Pediatric Feeding & Swallowing Therapy 

Hope Rafig and momSomething to Chew On...

Three-year-old Hope Rafig used to overstuff her mouth and couldn’t chew foods that other toddlers crunched easily, such as pretzels and apples. Meals grew stressful not only for Hope, but for her parents, too. When Hope’s GERD (gastroesophageal reflux disease) attacks began, her mother knew something wasn’t right.

Medical tests revealed that Hope had been swallowing food, like crackers, whole. She had walked and talked late also, due to an abnormal amount of cerebrospinal fluid accumulating in her brain, but Hope’s mother, Deborah, had no idea how to handle the feeding issues. The family was referred to Rehabilitation & Sports Medicine in Milford, one of Milford Regional’s three rehabilitation clinics, which now offers pediatric feeding and swallowing evaluations.

“As a mom, I was panicked, and it turned out to be something as simple as chewing,” recalls Deborah Rafig of Bellingham. “It was relieving to go for the evaluation and get some good tips.”

Michelle Whitty, MS, CCC-SLP, a pediatric speech pathologist at the Milford site who evaluates children from birth through school-age, worked with the family on Hope’s chewing issues. Many children have swallowing problems that arise from other conditions such as cardiac and pulmonary issues, Cerebral Palsy, or Down Syndrome. “Then there are kids that are just real picky eaters, or eat only five foods and they are all orange, like Cheetos and Goldfish,” Michelle explains. “These are kids that have a sensory-based feeding issue, but have developed normally in other areas.”

Unlike a doctor’s office, the speech pathology office has an infant feeding seat, school-age feeding seat, table, and toys. The evaluation focuses on oral motor skills, motor development, swallow function, and sensory-based feeding issues. “We tell parents to bring food the child eats well and to bring food that may be more challenging,” says Michelle. “We’ll do a clinical assessment. I talked to Hope’s parents about how they could alter the consistency or shape of her food, such as offering foods cut into a skinny narrow stick shape and telling her to use her side teeth. We also discussed strategies to increase the flavor, like sprinkling cinnamon on a banana, or adding garlic and salt.”

In addition, Michelle developed recommendations for Hope’s day care providers so she could enjoy snacks like the other children while maximizing her safety. “Hope is not a kid you can put a bowl of Goldfish in front’s better to put 2-3 in front of her, and when she finishes those, give her a few more,” notes Michelle. “As her overall skills develop, her chewing will become more refined and mature and her ability to monitor volume of food and bite size will improve also.”

Michelle explains that pediatric speech pathology is a specialized field and that therapists consult with pulmonologists, neurologists, or gastroenterologists if they believe the swallowing issues stem from an underlying medical condition. “You’re not just assessing skill, but you’re also trying to think of why this is happening and to come up with ways to make it better,” she says. “Many parents, especially mothers, blame themselves. Being able to take the child to someone who says ‘I know what this is,’ can take that weight off the parents and empower them.”

Some children require weekly or monthly feeding therapy, while others might just need a couple of visits. Hope visited the clinic twice and her mother says she has made significant progress. “We sit in front of her using the tips Michelle gave us,” Deborah says. “She’s definitely getting better. We were very thankful as we had no idea what to do. It’s a fantastic service and if your child is having trouble, they give amazing tips to help your child and to help you.”

For more information on pediatric speech pathology at the Milford site, call 508-422-2388.

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