In April of 2015, I received an e-mail about a little boy with Down syndrome named Colter. His mother was desperately seeking help…he couldn’t chew his food and she was at her wits end trying to figure out how to teach him.

Even though this is “speech therapy,” his actual speech was not an issue at this point…yes there were delays but if a child can’t eat that is priority #1. Plus, in the back of my mind I knew that if we targeted his feeding goals his verbal speech would start to develop as well.

I love feeding therapy! When we meet goals, it means we are getting nutrition and hydration to little ones and it positively impacts the whole family. Many people take for granted the ease that there is in getting a baby or toddler to eat meals and snacks throughout the day. However there are many families out there that experience a battle EVERY TIME, EVERY DAY they try to feed a child. There has got to be few things more stressful to a parent than a child not being able to eat or being an aspiration risk. Colter was a mix of both of those.

Colter was 18 months old and swallowed almost every solid he put in his mouth but without chewing. He yearned to eat but couldn’t get the motor plan down to do so. He couldn’t move his tongue side to side (also known as lateralizing) so if food was placed in the front of his mouth he would suckled it and then swallow. What is frightening about a child doing this is that if it happens frequently they actually lose their choking reflex. We had our work cut out for us.

I educated his mother on how to place meltable solids on the side of his lateral molars so he had a better chance at chewing it and keeping it there. For practice, we used the TalkTools Pre-Feeding Hierarchy, as described in Lori Overland & Robyn Merkel-Walsh’s book A Sensory Motor Approach to Feeding. This eliminated the risk associated with choking on food and focused solely on practicing chewing and tongue lateralization. This paired with a pre-feeding program began to work wonders on Colter. We used a Z-Vibe with pre-feeding exercises from Lori Overland’s TalkTools course Feeding Therapy: A Sensory-Motor Approach before we started any feeding therapy.

Colter’s mom was diligent about keeping up with this program, which was a major factor in how far he came! Within 6 months Colter was eating much more solid food and the best part was he was being safe while doing it!

A few months later, his verbal speech exploded. He always had a higher receptive ability than expressive and thanks to getting his feeding on track, his verbal expression blossomed. When I explained to his mother that his talking was most likely a direct result of oral motor therapy, she said “I know you said that him talking more could be a possibility when we first started therapy but I didn’t think it could happen!”

Currently Colter is 2 years, 9 months old and is eating everything. One of his first words was “eat”! He loves beef jerky, hummus with veggies, fruit snacks, watermelon, and grapes. He is beginning to speak in 2 word utterances and has great intelligibility when doing so.

The next frontier we are on is drinking from a straw. Colter still uses a bottle and isn’t thrilled with learning to drink from anything other than that! Now our focus has shifted to drinking from the Honey Bear. We had to put the beloved Honey Bear “away” for a month or so as he was so opposed to it. Then during therapy one day, I started to do some lip rounding pre-feeding exercises with Colter and he was successful, so we brought it out on a whim. All of the sudden, it clicked for him! While we are still working on him getting used to it, his family and I are thrilled with how far he has come!

What I love about Colter’s story is that he is a textbook case about what TalkTools can do for kids. In Lori Overland and Robyn Merkel-Walsh’s book A Sensory Motor Approach to Feeding, it is discussed that you cannot separate speech and feeding. While it may not be a 1:1 ratio, speech and feeding have a very close connection. Colter is proof of that!

~ Vanessa Anderson-Smith

Vanessa Anderson-Smith is a Speech-Language Pathologist born and raised in South Dakota. She received her Bachelor’s Degree at Augustana University and Master’s Degree from The University of South Dakota. In 2013 she began Anderson-Smith Speech Therapy, LLC. Her practice focuses on assessment and treatment of motor-based speech and feeding disorders among children and adults. Vanessa lives in Canton, South Dakota with her extremely supportive husband, Ryan.

Lily, 3 years 4 months old, Unilateral Cleft Lip and Palate

When I saw that my former supervisor from my job during college and graduate school was adopting another special needs child from China, I was glued to their journey (the family had adopted a boy with cleft lip/palate from China previously). I watched from my computer screen as the Shields family adopted another child with a cleft lip and palate. That little girl was Lily (pictured on the left). And oh my, I have learned so much from her!

She had many medical complexities, surgeries, and hospital stays in her first year home. I continued to follow her story and literally thought: “I need to find a way to work with this girl because I know I can help!” How was I going to help? Using my OPT skill set of course! I knew in my heart that using Oral Placement Therapy and a motor-based speech and feeding program would get her where we wanted her speech the most efficiently.

Finally, the time came for me to see Lily for therapy. She was 2 years 6 months when we started. She was communicating wants and needs by pointing, grunting, and whining. She had a g-tube but was able to eat orally, just not enough. I looked at her repertoire of speech sounds and we started at the beginning with /p/, /b/, /m/. She wasn’t getting adequate lip closure needed for consonant-vowel productions (such as “moo, bye, pa”). The first thing I did was create a sensory warm-up plan for her to bring increased awareness to her muscles in her mouth. I used a toothette and various exercises from Lori Overland’s “Feeding Therapy: A Sensory-Motor Approach” course, as well as exercises Monica Purdy taught in “A Three-Part Treatment Plan for Oral Placement Therapy” course that I took.

Next we started the Straw Hierarchy to help with lip closure, lip rounding and protrusion. I explained to her family that while this does not look like “traditional” speech therapy, it will help her to get the motor plan of lip closure so we can generalize it to speech. In addition, we began the Bite Tube Hierarchy due to jaw weakness and asymmetry, as well as the Horn Hierarchy to build up her abdominal grading.

Lily’s family was beyond committed to the program I designed and the whole family got involved. Every week I tweaked her program plan as she moved up through the hierarchies. Each session we started with her sensory-motor warm up, followed by her OPT and feeding exercises, a small snack, and ended with mass production of speech sounds.

Her endurance during eating still needs improvement but it has come quite far since the start of therapy. Due to her improving health and no recent hospitalizations, she is off of her tube feeding! The little girl that was struggling with one syllable word productions is now speaking in 3-4 word sentences consistently. Currently Lily is on Straw #5, Horn #6, Bite Block #3 (step one), and 4 pennies on a tongue depressor. Next, I plan on introducing the Button Pull Program and working through the hierarchies since it has been so successful for her already.

What I love about the TalkTools program is how diverse it is. I can adapt techniques to work with a variety of populations whether it is Cleft Lip and Palate, developmental delay, Apraxia of Speech, and countless other diagnoses. I am so thankful to have OPT in my “speech therapy tool box”!

~ Vanessa Anderson-Smith

Vanessa Anderson-Smith is a Speech-Language Pathologist born and raised in South Dakota. She received her Bachelor’s Degree at Augustana University and Master’s Degree from The University of South Dakota. In 2013 she began Anderson-Smith Speech Therapy, LLC. Her practice focuses on assessment and treatment of motor-based speech and feeding disorders among children and adults. Vanessa lives in Canton, South Dakota with her extremely supportive husband, Ryan.