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Intro

Kate Grandbois: [00:00:00] Welcome to SLP Nerd Cast. I'm Kate. And I'm Amy. And we appreciate you tuning in. Whether you are a speech language pathologist, a teacher, an EI provider, an allied health professional, or a parent or guardian of somebody with speech and language needs, we hope this podcast will give you some valuable information and keep you at least a little entertained.

In our podcast, we review and provide commentary on resources, literature, and we discuss issues related to the field of speech language pathology. 

You can use this podcast for ASHA Professional Development. For more information about us and certification maintenance hours, go to our website www.lpnerdcast.com if you don't need CMH hours, but would like a handout of today's episode or easy access to any of the links or resources that we discussed during the podcast.

[00:01:00] You can also find those on the episode page at our website. So it's feeding the third feeding episode. That's, that's very exciting. Feeding and swallowing interventions, sensory considerations, and we are very excited to welcome back, Tracy Callahan. Tracy, thank you so much for being with us today. Hi guys.

Thanks so much for having me. Um, before we get started on all the goodies for today's episode, um, do you have any financial or non-financial things that just all those housekeeping things, those financial and non-financial 

Tracey Callahan: disclosures. Um, of course. So, uh, financial disclosures. I am employed by a private practice in Boston, Massachusetts.

Um, and I have a private practice. I'm launching a new online platform called Guest Monster Games. Uh, non-financial is the, I'm a member of asha, the American Speech Language Hearing Association and the [00:02:00] corresponding special interest group, uh, SIG 13. That is specifically for dysphagia. 

Kate Grandbois: I always say dysphagia wrong.

Can I admit that at the beginning of this episode? Is it wrong or is it just different? I say dysphagia from, and then I have imposter syndrome that I said it wrong because I do say it wrong, don't I? I don't think that's wrong. Tracy, can you settle all this ones and for all? 

Tracey Callahan: I think they're both correct.

I think it, honestly, it depends who you had for your professors in grad school. Um, mine said dysphagia, so I always say dysphagia. Plus it, it dysphasia. It just seems more nasal. It just, you 

Kate Grandbois: just don't like it. Feels good. 

Tracey Callahan: Yeah. Yeah. 

Kate Grandbois: That's fair. Um, can we just real quick go back to one of your financial disclosures?

Sure. Did you invent, so I think you invented something. Did you invent something? 

Tracey Callahan: I did. The last time we talked 

Kate Grandbois: to you's been very busy. Yes. You just casually mention, oh, I'm launching, you know, this online cool thing and no big deal. Uh, what is guest Monster games? [00:03:00] Can you please tell us about this? 

Tracey Callahan: Sure.

So, um, currently during, uh, COVID Times I've been doing a lot of teletherapy and my husband, he is a computer science guy, and over the last couple of months I convinced him to help me with something and. Well convinced or forced, you know, either way, um, to help me. And so we've put together this really cool, amazing platform for speech therapy games, you know, language stuff, speech.

Um, it's kind of different than some of the other stuff that's out there. We do, it's really based around machine learning concepts. Um, so it's less about like a static PDF and more interactive, customizable. Um, cool. Yeah, and, and, uh, been, it's really cool using it for months and it's, uh, it's been really fun.

The kids like it. I like it and it's fun. 

Kate Grandbois: Good for you. That sounds very fancy. 

Tracey Callahan: Yeah, well, it's not, it's not fully functional yet because, uh, [00:04:00] we've been working on that in between our own jobs and our two children and all other responsibilities. Um, but yeah, we'd, we'd love for people to come and try it out.

And if any of your listeners are interested, um, they can use the code SLP nerd cast for two month free trial. 

Kate Grandbois: Oh, that's awesome. We have a code. I feel like, I feel like that makes us like a real thing. We have a code. 

Tracey Callahan: You guys already are a real thing. That's amazing. Yeah. But if, if your listeners are interested and they'd like to check it out, uh, I would really love for them to go and take a look.

Kate Grandbois: Oh my gosh, that's very exciting. If anyone is out there. And you use our code, please. That, that would be very, that would be really exciting for all of us. 

Tracey Callahan: Yeah, so guest monster.com, and then the code is SLP Nerd Cast. And then, you know, you guys will get an, anybody that, um, goes on will get an email and any feedback that people have, uh, we'd love because like I said, it's still, it's not, you know, [00:05:00] fully functional yet, but, um, we're pretty excited about it.

That's so awesome. That's awesome. You know, 

Kate Grandbois: feedback is so great. I know we say it all the time, but you really can't grow something without feedback. You can't make something better without feedback. So that's awesome. That's how 

Tracey Callahan: we learn. You went over the 

Kate Grandbois: feedback people. Yes, exactly. Didn't you go over 

Tracey Callahan: that in another podcast?

Kate Grandbois: Yes. So we, we, we've reviewed how uncomfortable it is to accept the feedback, even though it is extremely important to professional growth. But, um, well that's very cool. That's, that's really awesome. Good for you guys. That's, that's great. So, um, to all of our listeners who are interested in checking out, please keep us posted on how it goes.

That's, that's very exciting. Um, but moving on to the content of today's episode. Um, why are we talking, why did we decide to, to come back to the well for a third episode about feeding Amy, 

Amy Wonkka: putting on the, well, I mean, we've gotten a lot of feedback from listeners. People are interested in learning more. Um, you know, I think.[00:06:00] 

Finding out more about evidence-based pediatric feeding therapy is something that touches a lot of providers regardless of your set, of your setting. 

Kate Grandbois: Yes, I totally agree. And I'm also remembering, you know, we recorded the second epi, our second episode on feeding and swelling. When was that? April, March.

Somewhere around there, probably in April. Mm-hmm. Um, and I vaguely remember. Um, ending the episode and feeling like we were in the middle of really getting to a lot of really great, um, information and content. Um, and we ran out of time. So thank you again, Tracy, for coming back on our show. Let's do a quick review of learning objectives.

Um, first and foremost for our listeners, today's episode is more of an intermediate level. In terms of, um, the content that Tracy is gonna share, there are three learning objectives, um, and we're gonna, Tracy's gonna present these learning objectives in a slightly different format than our usual format.

So [00:07:00] usually we have three learning objectives and we go through each one in a sequence. And today there are three learning objectives, but they're all slightly related to one another. So we're gonna touch on each one of these objectives sort of cohesively throughout the episode. Does that make sense? I think it does.

Think it does. I needed validation there for a second. That what I was saying, it sense. Okay, cool. Well done. Um, all right. Excellent. Um, learning objective number one, list factors to consider before starting treatment of feeding and swallowing learning. Objective number two, identify two formal approaches to feeding, treatment and learning.

Objective. Number three, in general, explain what sensory components should be considered during therapy. Take it away, Tracy. 

Tracey Callahan: Uh, well thank you for reading those out, and I'll make sure as we're going through to kind of flag those, uh, different objectives as I'm talking about it. Um, so when we ended our, uh, [00:08:00] podcast talk last time, we started touching on the idea of food chaining.

Mm-hmm. Um, and the last couple words really centered around the schools, and I thought it would be really helpful to talk about different types of strategies, uh, to, to treat feeding and swallowing and how that would relate to the schools. Uh, so the ideas are jumping off points, sort of. Okay. You have this student and you, they are referred for, uh, feeding and swallowing therapy.

And sort of where do you go from there? Um, so once the assessment, you know, you get the referral, you get the assessment. Um, and I can't remember if in the last episode I had mentioned this, but even if the student is coming in with an evaluation, the treating therapist should still do their own evaluation.

Uh, they can use the past evaluation as a template, but they should still do their own evaluation. Okay. And I feel like that's probably true with a [00:09:00] lot of speech therapy in general. 

Amy Wonkka: And can you tell us a little bit more about kind of why, why that should just be common practice? 

Tracey Callahan: Common practice? Yeah. So, uh, you wanna confirm that there haven't been any big changes that have occurred.

So for example, if on the evaluation. That you've received from the feeding team. There's no coughing or change in breathing, but you are noticing that there's been a change that's really important to know. So you wanna make sure that there haven't been any changes that have occurred. And you also wanna familiarize yourself with how the student structures look, how they act, and you wanna take baseline information.

Yeah. And that's just super important for all speech therapy. And I know that you guys touched on that in your ethics talk, um, about how important it is that we're doing evidence-based therapy. And if you're not taking data, is it really evidence-based? 

Kate Grandbois: Right. When you mean our ethics talk? You mean the episode we did on data collection?

Tracey Callahan: Sorry, data collection. Yeah. You guys [00:10:00] referenced quite a bit of ethics stocks. We did. Yeah. I enjoyed that one. Yeah, that was really good. I enjoyed it on a run, actually. 

Kate Grandbois: Oh, nice. I'm so glad. Um, yeah, it, it, it's, I feel like, you know, I, and I know we mentioned this in that episode that. Key words like data and measurement aren't necessarily listed in the code of ethics, but you can't have evidence-based practice without data.

Um, right, and baseline data is your best way to measure progress. So if you don't have baseline data, what are you, you know, what are you measuring against in terms of making sure that your treatment is effective? 

Tracey Callahan: Exactly. Um, and then based on what you find during that, uh, evaluation that you're doing, you're going to use that information to write the goals that you'll use in the IEP.

Mm-hmm. Uh, we had spoken a little bit about how it, a feeding team might be writing goals that would be best suited for the home that wouldn't necessarily translate to the school. So it's important that the SLP collect the data, um, of [00:11:00] things that are gonna be looked at and needed for school. 

Amy Wonkka: Well, and I think, you know, just to echo some of the things that we talked about in the previous podcast, schools are a, are a different environment from, you know, an outpatient or a home setting.

So there, you know, just even broadly, you're typically writing your goals and objectives for a year instead of like a 60 day, you know, recertification period or something like that. Yeah. Um, and it may be more about generalizing some skills that, uh, student has into this new and different and more busy environment.

So yeah, those would be. Informed by the outside eval. Yeah. And informed by your eval, but may look a little different 

Tracey Callahan: and you, um, as the therapist might be looking at things in a more specific way. So if the evaluation was found that, um, the student had difficulty with X, you're gonna wanna try and make sure that you get a good picture of what's going on with that.

Right. That there's a sensory issue. Kind of explore that more so that you're, you can write your goal. Um, [00:12:00] so now in, um, so you know, uh, what the deficit is. And, um, just like in all other speech therapy, it really needs to be evidence-based when you're designing what your therapy will be. Um, so I have outlined a few different therapies that I think it would be good to familiarize.

Uh, with that I kind of pick and choose from when I'm designing therapy for the students that I work with. Great. So that's, so that's kind of getting into, um, one of those learning objectives was to identify a formal approach to feeding therapy. And the first one that I'm gonna talk about, uh, is often, you know, we often speak in acronyms is Sophie, so that is the trademarked name, Sophie.

It's supporting coral feeding and fragile infants in the nicu. Um, so you might be saying if this is for the school, why are we sort of mentioning this? Um, and I would say that [00:13:00] more and more often we are identifying kids earlier that need to, uh, be followed for feeding and swallowing. So if I was to read Naval, I might see that they had used this particular technique with a student in the past, and that will give some information on that.

So if people are interested in that particular technique, feeding fundamentals.com is their website. 

Amy Wonkka: And if you wanna just kind of Google it, it's the letters S-O-F-F-I. Exactly. 

Tracey Callahan: Yeah. And this is an evidence-based, uh, program for the little guys, and it helps with decision making around feeding. Awesome. Um, and then the next approach that I would talk about is one that I think a lot of the listeners probably are familiar with or have heard of, and that's gonna be the SOS seating approach.

Um, and SOS stands for sequential [00:14:00] oral Sensory Approach. And, uh, they actually, it was kind of cute. And the video on their website, they actually talk about how it also stands for Save Our Ship. When you think of sos, you know there's, 

Announcer: is that what that stands for? SOS stands for Save our Ship. Yeah. Is that true?

Yeah. Am I the only person that is just learning 

Tracey Callahan: this for the first time? My grand or code? My grandfather was in the Navy, so that was one that, that I think I learned when I was younger. Yes. Maritime knowledge. Yeah. 

Announcer: Wait a minute, Amy, did you know that already? I, I did. Ah, we did smarty pants. Fine. I, I just have, I have random knowledge.

That's, that's like my thing. I have random knowledge. I know, 

Tracey Callahan: but still. Anyway, moving on. But, um, I, I really like that I get the visual of, you know, a parent or, um, a child really sort of floundering and drowning and the idea of this being approach, you know, just. Sending a [00:15:00] buoy out there that's help them.

That's nice. Yeah. So that's sort of a nice visual that I get. Yeah. Um, about this approach. And this particular approach was developed by Dr. Kate Toomey. Um, and their website is os approach to Feeding Do com, 

Kate Grandbois: which we will have on the website. We'll have all of the links for all of these online resources on the episode page.

Tracey Callahan: And, um, Dr. K Tomi is amazing. Um, you know, and if anybody out there sees any information posted or websites where she's the author, you know, it's definitely worth her time to read because she's, she's really quite amazing. Um, and her, her approach, the OS feeding approach is very evidence-based. It's very easy to find information on OS therapy, um, online.

And there's tons and tons of articles, which I love. And Amy, I know you probably love because you also read. P in your free time for [00:16:00] fun. So cool. I 

Kate Grandbois: would, I would say that I feel left out, but I don't,

sorry. 

Tracey Callahan: Um, but there's, there's a lot of fun stuff to read, um, about the studies that have been done for this. Um, and this particular approach, again, to use sort of the ocean theme, um, they identify feeding, the feeding issue is the tip of an iceberg. You know, that the iceberg interesting. What you're seeing above the water is just the top, but there's this whole bigger picture underneath underwater.

And so they talk about how important it is to consider all of these other factors as you're designing, feeding therapy. Because if you were to. Try and treat feeding therapy in isolation without looking into these other factors, then you would be missing something and really be fighting quite an uphill battle.

Amy Wonkka: Can you talk some more about what those areas are? 

Tracey Callahan: Of course. Yeah. So this, this, again, these factors, um, [00:17:00] you would consider sort of before you start. So you would think about the organs, the muscles, so inside, outside all the senses. So taste, smell, hearing all of those different things. If there, um, is a history of learning issues, learning style, or what their learning capacity is, what their development is, their nutritional status and history, and just the environment in general that you're gonna be treating in.

So all of these issues are really important to think of. Before you start with your therapy. 

Amy Wonkka: I gotta say I'm not familiar with this approach, but I love that it's this all-encompassing framework. Um, and it makes me think about in the field of aac c it makes me think about the set framework, good framework.

So do you, Tracy, you love, love a good frameworks, the framework, but I think, you know, I think when you, you really do need to think about a, a lot [00:18:00] of different variables to make, to be making a fully informed clinical decision. And it's cool to see that that carries over into so many different areas in our field.

Right. So 

Tracey Callahan: Exactly. 

Amy Wonkka: Communication, feeding, like, so anyway, that's 

Tracey Callahan: very cool. Exactly. Yeah. And, and when you think about. Sort of the old way that maybe feeding therapy was, it's like, just jam the spoon in. Why isn't it working? And then you don't understand that this poor child has had pretty severe reflux their whole life and just the act of food in their mouth is causing this really severe response.

You know? And until your familiarizing yourself with that and maybe tackling that, um, often with part of a feeding team, then you're just not gonna be successful. You could have the best looking spoon, the most exciting place, mat and plate. But unless you're really considering all these factors that are occurring simultaneously inside this child, then you're just not gonna be successful.

And then SOS therapy is, uh, play with a [00:19:00] purpose they say. So you are really kind of playing with food. So it, it can work really well with, um, a lot of different ages. And the idea is that you are going to be taking the stress away from the feeding. 

Announcer: Mm-hmm. Um, so 

Tracey Callahan: it's, uh, it's a way to interact with food that's played non-stressful.

You start with what they're able to tolerate and then you go from there. So it might be, um, all the different senses. And so they talk in this SOS feeding approach to the six steps to eating. So just tolerating food in the physical presence. Can you be in the presence of food? Can you interact with the food without touching it?

Can you process and manage the smell? Uh, touching food with your body, what you know, and then even what part of your body are you okay with your hands, but then not your face, and then tasting, and then finally moving to chewing and [00:20:00] swallowing. 

Kate Grandbois: I have a question. I, I mean, I, I, what's funny is that I have always known, I guess through my ex indirect exposure to feeding and swallowing therapy as a, as a speech pathologist, that there is a hierarchy of tolerance training in terms of mm-hmm.

You know, but I, I think it's, I was never aware that it was like a packaged procedural framework sort of process. So I think that's so tremendously helpful and I am wondering why, 'cause the mechanism and components of chewing and swallowing are so complex, but they're in one step. 

Tracey Callahan: Yeah. So, I mean, just because it's a step doesn't mean that all the steps are sort of equal.

Right. Okay. So it's not like it'll take you 10 minutes to get through this and then everything is 10 minutes from there. Okay. Depending on what the child's needs are and what their abilities are, and then going back and thinking about, you know, what's below that tip of the iceberg. Um, tho all of those factors.

[00:21:00] May impact their abilities to kind of look at these different steps. So with some children, it could take a really long time to be able to touch it. 

Announcer: Mm-hmm. 

Tracey Callahan: Um, and then once they get past that, the chewing and swallowing is much easier because maybe that child doesn't have as severe of, or motor issues or another child, um, you know, they can move through that just fine.

But as soon as they get to tasting, that's where they got hung up. So that's sort of one of the cool, uh, things about this particular approach is that, um, they give you a lot of different things to consider and then you can take a look at the child that you're working with, take a look at that evaluation that you did, the evaluation that they came in with, and then you can use this for goal writing because where whichever step that they are getting hung up on.

That's, that's sort of where you can start writing your goals. 

Kate Grandbois: Interesting. I see here in your notes that, um, that [00:22:00] there is a training. So is there, is SOS like a, like a, you can become certified in SOS is it a pro proprietary kind of a thing or is it 

Tracey Callahan: it it is. So if you go on their website, there are, there is quite a bit of training that's available and you can get more information on their website.

They have a lot of workshops, there's mentorship and you can get a certification. Interesting. Um, and I would say that, um, you know, I, when I'm designing therapy, I do pull components of this particular therapy. Um, I myself am not trained. Um, in this, uh, particular modality I've read about it, but I would really encourage all of your listeners whose interest is ped to go to the website and to read some of the information from Dr.

Tumi. Um, so the positives of this, uh, particular approach, if it's very, very evidence based, it's [00:23:00] comprehensive, very well organized, um, and the reviews of people that have taken the courses is often really positive. And then I would say, um, that the other side is, it is very time consuming. They're very long courses.

It's not like, oh, I can do an hour long course and sort of get up to speed because it's so comprehensive. It, the, the training time is quite long. Interesting. Good to know. Yeah. Yeah. Um, and then we touched a little bit, um, at our last talk. About, um, food chaining, which I think is one that a lot of your listeners had wanted to hear more about.

Kate Grandbois: We had questions 

Amy Wonkka: about 

that 

Kate Grandbois: We did, and we, I think this is where we sort of stopped during our last episode. 

Tracey Callahan: Yeah. So food chaining is another approach. Um, it's another formal approach to feeding treatment and there is [00:24:00] a book that is written, it's called Food Chaining, the Proven Six Step Plan to Stop Picky Eating, solve Eating Problems, and Expand Your Child's Diet.

And, um, it's actually by quite. There are quite a bit of authors there, but, um, Sherry Fraker is the speech therapist on that team, and she is, um, S-C-C-S-L-P, but she's also, um, a certified lactation consultant, which is really cool as well. Oh, that is cool. Yeah. Yeah. So when she wrote this book and designed this approach, she has a lot of personal and professional experience with it, which is really, really cool.

So she, her son had a lot of issues and she really found this medical team that really supported her and her family really well. And then, um, you know, she started working on the approach as well, like developing this approach, things that [00:25:00] worked. Um, and it's an approach to treatment that really helps to introduce new foods by building on the successful eating experiences that the child has had.

Kate Grandbois: Okay, that makes perfect sense. I mean, in terms of everything we do, you know, zones of proximal development mm-hmm. Using strengths in, in treatment to tackle, you know, areas of deficit. It makes perfect sense to someone who knows nothing about feeding, swallow 

Tracey Callahan: Well, that's sort of what I like about these particular approaches is because as you're reading it, you're going, oh yeah, that makes perfect sense.

Of course you would do it like that, but these, uh, two approaches went beyond the, oh, that makes sense to, let's make sure that it works because there's a difference between what you think will work and proving that it'll work. Um, those, that's why the evidence 

Amy Wonkka: is so important, 

Tracey Callahan: and especially when we're [00:26:00] thinking about eating, it's, it's a nutrition thing and that's really, it's an important, um, thing that children need for survival.

Um, so if you are, um, treating it. You need to be making sure you're treating the feeding and swallowing with something that's gonna be successful. Um, so I would encourage your listeners to take a look at this book. I know that it's available, um, online because I found it pretty easily. So if you were to just type in, you know, food chain, the proven six step plan to stop picky eating, solve eating problems, and expand your child's diet, you would find it, you could also just type in food chaining and then, you know, if you forgot the long name and you'd say, oh, there it is, it's right there, there is that 

Amy Wonkka: long name right there.

Tracey Callahan: Yeah. And, uh, it was, it was written the year I, I graduated grad school, so. I know. I was like, oh, facts. That was a good year for me. Yeah. Yeah. Um, so, uh, this particular method, food chaining, [00:27:00] um, she developed it with an 11-year-old boy. So I know some of the other methods that I talked, well, the first method that I talked about, Sophie, is really for the nicu.

Announcer: Mm-hmm. Um, 

Tracey Callahan: but SOS and food chaining, they can be used really across the lifespan. And she developed it with an 11-year-old boy, which I think is really interesting. 'cause a lot of the techniques I find are either with adults or with young kids, and then they're sort of adjusted for the different ages. Um, and this particular boy was a picky eater and he became more and more selective until he was only eating peanut butter on white bread and milk.

Poor little guy. Yeah, that's not a lot. Um, yeah and um, so I'm not sure if our listeners remember the difference between a picky eater and a problem feeder or Kate. Um, if you maybe know the difference, but, um, I can go over that. [00:28:00] It's, uh, 

Kate Grandbois: no one can. I think that would be me, but my eyes just as nuts. 

Tracey Callahan: Alright, Kate, what's the difference?

Um, no, so the difference there are different. If I answer that question, they'll 

Kate Grandbois: take my license away. 

Tracey Callahan: You can't ask me things like that. Um, so a picky eater is someone who is selective about foods and they're probably eating 30 or more foods, whereas a problem feeder is eating fewer than 20 foods and that that's a problem.

Yeah. Um, picky eaters will eat certain foods for days at a time and then, um, they won't accept the food. You take a break. And you bring it back in and they'll eat it again. Whereas a problem feeder, um, once a food is rejected, especially for a long period of time, it would be very difficult to pull it back into the cycle, their repertoire of foods that they're willing to eat.

And, um, a picky eater, um, [00:29:00] may not have, um, an underlying medical condition, but there may be some reflux or some mild sensory issues. Um, but often for a problem feeder, there will be something going on, maybe a more severe reflux or something like that. And then a problem feeder will may also reject an entire group of food.

And so when we're thinking about the kids that are being referred for therapy, you know, there may be some picky eaters, um, but really they probably started as a picky eater. And moved into being that problem feeder or, you know, just went straight to problem feeder. 

Amy Wonkka: That's interesting. Well, that sounds like this, this guy who she developed the treatment with, you know, he started off picky and then, I mean, he's not eating Makes sense.

Any fruits. He's not eating any vegetables. You know, he's, he has a very limited peanut butter, white bread and milk. 

Tracey Callahan: Very limited. Yeah. And, um, one of the things that I, I [00:30:00] see a lot in the therapy that I do is these kids that get very dependent on milk because they were able to be super successful maybe with breast milk or formula and then, okay, it's similar, it's a liquid, the color is similar.

And then they, they'll get really stuck on milk and they'll drink a lot of milk or most of their protein and calories is coming from milk. And then one of the reasons why it's important to have a feeding team approach. For the medical piece because if you have a kid that's just drinking a ton of milk, you know, their weight might be okay, but they, they might not be nourished.

There is a difference there, right? He might not be, he or she might not be getting all of the nutrients that they really need. And the other thing to be concerned about if somebody is drinking a ton of milk is anemia. And so that's something that would be pulled in from the feeding team, [00:31:00] um, and something definitely to consider.

Amy Wonkka: Um, so is there anything that you need to do before, like if you're thinking about your clients and you're like, all right, maybe this food chaining thing, I'm gonna learn more about it, it might be a good fit. Is there anything that you need to kind of do before that? 

Tracey Callahan: Yeah, so, uh, similar to to the SOS approach, there is this idea of figuring out what's going on before you get in the room.

So, uh, to think to our learning objectives, the factors to consider before you start treating it would, it would be what they call pre chain in this particular, in this particular treatment. Um, and so is there an underlying cause behind the feeding issues? So is it medical? Is it, you know, is there something nutritional going on?

Is it swallow, is it sensory? And then, um, based on your evaluation that you do, [00:32:00] you create this sort of, um, sensory framework. 

Announcer: Hmm. 

Tracey Callahan: Um, and in the sensory framework you are evaluating the five senses as they relate to feeding. That makes sense. Yeah. You're gonna say that a lot, that a lot things. I think I have say that a lot.

Makes sense. Yeah. Because, you know, it should make sense, right? Yes. What, what you're doing, um, you know, how you're treating it should, should be something that you could track and follow. Says okay, yeah, that, that makes sense. Um, so the sensory framework, it's gonna be, um, similar in the sense, uh, to os as you're going to see how is the child processing, so how are they registering when they see it, when they smell it, when they taste it, the texture.

And you're gonna look for patterns. Um, which is, for me the most fun part is looking, looking 

Announcer: at the data. [00:33:00] Yes, yes, yes, yes. Virtual five. 

Tracey Callahan: I love that. Um, so you, um, you get, figure out what those patterns are. Mm-hmm. And um, for me, I figure out what the patterns are by um, sort of two processes. So one is I'm not going to be able to feed this child every single food.

It's just there's not enough time. And that actually sounds miserable to force a child to taste and then, you know, check off how it went. Right. Um, but what I do is I have a checklist that I give to parents or maybe to teachers, depending on what the setting is, caregiver, what is the child eating, what is he not eating?

And one thing that I really like to do that's fun is that I will, I'll give it to the family, then I'll give it to a different caregiver and I will compare the two. Yep. Because sometimes what they eat for mom, they won't eat for dad or vice versa or what they eat. [00:34:00] Annie is different than what they're eating at school is different than what they're eating at home, um, with the parents.

So all of that's really important when mm-hmm. You are figuring that out. And then you create your pattern, you create what they call that sensory framework, um, as it relates to the five senses. So, um, are they tolerating smell, or are they not? Are they tolerating touch? Um, can they be in the same room as things?

Um, are they only wanting, um, milk and, um, they don't want any other liquids, is it, uh, where, where is their tolerance not only just for food, but also food groups? Are they mm-hmm. Are, are they eliminating an entire food group? And we see that a lot and even with some of our picky eaters, I know. Um. My children definitely went through this really fun [00:35:00] phase of, you know, it's chicken, chicken nuggets and french fries.

Um, and that sort of, uh, 

Kate Grandbois: my children are still in that phase and my children are older than your 

Amy Wonkka: children. 

Kate Grandbois: French fries are amazing. I'm 

Amy Wonkka: just gonna put this out there, like they're 

Kate Grandbois: not maybe great for you, but delicious. I've probably done all the wrong things as like a, because again, I know so very little about feeding therapy, but they, they will, they won't eat beef, but they will eat brown chicken if I tell them that it's brown chicken because of the, you know.

Tracey Callahan: So it like rigidity, like it seems like, Kate, that you might be food chaining me. Hey, no. Good. Look at that. Good. Yeah. So Makes sense. So we're, we're gonna do a callback to that in a second. 

Kate Grandbois: Okay. I better pay attention. I'm paying attention. 

Tracey Callahan: Okay. Um, so with food chaining what you're gonna do is this concept of flavor mapping.

So analyze the preferences, look at the patterns, [00:36:00] because one of the patterns might be color, that they're accepting a lot of foods of a particular color. 

Kate Grandbois: Interesting. 

Tracey Callahan: Um, and another, uh, technique is flavor masking. So, for example, our kids out there that just love them, some ketchup, if you put ketchup on it, they're going to at least interact with it.

Right. Um, I mean that's at least a strategy that I've used at home. Yeah, totally. Yeah. Um, with my, with my own kids, but they just love ketchup. 

Kate Grandbois: There's a really cute children's book about this. The name is totally escaping me. Um, where he's a little, does anybody know he's a prince and his parents, he won't eat anything.

He refuses all foods. I feel like I need to now find this book. And they take him all over the world. It's a king and queen and he discovers ketchup and then all of a sudden he will eat everything. 'cause he just puts ketchup on it. Would you say that it's the Prince's breakfast? Yes, that's what it's 

Tracey Callahan: called.

A really 

Kate Grandbois: easy internet search. [00:37:00] Solved that one. I also have the internet right in front of me, but I didn't think to do that. Well, it was a, 

Tracey Callahan: it was a very good description. I basically, it's a very, very cute book 

Kate Grandbois: in case anyone's looking for a cute, a, a children's book to go along with this theme. 

Tracey Callahan: Well, it seems like I might also need to, um, put that on my wish list.

Um, so flavor mapping is analyzing the preferences, looking for patterns. Uh, flavor masking is going to be, um, figuring out flavors that are accepted. Um, and then you can use those flavors to bridge to new foods and, um, using this sort of as a chain, um, between, um, the old, like a, a old preferred food.

They've had a lot of positive experiences with it, they enjoy and to a new food. Um, so it makes the new food a little bit less scary. 

Amy Wonkka: So that's like the ketchup prints, right? The ketchup, yeah. That's what they're doing with the ketchup guy. Yes. 

Tracey Callahan: Yeah, exactly. So I think it's something that a lot of speech [00:38:00] therapists and some of us moms and dads and caregivers out there maybe have figured out.

Um, but they sort of pull it in and use it as part of their, uh, treatment approach. And then the other, um, sort of technique they talk about is the use of, um. Favorite foods to encourage. So, you know, take a, take some of the old food, some of the new food, have lots of foods available. So it's not like all just on the plate, it's just that food that they won't eat.

So if the child won't eat broccoli, for example, but really loves cheese, you know, both of those things are going to be on the plate. So, um, I've used a lot of different dips dressing. One that's really interesting is the idea of a seasoning like cinnamon. Um, that one you can bring in because it has a pretty strong flavor.

Announcer: Mm-hmm. And 

Tracey Callahan: you can put that on apples, that you can put it in yogurt and if you flavor it, um, and when you think about the sensory experience, you know, it'll smell like cinnamon. [00:39:00] The color will look like cinnamon. Um, it'll taste like cinnamon. The texture will be different. But you are, um, including a lot of these factors to make the new food similar to a, an enjoyed food.

And then That's very cool. Yeah, I, I, I like all of these approaches and I use them all the time, um, in the therapy that I do. Um, and then one tip, I, I actually heard a different podcast is called First Fight Fed Fun Functional with Michelle Dawson. And the episode is episode 69 episode and it's called Food Chaining with Cherry Breaker, M-S-C-C-C-S-L-P, clc.

She talked about the use of a pain scale, which I'm obsessed with. That is interesting. Interesting. Well, I love pain scales. I worked in the hospitals quite a bit. Mm-hmm. And one thing that I think is important, we touched in one of the other, uh, podcasts, was that what. We would [00:40:00] consider to not be pain. A child might be considering pain.

Announcer: Mm-hmm. So true. Depending 

Tracey Callahan: on what their level is. So they might be scared, but they might be processing that pain. And it's important that we give them the ability to communicate that to us. And when you give them a scale, you can figure out how bad is this food for them and is it only a little bit bad?

Is it a lot bit bad? Is it terrifying to them? To the point where maybe we're causing them, um, discomfort and pain, um, figuring out, you know, what that level is. And there's a lot of different pain scales out there that you can customize. And there's a new pain scale that I found that I am, I'm gonna say obsessed again, obsessed with, which is a vertical pain scale.

And I think a lot of our kids are familiar with like things going up stoplights. Red is, is stopped. Green is gold. Yeah. 

Kate Grandbois: I have a vague recollection that somewhere [00:41:00] sometime I learned that developmentally you scan vertically before you scan horizontally. Can anyone confirm, deny that information? I didn't.

I can 

Amy Wonkka: ask the internet. 

Kate Grandbois: We're asking the internet a lot today. Yeah. And we can ask if any listeners out there know the answer to that question. But anyway, it's irrelevant because that's a really interesting way to present a pain scale, I think. 

Tracey Callahan: And also it could depend on what the visual abilities of your student are because mm-hmm Some people might not have the ability.

They might have left neglect, and if you just put it vertically, it makes a big difference for them. Um, but one of the new pain scales, it's called the Outer Pain Scale. It's by, uh, bear. Um, and it includes different pictures with, um, with ethnic diversity, which I think is super important. So if, and it includes real pictures versus the sort of doodle, because when you think about when [00:42:00] somebody is, um, getting really red or if they're getting pink, it looks different in different people.

Uh, eyes look different, mouths look different, and children can pick the one that they feel best represents them. And so when they're talking about what their pain is, they're using, um, pictures of something that really represents them, and they found that this can help kids to better kind of communicate what's going on.

And so if people were to, uh, and I'll include the link, there's been some studies around that that I thought was really interesting, um, that we should be doing that we probably haven't been doing. 

Kate Grandbois: Um, that's, that's so interesting. I don't think I ever would've, I don't know. It makes a lot of sense, but again, I, I'm such a robot, but you know, these things are very logical.

But unless you are really doing this kind of feeding and swelling work on a regular basis and really entrenched in it, I'm not sure that. Or maybe other people are naturally making these connections and I'm just, and I'm just [00:43:00] not. But that's okay too. 

Tracey Callahan: Well, I think that there is a jump with speech to say, oh, pain scale, that's something you do in PT with stretching and AFOs.

Mm-hmm. Or bracing. Um, but no, because kids, especially younger kids, that's the way that they are, um, processing it. And so for them, it, you know, fear might be pain, but they could also have physical pain, um, when they're swallowing. And if they are, they need to have a way to communicate that to us. Or we need to help them identify that that's what's going on, so that we can alleviate that.

Because if they're in pain and it's because there's a certain food that's causing them reflux, or maybe they have an allergy to it. I know that, um, my husband, if he eats too many Kiwis, his tongue gets really like kind of itchy, you know? But if, but if he's a, if he's a kid, he's be, he'd be like, ouch, my, my tongue hurts.

Mm-hmm. Right? Um, and we need to track that because if there is an allergy, we need to figure that out. And maybe we don't let [00:44:00] him eat 20 kiwis. 

Announcer: Yeah. That doesn doesn't sound like it's a, 

Tracey Callahan: sorry. Um, but I'll make sure to include that in the link. So, um, you know, and they're all different pain skills. You can do Legos, you can do cartoons, you know, whatever is talking to the kid.

Um, and then the other thing that she talked about in this podcast was to talk about anatomy with kids. 

Announcer: Mm-hmm. 

Tracey Callahan: Um, which is something that I do sometimes, but I don't know if. A lot of people do, and I really feel like I should probably doing it more in my own practice because some kids are scared that when they swallow, they won't be able to breathe.

Mm-hmm. And so we talk about the idea that there are two elevators, which I really like. Um, so one for breathing and one for food. And so when you're eating and when you're swallowing, you are not going to be, um, blocking that up because some kids, you know, if they have difficulty with, um, [00:45:00] swallowing in the esophageal phase, that they're gonna be able to breathe, that they're gonna be okay.

Even if they're having some pain there. 

Announcer: Yeah. Um, 

Tracey Callahan: and also it gives them some language and understanding about the process that they're going through. And if we're talking about it with them, it's gonna be less scary and it's gonna, they're gonna be more open to it. And there are a lot of, uh, developmentally appropriate ways to go about that.

We're gonna kind of get into the nuts and bolts a little bit here of. So we talked a little bit about it last time and last podcast, uh, that we did, but I'll talk about it now again, where you start with preferred food and then you go from there and there's different steps. So you, the first step is to maintain, but expand the taste and texture a little bit.

So let's say you're starting with a cupcake. This is a good friend of mine. This is, this is her example. We, we did some food training. Um, so her daughter had, um, severe reflux and feeding, [00:46:00] um, difficulties and she would eat cupcakes, but not very much else in terms of bread products. And so what we did was we started with cupcakes and then we went to different brands of cupcakes.

Maybe now the cupcake is small mini cupcake. It's a big cupcake, um, with a different color wrapper, or maybe it's a heart shaped cupcake. Um, and then from there we went to vary the taste and maintain the texture. So it's a different flavor 

Announcer: cupcake 

Tracey Callahan: because she only wanted vanilla. So let's try chocolate or strawberry.

And then the next step you would maintain the taste and vary the texture a little bit. So like some sort of a vanilla or chocolate muffin. The texture is a little bit different there. And then from there, um, we varied the taste and the texture, and we threw in a blueberry muffin. Okay. And then from there, I see what you did there.

We got to blueberries, which was our target feed, because she [00:47:00] was not eating a lot of fruits. So we started a cupcake. And we ended with blueberry, which that is amazing. Wild to think about, but it totally worked. Now was it, it wasn't overnight, it took time. 

Kate Grandbois: Well, and I have to say I'm not, I, I can't really speak to the specifics, but there are a lot of, it's very easy to see that there are a lot of behavioral reasons why this works because you're pairing novel stimuli with stimuli that you already find reinforcing so that the new, the new texture, the new flavor gains, those reinforcing pro, it's just tall.

It makes perfect. Again, we should just rename this episode. It makes sense. It makes sense. It makes sense. Makes 

Tracey Callahan: perfect 

Kate Grandbois: sense. 

Tracey Callahan: It makes perfect sense. Um, so, um, I wanted to talk about a case study. If there's time. Is there time for us to chat about a case study? 

Kate Grandbois: I think so, yes. 

Tracey Callahan: Alright, great. Um, so this [00:48:00] particular, uh, case study that I'm gonna do.

Is, um, about a 3-year-old boy. So when I got the information, it said that he needs feeding therapy, period. Great, that's helpful. 

Announcer: Great. 

Tracey Callahan: Helpful. Um, and he has a history of moderate speech and language delay. Okay. And, um, that's what you get. That's what the piece of paper says. So step one, I need more information because I'm not gonna walk in there and just say, okay, is he verbal?

I don't know. Like, I need, I need more information. So thinking back to when we're thinking about these learning objectives, what are the factors that I'm going to consider before I'm even gonna start? Right. Um, so food chaining calls that pre chaining SOS calls that, you know, let's look below, um, that tip of the iceberg.

What's going on? I need to know what's going on. Um, so I send out two forms. So one has got the medical background and the other one [00:49:00] is feeding specific. I'm not gonna, I, I don't wanna see a child before I know this information because if, if, if there's something severe going on that is going to impact my ability to do an assessment, I need to know that before we start, there might be allergies, there could be an underlying medical condition.

And what if this moderate speech delay indicates that this particular child uses a device and oh, by the way, that device is broken. Um, geez. So what, what is it gonna be? And so this is the information that I wanna know before I go in and, um, I would encourage the school-based SLPs to get that feeding team's reports.

And any private practice, anybody, you're gonna wanna see what happened before I went in to see this kid. What, what worked, what didn't work? Or am I the first person to go in there and this poor child is three? [00:50:00] Am I the first person to take a look and say, Hey, what's, what's going on here? Um, and so that, that's really the first, the first step.

And then, um, then I start to look for breadcrumbs. That's sort of how I like to think about it. Um, that makes, 

Kate Grandbois: it, makes 

Tracey Callahan: sense. 

Kate Grandbois: Oops, I gotta come up with another phrase, but you're leaving bread crumbs. Crumbs for me, Tracy. That's what's happening. I'm following the bread crumbs. 

Tracey Callahan: Well, yeah. And, and so you say, all right, here's where we are.

I need to go backwards to figure out what's going on. And I keep going backwards until I hit that infant stage. So I'll say, how is infant feeding? How is transitioning to solids? And then I wanna look at the who, the when, the, where, why of what's going on right now. Who is eating with the child? When are they eating?

Is it frequent snacks? Is it. Meals, are they scheduled? Um, where, where is he seating? Is he moving [00:51:00] around? Um, one kid I worked with only wanted to eat in the car, and that's, that's just not functional, you know? Um, and then why is the family, um, feeding in that manner? And why is now all of a sudden it's a problem?

Because, um, sometimes families will feel like they've managed well up into a certain point, and then, then they need help. And then I always ask, is eating enjoyable? Right? Because it should be. And how stressful is it? Right. And back to numbers. I like meal Likert scale. Fine. 

Kate Grandbois: Data, data, data. Um, so I, I'm gonna make up a data song.

Amy Wonkka: Yeah, you should 

Kate Grandbois: like a 

Tracey Callahan: little jingle. Um, so sorry. How, how, so I'll give a question. I like, you know, a, sorry, a statement. I like meal times with my child. My child likes mealtime. Mealtime is not stressful for me. My child eats a variety of foods. I feel that my child is being nourished. I don't worry about my [00:52:00] child's, uh, food intake.

And I'll have parents scale that, you know, zero to seven. And that's also baseline data, you know, and that could be given to a teacher or to a teacher's assistant, whoever's working with this child. 

Kate Grandbois: Any 

Tracey Callahan: stakeholder. 

Kate Grandbois: I mean, you think about it 100%. Chances are, I know we had said, this also said this in a previous episode, but you know, a lot of the people that we work with in our profession do have a variety of complex needs or underlying conditions.

So chances are this child has other ot, PT teachers, tutors, you know, you name it, there's, there's, there are other pe, there are other stakeholder holders involved. 

Tracey Callahan: 100%. And then if there are multiple caregivers that are feeding the child, I wanna give this to all of the caregivers, right? That are all, all the stakeholders that are gonna be feeding the child.

So if I am not gonna be able to see the parents because I'm going into a daycare or a school setting, then I'm going to put this on that [00:53:00] form that I'm giving out before I go. And I see the child, um, most often personally, I'm able to talk to parents about this. Mm-hmm. Ahead of time. Um, but if it was a setting where it, that was not possible for whatever reason, you can put that on the form.

So, um, that step one, that case history, this is the stuff I need to know before going in. Um. And the, the case study that I'm talking about right now, um, this, this guy had feeding issues since day one, could not breastfeed, difficulty with bottle feeding, difficulty with latching, only able to bottle feed laying down.

So not side lying, only laying down. Um, and when you think about how much gravity needed to be in that process and awkward, have you ever tried swallowing, laying down? It's really hard. I can't, I don't even know if I could. That seems like it'd be hard. Yeah, it's, it's not. It's, and and is [00:54:00] that, was it pleasurable and was it enjoyable and no.

The whole time. No answering, no. Yeah. But this is, this is really stressful. And you know, when you're thinking about bonding as well, you know, that's a time where you're bonding. And if it's really stressful, you know, speaking from personal experience, both of my children had difficulty with feeding and swallowing.

Lots of reflux, lots of pain, weight gain issues, failure to thrive. You know, that's a really stressful experience. So, you know, it's important to kind of look at that too. Um, and, you know, all over the place. Sometimes he's eating, sitting down, sometimes he's not eating at all and lots of milk. Um, and so step two, I did my eval.

I'm looking at the oral phase, the pharyngeal phase, and um, you know, looking at the sensory components to those phases as well. 

Announcer: Mm-hmm. So, 

Tracey Callahan: um, just to state again, kids with a feeding disorder [00:55:00] often have some sort of underlying swallowing disorder and to call back to that episode of First Bite, um, where Sherry f Franker was on there, she was even saying that's been her experience too.

Announcer: Mm-hmm. 

Tracey Callahan: And I know in past, um, podcasts that we talked about, Kate, you had asked, you know, does one come first or, um, but I really feel like most, there's a really big overlap. Mm-hmm. I would say that it's, it's rare that I have a kid that's just feeding and everything else is going really, really well.

Mm-hmm. Um, so I've looked at the oral phase, you know, how are they engaging with it from a sensory perspective, how is his breathing looking for signs of. Stress Is he holding his breath when the food comes in? Because that's a technique that kids have figured out. If they don't like the smell of it, they can just hold their breath.

Mm-hmm. And then they don't have to smell it. Are they not looking at it? Is their whole [00:56:00] body turning away? Um, and then the big question is, is it different at home than at school? Yeah. And which environment is better? And what's, what do you think the difference is? And then how can we kind of adjust that?

And so, in my case study, um, you know, he was munching, sort of like you think about Pac-Man, like just, you know, like, and you just stick the food in like a carrot, like a bug bunny type of a thing. Um, on the front. Yep. Limited lateral jaw movement and then holding food in his mouth. And as I'm taking a look at this, I'm saying, is he savory?

'cause it's really, really yummy. Is it a motor planning thing? Is there a dysfunction? Um, this guy's not moving it from the front of his mouth to the back of his mouth. And I'm wondering, is this fear or dysphagia? Um, it, it could be both. Um, and limited bolus control, limited tongue movement. Um, and then I'm [00:57:00] gonna throw some jargon, uh, here, Kate, moderate piecemeal delution.

So there's a lot, you know, he's going to swallow and then that whole bolus isn't going down and there's oral residue. I was, 

Kate Grandbois: nobody can see me cringing and making very confused faces when you say those words. 

Tracey Callahan: Those are words that, you know, it just, they sound smart, right? 

Kate Grandbois: They do. Can you wanna say it again real slow?

Say it one more time. Sounds like grad school, 

Tracey Callahan: moderate piecemeal. Delution. 

Kate Grandbois: Delution. Yeah. Done. 

Tracey Callahan: Okay. I, um, learning all kinds of stuff today, you know, this guy's pocketing, um, and then we talked about how kids pocket in different areas. Where's their secret hiding spot? Um, this particular guy, he liked right behind the alveolar rich because if you told him to open his mouth, uh, oh, there you go.

And, um, I'm tipping my head down. So when you look, I was gonna say, look, you can't, it doesn't look like there's anything in there. You head down, down, if you have something [00:58:00] stuck 

Kate Grandbois: behind your Alveo ridge, tip your head down. Nobody's gonna see a thing. Yeah. 

Tracey Callahan: And, 

Kate Grandbois: uh, 

Tracey Callahan: and he very smart. I was like, oh, you, you've gotten smart about hiding it.

Um, and he was, he was better at school than he was at home. Much better. Um, and, um, so then I, I. I wrote goals with the parents. That's awesome. Yeah. So we wrote goals and we, they really wanted fruits and vegetables. Yeah. 

Kate Grandbois: And this is another great example, again, tying back to our goals and objectives episode.

Yep. The importance of considering stakeholder input when writing your goals and objectives. I think that, that, that's awesome. 

Tracey Callahan: That's 

Kate Grandbois: so great. 

Tracey Callahan: So with him, um, to talk about that example again about the food chaining that we did with him is, you know, he was, um, really liking, we'll say, uh, he was a carb kid, loved, um, pouches.

How he got his fruits and vegetables was pouches. Mm-hmm. So, you know, [00:59:00] like the, the classic like apple sauce. Apple sauce, yeah. You take the top off and you squeeze it in your mouth. Mm-hmm. And it was just like, shoot it right back and swallow. Yep. You know, so the, there's not a lot of sensory work in that.

And so what we did with him is we did some food chaining with that. So we started with the apple sauce. He only would eat one brand of these pouches. So then we said, okay, let's try apple sauce with a different brand pouch. 

Announcer: Mm-hmm. A different 

Tracey Callahan: size opening a different hole. And then let's move to a different flavor of pouch.

So maybe Kiwi, apple, I'm stuck on kiwi today. Kiwi apple. And see how that goes. And, you know, it took a while, but we did some food chaining, um, from there and to eating apples for him, which was a huge goal for parents because they felt like they could give their child something that was healthy. And, uh, you know, if.

Whole Foods is out of pouches, then they're not worried about how their [01:00:00] child is going to get the nutrition for that day. Right. Um, and then, um, he was not wanting to touch any of the foods initially. So we have this sort of garbage bin. So if you don't want it, you can, you can pick it up and you can put it in the bowl and say goodbye to it.

Right. 'cause even just the process of picking it up and saying goodbye to that particular thing, you've touched this thing that you don't really like. And over time it. Yep. Oh, I love that. Um, and then the other thing, you know, once he liked the apples, we cut those into sticks and we used peanut butter and so we got him interested in apples that way.

Sorry, in peanut butter that way. So you dip the apple stick into the peanut butter. And you know, he pretended to eat around it. And then eventually you interact with that peanut butter and now we've got that transition food that we can use with lots of different things. So it's the ketchup. It's the ketchup, right?

It's [01:01:00] the fruit ketchup. So, so great. So in schools it might need to be sun butter. Mm-hmm. Nuts aren't allowed. Um, but it's something that we did with a lot of success. So thinking about this particular guy, you know, I wouldn't say that he has, you know, 50 foods or so, but he definitely is now eating some fruits and vegetables.

And really for family and for the teachers working with him, that was really important because on days where there wasn't any food that he liked, any of the two foods or three foods, then is he not, is he not going to eat? Right? And so that was quite a big relief for everybody that, okay, now we at least know that we can get some food into him and he's not gonna be reliant on milk for the whole day.

Amy Wonkka: Oh my goodness. Yeah. That must be such a relief. 

Tracey Callahan: And seriously, it's, it's such a great feeling to be able to Yeah. Write this super functional goal. Yeah. And to really support this kid and his team [01:02:00] and his family, and to helping him achieve that goal and to be able to do it without instilling, um, you know, fear or anxiety.

So I implemented parts of all of these, well, the two approaches, the SOS approach, and then food chaining to figure out a customized program for this guy. Um, that was really helpful. And it's family friendly and it's teacher friendly, and, um, and it works really well. 

Kate Grandbois: I love having you on this show because you clearly enjoy this discipline so much.

I think it, I think that really shows, I, I always learned, I always learn a lot, but I feel like this, this one really made sense. I had to throw it in one more time. I had to throw it in there one more time. Is there, is there anything else that we can offer our listeners before we wrap up? 

Tracey Callahan: Um, I would say, uh, two other tricks to the trade are social stories.

Social stories are [01:03:00] your friends. I often make social stories for all of the kids that I work with, that we read at the beginning of the session. Um, and then the other thing is that, uh, building rapport, I can't, I really cannot stress that enough. All different approaches really feel that building that rapport is super important.

Um, important when working with any kid, but kid, especially around something as emotionally charged as eating and swallowing. 

Kate Grandbois: So emotionally charged, so deeply rooted in social interaction and family life and leisure and it so important. 

Amy Wonkka: It really does go across everything, and it's something that really does need to be an interdisciplinary approach to treatment as well.

You know, it's a team effort, um, and, and so impactful, 

Tracey Callahan: um, and the approaches that I talked about today. Um, you know, again, I am not personally trained in these approaches. There are things that I've learned about, um, through either [01:04:00] continuing education that I've done or work on the internet, but I would again, encourage your listeners to go out and, uh, look at these websites for themselves for more information and for more specifics on it.

Today, I was just trying to give some general information again and pique their interests. 

Kate Grandbois: That's great. Thank you so much, Tracy. All super helpful. Tracy. Thank you so, so much. Of course. Like I've already said, we love having you. Um, to all of our listeners, if you have any questions, please feel free to send them along [email protected].

If you were driving or cooking or cleaning and weren't able to take notes, there are handouts available on the website and you can access all of the online resources and references that we used in this episode for free on the episode page. Am I forgetting anything? No, I think you did a great job. It all makes sense.

I did very little. I think Tracy's the one who did the great Did. Oh, I see what you did there. I see it. I missed it at first. Funny, funny, funny. Oh, I [01:05:00] think that means we should probably be done. Thank you everyone so much for joining us and we hope to hear from you soon.