Step Away From the Sippy Cups!

As an SLP who treats babies with feeding challenges, I frequently hear from parents how excited they are to begin teaching their baby to use a sippy cup.  Problem is, those sippy cups seem to linger through preschool.
Parents often view it as a developmental milestone, when in fact it was invented simply to keep the floor clean and was never designed for developing oral motor skills.  Sippy cups were invented for parents, not for kids.  The next transition from breast and/or bottle is to learn to drink from an open cup held by an adult in order to limit spills or to learn to drink from a straw cup.

Once a child transitions to a cup with a straw, I suggest cutting down the straw so that the child can just get his lips around it, but can’t anchor his tongue underneath it.   That’s my issue with the sippy-cup: It continues to promote the anterior-posterior movement of the tongue,  characteristic of a suckle-like pattern that infants use for breast or bottle feeding.  Sippy cups limit the child’s ability to develop a more mature swallowing pattern, especially  with continued use after the first year.  The spout blocks the tongue tip from rising up to the alveolar ridge just above the front teeth and forces the child to continue to push his tongue forward and back as he sucks on the spout to extract the juice.

Discontinue use of the sippy cup if the child is over 10 months.  Allow your child to develop the next milestone by mastering a mature swallow pattern.  That is, unless you want to go to an orthodontist and speech language pathologist!

I get asked all the time to share early indicators of Autism. Here are a few:

Signs and symptoms of autism in babies and toddlers

If autism is caught in infancy, treatment can take full advantage of the young brain’s remarkable plasticity. Although autism is hard to diagnose before 24 months, symptoms often surface between 12 and 18 months.  If signs are detected by 18 months of age, intensive treatment may help to rewire the brain and reverse the symptoms.

The earliest signs of autism involve the absence of normal behaviors—not the presence of abnormal ones—so they can be tough to spot. In some cases, the earliest symptoms of autism are even misinterpreted as signs of a “good baby,” since the infant may seem quiet, independent, and undemanding. However, you can catch warning signs early if you know what to look for.

Some autistic infants don’t respond to cuddling, reach out to be picked up, or look at their mothers when being fed.

Early signs of autism in babies and toddlers

  • Doesn’t make eye contact (e.g. look at you when being fed).
  • Doesn’t smile when smiled at.
  • Doesn’t respond to his or her name or to the sound of a familiar voice.
  • Doesn’t follow objects visually.
  • Doesn’t point or wave goodbye or use other gestures to communicate.
  • Doesn’t follow the gesture when you point things out.
  • Doesn’t make noises to get your attention.
  • Doesn’t initiate or respond to cuddling.
  • Doesn’t imitate your movements and facial expressions.
  • Doesn’t reach out to be picked up.
  • Doesn’t play with other people or share interest and enjoyment.
  • Doesn’t ask for help or make other basic requests.

The following delays warrant an immediate evaluation by your child’s pediatrician

  • By 6 months: No big smiles or other warm, joyful expressions.
  • By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions.
  • By 12 months: Lack of response to name.
  • By 12 months: No babbling or “baby talk.”
  • By 12 months: No back-and-forth gestures, such as pointing, showing, reaching, or waving.
  • By 16 months: No spoken words.
  • By 24 months: No meaningful two-word phrases that don’t involve imitating or repeating.

Don’t let your accent hold you back from climbing the corporate ladder!

Accents are a beautiful thing.  It makes people unique and mysterious.  I love listening to someone with a foreign accent—as long as I can understand them!
We have all been in a situation before when we were talking to someone who had a strong accent.  Sometimes, that accent made it difficult to understand what the other person was saying.  If it was a social setting, it was a huge disaster.  Imagine if it had been at work.

If you have been speaking to someone lately and they had difficulty understanding you, you may have a strong accent.  This strong accent can interfere with your ability to hold meetings at work, give a sales pitch, or work effectively at a call center.

What is accent modification therapy?

Accent modification therapy begins with an assessment of your speech and articulation.  The first step is to identify which sounds you say incorrectly for English.  Next, a treatment program is established with your specific goals in mind.  The program usually takes 12-13 weeks with 2 visits per week at 30 min a session.

Does Insurance cover the cost?

NO.  NEVER.  Accent Reduction is like plastic surgery, it is elective.  It is not medically necessary.  If you are electing to take accent modification therapy, it is private pay.

What is Apraxia? How does it affect speech and language acquisition?

When I diagnose a child with Apraxia, the mother always goes home to do research on her computer about the disorder.  This is a very pragmatic thing to do.  However, there is a lot of doom and gloom about Apraxia on the internet.  Like any disorder, there are many different severities of Apraxia. 

Apraxia is a difficulty with motor planning for speech sound production.    Many of the children whom I treat for speech therapy have a form of Apraxia.  These children have difficulty imitating new words and have very unintelligible speech.  Children who do not have Apraxia, can hear a grown-up say a word and then say it.  Children with Apraxia often have to rehearse a word multiple times and still may not be able to say the word correctly.  This leads to frustration and often tantrums.

What can a parent do if they suspect their child has Apraxia?

First, have a speech and language evaluation to determine the diagnosis.

Second, introduce some baby signs to give your child a way to communicate immediately.  Start with signs that he would use for requesting, as this is the most motivating form of communication.  Kids love to sign “cookie” and receive a “cookie.”

Second, shorten the target words that you are trying to have your child imitate.  Think about words like: ball, cat, dog.  These words are less complex and will be easier to imitate.

Last, give your child multiple opportunities to rehearse the word until he achieves success.

And as always, keep it fun!

Lisping….. not just a speech problem!

I evaluate a half dozen kids a week who have parents that tell me their child has a lisp. A “lisp” is the common term for incorrect tongue placement when the /s/, /z/, /ch/, and /sh/ sounds are produced in words. If only it were that simple….
When someone has difficulty with these sounds, it is a result of an incorrect swallow pattern. Babies are born to push their tongue forward to express milk and swallow. The pattern is usually changed to a retracted swallow around 9-12 months when the child begins to drink from a cup. However, the creation of sippy cups, using the bottle too long, and extended use of a pacifier has inhibited the swallow pattern correction and left the child with a tongue thrust swallow pattern.

Then, as the toddler begins to learn speech and language sounds, the tongue placement is too far forward (between his teeth), producing the lisp. As the child ages, this problem becomes more and more difficult to correct.

What are some things you can do now?

First, remove all pacifiers, bottles, and sippy cups. The longer you wait to take them away, the more traumatic it will be for your child. Yes, I know the carpet is expensive to replace. Braces are expensive, too and will be needed if this tongue thrust is not corrected- so toss the sippy cups! Instead, look at the Wow Cups or a cup with a straw. The best (and cheapest) solution is the regular cup. Keep it at the table. When the child is thirsty, have him come to the table and take a drink.

Second, take a bendy straw and trim the first part of the straw in half. Next, have the child drink through the straw through his front teeth. Do not let the straw lay on the tongue. It needs to be in front of the teeth. As the child can do this, graduate to thicker liquids (applesauce, yogurt). The child’s tongue will have to retract to pull the liquid up. This is correcting the reverse swallow.

These methods, along with diligent speech therapy sessions and home programming, will improve the speech and swallowing problems.

And as always, keep it fun!

How can I help my child’s speech and language develop at home?

Parents always ask me what they can do at home to facilitate language development.  Below are some ways to foster speech and language development with your child at home.  Keep in mind, the most important part is to make it fun!

1) Choices.  One of the first things you can do is to incorporate choices into your daily routine.  By doing this, you reduce the number of yes/no questions you ask and help your child feel the power of expressing his wants, thereby decreasing frustration.

2) Picture Language.  Research shows that use of pictures with children with communication difficulties assists with both understanding and expression.  Make simple communication displays with photos and point to each choice and label.  Look at your child and wait for a response.

3) Routines and Directions.  Make pictures schedules for daily routines.  Review the routine and point to each picture and label.  Say “all done” when the routine is complete.  This works especially well with difficult times of day, like bedtime.

4)  Learning vocabulary- Take photos of family, friends, pets, clothing, and household items.  Create displays with photos by category.

5) Increasing Attention to Books.  Share books everyday.  The story does not matter.  Don’t read the story.  Instead, teach nouns, action words, he/she.  Make story time inter-active.  Ask questions.  If the child does not know the answer, give the answer.  Use the same books each night in a routine until the child can identify and label pictures.

6) Place preferred items out of reach so that your child will be obligated to use words, signs, or pictures to request what he wants.

7) Interrupt familiar routines to ask what happens next.

8)  Sabotage, be silly.  Say something like, “I am going to put pants on my head” as you put his pants on your head.  Wait for your child’s response.  Expand his response.

9) Time delay.  With a needed or preferred item present, look at the item and and your child expectantly for up to 15 seconds and wait.  Too often as parents we meet our child’s needs before they even have an opportunity to verbally communicate.  Don’t be so accommodating!