Apraxia Awareness Day: 10 Tips on Giving Kids With CAS a Voice

May 14 marks the third annual Apraxia Awareness Day, a movement headed by the Childhood Apraxia of Speech Association of North America (CASANA). The association’s motto—”Every Child Deserves a Voice”—entreats industry pros to correctly identify and treat kids with apraxia who may not develop intelligible speech. This is why apraxia awareness day is so important.

When I wrote the 10 Early Signs and Symptoms of Childhood Apraxia of Speech, many SLPs voiced their concern about how CAS is supposed to be a rare disorder and they are seeing over-diagnosis. Their concerns are valid. Current data, according to the ASHA portal, state that CAS occurs in every one to two children per 1,000. Over-diagnosis is a problem precipitated by factors that include:

  • Lack of clear and consistent diagnostic guidelines.
  • Lack of adequately validated diagnostic tools.
  • Professionals other than SLPs (pediatricians, neurologists) diagnosing CAS.
  • SLPs inadequately trained in diagnosis and treatment.

Over-diagnosis can cause families undue emotional stress and financial hardship. It also might divert important resources from those children who most need them.

According to research, children with CAS also often go undiagnosed if they truly DO have it! Differential diagnosis is critical with this disorder. Children not identified with CAS may struggle their entire lives and quite possibly not achieve intelligible speech without early and appropriate intervention. Consider that last line again: Without proper diagnosis and treatment, children with CAS may NOT achieve intelligible speech. This is what’s at stake!

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Apraxia awareness is crucial for professionals and families, so every child who has CAS gets the services he or she needs and deserves, regardless of how “rare” the disorder.

These children and parents rely on SLPs to be their heroes. So please, take time today—or soon—to learn more about childhood apraxia of speech. And if you suspect CAS in a client or student:

  • Seek out resources.
  • Attend a conference.
  • Listen in to a webinar.
  • Talk to and consult with your colleagues.
  • Wear blue and speak up for those who don’t yet have a voice.
  • Above all, be part of the solution.

These children and families are counting on you.

Having trouble getting reimbursed for CAS treatment? Read advice on making successful appeals.

And more resources to learn more about childhood apraxia of speech:

 

Laura Smith, MA, CCC-SLP, is a school-based and private clinician in the Denver metro area specializing in childhood apraxia of speech. She’s CASANA-certified for advanced training and clinical expertise in Childhood Apraxia of Speech and often speaks at conferences and consults for school districts or other professionals. Like her on Facebook, follow her on Pinterest, or visit her website at SLPMommyofApraxia.comlauraslpmommy@gmail.com

Helping Middle Schoolers With Organization and Time Management

Students often find the transition from primary to secondary school a challenge. Especially those who experience issues with executive-function skills. Many of my students (and even their typically developing peers) particularly struggle with organization and time management. For example, kids spend most of their time in one classroom in elementary school, while from 6th to 12th grade, they move through classes with different teachers and subjects.

I spend a lot of time working with my kids to develop these skills for many reasons. I stress that if they think it’s hard now, it will only get trickier as academic demands increase. Below are just a few ways I work on organization and time management with my students:

1. Folders
Students should use separate folders for each class. Many students already do this, but my kids must work harder to keep them organized. They pile everything into one folder and can never find what they need. Spend a session going through your students’ folders and putting papers where they belong. We also discuss what’s important to keep versus what they should throw out.

2. Planners
I don’t think I could get through life without some kind of planner or organizer. Introduce students to how and why to use a planner. It’s a visual reminder of what they need to do each day and for planning steps for future tasks or assignments. Check if your school has free planners. Also, you can print out weekly planning pages for your kids and make them a planner. If your students are tech savvy, show them how to use a calendar app. Or check out the many downloadable planning apps to see which ones they might like to use.

3. Check-lists/Schedules
Similar to a planner, checklists and schedules provide students with a visual reference of tasks they need to accomplish.

  • Checklists are great to organize all the things needed to get done for the day or week. We feel accomplished when we cross things off. Help students generate a checklist of what they need to get done. It can include homework, projects, reading, chores, etc…. You can also show them how to break down projects into smaller chunks, so they’re not as overwhelmed with assignments. For example, if they have a five-paragraph essay due, they spend each weekday working on just one paragraph, versus facing the WHOLE thing in one day.
  • A student struggling with time management may find a daily schedule helpful. Drafting a schedule together will help you see what the student does or can do with his or her time each day. It’s also a good opportunity to help that particular student come up with a plan.

4. Backpacks
I don’t know if it’s just my kids, but their backpacks are a MESS! Sometimes I take a look inside and wonder how they find anything. I’ve spent entire sessions just organizing and cleaning out bags. The kids are amazed at the things they find—lost homework or projects due months ago, for example. As with folders, this is a good time to discuss what they need to carry with them and what they should leave at home.

I hope these ideas will help your students with executive-function challenges. I like to try different strategies and see what’s successful. If one thing doesn’t work, try something else!

Gabriella Schecter, MS, CCC-SLP, is a full-time SLP working in a grade 6-12 school. She posts regularly on Instagram (@middleschoolSLP), sharing ideas and activities for this age group. Check out her blog or email her at MiddleschoolSLP@gmail.com.

 

When Patients Won’t Practice

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You give 100 percent in each session, but end up repeating last week’s activities because your patient didn’t practice. Who’s at fault?

We all tend to get complacent with the materials and techniques we use. Thankfully, we also take CEU courses to keep ideas and implementations fresh. But what if you try everything in your bag of tricks and your patient still doesn’t improve?

I discussed this exact issue with two of my patients recently. Each one had a different situation, but both were making limited progress. “John,” for example, sought treatment with the hope that others would stop complaining about his voice quality. He says he stopped doing the diaphragmatic breathing exercises I assigned, because his voice wasn’t any better. I replied that it takes more than a week of doing only breathing exercises to make improvement. Breathing is just the first component of coordinating a new voice.

He and I talked about the real reason he was here. I discovered that although he felt his voice sounded disordered, it was really only affecting those around him. It really didn’t bother him that others thought his voice was annoying, so he decided not to continue sessions. Fair enough.

“Sara’s” case was different. She and I worked together for several weeks and ended up going through almost the same session each time. She reported practicing, but I didn’t see evidence of that in her productions. Frustrations arose and she felt like she was getting nowhere.

In our most recent session, we talked at length about life and the projected outcomes of her condition. Her voice issues affect her life, which upsets her. This emotional roadblock gets in the way of her dedicating time to practice outside the treatment room. She also feels guilt and blames herself for the issue, even though it’s not at all her fault. She realizes that these feelings are holding her back, so she’s taking time off from sessions and coming back when she’s ready to commit.

We should try to build up patients when they come to us feeling down on themselves. That might be tricky, however, because we also point out their mistakes in order to correct them. Sometimes sharing personal experiences as encouragement helps. It’s never a bad idea to refer clients to a therapist or counselor as supplemental treatment—it’s even in our code of ethics and scope of practice.

I do this occasionally when sessions frequently turn into “therapy.” If I think a patient would benefit from talking through issues with a trained professional, I always refer out. That way when the patient comes to our sessions, we focus on the voice disorder and I know the other issues are being addressed.

If your patient isn’t practicing, it’s time to find out why. Is it motivation? Is it you? Do your best to figure out what else the patient needs from you to be successful, and offer many options. Sometimes all you have to do is ask.

 

 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech-language treatment in her private practice, a tempo Voice Center, LLC, and lectures on the singing voice to area choirs and students. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders. Knickerbocker blogs on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

 

Maximize Treatment Minutes by Assigning Homework

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A recently published article in Frontiers of Neuroscience supports what we as clinicians know: The more time clients spend on meaningful treatment tasks, the better their outcomes.

Yet there are only so many hours in the work day, so many sessions that insurance covers and only so many minutes of treatment we can give. So how do we get around these limitations? Give your clients homework.

The article mentioned above states that patients who do exercises at home in addition to their weekly sessions improve significantly more than patients who only attend sessions. But how do we find time to create, assign and track homework in the midst of packed schedules, IEP meetings and productivity expectations?

A go-to for SLPs are worksheets and activities like those found in the Workbook of Activities for Language or Cognition and Handbook of Exercises for Language Processing series. Many SLPs also develop their own activities or assignments that they write or print for clients. These paper-based exercises are free and individualized, plus they cover any range of skills from visuospatial reasoning to word-finding.

In addition, the increasing availability of technology offers several online-based options. The app featured in the study referenced above (Constant Therapy, free for clinicians) allows SLPs to assign a variety of language or cognitive homework tasks for clients to do throughout the week on their iPads, Androids or Kindles. Plus, clinicians and patients see all of the progress tracked by the app.

There are also several other apps that help patients work on specific skills. For instance, growing numbers of interactive, pediatric-oriented games allow parents to play with their children to practice treatment skills. (I like the Bag Game from all4mychild, for example.) There are also apps aimed specifically at adults, such as those from Lingraphica, Tactus, and Virtual Speech’s new, adult-oriented series of apps (like Verbal Reasoning). There are even apps that are built into many tablets and smartphones—calendars and alarm systems—that we can use with our clients to practice executive function skills independently and functionally.

The practice of assigning homework allows the clinician to more effectively manage our time and also has a great advantage of engaging patients in their own treatment programs. Today’s technology also allows clinicians to monitor clients’ compliance while empowering them to take responsibility for their improvement.

In today’s fast-paced, schedule-packed world, we must maximize our time and that of our patients! Try out a new homework option today—then share it with a clinician friend to help them save some time, too.

 

Jordyn Sims, MS, CCC-SLP, is a speech-language pathologist working in the Boston area. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; 2, Neurophysiology and Neurogenic Speech and Language Disorders; and 15, Gerontology.  Sims has experience with adults and pediatrics and is a clinical consultant for Constant Therapy. jordyn.sims@gmail.com 

How Do You Know When it’s a Language Delay Versus a Disorder?

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Editor’s Note: This is an excerpt from a blog post that originally appeared on Special Education Guide. 

How do you know when it’s a language delay versus a disorder?

Unfortunately, there is not always a straightforward answer to this question. A language delay is just that—a delay in acquisition of language skills compared to one’s chronological and cognitive/intellectual age-peers. A young child with a language delay may exhibit a slower onset of a language skill, rate of progression through the acquisition process, sequence in which the language skills are learned, or all of the above.

However, there is a subset of children who continue to demonstrate persistent difficulties acquiring and using language skills below chronological age expectations (by preschool or school age) that cannot be explained by other factors (for example, low nonverbal intelligence, sensory impairments or autism spectrum disorder) and may be identified as having a specific language impairment (language disorder).

In contrast to a delay or a disorder is a language difference. With a language difference, communication behaviors meet the norms of the primary speech community but do not meet the norms of Standard English. This difference can exist whether the person in question is a child from a different country or simply from a different neighborhood in the same city.

So, what are some options for addressing language delays and disorders?

Intervention for a delay may take on several forms:

  • Indirect treatment and monitoring
    • Provide activities for parents and caregivers to engage in with the child, such as book-sharing and parent-child interaction groups.
    • Check in with the family periodically to monitor language development.
  • Direct intervention, including techniques such as:
    • Expansions—repeating the child’s utterance and adding grammatical and semantic detail.
    • Recasts—changing the mode or voice of the child’s original utterance (for example, declarative to interrogative).
    • Build-ups and breakdowns—the child’s utterance is expanded (built up) and then broken down into grammatical components (break down) and then built up again into its expanded form.

Intervention for a language disorder is child specific and based on that child’s current level of language functioning, profile of strengths and weaknesses, and functioning in related areas, including hearing, cognitive level and speech production skills. The overall goal of intervention is to stimulate language development and teach skills to enhance communication and access academic content. The developmental appropriateness and potential effectiveness on communication and academic and social success should be considered when developing treatment goals.

 

Aruna Hari Prasad, MA, CCC-SLP, is ASHA associate director of school services.  ahariprasad@asha.org

10 Early Signs and Symptoms of Childhood Apraxia of Speech

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I was a practicing speech-language pathologist for five years before my daughter was born. I worked primarily at the elementary and middle-school levels. I took professional development workshops on childhood apraxia of speech (CAS) and treated it successfully in three kiddos from my caseload. Perhaps that’s why I was bewildered, angry and utterly devastated when I missed those very signs in my own child.

I hadn’t yet worked in early intervention, so I missed what seem like obvious signs to me now that I specialize in the disorder. I urge all SLPs to learn more about CAS, because the disorder requires a specialized approach different from other commonly used treatments for speech and language delays.

In addition, ASHA denotes that the qualified professional to diagnose CAS is an SLP with specialized knowledge in motor learning theory and skills with differential diagnosis in childhood motor speech disorder, not a neurologist or other medical practitioner. It’s important to know the signs, but also to refer your client to a qualified SLP for differential diagnosis if you suspect childhood apraxia of speech.

Here are 10 early signs and symptoms of childhood apraxia of speech:

  • Limited babbling, or variation within babbling
  • Limited phonetic diversity
  • Inconsistent errors
  • Increased errors or difficulty with longer or more complex syllable and word shapes
  • Omissions, particularly in word initial syllable shapes
  • Vowel errors/distortions
  • Excessive, equal stress
  • Loss of previously produced words
  • More difficulty with volitional versus automatic speech responses
  • Predominant use of simple syllable shapes

Other non-speech “soft signs” that may be present include:

  • Impaired volitional oral movements (oral apraxia)
    • Difficulty with volitional “smiling” “kissing” “puckering”
  • Delays with fine/gross motor skills
  • Feeding difficulties that include choking and/or poor manipulation of food
  • General awkwardness or clumsiness

These are early signs, but many overlap with other phonologic and language delays, so it’s important to keep in mind that differential diagnosis is critical, as over-diagnosis of CAS remains problematic. It’s still a relatively rare disorder; however, there are resources that can help if you suspect it.

You can tap the below resources to learn more about childhood apraxia of speech.

 

Laura Smith, MA, CCC-SLP, is a school-based and private clinician in the Denver metro area specializing in childhood apraxia of speech. She’s CASANA-certified for advanced training and clinical expertise in Childhood Apraxia of Speech and often speaks at conferences and consults for school districts or other professionals. Like her on Facebook, follow her on Pinterest, or visit her website at SLPMommyofApraxia.comlauraslpmommy@gmail.com

 

 

 

 

 

Interprofessional Pre-screening Shortens the Wait for Autism Diagnoses

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Editor’s Note: In recognition of Autism Awareness Month, we have several posts addressing autism-related issues throughout April. The screening program described here is one of several ASD initiatives at Wichita State University; another that eases children’s visits to the dentist is explored in this month’s April ASHA Leader issue.

 

Recently, I became passionate about expediting identification and diagnosis for young children who show signs and symptoms of autism spectrum disorder (ASD). This desire was fueled by a research project I conducted with Douglas F. Parham and Jagadeesh Rajagopalan; the results revealed that pediatricians and family physicians have not been screening young children for ASD as recommended by the American Academy of Pediatrics (regularly conducting ASD-specific screenings for children two times prior to their second birthday) in Kansas, Iowa and Oklahoma.

Based on these results, I determined that one way I could help advance the identification of these young children would be to develop an authentic interprofessional education opportunity for students in the allied-health and education programs at my university: Wichita State University in Kansas. In the spring of 2012, WSU students, faculty and community professionals agreed to form the Wichita State University-Community Partners: Autism Interdisciplinary Diagnostic Team (AIDT).

The team aims to:

  1. Educate undergraduate and graduate students to better recognize the characteristics of ASD and to be able to participate in screening, assessment and referral of children who demonstrate early signs.
  2. Provide a highly needed service to children and families throughout south-central Kansas.

Since the initiation of this team, faculty, clinical educators and students from eight departments—communication sciences and disorders (audiology and speech-language pathology), early childhood unified special education, clinical psychology, physical therapy, dental hygiene, physician assistant, nursing and public health—have participated. Additionally, the University of Kansas School of Medicine–Wichita (represented by a developmental pediatrician and an advanced practice registered nurse) has been a valued partner and referral source.

Faculty and clinical educators recruit and select students to participate in our screening program. Student participants must enroll in a field-based experience and/or an appropriate class within their respective programs. All stakeholders then do a one-day training prior to the start of each semester on identifying the characteristics of ASD, to screen, to participate in the assessment process and to identify appropriate referrals for children and families. The educators agree to participate in at least four diagnostic sessions each semester, ensuring that students from various professions have multiple opportunities to work together, while observing interprofessional collaboration among university and community professionals.

The partnering developmental pediatrician and the advanced practice registered nurse refer children and families to the screening program based on the “red flag” characteristics parents report on the pediatrician’s developmental history form. The program’s coordinator (that’s me) contacts the family via phone to gather additional developmental information, and then the team meets to discuss that information and other relevant documents.

The team conducts the evaluation over two days. The first day, we assess the child’s communication, play and cognitive abilities, using selected tools and strategies based on the child’s strengths and needs. The second day, we administer the Autism Diagnostic Observation Schedule-2 and the Childhood Autism Rating Scale-Second Edition, Standard Version, to provide the developmental pediatrician with diagnosis-relevant information. We also conduct hearing, motor and oral health screenings. The team then meets to discuss the aggregated assessment results, which, in addition to appropriate recommendations and resources, are shared with the family.

We schedule an appointment for the child and family with the developmental pediatrician approximately one week following our assessment. Someone from our team accompanies the family to the appointment to act as a liaison and assist with the examination.

Since the introduction of the AIDT, 133 students, clinical educators, faculty and community professionals across 10 disciplines have come together via this individualized education program field-based experience. Our students and professionals have assessed 24 young children who present with characteristics of ASD, and approximately 85 percent of these children have received a confirming medical diagnosis.

Participants and families alike gain from this experience. Students learn from, with and among others who are committed to interprofessional practice. Families voice their appreciation for receiving diagnostic information from multiple disciplines all at once, so they don’t have to run from place to place to receive it.

Mostly, they value how quickly the AIDT’s work enables them to get their child needed help.

 

Trisha Self, PhD, CCC-SLP, is an associate professor in the Department of Communication Sciences and Disorders at Wichita State University and coordinator of the school’s Community Partners: Autism Interdisciplinary Diagnostic Team. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; and 10, Issues in Higher Education.
Trisha.Self@wichita.edu 

Top 10 Lessons I Learned from Loving Kids with Autism

Lessons Learned from Loving Kids with Autism

Editor’s Note: Today is World Autism Awareness Day, so we have a special post to celebrate the wonders that people with this unique perspective bring to the world. Read more about autism in this month’s April ASHA Leader issue devoted to the topic, which includes articles on the importance of helping people with ASD predict what happens next and how to measure clients’ progress in social skills groups.

 

If you’ve had the good fortune of loving kids with autism, you’ve probably encountered a few unexpected lessons in life.  In honor of National Autism Awareness Month and to express my gratitude for what my friends with autism spectrum disorder have taught me, I’d like to share my Top 10:

#10. In a world of too many gadgets and gizmos, a spinning top is pretty cool.

#9. Echolalia keeps my “over 40” brain sharp. I’ve learned to repeat, repeat, repeat.

#8. Parents with patience are the best teachers.

#7. Consistency is so comforting.

#6. Random objects can bring one kid a lot of joy. I’ve learned to appreciate road maps, bathroom signs and every single state’s license plates, to name just a few.

#5. Sometimes, carrying a favorite toy all day long just makes everything go better.

#4. Flapping really does feel good.

#3. The world needs more quirky.

#2. The first spontaneous “hug” is the best one of all.

And the #1 lesson I learned from my clients with autism?

#1. Love is when you take the time to know someone who sees the world differently than you.

 

What lessons have you learned from loving kids with autism? I’d love to know. Let’s start a list here to celebrate and raise awareness of all that the world can learn from these extraordinary, beautiful people.

 

Melanie Potock, MA, CCC-SLPtreats children, birth to teens, who have difficulty eating. She is the co-author of Raising a Healthy, Happy Eater: A Parent’s Handbook – A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating (Oct. 2015), the author of Happy Mealtimes with Happy Kids, and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Potock’s two-day course on pediatric feeding is offered for ASHA CEUs.  Melanie@mymunchbug.com  

 

 

A Voice Lift? Is It Really Necessary?

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It’s an image-driven world in which we live. Instagram, Facebook, SnapChat, Twitter and YouTube launch llamas and two-toned dresses into stardom. We are also definitely not interested in showing our age. Botox and cosmetic surgeries work wonders for our outward appearance. But what is a person to expect as the larynx ages? Is a voice lift out of the plausible realm?

Some presbyphonia is present in many clients I see. As the male vocal folds lose mass, they bow outward and voice quality becomes breathy and high-pitched. The voice becomes lower in pitch as the female ages. This happens because muscle fibers do not regenerate as quickly when we get older, so the vocal folds begin to atrophy. The lamina propria (second layer of the vocal folds) is not as flexible and fibers tend to break down.

Three subsystems of the voice need to be in balance to have a fully functioning mechanism: breath, sound and resonance. When we age, lung tissues lose elasticity and rib-cage cartilages begin to ossify. Ossification also affects cartilages of the larynx. This is not always bad, as vocal scientist Ingo Titze suggests, because this hardening can help stabilize the voice box as it anchors the acrobatic muscles for speech or singing. A thoughtful article by Claudia Friedlander discusses this in further detail, as does this post from Gray Matter Therapy.

It’s helpful to think about our voices and how they differ because of gender. The female voice is affected by androgens, estrogen and progesterone. Wendy D. LeBorgne and Marci Rosenberg report in their book, “The Vocal Athlete,” that during menopause, low levels of estrogen cause the once thick mucosal membrane of the vocal folds to lose mass and flexibility. Progesterone has been shown to help shed cells off the vocal fold mucus membranes. Prior to menstruation, secretions and mucus on the vocal folds thicken, the larynx dries out, the voice becomes less agile and range may be affected. Hemorrhage risk and swelling is great at this time because capillaries change how they transport blood. Robert Sataloff has said in a NATS Chat recently, that the vocal fold swelling is protein-bound and cannot be shed by diuretics.

All of this happens because hormones are running rampant. A cure? Possibly regulation by birth-control medications, because they balance out those hormones. As menopause hits, hormones tend to disappear, and with them the qualities that made the voice sound female in the first place. Vocal folds thicken, epithelium atrophies, vocal fold nerve connections demyelinate. This might explain why vibrato slows as well.

What about the men? They start off with high-pitched voices, but when change occurs at puberty, pitch lowers with the presence of androgens. Booming male voices are the result of increased blood flow to the voice box. As with women, male hormones decrease with age, so power and tone go with them.

Presbylaryngis is an age-related voice issue caused by nature taking its course, but that doesn’t mean it can’t adversely affect quality of life. Voice pathologists do their best to rehabilitate with vocal function exercises and other treatment techniques. Sataloff says that 80 percent of the time this is sufficient. A surgical option is injection laryngoplasty, often coined the “voice lift.” The procedure consists of fat grafting, injectables or implants, and its necessity is controversial. Do people really need a rejuvenated voice? With an increase in hearing loss as we age, I can see why it’s popular.

 

Read about behavioral voice lifts. 

 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech treatment in her private practice, a tempo Voice Center, LLC, and lectures on the singing voice to area choirs and students. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders. Knickerbocker blogs on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

Want to Work in Acute Care Pediatrics? 5 Traits for Success

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It’s hard to believe I’ve been an SLP for 38 years! For most of that time, I’ve worked in an acute-care pediatric setting. I’m employed at the Florida Hospital for Children in Orlando, where I provide pediatric/neonatal swallowing and feeding services for multiple acute-care services, including neonatal intensive care, pediatric intensive care, newborn nursery, general pediatrics, oncology, epilepsy, ears, nose and throat, gastrointestinal, congenital heart surgery, plastics, and extracorporeal membrane oxygenation. Thinking on my feet, but carefully considering both the evidence base and interdisciplinary perspectives, is a must every day.

Sometimes people ask me: What are you passionate about? What drives you?

I am passionate about the neonatal intensive care unit and our tiny patients. Being a part of this wonderful team and fostering the parent-infant relationship through supporting safe and successful feeding continues to fill my heart with joy after all these years. I am a lifelong learner and am passionate about creating opportunities to learn from physicians, nurses, respiratory therapists, my rehab colleagues and the families I serve.

Are you interested in working with these tiny and fragile patients? If so, here are some questions to ask yourself:

  1. Do you like to solve a puzzle? Problem-solving is essential in acute care! Critically thinking about a patient’s medical history and co-morbidities, then looking at the data and making sense of the information is key. Is the infant/child safe to feed? If so, what is the best approach? How can the child best communicate? What is interfering?
  2. Are you passionate about evidence-based practice? Physicians want to know why you are recommending what you are and what evidence there is to back it up. Sometimes the highest level of evidence is our clinical experience and wisdom. But we need to be aware of what hard evidence exists and bring it to the physicians.
  3. Do you work best in a team setting? Looking at the critically ill child works best in the context of multiple perspectives. Physician specialists, bedside nursing, respiratory therapists, dieticians and our rehab colleagues bring information that helps us make better clinical decisions. Through team interactions, we jointly problem-solve.
  4. Do change and unpredictability give you a buzz? Some days we need rollerskates! The day can change quickly with new consults, children being discharged, and changes in the patients we are treating. Being ready for change and staying focused are key to riding the wave.
  5. Are you well-grounded in normal and atypical development? This knowledge allows us to problem-solve and recognize what symptoms deserve our focus. Experience in birth-to-3 is invaluable for preparing to become a pediatric acute-care SLP.

Do the traits above sound like you? If you are thinking about moving into acute-care pediatrics, stay tuned for more to guide you on your journey!

 

Catherine S. Shaker, MS, CCC-SLP, BCS-S, works in acute care/inpatient pediatrics at Florida Hospital for Children in Orlando. She offers seminars on a variety of neonatal/pediatric swallowing/feeding topics across the country. Follow her at www.Shaker4SwallowingandFeeding.com or email her at pediatricseminars@gmail.com.