Wednesday, July 18, 2012

Early identification: Late bloomer or language problem?

Wondering whether your 18 to 30-month-old child is a late bloomer or may have a language problem? There are some factors to look out for that can help a parent differentiate between the two. Do they understand language? Can they get their point across using gestures and other non-verbal communication? Are they rapidly progressing with language between 24-30 months of age? And lastly, if they seem to be delayed, are they still making some progress? If you've answered "no" to one or more of these questions, you may want to consider an evaluation with a speech-language pathologist.

Here is an excerpt from an ASHA article on the topic:

"Although the stages that children pass through in the development of speech and language are very consistent, the exact age when they hit these milestones varies a lot. Factors such as the child's inborn ability to learn language, other skills the child is learning, the amount and kind of language the child hears, and how people respond to communication attempts can slow down or accelerate the speed of speech and language development. This makes it difficult to say with certainty where any young child's speech and language development will be in 3 months, or 1 year.

There are, however, certain factors that may increase the risk that a late-talking child in the 18- to 30-month-old age range, and with normal intelligence, will have continuing language problems. These factors include:  
* Receptive language: Understanding language generally precedes expression and use. Some studies that have followed-up late-talking children in this age range have found, after a year, that age-appropriate receptive language discriminated late bloomers from children who had true language delays. Other researchers doing follow-up studies included only children whose receptive language was within normal limits because they believed that delay in this area was likely to produce worse outcomes.   

* Use of gestures: One study has found that the number of gestures used by late-talking children with comparably low expressive language can indicate later language abilities. Children with a greater number of gestures used for different communication purposes are more likely to catch up with peers. Such a result is supported by findings that some older children who are taught non-verbal communication systems show a spontaneous increase in oral communication.
  
* Age of diagnosis: More than one study has indicated that the older the child at time of diagnosis, the less positive the outcome. Obviously, older children in a study have had a longer time to bloom than younger children but have not done so, indicating that the language delay may be more serious. Also, if a child is only developing slowly during an age range when other children are rapidly progressing (e.g. 24-30 months) that child will be falling farther behind.
  
* Progress in language development: Although a child may be slow in language development, he or she should still be doing new things with language at least every month. New words may be added. The same words may be used for different purposes. For example, "bottle" may one day mean "That is my bottle," the next, "I want my bottle," and the next week, "Where is my bottle? I don't see it." Words may be combined into longer utterances ("want bottle" "no bottle"), or such longer utterances may occur more often.
  
It should be re-emphasized that negative aspects of these factors increase the risk of a true language problem but do not mandate its presence. For example, one research group found that one of their 25- or 26-month-old children with the worst receptive language had the best expressive language outcome 10 months later. On the other hand, children on the positive side of these factors may turn out to show less progress than predicted. The research group found that the child with the poorest outcome had the best receptive language and the largest vocabulary at the beginning of the study.
  
One study has found that the number of gestures used by late-talking children with comparably low expressive language can indicate later language abilities."

So what should you do if you are concerned about your child's speech and language development?

Come see one of our speech-language pathologists, and we will answer any questions you have about your child's language development. Research has shown that the time between birth and 36 months is an extremely critical period of development, so our work in early intervention allows us to both identify and treat very young children in an effort to minimize any potential speech and language developmental issues.

Helpful Links:
ASHA article
Developmental Speech & Language Milestones, Birth - 5 Years of Age  
Warning signs for communication disorder in young children

Tuesday, July 17, 2012

Treating Children With Feeding Disorders

Is mealtime a struggle with your child? Do they reject new foods, textures and tastes with gagging and fits? If so, they may benefit with help from a speech-language pathologist. SLPs work with a wide variety of feeding disorders in infants and children, usually as part of a team approach including the physician, occupational therapist, physical therapist and behavioral analyst.

From a 2003 article in the ASHA Leader:

"Justine Joan Sheppard, an SLP from Nutritional Management Associates and Columbia University, notes that behavioral problems associated with feeding may be called conditioned dysphagia. Conditioned dysphagia is a learned disorder or maladaptive habit that maintains a behavior beyond the physiological need. Feeding aversion, failure to advance to age-appropriate foods, food selectivity, negative mealtime behaviors, and gagging are examples of conditioned dysphagia and may lead to problems such as failure to thrive. ... When instituting a behavioral feeding program, it is essential that the clinician remember that nutrition is the primary issue."

Our goal as SLPs is to prevent problems such as failure to thrive and malnutrition.

Links:
ASHA article
Overview of our feeding therapy
Our feeding therapy FAQ
Feeding developmental milestones

Tuesday, May 8, 2012

Do you have a picky eater? Let Munchie Monkey help!

Munchie will happily eat anything, which will help encourage your picky eater to try new things. Munchie takes a bite, your picky eater takes a bite.

Getting Munchie to eat is simple:

1. Take a picture of some food.
2. Draw a path on the food that you'd like Munchie to follow.
3. Shake the phone for Munchie to take a bite.

Your little one will be rewarded as Munchie eats the food to reveal a fun Munchie plate.

Does your picky eater take too long to eat? Munchie has a timer mode that can be used to time goals from 1 to 45 minutes. Simply set the timer and Munchie will finish eating within the allotted time. Your little one can see exactly how much time is left by how much Munchie has eaten.

So, stop struggling to get your picky eater to eat. Let Munchie help now!

Monday, April 2, 2012

Miles for Miracles: Let's Support Brittany!


Help us Support Brittany in the upcoming Boston Marathon on April 16th!

"I'm fundraising for this event because I believe so strongly in all the good things Children's Hospital Boston does for kids. Its patient care programs are unusually sensitive to what sick and injured children and their families really need. Its researchers regularly make amazing discoveries that change children's lives. It welcomes kids whose families can't afford health care-more than any other hospital in Massachusetts. It makes a point of reaching out to local communities to help low-income and at-risk kids. And it really gets the importance of training the next generation of top pediatricians and nurses."

"Helping children and their families is a significant part of my everyday life. I work to help children achieve their utmost potential, as a Speech-Language Pathologist, at Chatterboxes Pediatric Speech Language Pathology, in Newton Center, MA."

"Thank you in advance for visiting my fundraising page below! I greatly appreciate your support in helping me achieve my fundraising goal."
-Brittany Boyle, M.S., CCC-SLP

To learn more about this event, or to make a donation, please visit Brittany's page by clicking on the below link:

http://howtohelp.childrenshospital.org/bostonmarathon/page/Brittany-Boyle.htm

10-Step Plan for Improving Nutrition & Feeding for Children with Autism


1)Transition to a healthy diet:
Avoid food additives, pesticides, refined sugars, processed foods, and trans fats

2)Get enough basic nutrients
Water
Macronutrients: protein, carbohydrates, fat
Micronutrients: fat soluble vitamins, water soluble vitamins

3)Take a multivitamin and mineral supplement
Contains 100-300% RDA of fat soluble vitamins (A, D, E, K), vitamin B complex (B1, B2, B3,B5, B6, B12, folic acid, biotin), vitamin C, minerals (calcium, magnesium, zinc, selenium, manganese, chromium, molybdenum)

Avoid multivitamins that have artificial colors and flavors, potential allergens (wheat, milk, soy, egg, corn), and herbs

4)Increase Omega-3 fatty acid
By eating fish and other foods that contain Omega-3 and/or with a supplement
Recommended intake of EPA and DHA Omega-3 fatty acids:
1-3 years old: 390mg/day
4-6 years old: 540mg/day
7 years and older: 650mg/day

5)Improve feeding problems
Enroll in the feeding therapy program if:
Restricted repertoire of foods (less than 20 foods)
Foods lost from diet due to burnout, and foods not regained into the diet
Persistent refusal of novel foods
Refusal of entire food texture groups
Adds new foods only after greater than 25 exposures

6)Heal the gut
Signs of gastrointestinal (GI) disorder include abdominal pain, bloating, gaseousness, diarrhea, constipation, reflux, vomiting, food refusal, limited variety of foods, mealtime tantrums, irritability, self abuse, sleep disturbances
Treat by modifying the diet, eliminating problematic foods, and/or taking supplements, including probiotics, antifungals, digestive enzymes, therapeutic levels of Omega-3 fatty acids, and glutamine

7)Identify food allergies and implement treatment
Foods responsible for 90% of allergic reactions include milk, wheat, soy, egg, peanuts, tree nuts, fish, and shellfish

8)Try an elimination diet
Most popular is the Gluten Casein Free Diet (GFCF)

9)Try high dose vitamin B6 with magnesium
Recommended dosage:
8mg of B6 per pound of child's body weight
3-4mg of magnesium per pound of child's body weight

10)Consider additional supplements
To enhance immune system: dimethylglycine (DMG), iron, magnesium, selenium, zinc, vitamins A, C, D, and E
To enhance cognitive function: carnitine, choline, coenzyme Q10, iron, zinc, ginkgo biloba
To enhance detoxification system: alpha-lipoic acid, glutathione, N-acetylcysteine, selenium, trimethylglycine (TMG), vitamin C, milk thistle

-Elizabeth Strickland

Tuesday, August 2, 2011

CHATTERBOXES PRESENTS APPROACH TO FEEDING SERVICES AT CHILDREN’S HOSPITAL BOSTON:



Outpatient Eating Disorders Program: Division of Adolescent Medicine

July 27, 2011

On behalf of The Feeding Group at Chatterboxes, Megan Rozantes, M.S., CCC-SLP was recently invited to present to the team members of the Outpatient Eating Disorders Program at Children’s Hospital Boston. Team members in attendance included physicians, psychiatrists, nutritionists, and social workers from the division of Adolescent Medicine.

An overview of Chatterboxes approach to Feeding Evaluations and Feeding Therapy was provided, along with discussions about Common Referral Criterion, Red Flags indicative of a Feeding Disorder and specific treatment approaches, including the AEIOU approach.

Children’s Hospital Team members were provided with extensive collateral materials for reference purposes. Such materials included example Evaluation Reports, detailed strategies and recommendations for parents of children struggling with feeding issues, common referral criterion, and feeding developmental milestones.

Many times parents of young children struggling with a range of feeding concerns, (varying from ‘picky eaters’ to children with severe sensory, behavioral and/or motor based issues) do not know where to turn for help. Many parents are not aware that Speech-Language Pathologists can provide assistance and treatment for a Feeding Disorder. The Feeding Group’s presentation was a positive measure to help such parents uncover the correct professionals for help

Modify the Mealtime Environment: Feeding Strategies


Modify the Mealtime Environment

The structure of the mealtime environment can have a major impact on a child's eating behavior. Overall, strive for a positive environment that is predictable and supportive. To optimize the environment, consider implementing the following:

• Schedule regular meals for the family. Have everyone remain seated at the table for the duration of the meal.

• Avoid grazing. Offer only water between meals and snacks. This will support a regular hunger-satiation pattern and may help lead to increased daily food consumption.

• Minimize auditory and visual distractions at mealtime by turning the television off and keeping toys away from the table.

• Try limiting meals to 30 minutes and snacks to 10-15 minutes.

• Do not rush through meals. Your child may need extra time given their developing self-feeding skills.

• Mealtime is meant to be a social experience. Talk with your child about the food you are eating, ask him questions about his day, or discuss his favorite things.

• Be sure that your child's seating allows free use of hands to encourage self-feeding.

• Model positive feeding behaviors for your child throughout the meal.