What goes through the mind of a speech pathologist when they’re on the job?
ARGH! My child won’t eat! She eats too little, he regurgitates what he eats, she won’t touch her food and they leave mouthfuls of food in their cheeks.
The amount of people I talk to, that say a child who doesn’t eat what is put in front of them is lazy, spoilt, defiant, or more sophisticatedly word it as having an ‘untrained palate’, is unbelievable! A parent desperate to feed their child will reach out to all sorts of people for advice.
If they’re lucky they’ll turn to a speech pathologist. We might think “hum, is this child being fussy or is there an underlying oral motor difficulty”. Perhaps a paediatrician should be involved. Is there a possibility this is a medical issue, like reflux that might be causing discomfort while eating?
Should we be working in a team with dieticians to explore growth and weight gain? Does this child appear small for their age?
I wonder how they’re toileting. Could constipation, diarrhoea, allergies or intolerances be impacting their eating habits?
Geeze the occupational therapist might be better equipped to work with this child as sensory modulation around food looks like it might be affected. This child’s eating posture looks like it needs work too.
Oh golly, I better get some more background information. Has the child had a bad experience with food? I know if I thought I was about to choke to death on a piece of food, I’d probably avoid eating it too! Maybe we will need psychologists in this child’s team.
All of this is considered before I even start using my discipline specific knowledge.
“Speechies” as we Speech Pathologist are affectionately referred to, work traditionally in what many would consider gross places, like the inside of people’s mouths.
We’re there when a child opens their mouth while eating, so we can see if they are rotary chewing. We also check out how they are moving and coordinating their lips, tongue, jaw and mouth.
Then we consider what sorts of food the child will eat. Does the child like yoghurt and puree?
Maybe the child likes those foods that dissolve in their mouth like cruskits, or cheese rings.
Perhaps the child has a preference for soft foods like bananas; conversely perhaps the child can manage hard foods like carrots.
What about those foods which require complex chewing skills like steak?
Now you might also think it’s strange when we speech pathologists come to your home and are just sitting there sometimes. During mealtime assessments it can look like we are not doing much, but we are taking lots in.
We usually ask you to arrange the mealtime environment as you normally would. You don’t suddenly need to eat at the table if normally you have dinner on the couch. We want to establish a baseline of what your child can do in their usual environment with foods they prefer.
This way we can see: if there is a preference for particular textures and what’s the difference between how they manage foods they like compared with foods they don’t? We also ask ourselves what your child is doing with their food. Are they pushing it out of their mouth with their tongue? Or are they chewing in an ‘up-down’, ‘rotary’ or ‘diagonal’ manner?
After all this, now comes the part we explain what we’ve observed to parents and carers. I often talk about stages of chew development and how children progress through textures. Sometimes I give parents or carers different textures and we eat, talk about what we are doing, how our tongue moves the food around and if we can notice our salivary glands softening the food.
This enhances understanding of the complexities eating involves. Then we reflect back to how their child was managing the foods. Sometimes we will jointly come to appreciate that the child is not fussy at all, they have a physical difficulty managing some food textures.
There is more analysis and trialling to be done, but hopefully this has given you some insight in how speech pathologists work to find out what underlying problems there may be with eating, before developing an individualised feeding program.
- Hannah Brooks is a certified practising speech pathologist who works for Northcott in Canberra.