The Importance of Mealtime Routine for Children with Feeding Difficulties


Many children who have difficulty with feeding from a sensory standpoint have a fear of the unknown. A child may fear a type of food because it is an unknown or non-preferred color, texture, smell, flavor, or sight of food. Giving children an opportunity to know exactly what to expect during a mealtime through utilization of a mealtime routine can minimize the fear of the unknown in feeding.

Getting Started

For sensory feeders, start mealtime with hand washing using a plastic shoebox sized tub of warm water with dish soap. Let your child splash in the water, play with the bubbles, and wipe their hands on a paper towel or washcloth when they are finished.

Introducing Food

After this, begin by introducing a preferred food to your child.  Presenting a child with a preferred food helps them to know that they are in control and that they will always have a food present on their plate that they are comfortable with. Next, present a child with a non-preferred or sometimes-preferred food that they can choose whether they want on or off of their plate – again, re-emphasizing that the child is in control of the food being put into his body.

Modeling Positive Interactions

Utilize positive mealtime language during mealtimes and model your own comfort with different food items by touching, smelling, and talking about interactions with different food items. Get creative! Turn your carrot sticks into cars and make them drive around a plate or up your own arm like a race track. Show your child how you can make bite marks in your food without actually taking a bite.

End of Mealtime

When it is time to finish eating, take turns placing one item of food into a designated “bye-bye bowl” at a time. Encourage interactions with food at the level where the child has demonstrated the most comfort. For example, if they take a bite of applesauce, have them take a bite of applesauce and place their spoon in the bowl. If they only tolerate touching a cracker, have them break it in half and place it in the bowl. Some families find that a reward at the end of mealtimes can also be a helpful incentive. Try giving a sticker, blowing bubbles, or playing with special toys designated specifically for post-mealtime play.


            The creation of a mealtime routine can revolutionize the way that your child interacts with food. Mealtime routines can also help children to be able to interact in a more comfortable way with both preferred and non-preferred foods by helping them understand the clear expectations of positive interactions with foods by utilizing verbal and visual models. 

-Laura C. Kinney, M.S. CF-SLP

**If you have any concerns with your child’s speech, language, hearing and/or feeding development, please contact Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love to meet with you and discuss options for your child. **

Language Development in Bilingual Children

Some parents we have come in contact with over the years ask us, “Should my child be exposed to multiple languages?” Approximately 20% of the U.S. population is bilingual, with most people speaking Spanish and English. At one of the schools I serve in Tennessee, 52% of the students are Hispanic. Many of them speak Spanish or at least have exposure to the language. Below are the stages of learning two languages simultaneously, and what to expect regarding speech and language. 

Stage 1

In the first stage, children may have different language systems, vocabulary in particular , that they use whether due to context or functionality. Approximately 30% of bilingual toddler vocabularies are comprised of the same word in both languages such as cat in English and gato in Spanish (Nicoladis & Genesee, 1996). However, the other 70% of their vocabulary has words that are only known in one language which is why a Spanish word could be used during a conversation in English. There is some evidence that learning two (or more) languages delays children’s discrimination of speech sounds in words (e.g. big vs. dig), but the delay is very minimal.

Stage 2

With stage two, the child has developed two separate vocabularies but may apply the same syntax, or rules regarding grammar, to both languages. As with any child, the simpler sentence structures will be learned first before ones that are more complex.

Stage 3

At this stage, the child has two separate vocabulary and grammar systems. There still may be some crossover between languages, but it is primarily confined to grammar errors. A child, if there is constant exposure to both languages, tends to reach this stage around age seven.

It has been suggested that learning two languages can be confusing and detrimental to a child; however, research has not supported this notion. In fact, according to the American-Speech Language Hearing Association, the benefits of bilingualism include: learning new words, learning reading skills, coming up with solutions to problems, listening to others, and connecting to others. By exposing a child to multiple languages the child gains insight into another culture. In regards to speech therapy, a child who is bilingual can have speech and language problems just like other peers. If there is a speech or language disorder, the errors should be observed in both languages. A trained speech language pathologist should able to recognize a disorder versus a difference based on the combination of two languages.


Nicoladis, E. & Genesee (1996). Word awareness in second language learners and bilingual children. Language Awareness, 5(2), 80-89.

Owens, Jr., R. E. (2012). Language development: An introduction (5th ed.). Boston, MA: Pearson Education

The advantages of being bilingual (n.d.) Retrieved from

-Erin Norwig, M.A. CF-SLP

**If you have any questions concerning your child’s speech and language skills, please contact Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love discuss options for your family. **

Traditional Articulation Therapy Explained

You know your child is receiving services at school to work on their speech sounds, but every time you ask your child what they do in therapy, they say, “we work on making funny sounds” or “we just say words and play”. What is your child doing in therapy all day?

Articulation therapy or speech sound therapy is working on the placement of articulators (lips, tongue) inside of their mouth to correctly produce their sounds. To master these sounds, speech language pathologists will break down sounds into 7 different levels.

  1. Isolation Level: If possible, without adding a vowel, your child will work on producing the correct sound in isolation (ex. s or t)
  2. Syllable Level: At this stage we add vowels either before or after the sound to practice making the target sound (ex. ko, koo, kay, key, ki). This helps them put their articulators in the correct placement making the correct sound.
  3. Word Level: Here the target sound is introduced in single words at the beginning, middle, and end of the word (ex. /k/: cat, jacket, back). Many different sounds affect our ability to produce the target sound correctly when its position in the word differs.
  4. Phrase Level: Now that your child has mastered the target sounds in words we add a few words together including a word that contains the target sound in the beginning, middle, and/or end (ex. the black cat).
  5. Sentence Level: Here the target sound will be addressed in grammatically correct sentences (ex. The black cat sat on the wall).
  6. Reading Level: Speech language pathologists may skip this level. Usually this level is addressed when the child is having difficulty carrying over their skill from the sentence level to conversation.
  7. Conversation Level: At this stage your child has almost mastered the target sound. We observe your child producing the target sound correctly during games, conversations, and other tasks, correcting their errors as they occur.

Conversation level can be the most crucial part of determining a child’s readiness for discharge from speech therapy. This level involves a child no longer needing “cues” or “reminders” to correct their speech, but rather requires the child to monitor and correct (if needed) their own speech. It also involves a variety of conversational partners, in various settings, and therefore carryover of their newly acquired speech skills is crucial. After a child has mastered the conversation level in therapy, they may be observed in a classroom setting to ensure that the sound has generalized or that they are successful in using the sound correctly outside of the therapy room. If successful, they will be discharged from therapy for the target sound.

If you continue to have questions about what your child does in therapy sessions, you should speak with your child’s therapist for more detailed information!

Natalie Keller, M.A., CF-SLP

**If you have any concerns with your child’s speech, language, hearing and/or feeding development, please contact Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love to meet with you and discuss options for your child. **

Apraxia-What Is It and How Can I Help?

What is Apraxia?

Apraxia is when a child has difficulty making the movements to produce sounds. The child knows what he/she wants to say; however, the brains ability to tell the muscles how and when to move to form speech is interrupted. Your child needs speech therapy to learn how to plan movements and how to make the movements to produce speech. The goal of therapy is to make speech more automatic. Think of it like riding a bike, at first you have to think about all the different movements you need to make to ride the bike. Once you have practiced multiple times, you no longer need to think about what you are doing it just becomes automatic. With apraxia, the more practice with the movements needed for speech the more they become automatic and easier for the child to produce.

How Can I Help?

Simple CV, VC, CVC and CVCV words are a great place to start for kids practicing movements to create sounds and words. Kids with apraxia benefit from using all of their senses to better understand placement of sounds. Having them watch your mouth to attempt to imitate what your mouth is doing, using finger placement cues on your face to help them understand what their tongue and lips should be doing (i.e., touching lips to produce /b/ sound) and using hand movements to understand how to produce sounds (i.e., sliding hand down arm while saying /s/ to demonstrate the continuous flow of air) all help them to grasp the concepts better.


Some great resources to learn more about apraxia and for free materials to practice with your children at home can be found at these websites:

Alexis “Lexie” Jones M.A. CCC-SLP

**If you have any concerns with your child’s speech, language, hearing and/or feeding development, please contact Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love to meet with you and discuss options for your child. **


FAQs About Your Augmentative and Alternative Communication (AAC) Device

Want to know more about Augmentative and Alternative Communication? Read on! 

Q: AAC…what does that mean?

A: AAC is an acronym for Alternative Augmentative Communication.  The 2 A’s in AAC are important to understand. The first A stands for Alternative. Meaning simply, an alternative method to communicate. If a child is unable to verbalize, then in order to have communicative exchanges, there needs to be some alternative. The second A is more overlooked and less understood: Augmentative. What do we mean by “augmentative”? Basically, it is used in a supplementary role. This means the child may have limited verbalizations but AAC is there to support the child in expanding their ability to communicate with a variety of people across many different settings.

Q: My therapist has started suggesting that we use AAC? What exactly does that entail?

A: AAC basically covers any type of communication that does not use verbalizations to communicate. This can take many forms, including (but not limited to): Sign language, objects, pictures, and speech generating devices.


Q: Has my therapist given up trying to have my child communicate verbally?

A: The very simple answer is: No. In fact, a recent study has shown that introducing speech generating devices may increase verbalizations in children with Autism (Schlosser and Wendt (2008)). But the fact is that a tremendous amount of growth in children’s communication skills happen from birth to 3. And for older children, being unable to fully communicate can lead to high levels of frustration, which in turn can lead to behavioral issues. If a child is struggling to communicate verbally, only working on verbal communication while not supporting the child with another pathway to communicate locks them out of a multitude of communication experiences.

Q: Will using AAC stop my child from communicating verbally?

A: No. When people communicate, we use the fastest, most efficient communication that we possess. If a child is able to get their message across verbally, that is what they will do. Using AAC requires more planning and more steps. For example, if a child needs to go to the bathroom, the easiest thing to do will be to say “potty”. The more complex task is to sign bathroom, find a picture, or use an icon on a device that says “potty”. But, if for whatever reason a child cannot verbalize the need to go to the bathroom, then ideally he or she will have another way of letting you know. From my own personal experience as a therapist, I have had children master high tech AAC, but use their limited verbalizations as well. And if the child can get their listener to understand their verbal message; that is ALWAYS what they use first.

Q: What is the best AAC to use?

A: There is no one size fits all, best AAC to use. Every child is unique in their abilities and their areas of need. What works fantastically for one child might be completely wrong for another child. All methods of AAC have pros and cons. You and your therapist should work together to select what is right for your  child.

Q: What different types of AAC are there?

A: AAC is often organized into 3 broad categories: No tech, Low tech, and High tech.

  • No Tech: Sign language, gestures
    • Pros: No cost. Available to the user at all times. No additional equipment needed.
    • Cons: Limited to the people who understand the signs and gestures. For example, the general population does not understand the sign for “more”.
  • Low Tech: Object/Picture Exchange
    • Pros: Low cost. Can use actual object representation or print out actual pictures of specific objects or use abstract symbols. Understood by a wide variety of people.
    • Cons: Difficult to transport. Difficult to have every symbol printed out and available at all times for every situation. Can be time consuming to use. No voice output.
  • High Tech: Speech Generating device
    • Pros: Voice output. Messages are easily understood. Can call out to people to gain attention/communicate with people who are not directly looking at the individual. Individuals get auditory feedback of their message. Can generally communicate a wide variety of messages (dependent on the device)
    • Cons: Wide range of cost. Devices can start at a couple of hundred dollars (generally these devices are limited in the amount of messages that they are able to communicate, such as devices found at: to thousands of dollars. More expensive devices can be explored through companies such as TobiiDynavox ( and Prentke Romich ( Some insurances will cover high tech devices. They can also be broken, not charged, or otherwise not available, then the individual will not be able to communicate.

Q: Does my child have master no tech/low tech AAC before getting a high tech device?

A: No. These classifications should not be seen as a hierarchy to move through. In my experience as a therapist, I have had many children-especially those with Autism- struggle with sign and picture exchange, but become highly skilled at using high tech AAC. Again, the system that you use is dependent on the child’s needs and should be chosen in collaboration with a Speech Language Pathologist. 

-Amanda Cox, M.S. CCC-SLP

If you have more questions regarding speech/language impairment and AAC devices, please contact contact Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love to meet with you and discuss options for your family.

Language Scavenger Hunt

Who doesn’t love a good scavenger hunt?  The best part about this particular scavenger hunt is that that you can do it from the comfort of your own home.  Did you know that you can target multiple language skills during a scavenger hunt?  I can think of five language skills off the top of my head—and yes, I am here to share them with you!

  • Object Function: a typically developing child should understand the use of objects between ages 3;0-3;5 and expressively tell how an object is used between ages 4;6- 4;11. Some ways to target object function while scavenger hunting could be:
    • Show me the object that (insert function).
    • What does (insert object) do?
    • What do you do with (insert object)?
  • Following Directions: a typically developing child should follow commands/directions without cues between ages 2;6-2;11. Some directions to follow while scavenger hunting could be:
    • Go to the kitchen.
    • Go to the bathroom and look under the sink.
    • Go to your room and sit on the bed.
  • Prepositions: a typically developing child should understand spatial concepts (in, on, out of, off) between ages 3;0-3;5 and expressively use prepositions (in, on under) between ages 4;6-4;11. Some examples of how to target prepositions while scavenger hunting could be:
    • Where is the spoon? (on the table, under the bed, etc.)
    • Place the ball under the couch.
  • Describing: for this skill, I like to start off describing an object by stating its category. A typical developing child should be able to expressively name categories between the ages 5;0-5;5.  Some examples of how to target categories while scavenger hunting could be:
    • A bed is a type of (insert category).
    • A hat is a type of (insert category).
    • Can you name two more types of clothing?
  • Vocabulary: your child’s vocabulary is continuously expanding. By introducing more and more objects each week, your child’s receptive and expressive vocabulary skills will begin to grow.   It’s as easy as that!

All developmental milestones were taken from the Preschool Language Scales, Fifth Edition basic developmental milestones chart.  See additional resources section below for more information. 

Here is a list of objects to get you started on your scavenger hunt: a napkin, scissors, crayons, a spoon, a key, a telephone, milk, a cup, soap, a bed, a hat, a chair, a ring, an apple, and a lamp.    When it isn’t raining, head outdoors and find some things around your neighborhood!Try mixing it up and add some new objects each week. Be creative, and HAVE FUN! 

Breann Voytko M.A., CCC-SLP

**If you have any concerns with your child’s speech, language, hearing and/or feeding development, please contact Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love to meet with you and discuss options for your child. **

Additional References:

Milestones taken from PsychCorp. (2011). Preschool Language Scales, Fifth Edition. Person, Inc.

Six Communication Tips for Speaking to a Loved One with Dementia

Dementia is a neurological disease that impairs the brain in areas of cognition, such as memory loss and judgment. As the disease progresses, your loved one’s social skills, such as carrying a conversation, will be impacted. Here are some helpful tips to successfully communicate with your loved one affected by this disease.

Communication Tips:

  1. Use normal tone instead of talking to them as if they were a child, slow down your rate of speech, and as appropriate, increase volume.


  1. Minimize environmental distractions when conversing, such as the TV or radio volume, or choose to engage in conversation in a quieter environment without other ongoing distractions.


  1. Increase your pauses and allow your loved one extra time to think and respond. They need extra processing time to understand and create a response. Try not to complete their thoughts or finish their sentences, but rather let them collect their thoughts and speak on their own. 


  1. Use specific vocabulary, rather than non-specific words such as “it” or “he/she/they”. Rather, identify the object using its specific name or person’s name. Additionally, avoid using sarcasm as this type of figurative language is difficult for your loved one to understand.


  1. During a conversation with more than one speaker, take turns speaking while providing extra processing time.


  1. Use external aids as appropriate. Use of calendars, photos, and memory books may help orient your loved one to the topic on hand, helping them communicate.

Natalie Keller, M.A., CF- SLP

**If you have any questions concerning your loved one and their communication, please contact Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love discuss options for your family. **

Defining Receptive Language

Children’s receptive language (ability to understand language) typically develops before expressive language (ability to use language to express wants/needs). For example, by 18 months, typically developing children understand approximately 200 words (receptive language), and produce approximately 50 words (expressive language). Receptive language is important because it helps children understand what is happening around them and in learning to identify desired objects/actions in their environment. Playing, talking, and reading books to your child will certainly help increase your child’s receptive language. There are more specific strategies that a speech-language pathologist might use during language therapy to focus on improving your child’s receptive language. Some of these are listed below!

  1. Hold objects/pictures in your child’s field of view and verbally label each one so that he/she can learn to associate a verbal word with a real object/picture.
  2. Model how to point to objects so your child can observe how to identify objects using hand and finger movements. If necessary, you can help your child by guiding his/her hand to an object (hand-over-hand movements).
  3. Present 2 or more objects/pictures (apple, train) to your child and ask him/her to show you one (“Show me apple”). Encourage your child to grab or point to the named object. You can also use this as an opportunity to allow your child to indicate his/her wants or needs by asking, “What do you want?” and encouraging him/her to point to it. Immediately give your child the object that he/she chose to teach him/her that his/her actions can bring about a change and get him/her want he/she wants (cause and effect).   
  4. Use errorless teaching to limit frustration and increase your child’s success when you ask him/her to identify objects. Errorless teaching means you give your child as many cues as he/she needs to be successful and not make any errors. For example, while completing a puzzle with your child, hold up two objects (truck, car), and say, “Show me truck.” If your child starts to reach for the car, move the car out of his/her reach, so that he/she reaches for the truck and therefore successfully identifies the correct object. Praise your child for choosing the correct puzzle piece and immediately give that piece to him/her as an award. From here you can increase the complexity as their ability increases in order to attain their specific goals.
  5. Ask your child to find things in your home. For example, you can ask them to find a specific food on his/her plate or in the refrigerator. You can also ask your child to find their body parts, clothing items, toys, or other household objects. 

Try implementing some of these strategies into your daily routines to help your child learn new words. Learning really can be fun! Good luck!

-Andria Burris, M.S. CF-SLP

**If you have any concerns with your child’s speech, language, hearing and/or feeding development, please contact Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love to meet with you and discuss options for your child. **

How Do I Practice Speech With My Child At Home?

Your child’s speech language pathologist (SLP) asked you to practice the /k/ sound at the beginning of words at home. But how do you go about doing that? It doesn’t have to be time-consuming or expensive. Here are a few ideas!

  • Scavenger Hunt – You and your child can go around your home to search for items that include your child’s target sounds in their name. Ex: toy car, cup, cartoons, coat, candle
  • Books – While reading a story together, look for words or pictures in the book that include more target sounds. Depending on what your child can produce correctly, have them repeat the word back to you or put it in a phrase such as “I found the car.”
  • Coloring/Painting – Grab some crayons, paintbrushes, paint, and some paper and draw pictures of animals, toys, or other objects that include certain sounds. Ex: car, cat, candy, kite
  • Play-doh – create objects out of the Play-doh that start with your child’s target sound. You can pretend to bake a “cake” or “cookies” together.
  • Catch – While playing catch with your child, say a word using the target sound before each throw. For repeated practice in short phrases, you can say “I caught it” after a catch.

If you are having difficulty coming up with words with your child’s target sounds, be sure to ask your child’s SLP to provide you with a list of possible words. I am sure he or she will be thrilled to help you!

This can be done targeting all sounds in all word positions, so take these ideas and run with them to practice the sounds that are applicable for your child’s therapy. Working on sounds in your home outside of direct therapy sessions is extremely important for developing carry-over skills of your child’s target sounds. Hopefully these ideas can provide more opportunities for fun practice together!

-Shannon Greenlee M.A., CCC-SLP

**If you have any concerns with your child’s speech, language, hearing and/or feeding development, please contact Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love to meet with you and discuss options for your child. **

The Importance of Vocal Hygiene

What are the things that truly define you?  Your personality?  Your appearance?  Your career?  All of these things make up different parts of who we are, but one part of us that people often leave unaccounted for is our voice.  Your voice is a defining aspect of your identity.  Protecting your voice is important.  The act and art of keeping your voice healthy is called vocal hygiene.  Vocal hygiene involves taking steps to keep your vocal folds healthy and your voice strong and clear. 

Our vocal folds are covered by a thin layer of mucous.  This mucosal layer is vital to the correct vibration of the vocal folds.  To function properly, the mucosal layer needs to stay moist.  Adequate consumption of water is vital to keeping the mucosal layer moist.  Water is your best ally in practicing good vocal hygiene!  One of the worst enemies of vocal hygiene is caffeine.  Caffeinated beverages (coffee, soda, etc.) dry out the mucosal layer, resulting in a rough voice and possible damage to the vocal folds.  Drinking water and avoiding caffeinated beverages is one of the best (and easiest) ways to maintain healthy a healthy voice.  Of course, water has many other health benefits as well.

Another important aspect of vocal hygiene is protecting your voice from abuse.  Vocal abuse occurs when the vocal folds are used improperly.  Do you love to cheer on the Vols every Saturday in the Fall?  Are you a teacher or a pastor?  If so, all your enthusiastic and heart-felt cheering or teaching might just be harming your vocal folds.  This “vocal abuse” occurs when the vocal folds are used improperly, such as with loud or prolonged shouting, cheering, screaming, or even talking.  While you are cheering or shouting, your vocal folds are slamming together hard.  After a period of time, this slamming could result in pathologies, such as vocal fold cysts or nodules.   These can be painful and result in permanent damage.  Protect your vocal cords from abuse!  If you find yourself led to cheer, do it!  Just be sure to have plenty of water on hand and rest your voice for a few hours afterward.

Following these simple steps will put you on the road to good vocal hygiene.  Drinking plenty of water and treating your voice gently (i.e. not using a loud voice or yelling frequently) both go a long way in preserving one of the most important parts of who you are:  your voice.    

Katherine “Kacey” Clark M.S. CF-SLP

**If you have any concerns with your child’s speech, language, hearing and/or feeding development, please contact Deborah L. Curlee Communication Consultants at (865) 693-5622. We have a team of experienced speech-language pathologists that would love to meet with you and discuss options for your child. **