Therapy Tip: Mistakes to Avoid for Picky Toddlers

It's Therapy Thursday here on the blog. This is the day I share a tip based upon my experience as a mother of a child with special needs and a pediatric speech-language pathologist. Today's tip is:

Mistakes to Avoid for Picky Toddlers

For my job, I often evaluate toddlers with picky eating habits and determine if their eating is extreme enough to qualify for feeding therapy. Over the years, I have talked with many families about their child's food preferences and patterns. I have directly worked with many toddlers who have restrictive diets (eating from only 1 or 2 food groups or a total of less than 5 different foods), gag easily, or avoid certain textures.

Feeding therapy is interesting work. Every child is different and responds uniquely when work is started to expand their diets. The work done during therapy is important but what is done at home is vital as well.

In the years of working with families, I have come to see some common mistakes at home. These mistakes aren't the cause of the child's feeding issues, but we definitely need to correct these mistakes when we get serious about adding new foods to a child's diet.

Mistake #1: Offering the same foods to the child.
This is the number one biggest mistake that I see parents making. I understand how it happens. The child eats only a certain set of foods. In frustration and over time, the parent begins to serve those same foods to the child. Then the child begins expecting these same foods. It's a vicious cycle that happens before a parent realizes it.

It is really important to offer foods to the child that they don't normally eat. This can come formally by putting a new food on their plate or informally by simply offering the child a bite of food from the adult's plate. It can also be offering a new food for a snack before resorting back to the familiar food. Bottom line, even if we know the child won't eat a new food, it's important to keep offering it to remind the child that new foods are a normal part of daily life.

Mistake #2: Letting the child dictate what's on their plate. 
You may think this mistake is like the first, but it's slightly different. In addition to serving the same foods to the child, another mistake is to never put something new on the child's plate. I don't care if a child eats it or not, but I want the child to tolerate something new on their plate. Children who are extremely picky and need me to work with them will often get upset with merely the presence of a new food on their plate.

Before I expect them to eat a new food, first I want them to tolerate it on their plate without pressure to eat it. I want them to be ok with the fact that I have added ketchup next to their chicken nuggets or that I have put raisins next to their crackers. This does a couple of things. First, this will help expose them to new foods in a no pressure situation. If the child seems fine with it on their plate, then I encourage them to touch or smell or even pick it up and throw it away. Secondly, this promotes the child to interact with food in ways besides just eating. You never know too- the child might just decide to try something one day!

Mistake #3: Only having food interactions during mealtimes. 
If your child is a picky eater, it is important to have some interactions with food outside of meal time. These opportunities encourage the child to touch food or simply be around it without any pressure to eat.

Have the child help in the kitchen by preparing food for other people or assisting with snacks. They can help make a sandwich by putting the meat or cheese on the bread. They can put vegetables in a pot before it's heated. You can make a trail mix with the child and let them add cereal, raisins, or pretzels together. If you are familiar with sensory bins, then you can use foods as a base for them as a way for them to engage with food in play. For these bins, I have put cereal, dry noodles, dry beans, pretzels, etc. in a big Tupperware container with spoons, little figures, and other small toys to allow the child to dig in the food for a sensory play experience. (If you need more info on sensory bins, click here or click here for even more.) Generally speaking, eventually these interactions should lead to the child being more comfortable with food and possible deciding to taste something. Usually, the kids I work with in feeding therapy will be very anxious when we are doing these food interactions even though I am not asking them to eat anything, so this is a good activity for them.

The bottom line: Picky and problematic eating often needs some changes at home to promote new additions to the child's diet. Little things like the ones mentioned today should not be discounted. Picky eaters take lots of time to change habits, trial-and-error with foods, repeated exposures, and many changes to help expand diets. If you find yourself making these mistakes with your child, it's not too late to correct them! 

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. 

Speech Therapy & Down syndrome: When & Why

I've been blogging everyday in October for the 31 for 21 challenge- where bloggers write each day in October for Down syndrome awareness month. Today, I'm sharing a popular post from earlier this year. Because my daughter has Down syndrome and I'm a pediatric speech-language pathologist, today's topic is near and dear to my heart. So, let's discuss:

When should speech therapy be started for babies/toddlers with Down syndrome? And why?

With all the research that has been made over the years, it is indisputable that early intervention for babies and toddlers who are at risk for developmental delays helps the child. The question becomes when should certain therapies begin. 

But it really isn't a simple question to answer. Most articles regarding speech therapy and Down syndrome that I have read suggested an evaluation by or at 1 year of age. However, it is rare to find an article to state a specific age that all children with Down syndrome need to be evaluated by a speech-language pathologist. I believe this is because we know that the language of a child with Down syndrome will most likely be delayed whenever testing is completed. But, each child has their own family structure, health history, strengths, weaknesses, and motor abilities to take into consideration. That's why this is somewhat of a individualized decision.

First...What would speech therapy look like anyway in babies and toddlers?

If your baby with Down syndrome is under the age of 1, then most likely the treatment will primarily (or only) focus on feeding and oral-motor abilities. There are babies, like my daughter, that struggle to suck, eat from a spoon, accept a variety of textures, or drink from a straw. These types of issues can be addressed with early speech-language intervention. There are some babies that nurse or drink from bottles without any concerns who wouldn't need this type of intervention.

Still, there may be concerns with the baby's low muscle tone and tongue protrusion that would warrant early speech therapy. A speech-language pathologist who has taken courses with Talk Tools, for example, will know some of these strategies that can assist with these oral and feeding concerns.

If feeding and oral motor is the focus, the family and therapist may decide how much and how many sessions are appropriate. Some therapists do intensive, short term therapy to build skills. Others may do weekly or monthly visits with the focus on training the family to complete activities at home. Again, these are decisions that are made individually.

Speech therapy that begins after age 1 may start to address language delays. This may include building the child's ability to use gestures, introducing sign language, encouraging vocalizations or words, helping them understand familiar words, and following directions.

Libby Kumin has written many great books and articles on the development of language and treatment strategies for those with Down syndrome. You can click here for one example.

Deciding when to Begin:

While I believe early intervention is key, I do feel that there are several factors to consider when deciding what is best for a child with Down syndrome. Some of these are:

• Family priorities: What are the main concerns for the family? In early intervention, we as professionals are told this is the guiding force that helps us make decisions. Even if the child may show big delays in language, we aren't suppose to push for speech therapy if the mom is mainly concerned about motor delays. The priorities and concerns of the family is a one thing to consider.
• Health & Medical Status: For babies with feeding issues, any digestive health issues need to be considered. Reflux and constipation, for example, need to be addressed medically and may affect progress in feeding therapy. Cardiac conditions may affect feeding as well and the energy level of the baby or toddler. This may be an important factor to consider if the child is getting multiple therapies in one day.
• Hearing: Ear infections and related conductive hearing loss are common with Down syndrome. A child's hearing history or concerns is a factor when considering if/when speech therapy should begin. Hearing loss or ear infections would put the child more at risk, and therefore may suggest therapy is indicated.  
• Other delays: Global delays in development are usually found with children with Down syndrome. When deciding on starting speech services, the team and family need to look at all delays present and consider how one may impact another. Fine motor delays may impact the toddler's ability to mimic sign language. Gross motor delays in babies will affect the speech-language pathologist's decision on positioning for feeding, for example. Therefore, speech can rarely be considered in isolation. The baby/toddler's overall development needs to be considered when deciding to begin speech therapy.
• Age: The child's age is always key. Sometimes there are agency rules, state guidelines, or program rules that state when speech-language therapy should or can begin. Some may consider 12 months too young to benefit from speech therapy that only focuses on language development as motor skills are still developing and attention spans are short. Some programs will not allow evaluations that are for language only to be completed for children under 18 months. Eighteen months is a common age to see speech therapy evaluations take place in any child without Down syndrome, since this is often the age when delays become noticeable and walking is established. It is important for parents and professionals to know the guidelines and rules that apply to them.

The take away

Every child with Down syndrome is unique. Each baby and toddler with Down syndrome needs to be evaluated while considering all the multiple factors that come in to play in order to determine when services should start. The earlier speech-language therapy starts, the better. However, therapy may be more productive when certain skills and milestones are met. It is my belief that every child with Down syndrome should receive a speech-language evaluation around 18 months of age and earlier if feeding issues (gagging, poor sucking, only eating pureed foods) are present.

This information is for educational purposes only and not intended as therapeutic advice.

Therapy Tip: Ways to Promote Independent Eating

Welcome to therapy Thursday!
This is the day that I give a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is:

Ways to Promote Independent Eating

As a speech-language pathologist working with the birth-three population, I sometimes come across toddlers who are really struggling to use utensils to feed themselves. These toddlers often have low muscle tone and/or fine motor issues that make holding and using utensils difficult.

When Jaycee was a toddler, she struggled greatly with this. It wasn't until she was 3.5 years old when she was able to successfully and independently use a fork and a spoon. I tried everything to help her learn to eat by herself. Ultimately, it took practice and some maturity for her to develop the skill (along with occupational therapy). From all of our practicing, I learned some things I could do to help put her in the best position to succeed. Today, I'm sharing three of these things with you.

1. Get the right plate!

You might think any toddler plate will work when teaching a child to use utensils. For those toddlers that are having issues, they may benefit from using a deep toddler plate. Here is the deepest toddler plate I have at home.

It may look similar to the ones you have in your cabinet but this one is at least an inch deep. This depth is important when a child uses the sides of the plate to help food get onto the spoon. A plate with short sides or sides that curve out will make it more challenging for the child who is working on using utensils independently. A deep plate or a bowl will provide one level of support for the child. 

2. Make sure the plate is secure.

Another thing that needs to be looked at for some toddlers is the movement of the plate. If the toddler is really working to get the food on the utensil, the plate may slide or shift around which only causes more problems for the toddler. There are many plates available with suction cups on the bottle to combat this problem. These are great for chairs with plastic trays. But, I never really had a great suctioning plate that could withstand my daughter's attempts.

Recently, I came across the Happy Mat, which I absolutely love and is pictured above! This is a place mat and plate all in one. This automatically seals to the surface you set it on which keeps the plate stable while the child is trying to scoop against the plate. The other good thing about this product is that does have deep partitions which again helps the child scoop food onto their utensil much easier.

A great alternative to the Happy Mat or other items that promise to seal or suction is simple cabinet shelf liner. You can cut a piece of liner out for your child's plate to sit on. This should help minimize the movement of the plate while allowing the toddler to be more independent. This is a relatively inexpensive way to keep any plate you have in your cabinet more stable for the new feeder.

3. Get the right fork and spoon.

There are many different spoons and forks available in chain stores and online. I have a large collection of spoons but here are a few:

Depending on your child's issue, they may have more success with a specific type of spoon. There are spoons with thicker handles while some have thin handles. There are spoons made with flatter bowls while others are typical toddler sized bowls. There are spoons with angled handles to help the toddler with limited hand and wrist movements. The differences in utensils are important for some feeding issues. For example, toddlers with Down syndrome who have smaller oral cavities in general, may benefit from spoons that have bowl sizes that are smaller. (Here's a post specifically about making spoon choices!) If your child receives occupational therapy or speech-language pathology, they should be able to observe your child eat and make a recommendation for you on which utensil might be most successful.

When I work with a child in therapy on self-feeding, I generally start with the fork. I may have to help the child stab a food in order to get it on the fork, but the child can work on rest. A fork is good because the child can turn the utensil any way he pleases and the food won't come off. Whereas, a spoon you often have to keep it positioned level to make sure it stays on. If a child won't eat any foods that can be forked, I try to select easy to stick foods that will help spooning be more successful. Examples of these include: mashed potatoes, pudding, and yogurt.

If your toddler is struggling, try some of these tips, consult your child's therapist, and keep practicing!

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

Therapy Tip: Alternatives to Sippy Cups

It's therapy Thursday! Hooray!
This is the day that I share a tip based upon my experiences as a pediatric speech-language pathologist and a parent of a child with a disability. Today's tip is:

Alternatives to Sippy Cups

After bottles, most parents offer their child sippy cups. Sippy cups are often a favored choice by parents for many reasons with the main one being that they avoid spills and leaks. But, they aren't favored by specialists like me.

But, hang on! I am a realist. I understand that sippy cups have their uses. For a child who is traveling or tends to throw things, a sippy cup is helpful. I'm not a total anti-sippy cup person, but there's something you need to know about these handy cups.

Sippy cups are not always the best for babies and toddlers who are already in speech therapy or have delays in development. When a baby is drinking from a bottle, the baby uses a suckle-swallow pattern to drink. The tongue is kept in a forward, low position to drink. A sippy cup essentially follows that same pattern. It encourages the tongue to stay in a low, forward position.

For children with low muscle tone or diagnoses such as Down syndrome, the sippy cup encourages the very thing (tongue forward position) that speech-language pathologist often are trying to discourage.

For these reasons, many therapists will offer alternatives to sippy cups. These alternatives do a few things. They encourage the toddler's tongue to retract and have more elevated movements.

A straw cup or an ordinary open cup are ideal alternatives to sippy cups that are easily found. Not every child has the motor abilities to drink from a straw or an open cup successfully. Therefore, I'm going to share some cups I have used with toddlers in my therapy practice. Below are cups that I have personally used. These cups are temporary tools to teach straw or open cup drinking. These are generally not needed long term because they are used simply to teach the drinking method to the small child. Some children work with one of these cups for a few weeks before moving on while others need more time to learn where their lips and tongue should go to drink successfully.

Reflo Cup
I found this cup this year and have started trialing it with some of the children I see in therapy. I really like this product! The cup basically has this special valve inserted inside their otherwise open cup. It slows the rate of which the water comes out of the cup. This is a great way to teach open cup drinking while the child learns how to tip a regular open cup and control the water flow rate. The top of the cup is just like an ordinary cup, which requires lip closure and tongue retraction in order to be successful.

The Honey Bear
The Honey Bear has become a staple item in my therapy practice. This is the cup I use to teach a child to drink from a straw when a child has absolutely no concept of straw drinking. I can gently squeeze this cup to assist in bringing the liquid up and in the child's mouth. You can achieve a similar effect using a standard juice box. However if a thin liquid comes out to quickly, I can put applesauce in the honey bear cup in order to teach the child to straw drink. I have used the Honey Bear multiple times to help children learn to straw drink.

Infa Trainer Cup
This cup is similar to the Reflo cup but with some differences. It slows the liquid before it comes out so that it can more easily by managed by toddlers learning to drink. By simply twisting the lid, the flow rate can be changed to a higher or lower rate. There are three flow rates to choose from. This does have a spill resistant design, so that is a plus with this cup. The children I have worked with generally have more trouble learning open cup drinking with this cup because of the spouted opening, but I still think it's a good option for some.

Recessed Lid Cup
This cup has a very simple design. The lid of the cup is, as it's name suggests, recessed. Therefore, this cup can be used for open cup training, but it can also accommodate a straw too. I like this cup because the lid is recessed, which makes the lips close on the cup as if it were a regular open cup. The flow rate is reduced by the small holes in the lid. This cup also provides handles, which is more helpful for some children. This can be another great option for children who need the water to flow out of the cup more slowly to open cup drink.



There are many widely available alternatives to sippy cups. When a child just can't simply do a straw cup or an open cup, these are some great options for training. Determining which cup is more appropriate requires one to look at what is hindering the child's progress. Your child's therapist should be able to help guide you through this process if you have trouble deciding which one to try. One of these cups could be a key to your child's progress, so don't be afraid to give one a try.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. Please consult your child's speech-language pathologist if you want specifics on how to use these cups. 

Therapy Tip: Spoons for Feeding Issues

Welcome to Therapy Thursday! This is the day I share a tip based upon my experiences as a pediatric speech-language pathologist and a mother of a child with special needs. Today's tip is:

Spoons for Toddler Feeding Issues

Working with toddlers, I run into a variety of feeding related issues that require intervention. Most of my feeding clients need help moving through textures. These kids may be orally defensive, gag easily, and even vomit with dietary changes. I also see kids who have a very restrictive diet. These children generally eat from one or two food groups (grains), and their problems are much more serious than just "picky eating." These kids too may have gagging or some other response when a new food is introduced. Other children I see may have low muscle tone or lack a chewing response that requires intervention as well.

Every child in feeding therapy is unique. Each has their own preferred foods, reactions to new foods, and physical responses to changes. Feeding therapy is very individualized and requires lots of brainstorming and trial-and-error. There are many, many things that go into feeding therapy, but today I'll address just one aspect-spoons.

The utensils that are used with a child may have a role in feeding intervention. Utensils are never THE fix to a solution, but they CAN be one tool or factor in helping a toddler. Today, I'm going to share a few of the types of spoons I commonly use in feeding therapy.

-The Maroon Spoons

Maroon spoons look simple, but they are unique. They have a very flat bowl. This flatness does a couple of things. First, there is no edge on the spoon, which benefits some children. Some toddler spoons are very deep and require strong lip movements to remove the food. The design of this spoon makes this much easier for children who have poor lip closure to eat successfully. The smaller maroon spoon, which is what I typically use with toddlers, limits the bite size that a feeder can give, which may be important for those who gag easily.

I personally used this spoon when my daughter with Down syndrome was eating baby foods. The difference between standard baby spoons and the maroon spoons was remarkable. With her low muscle tone, poor lip closure, and tongue protrusion, these spoons made meal times easier for her.  

If a flat bowled spoon is what you are seeking, there are some cheaper options that can be found in stores. I have found that the Kroger and Wal-Mart "take and toss" spoons have very flat bowls that meet the needs for some of my clients. The quality isn't as good because you get what you pay for, but it is another option. 

-Textured Spoons

I love, love, love textured spoons! There are a few different options for textured spoons, but the ones pictured above are my favorite. Like the maroon spoon, they have a very flat bowl. Therefore, they are useful for the same types of children as the maroon spoon, but offer one additional feature. On the bottom of the spoon, there are small ridges or bumps that provide the tongue with a new feeling during feedings.

The texture on the spoon does a couple of things. First, it provides more feedback for the tongue giving more intra-oral awareness. Secondly, it provides a way to work on texture transitions. This is the reason I use textured spoons in therapy most often. If I have a child who eats Stage 2 baby food without incident but has a major negative response (gagging, vomiting) to the next stage, then I like to use textured spoons to fill in the gap. By keeping the child on Stage 2 foods but changing to a textured spoon, the child can get accustomed to a new texture via the utensil while their known food does not change. Generally, the toddlers will notice the change and sometimes gag with the change in spoon, but I can use this spoon to desensitize them. Sometimes, I can only use the textured spoon for a few bites because the reaction is so severe, but I can keep working to build up to a full feed using these spoons. 

Like maroon spoons, the manufacturer cautions using these spoons on children who will clamp down and bite on these spoons because they could potentially break them. I have never had a problem with this, but it is something I warn parents about. I never allow a toddler to use a textured spoon without adult supervision. 

-Spoon Tip on DnZ Vibe

If you have a DnZ vibe, then the spoon tip option is another handy tool to have in feeding therapy. Again, these tips have a flat bowl. (See a pattern in what I like?) By attaching these tips to a DnZ vibe, you can then use vibration as another way to provide a different input for the child who is struggling with oral aversions or texture changes. I have had some children who had no problems with the textured spoon but did exhibit a negative response when this tip was added with the vibration from the DnZ vibe. Therefore, the vibration gave me a transitional method when bridging the gap between two different texture phases. The vibration also gives the inside of the mouth more input, increasing the oral awareness on the tongue, lips, and cheeks during feeding. This oral awareness is important to achieve for those with low muscle tone. 

-Angled Spoons
Sometimes in feeding therapy, things progress to the point where a child needs to work on self-feeding. Spoons and forks that are angled do sometimes help a child be more successful with scooping food and placing it inside their mouth. The toddler's wrist does not have to make as many movements when a spoon is already angled, which can be helpful for children that have delays in fine motor skills. There are many angled spoons on the market and some options are available in common stores like Babies-R-Us. However, the spoons may all be slightly different.

Besides the angle, you need to look at the spoon bowl depth and handle thickness. Here a deeper bowl may be more beneficial as things won't spill off of the spoon before getting it to the child's mouth. If you are working on sticky, easy to scoop foods like pudding or mashed potatoes, then a flat bowl will still be appropriate. A thick handle may be easier for some children to hold but possibly too large for those with small hands or fingers. Trial-and-error may be necessary to find the perfect angled spoon, but these can be helpful for aiding in self-feeding.


In short, spoons are just ONE aspect of feeding therapy I consider in my practice, but sometimes they can be a very crucial piece that leads to success. I hope that you have some new things to consider when choosing a spoon for your toddler who has a feeding issue.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. Please consult your child's therapist before trying these spoons, and always follow the manufacturers' instructions on use.

Therapy Tip: Should I Invest in Talk Tools?

It's Therapy Thursday!! This is the day that I share a tip based upon my experience as a pediatric speech-language pathologist (SLP) and a mom of a child with special needs. Today's tip is for both parents and professionals, which is:

Should I Invest in Talk Tools?

Have you ever heard of Talk Tools? If you are a speech-language pathologist (SLP), then you have surely heard something about them. If you are a parent of a child with Down syndrome, you may have heard of them at conferences, through parent articles, or word of mouth.

Talk Tools is a company that their website says provides "the best Oral-Placement Therapy (OPT) techniques, training, and tools to clients, therapists and parents." They state that their therapy techniques add a tactile component to feeding and speech therapy, enabling clients to “feel” the movements necessary for the development of speech clarity. To see everything they offer, visit their website. 

Talk Tools is a unique company offering trainings, parent education, tools, books, and step-by-step protocols on how to achieve certain goals like improving jaw strength, for example.

As an SLP, I heard about Talk Tools through professional literature. I considered taking some courses, but the live courses were seldom held in a town near me. The costs was also expensive, but any professional training usually is.

After my daughter with Down syndrome was born in 2006, I decided I NEEDED to learn more about the philosophy from Talk Tools. Jaycee's low muscle tone made sucking hard and tiring for her. When baby food was initiated, she had a reverse swallow and a significant gag response. As I moved her through more textures, vomiting started accompanying the gagging. This happened EVERY meal I attempted with any sort of texture. Straw drinking was absent for a long time. She had major issues her in mouth that was making feedings simply miserable for the both of us.

I can't speak for every SLP out there, but I can say that my coursework and fellowship did not prepare me for these problems. I knew basic information but I didn't feel confident about treating complex pediatric oral-sensory and muscle tone related feeding issues. I needed more education not just for Jaycee but for other children I had started seeing in my job in the birth-three program.

Enter Talk Tools. I took a course. Then another one. Then another on DVD. If I went to a Down syndrome conference, I'd sit in those courses as well. In case you are wondering some of the courses I have taken are: 3-Part Treatment for OPT, What You See in the Body is What you Get in the Mouth! Bridging the Gap Between NDT, Feeding, & Speech, Organizing the Mouth for Feeding and Speech, Pre-Feeding: Preparing the Oral Musculature, and finally Developing Oral-Motor and Feeding Skills in the Down syndrome Population.

As you may have guessed, I have found strategies and methods taught through Talk Tools to be a valuable part of my daughter's early progress and other children in my private speech practice. There are many websites and companies that sell tools to help with various sensory, feeding, drinking, or tone issues. With Talk Tools, you can buy the tool such as the red chewy tube, know the reasoning behind it, know how to best use the tool, and know the guidelines for when it's mastered. The information has given me professional confidence and has helped treat many children more successfully.

In my field of speech pathology, I have heard complaints about Talk Tools. The chief complaint has been that the company is making money off of courses which are promoting the purchasing of tools they also sell. Some also doubt the effectiveness of the tools. I disagree with these opinions. When you take a training course, especially the 3 Part Treatment course given live, then you can clearly understand the rationale and passion behind the company. You will also see that they aren't just trying to sell tools. They stress in their live workshops that the tools aren't as important as knowing why, how, and when to use them.

That being said, let's get back to the original question. Should YOU invest in Talk Tools? My advice is...YES!

For professionals, I personally feel the 3-Part Treatment course is essential for professionals to get a good foundation in feeding and oral-placement therapy. From there, you might find other courses helpful depending on what your caseload entails. There are many tools that I have used again and again in my private practice. Some of these include the Honey Bear straw drinking trainer, lip blocks, the toothette vibrator, and jaw grading bite blocks. If you have children on your caseload who are orally defensive, have difficulty moving through textures, or have low tone, then Talk Tools can help you in your practice.

For parents, I think you have to be choosey with Talk Tools. The costs of these products can add up, and you really need to know what you are doing to make it successful. Therefore, I would highly recommend finding a therapist who has taken Talk Tools trainings. Even better, locate a certified Talk Tools therapist on their website and schedule an evaluation. You may have to drive a distance to find one, but an evaluation should give you a detailed treatment program with step-by-step directions on how to proceed at home. If this isn't possible, there are many articles and parent geared videos or parent friendly conference opportunities such as at national Down syndrome ones that will help you get started. I just wouldn't start buying products at random off the website without knowing how to get your desired outcomes. You can always email the company too with any questions. I have emailed a few questions over the years as I have been working with my daughter and have been given a thoughtful and helpful response back.

In short, Talk Tools has been helpful in my personal and professional life, and I know other people have found them helpful as well. Should you invest in them? I did! So, yes I believe they may help many other families like mine.


Note: Talk Tools does certify professionals through a level training program. While I have taken coursework, I am not a "certified" Talk Tools therapist. These opinions are my own and am offering them for those who are considering Talk Tools.

Therapy Tip-3 Ways to Help Toddlers Use Utensils

Welcome to therapy Thursday!
This is the day that I give a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is for:

Helping Toddlers Use Utensils

As a speech-language pathologist working with the birth-three population, I sometimes come across toddlers who are really struggling to use utensils. These toddlers often have low muscle tone and/or fine motor issues that make holding and using utensils difficult. When Jaycee was a toddler, she struggled greatly with this. It wasn't until she was 3.5 years old when she was able to successfully and independently use a fork and a spoon.

Here are my 3 basic tips and things to consider when helping toddlers who are struggling to use spoons and forks.

1. Get the right plate!

You might think any toddler plate will work when teaching utensils. For those toddlers that are having issues, they may benefit from using a deep toddler plate. Here is the deepest toddler plate I have at home.

It may look similar to the ones you have in your cabinet but this one is at least an inch deep. This depth is important when a child uses the sides of the plate to help food get onto the spoon. A plate with short sides or sides that curve out will make it more challenging for the child who is working on using utensils independently.

2. Make sure the plate is secure.

Another thing that needs to be looked at for some toddlers is the movement of the plate. If the toddler is really working to get the food on the utensil, the plate may slide or shift around which only causes more problems for the toddler. There are many plates sold with suction cups on the bottle to combat this problem. These are great for high chair trays. Back when my kids were small, I didn't have any luck with these suctioning enough to stay put. If this is happening for your child too, then a great alternative is to purchase some cabinet shelf liner. You can cut a piece of liner out for your child's plate to sit on. This should help minimize the movement of the plate while allowing the toddler to be more independent.

3. Get the right fork and spoon.

There are many different spoons and forks available in chain stores and online. I have a large collection of spoons but here are a few:

Depending on your child's issue, they may have more success with a specific type of spoon. There are spoons with thicker handles while some have thin handles. There are spoons made with flatter bowls (open part) while others are typical toddler sized bowls. There are spoons with angled handles to help the toddler with limited hand and wrist movements. These differences in utensils are important for some feeding issues. For example, toddlers with Down syndrome who have smaller oral cavities in general, may benefit from spoons that have bowl sizes that are smaller. If your child receives occupational therapy or speech-language pathology, they should be able to observe your child eat and make a recommendation for you on which utensil might be most successful.

If your toddler is struggling, try some of these tips, consult your child's therapist, and keep working!

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

Therapy Tip-Items at Wal-Mart for Oral-Sensory Play

Welcome again to Therapy Thursday!

This is the day I share a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is:

Items at Wal-Mart for Oral-Sensory Play

The teething and rattle section at my local Wal-Mart

Almost every parent purchases toys for their babies to chew on for teething and play. Providing these type of toys is just a normal part of every baby's learning experience and development.

But there are babies who need oral-sensory play to address their developmental, medical, or sensory needs. Who? Babies who have low muscle tone including those with Down syndrome. Babies with a feeding tube with limited or no oral feedings but with the hopes of one day becoming an oral feeder. Babies who eat orally but have feeding challenges none the less.

As a speech-language pathologist, I have access to websites and catalogues selling costly tools for oral play. Many of these tools are designed to:
-provide texture for a sensory experience
-provide resistance to develop jaw strength
-provide stimulation (and therefore a specific movement) of the lips, tongue, or jaw
-encourage munching or chewing motions
-provide vibration to help the child receive added input

These specialized tools are great and useful. In fact, there are many courses and books that tell speech-language pathologist how to best use them and even have hierarchies for determining progress. I have purchased many of these and use them in my practice. But, what are parents suppose to do beyond the prescribed exercises? Many of these tools are not meant to be handed to a baby for their own oral play. Instead, they are done with a parent/SLP making sure the tool is used appropriately. These programs are great, and this entry is not about finding an alternative to them.

But the questions becomes for me as a speech-language pathologist:
How can I encourage the baby's oral-sensory play in a safe manner once I leave the house?

My answer has been to look for things available to any baby at local stores. Over the past few years, I have been finding more and more teethers and baby toys that can help fill some of the objectives I have with babies who need oral-sensory play.

Below are some products I found at my local Wal-Mart that would be useful for babies under 12 months who have been determined to need oral-sensory play. While I cannot go into too much detail in this blog about how to use each tool for a specific problem. I will tell you what I see when I look at these products as a speech-language pathologist. Hopefully, this can help you when you are shopping for your child.

Here are some things I like about the Munchkin Orajel Massaging Teether:

-It has bite activated vibration which should encourage baby to repeat biting.

-There are different textures on the teething parts which will give different feedback to the baby.

-The actual teething parts of this are made of different shapes. These allow the baby to use different teeth or to use varying amounts of force to compress the teether.

Next up is the RaZ-Berry Teether.

-I especially like this for those babies who are tube fed and need oral stimulation during feedings. This pacifier type teether is not smooth but has bumps and textures on it giving different feedback than a typical pacifier.

-This can be frozen to allow a cold temperature to be introduced and therefore add another layer of stimulation to the baby's mouth.

This is the Gummi Teething Necklace.

-This is a very basic version of an expensive version sold by therapeutic companies. This has texture on the teether to give the baby additional feedback in their mouth.

-The necklace is designed to be worn on the mother while the baby chews. This could be beneficial for babies who need oral play but like to be on mom's lap often. This teething necklace isn't necessarily that special, but I see where it would have uses for particular babies.

Now, let's look at the Nuby 3 Step Teether Set.

-I love how this includes three teethers going from Step 1 to 3. While they determine the steps on which teeth are needed for the teether, it can be also be said that these teethers go from least resistance to most resistance. That means the amount of jaw strength needed to compress or bite the teether increases through the steps.

-Again, I love that each teether has different textures on them for providing different feedback for baby's mouth.

Here we have the Infantino Vibrating Teether.

-I love anything that vibrates to give more feedback to the baby, especially those with low muscle tone.

-Vibration is again activated with biting, so this may give you some indication of the baby's jaw strength.

Finally, this is one of my go to products in my therapy practice, the NUK tooth and gum cleanser with a finger brush. Though, this is a product that baby cannot use alone.

-Proving oral stimulation of the gums and teeth is essential early on for babies who have low muscle tone or feeding difficulties. This product is great because you get the cleanser and also the finger brush to provide this stimulation. If the baby cannot tolerate the cleanser, you can still use the finger brush.

-The finger brush can also be used to encourage munching movements on a baby by stimulating the back molar region of the gums. This is a technique that I have learned about by taking courses through Talk Tools. For more information on this, please consult a trained SLP.

I hope you can see what I see when I look at these types of products for babies and promoting oral-sensory play. Check out your local stores and see what you find.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. Please consult your child's speech-language pathologist to see how and if these products can be used for your child.

Therapy Tip: Holding Bottles

Welcome to Therapy Tip Thursday!

For you newcomers, this is the day that I give a tip based upon my experience as a pediatric speech-language pathologist and a mom of a child with special needs.

Today's tip is for:

Helping A Baby Hold Their Bottle

When my daughter was a baby, I could not get her to hold her bottle. Due to her Down syndrome, she had low muscle tone and short fingers. She had a heart condition as well which meant her stamina was poor.

Today's tip was born out of desperation. I wanted Jaycee to hold her bottle. I tried cupping her hands on it, while giving her support with my hands over hers with no results. The only success I had was with a very small two ounce bottle from the hospital which was skinny enough for her to hold in her small hand. A two ounce bottle was not practical all the time though.

Jaycee was on a bottle for a prolonged period. Her oral-motor abilities were poor for drinking and eating. She was on a bottle until around age 2 when I was finally able to transition her to a sippy cup and straw. Her health and calorie intake always dictated how fast we could move her through feeding milestones.

When a child isn't doing a developmentally appropriate skill, I think it's always important to think of supports to help them rather than view the child as just obstinate. I wondered how I could help Jaycee hold her bottle to be more independent. Then an idea came to me. I made it, and it worked the very first time I tried it! Using a can koozie (a.k.a. can hugger), I made a support for Jaycee's bottle.

To replicate this, you will need scissors, a can koozie, masking tape, and the baby's bottle. The idea behind this is create little holes in the sides of the can koozie for the baby's fingers to slip through in order to support baby's hands in holding the bottle.

Here's how to make it:
First, place the bottle inside the koozie. If your bottle is loose in the koozie, use the masking tape to tighten up the koozie by wrapping the tape around the bottom and the top of the koozie. The can koozie needs to be tight enough to stay on the bottle. Next, make 4 little slits on each side of the koozie for the baby's fingers to slip in the koozie and on to the bottle. You might want to use a marker to mark the spot where the baby's fingers naturally hit the koozie with the bottle inside. The slits should not be too tight on the baby's fingers. They should not cause pressure on the fingers or hurt the baby. Of course, this support should still be used with an adult present.

Now, you should be ready to give it a try. Place the baby's prepared bottle inside the can koozie. Gently place the baby's fingers in each finger slit. Hopefully, this should give your baby support to hold their bottle. If it doesn't work the first time, don't give up. Give it another try!

This worked the very first time I tried it with Jaycee. I felt that I witnessed a miracle with this can koozie. I hope it helps your baby too!

Therapy Thursday is for educational purposes only and not intended for therapeutic advice.

Therapy Tip: Throwing At Mealtime

Welcome to Therapy Tip Thursday!

This is the day that I give a tip or idea based upon my experiences as a parent of a child with special needs and a pediatric speech-language pathologist.

Today, the tip is for children who throw their plates.

What? Your child has never done this? You are blessed! Come back next Thursday!

This was a problem in my house for what seemed like an eternity. When Jaycee was a toddler, she often threw her plate and cup at meals. She thought it was hilarious. She didn't understand when we got on to her. We were so frustrated as we spent our meals holding Jaycee's plate down to keep her from throwing it. In resturants, we were reluctant to give her a plate because we knew that she would toss it to the floor when we were unprepared.  

The solution I came up with was:  picture cue placemat.

This placemat was a miracle for Jaycee. The placemat, with an actual picture of her plate, provided her with the visual cue to keep her plate on the table. At the time, Jaycee was good at matching pictures, so this concept helped make this work.

Steps to make:
1. Gather up your child's plate and cup, if needed.
2. Take a digital picture of the plate (and cup) as if it were sitting on your child's highchair or table.
3. Print out this picture in an 8X10 size or sized to fit your child's highchair tray.
4. Laminate the placemat or place it in a plastic sleeve to protect it.
5. Tape the protected placemat to the tray or table where your child sits.


Using the placemat:
-Once the placemat is placed where it needs to go, show the child the real empty plate. Tell the child, "I'm going to fix your plate and give it to you. You need to keep this plate here."
-Show the child how the plate and the placemat plate are the same. You may check their understanding of where it goes.
-Fill the plate up with food and place it on the plate on the picture located on the placemat.
-Give your child verbal cues to keep the plate where it needs to be.
-Only after several successful meals using the exact plate on the placemat would I suggest that you change the real plate to avoid confusion.



I have tried this with other children with varying degrees of success. I hope this makes your mealtimes more enjoyable.

Therapy Thursday is for informational purposes and not intended to be therapeutic advice.