He's like, "But it tastes so good." I'm like, "This is a societal rule that we have to follow." And he's like, "But why?" Which is a legit, great, freaking question. The why. Why can we not stick our entire face and/or hand into the Chick-fil-A sauce? 

[0:26:42] EF: Well, it's a bit of a safety. It's a bit of a safety. Like a germ.

[0:26:48] MD: And once I explained it to him that way, he gets it. But try to teach my neurodiverse children social rules and then try and explain the why we have this social rule. Sometimes they're stupid social rules. And I'll acknowledge that. But this one, we can't double-fist guac like that. Erin, how many years have we had that conversation with him? 

[0:27:17] EF: Yeah. Yeah, we did. Well, and the difficult part is that so much of like medicine is based off of like patient report. When you have patients you work with who don't understand why they are feeling that way. I had a patient I worked with who I saw from Ð I've talked to him before. But I saw him at age three. And I knew something was going on. He had a lot of sensory differences. Would hit himself in the head. Would have meltdowns because he was dysregulated. Also had something possibly neuro going on. His head hurt. 

He didn't know that like he had ended up having EOE. But it was very, very hard to read his cues. So, so hard to read a lot of the children we work Ð children we work with cues. Because they don't always know. They don't Ð how our body feels is interoception, which is an internal sensory experience. When we have to go to the bathroom, we are hungry, our emotions. And that's a very, very high-level sensory skill. 

A lot of the children we work with that are neurodiverse don't even have their exteroception, touch, pressure, our proprioceptive vestibular, where our body is. They don't have those fully developed and integrated. How are we going to expect them to know how their body feels? And that's why we have to Ð I work with OTs that will get a kid for a feeding evaluation. They have sensory concerns. They're like, "Oh, no, no, no, no. We need to work on overall sensory before you can work on feeding sensory." 

In my perspective, from a communication language feeding, if I'm not able to help them engage with me at baseline, how am I supposed to help them engage with me at mealtime? I'm going to take a step back often and work on engagement, and trust, and play, and relationship first. Because feeding is incredibly difficult. 

And I will say to parents too, a lot of times parents want to expand their diet or wean from tube feeds. But then they also want them to sit at the table during mealtime. And I equate those as two vastly different things.

[0:29:24] MD: You have to pick one.

[0:29:25] EF: You have to pick one. And we may Ð like I will either bring play to the table to make them feel comfortable at the table and then bring food to the play. So that it's not all at once. And I talk in my lecture about like breaking down mealtime. What are we actually asking a child to do? Which I love you all. I love all you speech therapists like me out there. There's a cuckoo clock, if you can hear it. Again, I don't know how Michelle deals with this. But I love Ð like I said, I love speech therapists. Are we good at task analysis and breaking down what we're actually asking a child to do? No. 

[0:30:01] MD: No. Because we were not explicitly taught. We were not taught this. 

[0:30:04] EF: If you listen to Karen and I's episode, we can help you also. 

[0:30:09] MD: Okay. We had the joy at JMU, Dr. Carol Dudding, who's the current ASHA VP of Ethics. She's the director of the Distance Program. She had Dr. Sue McAllister come over and visit from Australia to impart upon our faculty as well as we hosted an event with like 15 different universities across the South, actually across the country, to teach us all about Australia shift towards competency-based education. 

Y'all, Australia has completely eradicated the minimal hours requirement and moved entirely to their version of competency-based measurement of clinical performance in lieu of the hours. It is mindboggling. Let me just leave it with it is mindboggling. 

But Sue asked us as a clinic, as a department within JMU, what are your goals? What do you want the JMU SLP students to be known for? And the first one that came across was lifelong learning. Because we recognize, and almost all faculty everywhere recognize your master's degree is supposed to give you a little bit about a lot. That's all we can do in two years. 

We cannot set new CF candidates up for deep-level knowledge about a specific topic. Because that's not the purpose of graduate school, right? But in the mantra of being a lifelong learner, that means that as their faculty, as their professors, we ourselves have to continue that walk towards expanding our evidence-based practice. 

One of the books that I'm reading, because there are lots of different ones that I'm reading, it's called The Therapeutic Use of Self in Counseling and Psychotherapy by Linda Finlay. And I got this book from Erin. Erin told me about this book. And it is therapeutic presence isn't something that's discussed within most graduate programs. 

But in short, it's how do you use your whole being? Therapy starts from the moment the child or their caregiver can lay eyes on you. That's when your session begins, right? It's not when you sit down at your table. It is the moment they can see you. Whether that means that you're walking to greet them at your clinic door or whether that means you're hopping, you're pulling your car into their driveway. Or you're having your student or a rehab tech bring them to your room. That's when that moment of interaction, that moment for the potential for moving the needle forward, that's when it begins. 

And when you truly engage in neurodivergent affirming therapy, you have to expand your emotional intelligence to recognize how incredibly important your body language is. And I don't really like calling that your nonverbals. I know historically that's been called your nonverbals, right? 

[0:33:26] EF: But it is your nonverbals. Yeah. Yeah.

[0:33:28] MD: Yeah. but I feel like when you say nonverbal to somebody, then they're going to assume like non Ð I don't know. So much of the Ð in my mind, I take nonverbal as a we have shifted away from that to non-speaking because we can communicate through like AAC devices. Your non-spoken language, your body cues. But that's imperative. 

And when we're engaging in this approach to therapy, I feel like we also have to coach our caregivers in their body language and their therapeutic use of self. Because I have a little guy that we're working with right now and the mom really truly wants him off his feeding tube. He is neurodivergent. Has a lit mean of ideologies, but has been 100% tube-fed for almost 5 years. 

And when cases like that come up, yes, I hear the caregiverÕs desire to get off of the feeding tube. But right now, this is our only source of nourishment. This is our only way that we're growing. And what I have also seen is that parents in their desire there, they can try to expedite or hasten the process. And that can come across as Ð with good intention. I'm not saying this is done with malice. With good intention, it can come across is more aggressive, right? 

[0:34:59] EF: Well, and the word for what we're looking for is that attunement. Attunement is when a caregiver, clinician, whoever is attuned as the best Ð is in match with a child's emotions and where they are. And that builds attachment and that builds relationship, which is our driver for growth and development is relationship. 

And so, what happens at mealtime often when it's stressful is caregiver is not attuned with their child because there's so much going on. And when child is refusing and caregiver is stressed or when caregivers is acting like everything's fine. And there's nothing that stresses me out more than when like a child is having a melt or they're freaking out and they're like, "It's fine." We're pretending like things are fine. That's not Ð that is so frustrating for any. 

[0:35:59] MD: Us saying it's fine.

[0:36:00] EF: Yes. It can be very frustrating. Think about when you're really upset and somebody looks at you and they're like, "Well, why are you worried about it? Everything is okay. I don't know why you're so stressed." That can be really, really frustrating. 

And so, our goal at mealtime is to help caregiver and child become more attuned. And often times, what I try to do is help a caregiver and child be more attuned, enjoy Ð excuse me. In whatever way that is. Where can I get a child to be joyful at mealtime? And where can I get the caregiver to also feel joy and wherever that is? And that means you're breaking down those goals into to figuring out where they can both be successful, which is really challenging as a therapist. How do you help caregiver feel successful and how do you help child feel successful as well so they can have joy around meal time again? 

And that can be really hard to explain to parents. And that can be really hard to explain why you're doing what you're doing. Because often times, it doesn't look like feeding therapy at first. And they'll be like, "You're not bringing in food. You're not doing this. You're not doing that." And I always tell parents like I'm studying the groundwork for whenever this child feels comfortable to be eating what they're eating. And I'm also acknowledging that when we honor a child's refusal, it's likely going to make them more likely to come back to the table with us. 

And I work right now where I am with our inpatient kids who have just been discharged. Because I work at a children's hospital that does really complex procedures, oftentimes, children will go in for a procedure. Then they'll stay at the Ronald McDonald House right next door so they don't have to be in the hospital room anymore. But they're still children that would probably be inpatient at another institution. 

And so, I get kids that have neuroblastoma and have just had a liver transplant and have had all this trauma. And I spend a lot of time our first couple sessions telling caregivers like, "Even if our session's 15 minutes if they're really telling us no, I'm going to honor that right away." So that they feel comfortable to come back. 

[0:38:07] MD: What you were talking about was the pre-feeding skills. That's what we're doing. That's what you're specifically working on with a lot of these little ones that have had long-term feeding tube dependency. Some of the fairy godmothers of pre-feeding skills, it's Suzanne Evans Morris and Marsha Dunn Klein, who's an OT. Again, we got to get out of our profession when it comes to looking for the resources, right? 

They have, I mean, their textbook on it, which again you can find that one on Amazon. It is fundamental to our foundation. If we're not creating a safe space for those pre-feeding skills to occur, we can't expect feeding skills to occur. You can't put the cart before the horse. 

[0:38:53] EF: And the important part with that too is like is it safety versus felt safety? For a lot of children, we may know it's safe. We may know they've recovered from their medical ideology. We may know that they're not going to have an allergic reaction. But if they don't feel safe, it doesn't matter. 

And Michelle talks about food age in regards to a child's experience with food. I don't use that in a way of saying like we're going to hone in on where you are developmentally. But I think from a neurodiversity-affirming standpoint with feeding therapy, if we acknowledge where a child is, it can give the caregiver better understanding of why we're doing what we're doing. Because what gets tricky is when you have an older kid who wants to mess with and play with food. Because that's not an experience that they had before. And caregivers are like, "Well, they're five. They shouldn't be doing this." 

Or when you have a four or five-year-old that's putting every toy in their mouth, to me that signals you're ready to learn about things. Because babies, and infants and toddlers learn about objects by putting it to their mouth and touching it with their hands. Because your mouth gives you so much information.

[0:39:53] MD: Yes. But they have to go through that stage. If they don't go through that stage Ð one of my mentors Ð oh, my gosh. She always teases me and calls me a hummingbird. She said you got to find Ð if it's a round hole and you're giving them a square peg, they have to figure out it won't work. And I thought that was the greatest analogy for this. That's right. They have to go through that round hole, round peg works.

[0:40:21] EF: And it also gives you information. I take that as information. When they start to do that, when parents say, "Oh, they're starting to put toys in their mouth." Okay. They might have been refusing before. They might be ready now to explore food. Because they're doing it with toys and they're doing it with other objects. 

And then if we get them to food and they're completely refusing food, okay, why do they only do that with things they know aren't food? I had a patient I worked with who would chew on blue things. Because most food isn't blue. He could guess that when he was chewing on it, it wasn't going to be food. Whereas like something that's red, or brown, or yellow is more likely to be food than something blue. Which, again, gives us information. 

And a big part of neurodiversity-affirming feeding therapy is similar to like what Michelle talks about with fed is fed. It's we need to get out of this box of an expectation of what foods children need to eat. And I don't even know necessarily where the research is on like a child has to have five foods in each food group. I don't know Ð 

[0:41:27] MD: Actually, the food pyramid is Ð I don't like the word Ponzi scheme. But it is companies paying money to Ð big industry pays money to have lobbyists advocate for where their particular foods are on the food pyramid. We've all seen the food pyramid. It used to be the basis of school lunches. Why you have to have so many portions of grains? Why you have to have so many portions of meat? 

However, that food pyramid is predicated on a upper middle class white subset of the population. Because if you actually look at different foods across religions, cultures, there's natural ebb and flow give or take religious influence, availability within the community, what Ð and so, that food pyramid is truly an upper middle class white American interpretation of what foods need to occur. 

Oh, it gets me so mad because did you Ð they were going to do away with dairy having such a high level on the food pyramid. Such a large volume. Because most humans are in tolerant or allergic to lactose and milk protein. But Dairy Association came in clutch and it's still there in a large amount. 

[0:42:46] EF: Well, all of that also I struggle with because it's like our bodies and the way we have developed like other cultures, the way that evolution works is like people that were in those certain areas changed and developed based on the resources they had there. 

We live in a world now where like we're not actually eating food from like where we are in the ground. Yeah, it does make it more difficult. But I tell parents and caregivers, "You have to try to trust your child." And I think when we also get from a medical Ð if we're looking at social versus medical. From a medical standpoint, we don't give children much of a chance. 

I work with so many wonderful physicians, but it's like there are these tube feeds, they're so structured. And I had one family who was so wonderful, they were like like, "Well, what if we're force-feeding?" We don't know. We're giving this child the same amount every time just because of the tube does it mean that you can't be force-feeding them? And I was like, "That's a wonderful question." We have to listen to our kids and help them figure out what's right for their body. Because I think sometimes by a lot of the interventions that we do, we really negate a lot. And sometimes we have to from a medical standpoint. 

But once we get to a point, like we have to start to pull back so that we can allow them to figure out what works for them. And we have to learn that people are motivated by different things about food too. I'm super motivated by that social engagement piece because I'm Italian and my family sat together every Sunday and we made sauce. And we were in the kitchen. And it was like has all these memories. 

For a child that we work with that's more Ð that is neurodivergent and maybe socializes differently, we have to look at what their motives are. I had patients I worked with who would eat a random food because they watched a character they really connected with eating in a show. 

[0:44:47] MD: Read it in a book The Hungry, Hungry Caterpillar. I've had children that would not eat anything. But the hungry caterpillar experienced it and the caterpillar was safe. And they wanted to eat it because the caterpillar did it.

[0:44:59] EF: And because they learned Ð what I love about the neurodivergent children I work with is that, so often, they want to learn things deeply. They want to understand it on a very deep level. What I had to learn to take a step back was like, okay, if I'm bringing in something new, we need to, maybe like you said, read a story about it. Watch a video about it. Engage with it. Watch someone else eat it. 

There are a lot of steps that we have to go through from a social learning standpoint before maybe we'll feel comfortable eating it. And also, children who haven't had the experiences that weÕve had with food. Like you and I know when you say Mexican food. Like what Mexican food is going to be like. But children, and I call it their food literacy, what's their food literacy? What's their understanding about what food is and how it works? And we can't just put food in front of a kid and expect that they're going to even know that they have to eat it.

[0:45:57] MD: Yes. Food literacy is a brilliant freaking term, honey. That is profound. Because it's the same Ð yes, you just connected several different neurons in my head. Hold on. I'm trying to process all of them. 

[0:46:08] EF: And that you heard that here. You heard that here. So just for all you people.

[0:46:13] MD: Okay. My thought process is when we say they have to have an exposure. And exposure doesn't mean it's one-and-done. For some of my families, I'll say, "All right. So they need to have exposure to this food. They need to have experience." Maybe the child is tube fed five to six times a day and they're allowed oral feeds one time a day. 

Well, cold and flu season is upon us, right? We're going to get naturally creepy. But if you have a child that has an underlying dysphasia, when you hear creepiness, the risk for penetration aspiration is real, right? That might inhibit their exposure or experience with that food. 14 positive exposures or experiences within 21 days. I don't actually know where that was instilled in me, but that's what I've always gone by. 14 in 21. 

It can't be, well, we expose them to this bottle once a week. That is not enough exposure or experience to develop those pre-feeding skills or feeding skills with that novel concept, novel presentation, or novel idea, right? 

I understand clinically that it can be stressful, especially if you're doing home health or if you're in private practice. If that kid only comes to you once a week and you're engaging in caregiver coaching and how to make this a joyful, positive experience and to avoid trauma. But, say, the creeping crud has affected kindergarten and the kid is immunocompromised. And two of your four sessions this month are not stellar because the kid at baseline has a medical deterioration, right? They're just not feeling well. Then that's not the time to put significant emphasis on creating a positive experience with this novel food. 

I'm going to offer the suggestion of this child probably has other goals on their plan of care. Work on those. Address those. Because we have to respect the unspoken, unknown potential trauma that the child has gone through and that the caregivers have gone through and select optimal times for learning and optimal times for healing in order to create those positive experiences. Does that make sense, Erin? 

[0:48:40] EF: Yeah. And then the point of bringing in that neurodiversity-affirming perspective and there is how are you going to introduce it? And what's a way that honors their individual differences? And what are things Ð I have a patient. And that takes time. I will say to families, "I'm going to spend a lot of our first sessions just getting to know your child." Because they're worth so much more than an evaluation. 

And I really need to be able to understand how they view the world so that I can help them let me into their world. And for things I'll do, I have kids that if they're a Gestalt language processor, I will oftentimes like record myself eating, or cooking, or something. And then I'll narrate it and label it so that they can watch it from a very safe place and safe distance. 

I had one patient who would cook for dad. That was his big Ð his way of like I'm making food, but I know I don't have to eat it. But I'm having engagement with it and it feels safe and it feels comfortable. And I had a patient who loved Ð what show did he love? He loved a show. I forget. And so, we found foods that were in the show. And those were the foods that we introduced. 

Because, to your point, he had already had certain exposures with those food. And so, the value Ð and if you go back to Karen and I's episode, to learn more about the sensory system, the value of learning about the sensory system is that you can understand which senses that affect them a little bit more. If you understand how they learn. That's I think the biggest thing, is how they play and how they learn. 

Because I want to know how a child connects. Like, bridges things together. I had one patient who, when he would see things that look similar to him, he would say twins. That was his like word of connecting them, which is my favorite thing. It was so smart. 

When he would say twins, I would be able to see the two things he was connecting and see that bridge. Similar to food chaining. Okay, what are the ways that we can change food? What are the bridges that they're building in their brain? And why are they building those bridges? And then how can I help connect more things for them? But I need to understand how they learn first. 

And this is not feeding. I will see him for feeding, this patient. I love him so much. He loves Ð someone saying we're going on a bear hunt when they were at a nature center. And I don't know, it clicked with him. Mom, who's fantastic, has started to go on hunts for different animals. And then his food, how he's trying new food, is the song "Do you like apples? Yes, I do." They use that song to introduce new things. 

And we were playing a game and there was like a crocodile. So we were going on a crocodile hunt. And then in the play schema, he starts singing, "Runaway do-do-do-do-do-do," from the Baby Shark Song. He's like connecting these different songs and mitigating these things to learn. 

What are we doing in feeding therapy? We're singing, "Do you like whatever? Yes Ð" that's how we're introducing foods. And that's the thing that also Ð and I'm working on it, for those of you that are listening, to create like a program to help people start to like connect these dots of neurodiversity, trauma Ð neurodiversity and trauma-informed feeding therapy. Because I don't think it needs to be like a Ð I don't want this to be viewed as like a mentorship program. Because I don't want to be viewed as like I'm a mentor over you. 

But I think when you do this type of therapy, you need people you can bounce ideas off of and you need people to help. Because a big part of it with that therapeutic use of self is to do it in a way that feels authentic to you and feels authentic to your practice and what you've been through. And I don't know your whole history of being a therapist. 

I can give you information. I can give you tools. I can give you theories. And we can talk through them. I'm building this program that I hope some of you will join. But to that point, when people come to me and they're like, "How do I do Ð" hi, Dogwood. How do I do neurodiversity-affirming feeding therapy? It's like it's different for every kid. And I can't give you direct strategies of try this, try this, try this. I can just talk from my own experience. But it's really about learning the children you're working with.

And Michelle and I have had this conversation a lot about trauma-informed care. Hi. You look so pretty, dog. Is that a trauma-informed goal Ð so a goal that's written the exact same way may be trauma-informed for one child and not trauma-informed for another. 

And the point of a neurodiversity-affirming trauma-informed goal is to include the supports the child needs and to understand we may never be able to take away all of those supports. And that's okay. You're not going to give a tree sunlight, and water and fertilizer and then just say, "Good luck without it. Now you can grow on your own." That's not how that works. 

[0:53:34] MD: To translate that into what do these support look like. A child may always Ð I say this from the perspective of a Ð I have an adult special needs brother. He's 45 years old. And as an adult, he will always and he is autistic amongst a litany of other things. In order to be successful, he will always need his food pre-cut. Because he simply cannot Ð he cannot do that himself. And that's okay. That is honoring Uncle Matthew needs, right? And he is successful at self-feeding as long as his food is precut. 

A child may always need a little bit more time. And that's okay. A child may always need lateral supports in their chair or a footrest. And that's okay. But with those supports, they're successful. They may always need a secret sauce, a condiment, a flavor added to their food. Because that's their preference. And that is okay. 

Erin, what's your favorite condiment? 

[0:54:42] EF: Ranch maybe. That's not the right answer. That's just what came to my brain.

[0:54:46] MD: Yes. But which type of ranch? Because you know there's good ranches and bad.

[0:54:49] EF: Hidden Valley, for sure.

[0:54:52] MD: You're a snuck out. Okay. Duke's mayonnaise. I will throw it down. Duke's mayonnaise is the only real mayonnaise. There's no other mayonnaise.

[0:54:59] EF: Duke's is not my favorite. Duke's has a sweet hint for me. I don't love that.

[0:55:04] MD: It's perfection. But if that's your condiment of choice, I'm going to respect that. And I will keep Erin's favorite ranch on stock when she comes and visits. Because this is what Ð 

[0:55:16] EF: But do you also know the other component of why people love Duke's? There are memories of my grandma made my tomato sandwich with Duke's mayonnaise. There's also that memory and that emotional component behind the food that we eat. 

[0:55:31] MD: Yes. And if we acknowledge and honor that, that can in turn be an accommodation. It could be a support strategy. And that's okay if they need that. 

[0:55:44] EF: And also, there are going to be kids that don't have the emotional connection to food. And that's also okay. For them, they're not going to pull from this emotional experience with food. They might just be eating to eat and something that they think tastes good. And so, for that reason, there may not be as much of a I'm motivated by somebody else eating the food. Because I prefer to connect with people another way. 

In our podcast episode, Emily, the autistic SLP that I interviewed with talks, she's like Ð and other people I work with will say, "I can eat the food at the table with you. But I may not be able to engage with you in that way also. Do you want me to engage with you or do you want me to eat with you?" Because that might not be the same thing. 

And also, why this is another thing that really irks me. And I think we're getting better at it from a language perspective, especially with like Ð we use AAC. Language. The point of AAC is so that language and communication is as easy as it can possibly be. I know we want to work on skill. But why do we always have to make feeding so hard? Why do we have to make it Ð why does everything have to be about them growing and meeting goals? And why can't a lot of our goals be about how can I make this better for you? That's the shift we also need to make. We need to stop looking at the developmental progression and that we have to keep meeting these milestones. And we have to look at it is our job is to make mealtime better, easier, more functional, more enjoyable. That should be the goal. 

What can be difficult is when parentsÕ goals are different we have to accommodate those. But that's a shift we have to make. Because we have the joy of understanding meal. We have the joy of understanding. Our job isn't always to progress them. Our job is to understand. We have tools to make it easier too. Our tools are only just to grow their skills. 

[0:57:42] MD: Yeah. What you're talking about is us checking our own biases at the door. What you're talking about is us recognizing and respecting where the child and their caregivers are at the core of this. I struggle with having a meal together at the table as a family is huge for me. Because I am a child of divorced parents. It was really traumatic. I didn't have meal time together with my family except for when I was really little and my parents are married before all hell broke loose. 

And when I hit late middle school, early high school, we did it for a year or two with my dad and my stepmom. It was only like every other weekend. But my person that I broke bread with every day was my grandma. Every morning, she made the how Ð the interesting insight is, every morning for four years, for breakfast, I had a grilled cheese sandwich with ketchup. 

[0:58:41] EF: We do grilled cheese. I remember that. Yeah. 

[0:58:43] MD: Yes. And sweet tea. It was consistent. It was comfortable. And I did not deviate from it, right? But now as an adult, I want to, as a mom, have breakfast and dinner together as a family. And we do that at the kitchen table, honestly, four to six times a week. But that is coming from a place of trauma. It's coming from a place of I didn't have that as a child consistently. And I want to foster that healthy relationship with food and healthy relationships amongst ourselves. 

But I have to check my heartfelt desires at the door when I go to work with other families. Because their desires could be completely different. But that's addressing our own biases and our own traumas, which gets back to how are we addressing our emotional intelligence and where we are? Those are hard questions. 

Ooh. Potential solutions for finding out your emotional intelligence. ASHA has free resources on their ASHA Leadership page. So you can take this personality quizzes. But from a Ð not from like Ð whenever I say personality quizzes, Erin, please know that I always go to like the anagrams with you and like my horoscopes in my head. And I'm like, "No. No. No. Let's do like not those. But like the scholarly ones." Not that those aren't scholarly, but Ð 

[1:00:09] EF: Yeah. I don't use them in my practice. 

[1:00:11] MD: Yeah. We don't use them in our practice. Just Ð 

[1:00:14] EF: I love a zodiac moment, but I'm note telling caregivers like I'm a Sagittarius. 

[1:00:20] MD: I don't know. I have had a couple parents like, "You're totally a Pisces." And I'm like, "How could you tell?" And they're like, "Well, you like drip empathy." And I'm like, "An empath." I'm like, "Yeah, whale." That can be beneficial and also heartbreaking. 

No. But seriously, go check out the leadership tools. Because when you find out what your strengths and weaknesses are, that can help drive part of your sessions and help you learn what specific areas you need to grow in. I'm a pace setter. I go 100 miles an hour when I have an idea and we are going to go all-in. That is my natural desire for therapy, for management, for all of the things. 

However, recognizing that in myself and recognizing that I have to not only pump the brakes, but just like straight up turn them on and sit at the stop sign sometimes. That helps change the trajectory in the pace of my therapy sessions. 

[1:01:16] EF: And that's why I'm hoping with creating this trauma-informed feeding therapy group. I don't know. I'm working on the name. But the goal is to have Ð what you really need are people that you can go to, that you trust that are going to Ð Michelle and Karen especially are people that like I can just vent to and then they can, in the next breath, give me ideas, and recommendations and really help me with working with my families. Because this is really hard therapy. This is really emotional. You're giving a lot of yourself and you're having to shift yourself for all the families that you work with. 

And for those of you that work in like an outpatient clinic like I do where you're seeing like 10 kids a day, it's exhausting. Because every family is so different. And so, I don't want anyone Ð this is a journey. I say, like we're on The Bachelor or something. But I learn every day. 

[1:02:18] MD: [inaudible 1:02:18] episodes just cracks me up. Continue. 

[1:02:24] EF: Give yourself grace and just be authentic too. You don't have to have all the answers. And I think when I'm in sessions too, I call it out when I make a mistake or when I try something with a kid and they don't like it. Or because I want parents to feel comfortable too, like I'm not perfect. I don't know. They know their kid better than I do. And so, that's all you can do. And I think people really respect that when you're really honest and you act like a human, you build a relationship. 

Michelle and I always say, if you guys ever have any questions or like want to bounce ideas, that's going to be the goal. But stay tuned because I will have a program coming out that provides a lot deeper dive into a lot of these ideas. And then giving opportunity to sit in it. 

Because that's another thing, is you really have to sit in this and sit with families in what they're going through to be able to get out of it too. If you try to scrape the surface of it, it's not going to have the same effect. 

[1:03:24] MD: Dr. Burns taught me, you have to sit in the uncomfortable to move towards the comfortable. And that's okay. We can sit in the hard spot with them. We can let them mourn. We can let them grieve. Both the patient and the caregiver. We can let them feel their hard feelings and, as Erin would say, acknowledge it and respect it. And then with slow systematic changes, we can move forward. 

[1:03:50] EF: And it's really beautiful when you learn about a child's individual differences, and their strengths and their growth. It gives caregivers more opportunity to see that growth and development when you help them shift their perspective too because they get to to see the beauty of their kid. And that's what I love from both a feeding and language perspective and what we do. And using a neurodiversity-affirming lens is like I learn so much. 

And I work with caregivers. I'm not trying to change your kid. I'm just trying to understand them better. And they teach me every day. And when a caregiver like lights up and is like, "I love my Ð" because sometimes they think it's so hard. They love their kids so much, but they don't understand them. And I can't imagine having that feeling. So how do we help them better understand their kid to advocate? 

I forget who it was. But maybe it was Kim Barthel. Somebody talks about like the most important thing is for a child to just feel unconditionally loved by one person. And so, we get to help caregivers. They already love their child so much, but we get to help empower them to be able to advocate for their kids needs, and who they are and what they are.

And I'll tell parents, I'm like, "When somebody asks, you can either say it's none of your business. Or I will give you the information and the neuroscience and all of behind like why we're doing what we're doing." Because sometimes it there really is nobody else's business. 

[1:05:15] MD: Yes. Privacy. I don't think you realize, Erin, how much you mentor me in understanding the boys. Just saying. I know you're like the world's coolest aunt. But I become impatient as a mom. And you remind me how to give grace and how to seek to understand in those moments when I am exhausted as a mommy. And it's okay to admit that. Love you.

Also, my favorite is that Goose texts Ms. Erin to make sure Ð because we can find our family and friends on our apps, right? He frets over making sure Ms. Erin has an umbrella or a rain jacket sometimes if the weather is going to be bad. 

[1:05:56] EF: Gets very concerned if Ms. Erin is not at her own apartment at night sometimes. And Ms. Erin doesn't need to explain to Goose where she is sometimes.

[1:06:11] MD: Oh, my God. Mommy, Ms. Erin has not gotten home yet. It's okay. She may be having a sleepover. But she's safe, right? I'm like, "Yep. Ms. Erin is having a sleepover." Oh, my God. This is going to get more awkward in the next five years. Oh, thank God. Oh, yeah. Aha. It's all right. And then there's Bear. Who's she sleeping over with? Are they flirting?? I'm like Theodore Alexander, go away. We're fine. It's about Ð 

[1:06:42] EF: We have to watch out for him. Yeah, we do. Goose, everything. Goose shows everything on his face. You can tell everything Goose is thinking on his face. Bear gets in a little Ð he gets in his little shell sometimes. And you got to pull it out of him sometimes. 

[1:06:58] MD: Yes. Which means he needs food. Sometimes sugar. Because his sugars run low and get really emotional. Or simply put him outside and let the fresh air hit him and he perks right up. Yeah. My children. 

Okay. Well, everybody, thank you for giving this incredibly exhausted mommy who may or may not have some type of bleed, which is why my iron's in the toilet and I'm exhausted. But thank you for giving us grace and only casually being two full months behind in this episode. Erin, you're the most patient person in the world. Thank you. And come check us out at ASHA. 

[1:07:36] EF: Aren't we going to do like a live episode at ASHA or something? 

[1:07:38] MD: Yes, we're going to do a live episode at ASHA at the speechtherapypb.com booth. So come by and check us out there. When we're recording, we probably won't be able to like interrupt to like shout out loves. But who are we kidding? We both will. But we'll be there. 

And if you haven't already, I am a huge fan and supporter of the ASHA Foundation. They have tickets for the ASHA Foundation fundraiser that are still available. That money Ð your money actually goes directly towards scholarships or students. I'm humbled and in awe to say I've had two students, one at USC and one at JMU, that have been recipients of the ASHA Foundation Scholarship. And it does legit help pay for tuition. And it also funds research to move our professions forward. I say professions because it supports speech pathology and audiology.

[1:08:31] EF: The other thing I will say, and we won't really go into it. We're going to have episodes that talk more about this. But everybody is like ASHA is not doing this, ASHA is not doing this, ASHA is not doing this. Our whole profession is Asha. I see a lot of anger. We're putting out on social media Ð we're putting this anger and this frustration out to this like magical guy hiding behind like the Oz. I feel like that's how people Ð but yes, there are people at ASHA exec. But like we are all ASHA. 

If you're getting frustrated that things aren't happening, like we have to do it too, and we have to advocate, and we have to Ð especially from a lot of things like state-level wise, ASHA can't do that. 

[1:09:17] MD: Correct. That's your State Association. Because they pay their lobbyist. Not ASHA. The State Association pays a state-level license registered and/or certified, give or take the state or commonwealth that you reside in, to advocate on behalf of the association's need at that level.

[1:09:35] EF: Yeah. And just be kind. The world is like Ð there's like really horrible things going on in the world. And any little nice thing you can do for somebody. And like I love our field. But it can get pretty catty, and mean and over what? Just show grace. Be kind. We're heading into the holiday season, which is beautiful and really hard for a lot of people. Keep that in mind. 

[1:10:01] MD: Yes. My good deed of the day, I left my quarter and my shopping cart at ALDI . That always makes me very happy. It's a tiny thing. But like I have been there where I'm like, "Oh, my God. I don't have a quarter." And like you're panicked. And so, I left my quarter in and I was like, "Oh, good deed of the day. Check." 

[1:10:18] EF: I never have a quarter. Good thing I don't go to ALDI.

[1:10:20] MD: Yeah. I love ALDI. 

[1:10:21] EF: Because I think like I think that girl math, I think when I have cash, it's like free money. 

[1:10:28] MD: What? I saw a meme last night before bed. That was we know boy math, we know girl math. What about dog math? Dog math, you've been gone for three hours. You've been gone for three hours. You've been gone for three minutes. You've also been gone for three hours. I was like that's dog math. Yeah. 

Okay. Check us out on First Bite Instagram, Facebook, on all the things. We love it when you message us. How can we help? How can we serve? Who do you need us to interview? What topic do you want to know more about? Just message us.

[1:11:00] EF: Yeah. Give us some of those. You haven't done that in a while. Why don't you put what topics you want? 

[1:11:03] MD: Yeah. Oh. We'll do that.

[1:11:05] EF: It's a great idea. We'll do a little question.

[1:11:08] MD: Yes. All right, darling. Thank you. I'm so sorry it took me forever. Good luck with the bills. They're playing. It's Buffalo Bills. I got them right.

[1:11:17] EF: Not the Bills. Like the Buffalo Bills. Yep. You're right.

[1:11:20] MD: Yes. Sports team. All right. Well, have fun.

[1:11:23] EF: All right. Everybody, thanks for tuning in.

[1:11:26] MD: Bye.

[1:11:26] EF: Bye.

[OUTRO]

[1:11:27] ANNOUNCER: Thank you for joining us for today's course. To complete the course, you must log into your account and complete the quiz and the survey. If you have indicated that you're part of the ASHA registry and entered both your ASHA number and a complete mailing address in your account profile prior to the course completion, we will submit earn CEUs to ASHA. Please allow one to two months from the completion date for your CEUs to reflect on your ASHA transcript. Please note that if this information is missing, we cannot submit to ASHA on your behalf. 

Thanks again for joining us. We hope to see you next time. 

[1:12:08] 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 249		Transcript

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