Tongue Thrust in Children

What is it? 

A tongue thrust is one type of “orofacial myofunctional disorder,” which just means the movement of the face and mouth is abnormal. In the case of a tongue thrust, it refers to the abnormal pushing movement of a person’s tongue during eating, drinking, and speaking.  

Why does it happen? 

Great question. There is no single cause as to “why” a tongue thrust occurs. Some contributing factors are blocked nasal passages due to enlarged adenoids or tonsils, sucking and chewing habits past age 3, and anything else that could cause the tongue to sit inaccurately against the mouth or lips. This could include an overbite or underbite, drooling, difficulty closing mouth, and/or limited tongue movement. 

What should I do about it? 

You can see a few different professionals to find out if your child has a tongue thrust, including a speech language pathologist (SLP), dentist, orthodontist, or doctor. These professionals can assess the possibility of contributing factors and the treatment that may help with their swallowing, breathing, and/or speaking. 

What is the SLP’s role? d

An SLP can help with treatment of a tongue thrust AFTER the breathing problems are medically assessed and treated. He or she can provide speech therapy for your child to help articulate their speech sounds more clearly, change their chewing and swallowing habits, and increase their awareness of how their tongue and mouth work during eating or talking. 

If you have concerns regarding this issue, please reach out to us at Curlee Communication Consultants! 

Shannon Greenlee, M.A., CCC-SLP 

Food Chaining 101: Expanding your picky eater’s food variety

What is Food Chaining? 

Food chaining is a method that helps a child feel safe with a wider variety of foods. There could be many reasons that your child has developed aversions to certain foods including stomach pain from an undiagnosed allergy, an inability to physically swallow certain consistencies, early experiences with feeding tubes, or a sensory processing disorder. Whatever their trigger is, your child feels threatened by these unfamiliar foods. Food chaining allows your child to move foods out of the scary mental box and into the safe mental box.  

A food chain is a gradation of similar foods. For example, a child who eats only orange Cheetos may accept white cheddar Cheetos, then veggie sticks, then carrot sticks, then actual carrots. Each food must be similar to the preferred food in texture, taste, or color. Another example might be for a child who does not enjoy wet foods, but tolerates apples. He begins with apple bitesthen moves to apples dipped in applesauce, to applesauce with large apple chunks, to applesauce alone. The progression takes place over several sessions, and each step on that progression involves a sensory chain of touching to fingers, touching to lips, taking a bite and spitting it out, chewing a bite and spitting out, and finally taking a bite and swallowing it.  

How Can I Use It? 

Please do not attempt to start a food chain by yourself! If you have a picky eater, a Speech Language Pathologist (Speech Therapist or Feeding Therapist) can help you determine the cause of your child’s aversion, screen for swallowing disorders, and identify the food chain progression that would be best for your child. Pushing a child to eat foods that he/she physically cannot handle without professional consultation could lead to food going into the lungs instead of the stomach resulting in pneumonia and hospitalization.  

What Can I Do? 

Before the Evaluation:  

  • Take note of what your child is willing to eat, and how much they eat.  
  • Offer new foods and notice how they refuse (do they gag? Push away? Cry? Choke? Get down from table?)
  • If your mealtimes are consistent already, be prepared to tell your therapist what is normal in your home. If not, try to have meals around the same time each day with a routine that lets your child know it is time to eat. (See https://knoxvillespeech.com/importance-mealtime-routine-children-feeding-difficulties/).
  • Provide choices for your child when offering new foods. Choices give your child a sense of control and decreases their stress even though you are still controlling what those choices are.  
  • Reward your child for good behavior even if there is a large amount of negative behavior. Change will not happen overnight, and feeding will be much more enjoyable for you and your child if you celebrate the baby steps on the way there.  

During the therapy session:

  • Communicate with your therapist about your observations at home about what your child will accept and their behaviors when they refuse
  • Have foods with a variety of textures on hand: applesauce, crackers, bread, fruit cups, oatmeal, yogurt, meat.  
  • Talk to your therapist about goal foods that you want your child to eat. 
  • Observe your child’s response to the structure and prompts of the therapist. 

  During your mealtimes:  

  • Be consistent with the routine and structure your therapist recommends for mealtimes. Structure can eliminate a stress around mealtime so your child has more emotional bandwidth to try foods he/she thinks are unsafe. 
  • Watch your child for obvious signs of aspiration such as coughing and choking, but also watch for increased eye watering, nose running, and a gurgly voice quality. 
  • Introduce at least one new food each day. Even if your child refuses, you are setting the tone that picky eating is not the norm in your home.  

 Summary 

A feeding disorder can present in many ways including an inability to drink enough milk, difficulty transitioning from milk to solid foods, choking and gagging at mealtime, refusal to eat all but certain foods, and more. If you have concerns about your child’s feeding development, please do not hesitate to give us a call at (865) 693-5622. Whether your child is having physical difficulty swallowing or you are having negative behavioral situations, a feeding therapist can benefit both your child and your entire family by reducing stress for you and your child at mealtime.  

-Brianna Teague Scanlan M.S. CCC-SLP

 

Pacifier Use – When do you stop?

This question has popped up more and more over the last five to ten years as additional research has been released. Many new parents are wondering, “When should I take away their pacifier?” 

Pacifiers fulfill the need of a new baby’s innate sucking instinct. For older children, they offer a sense of security and comfort. In both scenarios, it is important to understand the possible effects of pacifier use.  

A pacifier can provide many benefits for your child. According to the American Academy of Family Physicians, pacifiers may lower the risk of SIDS, sudden infant death syndrome, especially when used while sleeping. It can provide a sense of comfort during painful situations such as blood draws or shots. In premature babies, sucking on a pacifier has been associated with increased success with bottle feedings and possibly shorter hospital stays.  

It is suggested that pacifiers have the most success when used in infants 6 months and younger. In an article, The Impact of Prolonged Pacifier Use on Speech Articulation:  A Preliminary Investigation, prolonged use of a pacifier (routine use after 18 months of age) led to various dental issues involving bite, articulation problems due to some of these dental issues, and increased otitis media (ear infections). In addition, the pacifier can decrease their ability to freely babble and produce vocal play, leading to possible expressive language delays.  

A great speech and language therapy blog, “Heather’s Speech Therapy,” provides some wonderful tips for weaning your child off their pacifier.  

  • Keep the pacifier out of sight. Your child is less likely to think he/she needs it if they forget about it or can’t see it. 
  • Begin by reducing the amount of time the child can have it, by finding certain times that the pacifier is allowed. Suggested times include nap time or bedtime. It doesn’t have to be taken away completely right away; it can be gradual. 
  • Stay consistent and don’t give in. Your child may try to push you for it, but be consistent. 
  • Find other things that can provide a sense of comfort and security. A favorite toy or cuddles. Nothing can be substituted for nurturing. 

Many opinions exist regarding pacifier use, and the optimal age to “stop” using them really doesn’t exist. However, the connections between prolonged pacifier use and increased dental problems, speech/language issues, and/or ear infections have been noted. Because of this, it ultimately is up to the family to decide what is best for their child. If you have specific concerns, make sure to reach out to your pediatrician, dentist, or speech language pathologist! 

Shannon Greenlee, M.A., CCC-SLP 

References: 

  • Shotts, L., McDaniel, M., Neeley, R. (2008). The impact of prolonged pacifier use on speech articulation:  A preliminary investigation. Contemporary Issues in Communication Science and Disorders(35), 72–75.  

Fun and Free Learning Websites for Kids

As a parent of young children, I try to limit the amount of time spent on electronics. At the same time, I understand that my children’s future is going to be filled with far more technology than I can even imagine. I decided that if they are going spend time on iPads or computers, I wanted it to be something that will actually benefit their learning. In other words, no more watching other kids open and play with toys! I have found some amazing, free websites that are great for children of all ages. They truly make learning fun and engaging. 

One of my favorite, free websites is the BBC Dance Mat Typing. It teaches even young children the basics of typing in a fun, dance format. My kids love it! 

Many of the schools’ curriculums include learning to code. I think I learned some basic coding in a college course (but could never quite get it right), but my 1st grader can code an entire video game. One of his favorite sites is CODEMOJI. I definitely had to watch the tutorial videos, but it is amazing how quickly my kids pick up on it.  

Another one of my favorite learning websites is PBS Kids. This site has math games, reading and comprehension games, and so much more. While many of the math and literacy games are geared towards younger children, PBS Kids also has Spanish learning games which are great for all ages (yes, even for adults). 

ABC Mouse has a free 30-day membership that gives you access to math, reading, science, and art games and activities. This site is geared more towards younger children, ages 2-8 years old, but I have found that our 11-year-old foster son with Autism also loves this site. It reinforces math skills he has while also expanding on his knowledge of reading and science concepts. I would much rather him engage in learning sites (even if they are “easy”) than watch the opening to his favorite gameshow for the millionth time.  

My personal favorite learning website is National Geographic Kids.  This website has information on pretty much any animal or species you can think of: insects, mammals, reptiles, birds, fish, amphibians, and even dinosaurs. What is more exciting is that they have so many interesting videos and activities related to state parks, countries around the world, US states, bizarre facts, space and more! I personally could spend hours on this site. My kids actually ask to look up information and then tell relatives about what they have learned (and that is way more rewarding as parent than hearing them talk about the mystery egg they watched a kid open). 

I hope you and your family enjoy this learning resources as much as we do! 

-Jessica M. Lenden-Holt MA CCC-SLP 

Targeting Vocabulary with Deaf and Hard of Hearing Children

Research demonstrates that vocabulary knowledge is directly related to overall language development, academic and professional success. Building vocabulary knowledge is essential to becoming a successful reader. Vocabulary assists in teaching phonological skills, which are necessary to become proficient at decoding (applying letter-sound knowledge to correctly pronounce written words). Vocabulary also allows for the development and use of background knowledge, which is necessary for reading comprehension.

Children who are deaf or hard of hearing (D/HH), and have been aided with cochlear implants or hearing aids, experience a period of auditory deprivation. During this time, they have not been exposed to new vocabulary and they have not been able to adopt strategies for incidental vocabulary learning. Because of this, many D/HH children who are aided need extra support to build sufficient vocabularies — relying on incidental learning will not be enough.

Direct strategies for targeting vocabulary:

1. Use a theme: Pick words that relate to a relevant theme or the student’s curriculum. This is beneficial as it allows for multiple opportunities to expose the child to the word and builds on their previous knowledge of the topic.

2. Pre-teach key terms: Explicitly identify the words you will be targeting, give the child a simple definition, and rephrase the definition at least once.

3. Practice the Universal Design for Learning: In order to fully understand and use a word a student needs to be able to hear the word, see the word and manipulate the word.

  • Hear it: Repetition is key! Students may to need to hear a word a minimum of 25-30 times before they fully understand it! Use the word frequently and across different contexts as well as embedded in stories.
  • See it: Use visual aids as much as possible and explicitly point them out to the child. For example, write the word down as it arises, point it out in a book, offer a picture and/or sign the word.
  • Manipulate it: Make sure the child has plenty of opportunities to interact with the word. For example, matching the word to a picture, acting it out, writing it down or using it in a sentence.

Indirect strategies to use in therapy or at home:

  • Make listening easier: Modify the child’s environment by reducing background noise, e.g., turning off the TV or waiting to run the dishwasher. Curtains and rugs can also help reduce echoing sounds.
  • Auditory bombardment: Repeat vocabulary terms as much as possible and across contexts.
  • Auditory sandwich: Offer the new word, then provide more information with familiar language and/or a visual, if possible, then repeat the word. For example, if you are targeting the word “chilly”, try saying, “It’s chilly. I’m feeling cold, brrr. It’s so chilly.”
  • Narrate: Talk about what you are doing and try to incorporate the vocabulary term as much as possible. Again, try to use the key terms in different ways and across contexts.

“I’m cold, brrr. It’s so chilly in here; I’m going to get a blanket to warm up because I’m really chilly, brrr. Are you cold? Are you chilly?

  • Shared reading: This is a great opportunity to target new vocabulary. Before you begin reading, let the child know what word you want them to listen for. Point to the word while reading and have the child point to it as well. Emphasize the word and rephrase what was read aloud.

Key points:

1. The child should have opportunities to see, hear and manipulate target words.

2. Quality > Quantity. Spend time targeting a small number of keys terms that are relevant to the child’s day-to-day life and/or school curriculum.

3. Repetition! Use the word in different ways, across different modalities and contexts.

If you have any questions or concerns about your child’s speech/language, please contact our office. We have SLPs that specialize with population and we would love to work with you! 

-Olivia Hecker, M.S. CF-SLP

References

· Douglas, M.W. & Lund, E. (2016) Aspects of effective spoken language intervention. Audiology online presentation. Retrieved from: https://www.audiologyonline.com/audiology-ceus/course/aspects-effective-spoken-language-interventions-28145

· Edyburn, D. (2005). Universal design for learning. Special Education Technology Practice, 7, 16-21.

· Language for the Playground. (September 4, 2017). Vocabulary development for children with cochlear implants. {Blog post] Retrieved from: http://languagefortheplayground.com/2017/09/04/vocabulary-children-cochlear-implants/

· Lorraine, S. (2008). Vocabulary development. {Hand out}. Super Duper Productions.

· Luckner, J.L & Cooke, C. (2010) A summary of the vocabulary research with students who are deaf or hard of hearing.American Annals of the Deaf, 155, 38-67.

· Lund, E (2015). Vocabulary knowledge of children with cochlear implants: A meta-analysis. Journal of Deaf Studies and Deaf Education, 00, 1-15.

· Lund, E. & Douglas M.W. (2016). Teaching vocabulary to preschool children with hearing loss. Exceptional children, 83, 26-41.

Early Intervention in Children with Hearing Loss

 Children with hearing loss benefit greatly from early identification and amplification. When identified at birth, aided around three months, and in therapy around six months, children with hearing loss are likely to develop age appropriate speech and language skills. A child using amplification such as hearing aids or a cochlear implant can ‘hear’ however they will benefit from being taught to ‘listen’. Think of ‘hearing’ as being aware of auditory input and ‘listening’ as taking in the auditory input in a meaningful way. Here are three strategies that can be used in therapy and at home when working to develop language and listening skills in young children that have a hearing loss:

  • “Make your point”- This strategy involves pointing to your ear when you hear a sound (an environmental sound, such as a car horn or dog barking), a toy that has been activated, etc.) and say, ‘I hear that’. Then imitate the sound you heard and label it with a vocabulary word and a visual. 

 

  • “Auditory sandwich”-This strategy provides auditory input, followed by auditory input combined with a visual, followed by the auditory input again. Here is an example that could be used when playing with a barn and animals. First, make the sound you want to teach such as ‘moo’ for a cow. Then point to the cow or bring it to the child and say ‘moo’ again or ‘the cow says moo’. Finally provide the auditory input again for the targeted sound ‘moo’.

 

  • “Acoustic Highlighting”-Acoustic highlighting is used to emphasize the target word or sound in continuous speech. You can do this by increasing your volume when you say the target, slowing your rate of speech, and pausing slightly before and after saying the target word.

Hopefully these tips will allow you to help your child  learn developmental speech and language skills amidst a hearing loss. If you have any questions or concerns, please contact our office. We have therapists that specialize in hearing loss/cochlear implants that would be more than happy to work with you and your child. 

-Pamela Johnson, M.S. CCC-SLP

 

Speech and language services in the schools

OK. You just received a letter in the mail from the school saying your child is being referred for speech and language testing and services. So now you’re probably thinking “what is a Speech Pathologist and what do they do? What is this “testing/evaluation” going to look like for my kid?” 

Let’s break it all down, starting with who will begin this process with your kiddo: the SLP. According to the American Speech-Language-Hearing Association, a Speech Language Pathologist (SLP) “works to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.”  

Now, you may be thinking “Um, speech and language? What’s the difference?” Well, if your child has trouble with speech, they will struggle with the “how-to” of talking. More or less, your child will have difficulty with the coordination of the muscles and/or movements necessary to produce accurate speech sounds. Often in the SLP world, saying “sounds” is referred to as articulation. If your child has trouble with language, they may struggle with understanding or comprehending what they hear (receptive language) or they may struggle with having the words necessary to express their thoughts into a meaningful message (expressive language). It is possible that a child may have issues with one area–speech or language–but it is not uncommon that speech and language difficulties co-occur.  

Now back to the words “Testing and evaluations.” Really, testing for speech and language is nothing that you, as a parent, or your child should fear.  In all reality, your child will most likely not realize that they are even taking a “test”. The evaluations are performed in order to give the SLP more specific information about the speech and language development of your child and help determine if there are any skills that may need to be addressed. We, as SLP’s, are able to create goals for your child based on their needs demonstrated from the test results.

After testing and confirmation that your child qualifies in the school system, the SLP will begin to instruct, model, and teach your child in their areas of need. The SLP will continue to monitor and measure your child’s progress during their sessions to determine if the goals that were created after testing have been met, or how therapy may need to be adjusted in order to continue progress.  You should get updates on their progress. If you have any questions or concerns, be sure to speak up! The SLP will be glad to speak with you and answer any questions you may have.

If you have concerns about your child’s speech and language skills, please contact our office. We would love to set up a free screening to determine if your child may benefit from our services. Curlee would love to work with your family!

Madison McDowell, M.A. CCC-SLP

Navigating the IEP Process

We know that the beginning of the year can be stressful. For some parents, needing an IEP for their child can add additional stress and anxiety. Navigating the IEP process can seem daunting, but with the right information and knowledge of your rights and the rights of your child, you can be well prepared for an IEP meeting. We’d love to walk you through the process and put your mind at ease!

When you receive a letter in the mail stating that a meeting will be held regarding your child’s speech and language, make sure you sign the paper that you will be able to meet with the team at your child’s school or that you would like to change the date. If the date and time are not convenient for you, that is okay! You have the right to change the meeting to a time that is convenient for you.

The first meeting will be to talk about the concerns regarding speech and/or language skills. Members of the IEP team include you, the speech-language pathologist, the classroom teacher, and a local education agency, which may mean a counselor or principal. All of you will decide together whether or not your child should be tested for speech or language services. If you have an older child in middle or high school, he can be at the meeting to provide his input as well. You are entitled to bring anyone to the meeting. You can bring a grandparent, a trusted friend, an attorney, or even another speech-language pathologist. You can also request certain people to be at the meeting, such as a certain classroom teacher or administrator. 

If you decide to have your child tested, the speech-language pathologist (SLP) can share how your child will be tested, what tests will be given and listen to your concerns. Once your child is tested, you will receive another letter to have a meeting to discuss the results. Again, you can bring someone to the meeting with you if you choose. If your child qualifies to receive services in the school, the team-which includes you-will set up some goals for the speech-language pathologist to work on with your child throughout the year. You will discuss the frequency that your child will receive services and how those services will be provided. You will also talk about your child’s medical history, development, other concerns you have, as well as your child’s strengths and weaknesses. This will all be documented in an Individualized Education Program or IEP.

 Speech-language therapy through the school system is always a free service to you and your child. Your child’s speech-language pathologist will send home progress reports throughout the year and you can contact the SLP at any time to discuss progress. Each year, the team will update the IEP with any changes to goals or to consider any other services that may be beneficial for your child. Every three years, your child will be assessed and you can see how much progress your child has made throughout the year. Remember that the IEP team includes YOU. You know your child best and the IEP team wants to work with you to help your child succeed!  

If you have any questions about your child’s speech and language development, the IEP process, or ways that we can work together to help your child, please contact us— we would love to assist your family!

Margie Busby, M.S. CCC-SLP

Targeting Articulation at Home for Parents

Happy summer! With schools being closed, we get so many questions from parents asking us how to work with their child during the break. Likewise, we get many parents of office clients inquiring about how to work on speech sounds with their child outside of their assigned speech appointment. Working outside of therapy to improve your child’s speech sounds is a great way to encourage your child’s progress. The following are some positive suggestions to encourage and work with your child at home in improving their articulation skills.

  1. Model the sound your child is working on with extra emphasis in daily activities. Such as “go to the car to grab your backpack” if your child is working on /k/. See if your child notices when you do so. 
  1. Read with your child. Take turns pointing out their target sound as you come across the sound together. 
  1. Spend 5-10 minutes practicing words with their target sound together in fun activities: such as coloring pages, reading, games, etc. Ask your speech therapist to send home or email a word list or a worksheet that you can complete together. 
  1. Attempt to recognize and congratulate your child when you hear them make their correct sound. It is important that you are recognizing their progress and that your child can understand and hear the difference between errors and the target sound. 

Working on your child’s sound at home for short periods of time is beneficial to helping them generalize the skills they are working on at school with their speech therapist. 

-Natalie Keller, M.A. CCC-SLP

Slimy Speech!

Slime making kits are everywhere in stores. My own kids beg to make slime all the time, and the children I see in therapy love my “speech slime days”. Not only is slime a great sensory activity, I have also found tons of ways to incorporate speech and language activities into our sessions using slime. Here are 4 of my favorite speech-language slime activities:

Following Directions

If your child is able to read, have them read the instructors out loud and follow the directions to make the slime. If your child is not yet able to read, you can even draw simple pictures (or use pictures from the box) to help them follow the directions to make the slime.

If you buy pre-made slime, have your child follow 1 or 2-step directions to add items to the slime. Examples: Get the green glitter and add 1 teaspoon of slime. Put half of the slime in the container and give the other half to your brother.

Making slime is also great for measuring/math skills!

Identifying Items

Kids love “hiding” items in the slime. This is a great opportunity to work on identification of items. You can use small toy farm or zoo animals (Put the “cow” in. Put the “zebra” in). I also love to use small toy furniture, small food items, and plastic letters. Dollar stores or dollar sections in stores often have tons of great, cheap items to use.

If you need to increase the difficulty level, have them identify items using a variety of modifiers (i.e. Put the small, pink pig in. Put the big, blue chair in. Put two pigs and one cow in.)

Expressive Language

I usually get great expressive language from kids when they are playing with slime. It is so easy to target a variety of adjectives to describe how the slime feels: slimy, sticky, wet, gross, gooey, mushy, squishy, etc. You can also use adjectives to describe how it looks and smells (add a few drops of juice, flavor packets, or essential oil to add extra smelly fun).

Having your child describe how the slime was made is a great sequencing and retell activity. Use pictures to help them if necessary. They can describe what they did first, next, and last.

Speech/Articulation

To incorporate speech/articulation activities, collect items that have your child’s target sounds. For example, if they are working on “r”, I might have a small car, fork, rainbow eraser, rabbit, jar, robot, bird, ring, rock, dinosaur, or any other “r” item (either the real item or a laminated photo work great).  Sometimes, I mix in items that do not have their target sound to see if they can determine which words contain their target sound. After I hide the items in the slime, I ask the kids to find as many “r’ items as possible. Then, we practice saying the words.

I hope you enjoy these fun, speech-language activities with your children as much as they enjoy them!

-Jessica M. Lenden-Holt M.A. CCC-SLP