Let’s Talk Articulation!

Posted on March 15, 2024March 18, 2024

When Do I Bring My Child for a Speech Sound Evaluation?

As our children grow and develop speech, they don’t learn to use all the speech sounds in their native language simultaneously. That’s why my little one tells me that “it’s dart outside” when he looks out the window after dinner these days! But how do you know when to seek out a speech therapist for your child?

Check out the chart below, which is available as a downloadable PDF on the SLP now website at https://blog.slpnow.com/the-slps-guide-to-speech-sound-disorders-articulation-phonological-development/; when looking at the chart, understand that some children start to develop sounds before the ages listed. The ages listed represent the age at which 90% of children have mastered each sound. For many speech sounds, there is a wide range of ages at which a child may start to produce the sound or approximations inconsistently before they truly master the sound. However, it is a quick rule of thumb that if a child cannot produce one of the sounds listed under their age, speech therapy may be indicated.

What Can I Do at Home to Help My Child with Their Speech Sounds?

So, what can a parent do to help their child develop speech sounds correctly at home? The first strategy I recommend is to make sure your child is looking at your face when you’re producing words or sounds that they had difficulty with. Draw attention to your mouth by pointing. Children learn a lot about how a sound is produced by observing you.

Another strategy that you can use is called recasting. Recasting is when you repeat what your child says precisely, including the errors, in a questioning voice. For example, if your child says, “Look at the tar” when they mean “Look at the car,” you might respond by saying, “Tar? Is that what you meant?” When the child attempts to correct himself or herself, if he or she cannot do so, I suggest using the first strategy we discussed. Your child may not produce the sound at that moment, but that’s okay because they are still learning from what they see and hear from you.

I also recommend reading with your child regularly. Even if a child cannot read independently, draw their attention to some of the letters in the book, especially if the book has large decorative letters at the beginning of paragraphs. Talk about the sound the letters make, and again, ensure your child is watching your face.

For emerging readers, phonics activities are an excellent time to work on articulation at home. While doing phonics homework with your child, could you talk about how each sound is made? For example, the “T sound is made with our tongue on the roof of her mouth.” If you’re unsure how to describe how sounds are made, PeechieSpeechie.com has an excellent video library with tutorials for each sound.

If your child is receiving speech therapy services, their SLP will be able to provide you with additional, personalized resources.

How Can Carolina Therapy Connection Help?

If you are still unsure or feel that your child’s speech is difficult to understand compared to others his/her age, Carolina Therapy Connection has licensed Speech Language Pathologists at the clinics in Greenville, Goldsboro, and New Bern that are highly qualified to evaluate and diagnose speech sound disorders. You can schedule a speech sound evaluation at whichever clinic is most convenient for your family at 252-341-9944. Our professionals can also provide personalized resources for your child’s needs.

By Michelle Berghold

Stuttering: Developmental or Disordered?

Posted on February 1, 2024January 31, 2024

Stuttering in children is a speech disorder characterized by disruptions in the natural flow of speech. Developmental stuttering is a common experience, typically emerging between the ages of 2 and 5 when children are first learning to speak fluently and developing a large repertoire of words, phrases, and sentences. While many kids experience a phase of disfluency in their normal speech development and may outgrow it, some might continue to stutter as they grow older. In this case, speech therapy may be recommended.

Causes of Stuttering in Children

The exact cause remains unclear, but it’s believed to arise from a combination of genetic, neurophysiological, and environmental factors. Children with a family history of stuttering are more likely to develop it. Some kids experience stuttering due to differences in brain structure or function related to speech production. Emotional factors like stress, pressure to communicate quickly, or a hurried environment can also increase stuttering. Stuttering occurs at the initiation of voice, which is why we typically hear disfluencies at the beginning of words and phrases.

According to Johns Hopkins Hospital, A child is more likely to stutter if he or she has:

A family history of stuttering
Stuttered for 6+ months
Other speech or language disorders
Strong emotions about stuttering or family members with fears or concerns

Types of Disfluencies

Stuttering manifests in various ways, such as repetitions (repeating sounds, syllables, or words), prolongations (elongating sounds), and blocks (inability to produce sounds). These disruptions can lead to tension and anxiety, causing the child to avoid certain words or situations where they might feel pressured to speak.

Speech Therapy for Stuttering:

Speech therapists play a crucial role in assessing, diagnosing, and treating stuttering. Here are some primary approaches utilized in speech therapy:

Speech Modification Techniques: Therapists teach children to use gentle starts to sentences, and employ smooth, relaxed breathing patterns. This helps in reducing the frequency and severity of stuttering moments. Continuous phonation, for example, is a technique where speakers learn to keep their voice on and vocal folds vibrating throughout speech.

Fluency Shaping: This technique focuses on reshaping the child’s speech patterns by teaching smoother speech movements. It involves controlled breathing, gentle voicing, and gradually increasing sentence length to enhance fluency.

Stuttering Modification: This approach concentrates on changing the child’s emotional and cognitive reactions to stuttering. It involves desensitizing the child to the fear and anxiety associated with stuttering and teaching strategies to manage and accept disfluency.

Parental Involvement: Educating parents about stuttering and how to support their child’s speech development is key to increasing the child’s success. Therapists often teach parents techniques to practice at home, creating a supportive environment for the child’s progress.

Communication Skills Training: This includes enhancing overall communication skills, like turn-taking and using pauses effectively. It helps in building the child’s confidence and reducing the pressure associated with speaking.

Long-Term Outlook

Many young children outgrow developmental stuttering; however, some might continue to stutter into adolescence and adulthood. In such cases, ongoing therapy, support groups, and strategies for managing stuttering in social and professional settings become vital.

How can Carolina Therapy Connection help?

Children who sutter often benefit from therapy from skilled Speech-Language Pathologists. Stuttering in children is a complex speech disorder that necessitates early intervention and specialized therapy. Speech therapists employ a variety of techniques focusing on speech modification, emotional support, and overall communication enhancement to help children manage and, in many cases, overcome stuttering. Family involvement and a supportive environment are fundamental in the child’s journey towards improved fluency and confidence in communication. At Carolina Therapy Connection, our treatment is highly individualized to your child’s needs. A standardized assessment will be administered to detect any disfluencies, and our therapists will work with you and your child to develop a plan for enhancing skills to build confidence across all social environments (home, school, social groups, etc). If you have any concerns or questions regarding your child’s development, call our clinic at (252) 341-9944.

By Ashley Holloway, MS, CCC-SLP, CAS

Hearing Loss in Children

Posted on December 15, 2023December 15, 2023

About 2 to 3 out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears! Hearing loss can occur gradually over time and parents may not even realize their children have it. Children may simply adjust to the changes in their hearing and not realize they are missing out on important speech sounds and words.

What is a hearing screening?

A hearing screening is frequently used to check a person’s ability to detect the loudness and pitch of sounds. You can either “pass” or “fail” the screening. If your child passes and there are no other concerns, then you can continue with your child’s regularly scheduled hearing screenings. If your child “fails”, or if you have other concerns about their hearing, then an appointment for more in-depth testing may be necessary to see if there is a hearing loss and what treatment options are best to help support your child. These hearing screenings can help identify people who may need a more thorough hearing evaluation that can be completed by medical personnel such as ENTs or audiologists. Pediatric hearing screenings may take place in early intervention, school audiology, medical, and/or home settings.

How can I tell if my child has hearing loss?

Difficulty recognizing familiar voices
Delayed or absent speech sounds (not making cooing noises, babbling less, few words, distorted speech sounds, etc.)
Not turning head toward interesting or startling sounds
Delayed language (difficulty understanding simple words, following directions, etc.)
Delayed or absent emergence of first words as by two years old children should start combining words into 2-word phrases)
If child is older, they may frequently asks others to repeat themselves for clarification
Child is speaking louder than others
Lack of attention to others, conversations, environmental surroundings
Struggles with academics

What causes hearing loss in young children?

Frequent ear infections (otitis media; most common)
Measles or meningitis
Head injuries
Exposure to loud noises
Genetic disorders

Interesting Fact… 5/6 children experience ear infections (otitis media) by the time they are 3 years old!

What should I do if I suspect my child has hearing loss?

If you suspect your child has hearing loss, speak with your healthcare provider and discuss your child’s current hearing abilities and address your concerns if you suspect signs of hearing difficulties at home. Early hearing detection and a formal evaluation completed by an audiologist, ENT and/or other qualified medical professional can help determine specific needs and appropriate treatment goals to further support your child’s success. It is important to regularly check on your child’s hearing health to monitor potential changes in hearing!

How can Speech therapy help?

Speech-Language Pathologists can play a role in your child’s hearing health by completing hearing screenings as a part of a formal speech and language assessment. If your child does not pass a hearing screening completed by the Speech-Language Pathologist, then a referral will be made for further evaluation with audiological/medical professionals to provide the best of care to your little one. Language acquisition is an essential component of your child’s overall development. Significant hearing loss, if undetected early, can lead to a speech and language delay, further putting your child at risk of falling behind same-aged peers. Given that our hearing plays a significant role in living our daily lives, it is crucial to have your child’s hearing formally evaluated at key milestones, beginning at birth to help lead them to better speech, language, and educational outcomes in the future!

Schedule a screening at Carolina Therapy Connection today!

Blog By: Lindsey Bryant, SLP

What is AAC?

Posted on November 7, 2023November 7, 2023

AAC stands for Augmentative and Alternative Communication. It encompasses all of the ways in which an individual may communicate outside of speaking verbally. Augmentative communication means to add to someone’s existing speech skills, and alternative means to be used in place of verbal speech. There are many different kinds of AAC including, but not limited to: gestures, facial expressions, writing, pictures symbols (e.g., picture exchange communication system/ PECS), drawing, sign language, high-tech speech generating devices, communication boards, etc. Some people may use one of these modalities, and some may use multiple modalities depending on the way in which they can most quickly and clearly communicate the topic.

Who Needs AAC?

Many different people use AAC throughout their lifetime. It can be used across the lifespan by any age, at any time, and for a variety of different reasons. Some people use AAC for their entire life, and some use it for only a short period of time. AAC can help any person who has difficulty fully or partially meeting their daily communication needs such as expressing wants and needs, socializing, asking questions, and a variety of other functions.

How can AAC help your child?

AAC may be able to help your child if they have difficulty being understood by others, have a limited vocabulary, demonstrate limited spontaneous speech, are non-speaking, and a variety of other different reasons. There are no prerequisite skills to your child beginning to use AAC. One common misconception is that AAC will hinder language development or cause your child to become dependent on it for communication. While some children may have minimal to no verbal speech throughout their lifetime, there is research to show that AAC can actually help children to develop language. Using AAC can also help to reduce frustration surrounding communication attempts, and help your child to communicate their needs more clearly, quickly, and effectively.

Parent’s Role in AAC

When introducing AAC to your child, it is important for family members/ caregivers to make the commitment to help the child succeed with the chosen AAC device. Your input is crucial in helping to choose and develop an appropriate AAC system, and using the device at home and in the community is a vital step to help both you and the child continue to learn the system. According to Jane Korsten, SLP, the average 18-month-old has been exposed to 4,380 hours of oral language at a rate of 8 hours/ day from birth. A child who has a communication system (AAC) and receives speech/language therapy 2 times/week for 20-30 minutes will reach the same amount of language exposure (in their AAC language) in 84 years. It is our role as professionals and caregivers to help minimize the communication gap between oral language users and AAC users.

Modeling: Modeling is an awesome way to both learn your child’s AAC system, and teach them an example of how they can use it. The best way to model is to speak and use the system at the same time, although you do not always have to select an icon for every word you say. For example, you may verbally say “time to go to school” while modeling “go” and “school” on the AAC system. A general rule of thumb is to model the number of icons your child is currently using, plus one. If your child uses 1 icon at a time, you may choose to model 1-2 icons at this time. It is important to model without expectation, meaning that you use the AAC system without expecting or requiring the child to respond, withholding items or activities, or “testing” their skills. The goal is to provide an example to the AAC learner, which they will then learn by watching and listening to what you do/say.

How can CTC help you and your child?

Whether your child is already receiving speech/language therapy services at our clinic or not, CTC is ready to help support both parents and children through their own individual journey with Augmentative and Alternative Communication. If you believe that your child may benefit from the use of AAC, talk to one of our many incredible speech-language pathologists to begin the process of figuring out what type of system (no tech, low-tech, mid-tech, high-tech) will work best. This process can take time, but with your support and the support of your SLP, it is possible to find the right system for your child!

Does My Child Have Dyslexia?

Posted on September 12, 2023October 4, 2023

What is Dyslexia?

Dyslexia targets about 15-20% of our population! Most of us may not even know we are dyslexic. We could continue our lives undiagnosed and seek little to no help with this problem. Many people with Dyslexia that have been evaluated struggle with academics, self-esteem, and most importantly, they struggle with reading/writing within their own home and in the school environment. Many adults with this diagnosis have difficulties with finding or obtaining employment and causes them to lose self-confidence. Dyslexia is a type of learning disability, specifically reading, but not to be compared with low intelligence. There are many types of disabilities that involve learning, but dyslexia meaning is more in-depth of someone having issues with learning to read, although they are most likely educated enough to learn when want to learn.

What are the symptoms of dyslexia before and at school age?

When it comes to signs of Dyslexia, it can be difficult to visually see a child’s symptoms before they reach a certain age or start going to school. There’s a high chance that the child’s educator will notice an issue before the caregiver.

Here are some signs of Dyslexia:

The child will have difficulties with letter reversals; (b and d) and/or word reversals (was and saw).
Your child could be a late talker.
Problems processing and understanding what is heard
The child may have difficulties with reading aloud and learning new words and an age-appropriate pace; the child may avoid activities that involve reading
The child may mispronounce words; or form words incorrectly, such as reversing sounds in words or confusing words that sound alike.
The child may have trouble with rhyming words and remembering nursery rhymes
Difficulties with math word problems.
Difficulties with understanding jokes, punchlines, sarcasm, and inferences.
Your child may have difficulties with following a written outline of directions or telling directions.
Difficulties with spelling, learning to read, and recalling names or words.

What Causes Dyslexia?

Dyslexia is not a disease. It is a neurological condition caused by the way the brain is wired up enabling reading and writing causing the individual to result in utilizing coping strategies to adapt to normal environments. Studies show that an individual born with this condition are neither more nor less intelligent than the general population. Research has shown that dyslexia is one of the most common inherited neurological disorders an individual is born with. Even though it affects how the brain processes reading and language, most children have average or above-average intelligence; therefore, work extremely hard to achieve and overcome their reading problems.

What should you do if you suspect or if your child has Dyslexia?

Have a conversation with your healthcare provider and discuss your child’s reading level if you or his/her teacher notice a below-level reading status for your child’s age or if you notice other signs of dyslexia. Fortunately, with the proper assistance, most kids who are dyslexic can learn to read and develop strategies that allow them to stay in the regular classroom. If you suspect you or your child may be dyslexic, early detection and evaluation to determine specific needs and appropriate treatment can improve success. In many cases, treatment can help children become competent readers. It’s important to set an example and support your child with goals that are attainable. Show your child that reading can be enjoyable.

Set Goals for yourself and the child:

As a parent, you should play a key role in helping your child succeed.
You can assist your child by reading aloud to them while they are young, then transition to reading together when they’re old enough.
You can also listen to recorded books with your child.
Collaborate with your child’s educator.
Engaged in creating a schedule for reading time.

How can Occupational Therapy help?

Pediatric occupational therapists and certified occupational therapy assistants can encourage children to participate in meaningful tasks within the school and home environments. Therapists can assist in managing dyslexia and assist in increasing children’s confidence and participation in reading and writing tasks. Occupational therapy for kiddos really focuses on building confidence and implementing client-centered care for the child and their families. OT’s can provide strategies for home and school such as:

Implementing multi-sensory approaches – using other senses to approach learning such as seeing, listening, doing, and speaking).
Visual prompts: Providing visual prompts for both instructions and organization.
Visually sequencing tasks (or components within a task) using visual cues.
Use of colored lines and templates to assist with line placement and letter sizing.
Visual strategies to assist with reading and spelling such as colored coding paper size according to letter size.
Using modeling techniques rather than only giving a simple verbal instruction
Letter formation practice

Written By: Carlos Guilford

Mealtime Tips For Your Picky Eater

Posted on January 20, 2023October 4, 2023

Why Is Mealtime So Important For Children?

The 3 most important things for humans to survive is: food, water and oxygen. For some parents, the concern for their kiddos health and well-being becomes heightened when they notice their kiddo isn’t eating as much food or as many types of foods as they may have at one time. Some kiddos who are referred to Occupational Therapy are considered “Picky Eaters” and others may be referred to as a “Problem Feeder”. We all know a picky eater. This is a person/kiddo who has at least 30 foods in their repertoire. Whereas a “Problem Feeder” is a person/kiddo who has less than 20 foods in their repertoire. There are many reasons this could happen such as trauma, sensory related challenges, anxiety, behavioral challenges, and more. As Occupational Therapists, we are trained to assist these kiddos by addressing these challenges which can increase their tolerance for trying new foods! Keep reading to learn more picky eater tips we have below!

So why is MEALTIME so important to assist with this?

One of the first things we will ask as OTRs or COTAs is “What does mealtime look like at home?” Some parents may say,

“We all sit down as a family every night for dinner but we are busy or gone for breakfast and lunch”, “We are so busy that we are lucky to eat all at the same time”, or “(The child) eats all day but won’t eat the food I cook at dinner”. Of course these are just examples, but can you relate to any of them? It’s a possibility!

Asking about mealtimes is very important to your therapist because this gives us an idea of how your child eats during the day. Kiddos need fuel to keep their bodies going. However, WHAT they are taking in and HOW/WHEN they are taking it in will make a huge difference in behavior, attention, ability to process/retain information and regulate emotions/emotional responses. To give you an idea of why the “what”, “how” and “when” are so important, I’ll follow up on the questions above.

1. “We all sit down as a family every night for dinner but we are busy or gone for breakfast and lunch”

This could be a beneficial time to incorporate feeding techniques and build interest in the foods around the table. Interest always comes before action. A child must first be interested in the food before they will interact with it. This is one reason that mealtime is so important for kiddos. It can be an opportunity to build interest in various smells, sights, and textures of foods provided by parents in a supportive and positive manner.

2. “We are so busy that we are lucky to eat all at the same time”

How can you work your schedule to have a least one meal together every other day? We understand that this busy world requires busy people to keep it going. However, when you are overwhelmed and exhausted your child may pick up on that. Children are very intuitive. Incorporating as many mealtimes as possible may assist with parent/child interaction and decreasing anxiety and overwhelming emotions in adults which can in turn make eating less stressful for a “picky eater”.

3. “(The child) eats all day but won’t eat the food I cook at dinner”

Grazing is when a kiddo eating little snacks all throughout the day. Have you ever seen a child leave a snack on the table, go play for 30 minutes, then return to finish the snack? If your child is doing this all day, it may explain why they are not eating at mealtimes. Typically, the brain lets us know when we need to refuel because the digestive system sends signals saying, “I’m empty in here!”. When grazing, a child’s brain will begin to have a hard time distinguishing when the child is hungry due to constantly having food in the digestive system. This can effect metabolism and the ability to regulate hunger. When given mealtimes, the body has time to regulate, digest and filter out what it needs for fuel. Additionally, if given processed snacks that are high in sugar or carbohydrates throughout the day, the body will begin to crave them. This can create a difficult loop to break when introducing thing like vegetables, meats and some fruits. Positive interactions at mealtimes can assist with parent/child interactions, lowering anxiety and stress levels, giving the child’s body time to process what it needs for fuel and providing learning opportunities for the sensory system. This can be a major changing factor in how your child engages with food!

Additional Mealtime Picky Eater Tips

Picky Eater Tips #1: Don’t force foods on children

As parents, we want our children to eat a variety of foods, including vegetables, fruits and other healthy snacks to help them grow to be strong and healthy. Studies show that forcing a child to sit and eat until they have cleared their entire plate is not the best method for achieving this goal. Instead, parents should promote foods that may have not been a hit the first time around. You can model this yourself by trying a food you haven’t liked in the past, and explain that you’re giving it another chance because your tastes may have changed. We want to show kids that we are adaptable. Remember: It can take as many as 10 or more times tasting a food before a toddler’s taste buds accept it.

Picky Eater Tips #2: Get Creative With Food Bingo

You can also put together a list of new foods for the family to try and make a game out of it—what will we try tonight? You can make it interactive and fun by doing something creative like Food Bingo. There are many free printable online similar to the image shown below. You can even make your own! Hang it on the fridge and have your child place a sticker or check off the new foods they have tried. You can even add in a reward for them getting “bingo” – a trip to their favorite place, a new toy, a play date, or something else they really enjoy!

Picky Eater Tips #3: Don’t Make a Second Meal

When you serve a meal to your family and your kiddo refuses to eat it, we recommend having simple and consistent back up options, such as yogurt, a cheese, nut & fruit snack pack, apple sauce, cereal etc. It’s important for children to know that if they can not eat the meal you have prepared, they will receive the standard option – rather than the usual chicken nuggets baked quickly in the oven. We should also teach kids that a meal isn’t ruined if it comes in contact with something they don’t like. Finding an unwanted pickle on your cheeseburger will not contaminate it. Children should be encouraged to push food they don’t like off to the side, or onto another plate, or offer to share it with someone else.

Picky Eater Tips #4: Involve Your Kiddo in the Meal Prep Process

Some cooking tasks are perfect for toddlers and small children (with supervision, of course): sifting, stirring, counting ingredients, picking fresh herbs from a garden or windowsill, and “painting” on cooking oil with a pastry brush. Allowing our children to interact with the foods they are going to eat will help to promote and encourage them to try it!

Picky Eater Tips #5: Food Chaining

Once your kiddo tries a new food and that food is accepted, use what one our Occupational Therapist’s favorite pickle eater tips call “food chaining” to introduce others with similar color, flavor and texture to help expand variety in what your child will eat. Children with sensory concerns have difficulty with leaping from the types of food they are willing/able to eat. Food chaining builds a bridge to get to those foods you really want your child to eat one step at a time through links to food they’re already eating. Examples include:

If your child likes pumpkin pie, for example, try mashed sweet potatoes and then mashed carrots.
If your child loves pretzels, try veggie straws next, and then move on to baby carrots or carrot sticks. Carrots are hard, crunchy, and stick shaped, but are cold and have a different taste.
If your child loves French Fries, then give a try to Zucchini fries.
Move from cookies to Fig Newtons, to jam toast, to jam sandwich, to bread with sliced strawberries, and lastly to fresh strawberries
If chicken nuggets are the fan favorite, try to first change the brand of nuggets, then move to homemade chicken nuggets, then to homemade tenders, and lastly to a baked chicken breast.
Maybe your kiddo love goldfish crackers. Next give Cheeze Itz a try, and then move on to saltine crackers, and lastly to saltines with cheese slices.

How Can Carolina Therapy Connection Help?

In addition to utilizing the tips above at home, we know that sometimes children need an extra push to expand their food repertoire. At Carolina Therapy Connection, our occupational and speech therapists provide feeding therapy that uses a collaborative approach to work closely with you and your child to determine the source of a child’s feeding difficulties, and develop specific intervention plans to make the entire eating process easier and more enjoyable. Often times, feeding therapy happens on a weekly basis and may consist of working on difficulty with trying new foods, chewing, swallowing, sensory issues, irritability at meal time and so much more. Our goals are to broaden your child’s scope of foods, teach them the benefits of healthy eating, and develop oral motor skills needed for optimal growth and nutrition.

Our Occupational Therapists take a sensory-based feeding approach to therapy. They focus on: oral motor skills, sensory sensitivities, progressing through food textures, and using adaptive equipment and tools to develop self-feeding skills. They also use a process called food chaining, which is a child-friendly treatment approach that helps introduce new foods while building on the child’s past successful eating experiences. In this process, the child is presented with new foods that may be similar in taste, temperature, or texture to foods the child already likes and accepts. Our occupational therapists are certified in the SOS Feeding Approach, a nationally and internationally recognized approach for assessing and treating children with feeding difficulties.

Our feeding therapists have 15-20 years of experience with children of all ages and a variety of feeding disorders. They have certifications in SOS and AEIOU approaches and significant training from around the country on feeding approaches, treatment strategies, and focused plans. We also having consistent collaboration with other professionals in the community to guarantee the best care. Call our clinic at 252-341-9944 for a free phone screening with one of our feeding therapists and schedule an evaluation today!

Blog Written By: Shelby Godwin, COTA/L, AC & Morgan Foster, MS, OTR/L

Transitioning from Bottle to Cup

Posted on February 15, 2022October 4, 2023

When should my child transition from their bottle to a regular cup?

It’s time to transition off the bottle! The American Academy of Pediatrics recommends transitioning from a bottle to a cup when your baby is about 15 months old. You might think it is time for those adorable sippy cups! BUT, current research is clear, and many therapists are recommending skipping the sippy cup altogether and moving straight to an open cup or a straw cup.

Many parents decide to use a sippy cup because they think that’s what they are supposed to do. Sippy cups were not designed as a tool for proper oral motor and feeding development, but instead were created to keep the carpets clean! The occasional use of a sippy cup is nothing to worry about, as it can be great for those long car rides and times where cleanliness matters. It is important to note that if your child has a medical reason to use a sippy cup, follow your pediatricians recommendations (i.e. some children require a valved sippy cup for safety). Despite the convenience of a sippy cup, parents should be aware that it is easy to become dependent on anything that makes life less messy, so when it’s possible to bring out the regular cup or straw, do it!

Why should I skip the sippy cup?

At only 12 months of age, your baby is developing a more mature adult-like swallow pattern! As opposed to the anterior-posterior suckle pattern infants use with a bottle, at only a year old, the tongue begins to stay in place or even move backward and rise while pressing on the alveolar ridge (the hard, ridged spot just behind the front teeth). The tongue will rise, push, and propel the food backwards! When your little one drinks from a bottle or a sippy cup, the spout prevents their tongue tip from elevating, often forcing the tongue down or requiring them to stick their tongue out in order to drink. If the tongue doesn’t rise to the alveolar ridge at rest and when swallowing, the brain creates a habit to keep the tongue on the floor of the mouth. This can contribute to oral motor weakness, and an impaired oral phase of the swallow.

According to the American Speech-Language and Hearing Association, when the tongue sits low in the mouth it often forces the mouth to rest in an open position, which leads to mouth-breathing instead of your little one breathing through their nose. Long-term use of a bottle or sippy cup may also lead to dental concerns. The immature pattern of an anterior tongue thrust during the swallow increases the risk of pushing their teeth forward and creating a dental malocclusion. The tongue, lips, cheeks, and jaw all play important roles in both articulation of speech sounds and eating, and little ones with weaker oral motor skills may be at increased risk for a speech sound delay.

What are the benefits of using a regular cup or straw?

Open cups and straw cups help build normal movements in oral musculature.
Using a straw helps your child develop lip, cheek and tongue strength.
Open cups provide practice using the mature pattern of swallowing that will allow your child to safely drink and eat.
Straw drinking supports a child’s early articulation of speech sounds.
Regular cups and straws encourage proper breathing patterns and prevent mouth breathing.

What’s the best way to make the transition from the bottle to a cup?

When beginning to make the transition from a bottle to a straw cup or regular cup, it’s important to start small! This process can take time and it’s important to know it won’t happen overnight.

Start by introducing an open cup at mealtimes. You can hold the cup for your child to sip from the side of the rim to get them comfortable.
A great straw sipping cup is the Talk tools Honey Bear Straw Cup, which allows your child to squeeze the bottle so they can get comfortable with using a straw to start out with.
Offer both straw cups and open cups to allow for comfort with various drinking cups.
Use a weighted straw cup, which is spill-proof and allows a child to drink from any angle!

How can Carolina Therapy Connection help?

Your child may need speech therapy if they have difficulty with speech/articulation (pronouncing sounds or words) or using words to communicate. Because the muscles and structures used for speech (such as lips, tongue, teeth, palate and throat) are also used in drinking and eating, a speech and language pathologist may also help with feeding, drinking and swallowing difficulties, also known as dysphagia.

While using a sippy cup does not necessarily mean your child will need speech therapy, it’s considered best to encourage oral motor development by using open cups or straw cups at home! Ditch those sippy cups, and check out the spill-proof options for open cups and straw cups they make these days! Spill-proof….now that’s a concept we can ALL get behind!

As always, if you have any questions about your child development, call our clinic at 252-341-9944 to speak with one of our speech-language pathologists!

Written by: Ashley R. Holloway, MS, CCC-SLP

Phonological Patterns

Posted on January 14, 2022October 4, 2023

What are phonological patterns?

So your child’s speech-language pathologist says your child presents with phonological patterns…What does that mean? Phonological patterns are “patterns of sound errors that typically developing children use to simplify speech as they are learning to talk” (Hanks, 2013). Children often demonstrate difficulty coordinating their lips, tongue, teeth, palate, and jaw for intelligible speech. There are many different patterns that your child may demonstrate.

What is a phonological disorder?

A phonological disorder is when a pattern persists past what is considered “normal” for their age. For example, if your 4 year old still uses the phonological process of “reduplication” (saying, “wawa” for “water”) that would be considered delayed since most children stop using that process by the time they turn 3 (Hanks, 2013).

Typically, if your child is exhibiting several phonological patterns, their speech is difficult to understand or “unintelligible”. You, as a parent, may understand what they are saying because you are familiar with these speech sound patterns; however, other family members and peers demonstrate difficulty understanding your child.

As described above, a speech sound disorder is considered a phonological disorder when:

Phonological processes persist beyond the typical age of development.
Phonological processes are used that are not seen in typical development
A child is highly unintelligible due to the excessive use of phonological processes

What are common phonological patterns and what do they mean?

Assimilation: when one sound becomes the same or similar to other sounds in the same word

Age of Elimination: 3 years
Example: “I want a pip” when they meant to say “I want a sip” (the “s” becomes like the “p” at the end of the word)

Final Consonant Deletion: when a child drops off or doesn’t produce the last sound at the end of a word

Age of Elimination: 3 years
Example: “Look at the bow!” for “look at the boat!”

Devoicing: when a child produces a voiceless sound instead of the voiced sound

Age of Elimination: 3 years
Example: “Where is my back?” For “Where is my bag?”

Voicing: when a child produces a voiced sound for a voiceless sound

Age of Elimination: 3 years
Example: “I want more bees” for “I want more peas”

Stopping: when a child stops the airflow needed to produce a sound and substitutes it with another sound

Age of Elimination: 3-5 years
Example: “my two” for “my shoe”

Fronting: when a child substitutes sounds that they should be making in the back of the mouth with sounds towards the front of the mouth

Age of Elimination: 3.5 years
Example: “Daddy’s tea” for “Daddy’s key” (substituting “t” for “k”)

Cluster Reduction: when a child drops off or deletes one of the consonants in a “cluster”

Age of Elimination: 4 years
Example: “I see a nail” for “I see a snail”

Weak Syllable Deletion: when a child drops off or doesn’t say one of the syllables within a word

Age of Elimination: 4 years
Example: “I want a nana” for “I want a banana”

Deaffrication: when a child doesn’t produce the pressure sound in a combined sound

Age of Elimination: 4 years
Example: “I want ships” for “I want chips” (ch -> sh and j -> zh)

Gliding: when a child substitutes the “l” and “r” sounds for the “y” and “w” sounds

Age of Elimination: 5 years
Example: “The apple is wed” for “The apple is red”

*Examples and explanations are referenced from Adventures in Speech Pathology

How can Carolina Therapy Connection help?

This is a lot of information that can be overwhelming for a parent trying to help their child. We know that you want the best for your kiddo and we want to help! Our team of pediatric speech therapists provide screening, assessment, consultation, and treatment to help children overcome communication obstacles. Call Carolina Therapy Connection at 252-341-9944 to speak with one of our skilled and knowledgable speech-language pathologists. They can evaluate your child’s communication patterns, further explain phonological processes, and discuss the best treatment interventions for your family.

Written by: Brandi Ayscue, MS, CCC-SLP, CAS

Now Offering Free Screenings!

Posted on June 1, 2021October 4, 2023

What is a Screening?

A screening for occupational therapy, speech-language therapy and/or physical therapy is a quick 10-15 minute discussion or observation of your child for potential areas of developmental concern. A screening may be over the phone, zoom or in person. A screening is used to determine whether your child may or may not need a formal evaluation.

What is a Formal Evaluation?

There are a variety of evaluation methods and standardized tests that are designed to assess different areas of functioning including visual-motor, visual-perception, gross motor, fine motor, sensory integration and many others. A child’s performance on each of these tests is compared with the average performance of other children in his or her age group. In addition to these tests, clinical observations are made based on discussion between the parent and the therapist. These formal evaluations allow the therapist to see your child’s current level of function, determine if services are needed, and develop client-centered goals and planning for therapy outcomes.

Everything You Need to Know About a Screenings

One of our amazing Occupational Therapist, Kelly Burton, explains everything you need to know about the screening process in the video below. If you have any questions or concerns about your child’s development or would like to set up a screening, call our clinic at 252-341-9944!

Apraxia and PROMPT

Posted on May 16, 2021October 4, 2023

May is Apraxia Awareness Month

According to Apraxia Kids, for the first time, the entire month of May has been designated Apraxia Awareness Month and corresponds with May is Better Hearing and Speech Month, sponsored by the American Speech-Language-Hearing Association (ASHA). Childhood Apraxia of Speech is a motor speech disorder in which a child knows what they would like to say but has difficulty sending the message from their brain to their mouth. It is a significant problem with motor planning and coordination of the lips, tongue, jaw and palate to produce intelligible speech. Parents of children with childhood apraxia of speech commonly say things like, “No one can understand my son,” “It looks like he is trying to say the word, but can’t get it out,” and “He said that word one time, and then I never heard it again.” Our goal this month, is to educate families about apraxia, spread awareness, and provide resources that may be helpful for children struggling with apraxia.

A quote from Apraxia Kids: “The more people that know and understand Apraxia, the more support children and families will have. Early intervention is crucial. A team supporting a child with Apraxia is crucial. I’ve learned along the way, we don’t know what we don’t know. Let’s help people know about Apraxia!”

What are the signs of apraxia?

According to the American Speech-Language-Hearing Association (ASHA, 2007), the three most common features in children with apraxia of speech are:

Inconsistent errors on consonants and vowels in repeated productions of syllables or words (for example, a child says the same word differently each time he tries to produce it).
Difficulty producing longer, more complex words and phrases.
Inappropriate intonation and stress in word/phrase production (for example, difficulty with the timing, rhythm and flow of speech).

Apraxia and PROMPT

PROMPT (Prompting for Restructuring Oral Muscular Phonetic Targets) is a multifaceted approach used to treat a variety of speech production disorders such as expressive language, stuttering, motor planning, articulation/phonology, and auditory processing as well as cognitive or global delays. PROMPT is a highly successful treatment method for children with motor speech disorders such as apraxia. During PROMPT, a speech-language pathologist manually guides a patient’s jaw, lips, vocal folds, and tongue by targeting certain words, phrases, or sentences. They use touch cues to shape and support the proper movements. In doing so, the therapist helps the patient produce phonemes, or the smallest units of sound that distinguish one word from another. Together, the therapist and child progress through different sounds at a steady pace, moving to new sounds only when the patient is ready. The child learns through assistance and repetition to plan, organize, and create steadily more advanced vocal sounds. For more information about PROMPT, watch this quick video.

Carolina Therapy Connection is now using PROMPT

To be certified in the PROMPT method, a speech-language pathologist attends PROMPT training courses and meets a number of certification requirements established by the PROMPT Institute. One of our amazing Speech-Language Pathologists at Carolina Therapy Connection, Lindsey Grant, is now certified in PROMPT! Lindsay graduated Summa Cum Laude in 2012 from East Carolina University with her Bachelor of Science degree in Communication Sciences and Disorders and a minor in Hispanic Studies. She then continued at East Carolina University, receiving her Master of Science degree in Communication Sciences and Disorder in 2014. While completing her Master’s degree, she completed a research project on the relationship between dyslexia and language. Lindsay has experience working with children of all ages in a variety of settings including school, home, daycare, and clinic. She is a member of the American Speech-Language-Hearing Association, where she received her Certificate of Clinical Competence. She is also a Certified Autism Specialist through the International Board of Credentialing and Continuing Education Standards. Lindsay has a passion of helping children with apraxia of speech make significant improvements to their speech and communication skills.

If you have any questions about your child’s speech development, apraxia or PROMPT, call our clinic at 252-341-9944!