It’s a Sippy Cup Nation

No matter how many times SLPs, Physicians, Nutritionists provide parents with the DO NOT USE THE SIPPY CUP rule,it will be broken.  Not because parent’s don’t want what’s best for their children, but because the practitioner did not position ourselves as a value add.  Being a value added professional is something I hear my corporate friends discuss a lot.  How to become a value add, how to position themselves or support their direct reports in being value added members of the team.  In fact, one of my famous interview questions is “How will you be a value add to SLC and your colleagues?”  Being a value add is just that.  Adding more than the “Don’t and Why” but also the “How, Where, When, and What”.

Let me back up…I am a behaviorally based SLP with extensive training in Applied Behavior Analysis.  I also have worked successfully with many many families.  One of the reasons I am a fan and have an astute knowledge base in applied behavior analysis is that the model works and has enhanced how I collect data, train families, support and train my staff, and program for my clients.  One of the major rules in applied behavior analysis is that practitioners should Replace the Behavior we don’t want with the Behavior we want to see.  The replacement is not overnight, it is not judgemental, it is not accomodating.  But it is clear about the scope and sequence of moving from the baseline toward proficiency.

In the case of the sippy cup.  It is true, using sippy cups are not a great idea.  But wait…is that totally true?!?  Think about it…doesn’t the language seem total and exact.  Are all sippy cups really bad?  Or do we want to tell parents which ones they should use?  For the busy mom with triplets, do we want to add extra parental guilt to the sleep deprived busy parent or do we want to show ourselves as a value add to the parent’s team or village.  For me in clinical practice, I want to add value. Not with finger pointing admonishment disguised as education.

I want to

1. Verbally acknoweldge and authentically understand why she uses the sippy cup;

 2. Show her how to use a cup with her child;

3. Look at her daily schedule to see when we can move my recommendation into her life;

 4. Plan for the use of the new way of thinking/drinking;

 5. Keep adding the new way of drinking to the schedule so that the conscious becomes a second nature habit.

Too much you think?  Not really.  Remember the role of Value Add in teamwork.

With full disclosure, I am a busy mother of a very busy almost one year old.  Because I am an SLP, I’m on top of it…well at least on a good day.  When I google sippy cup, a pleothora of cups invades my computer screen.  I know what I want BPA free, straw.  So I stay away from the choices that I see at my son’s play group.  These are popular but NOT right choices if you are going to use a sippy cup.

So the more expensive sippy cups are available AND they are the next shape I’m looking for to support speech and swallowing development.  They are straw cups, controlled for mess, and with the Safe Sippy little spillage if you turn it upside down.

There was a recent blog on ASHASPHERE written by Ms. Melanie Potock, MA., CCC-SLP  entitled Step Away from the Sippy Cup.  While I do not disagree with Ms. Potock’s points about why we should not recommend or encourage sippy cup use, I could not totally embrace the perspective of “NO”.  The reason for me is simple, there was no replacement behavior or steps toward removing and replacing the behavior of sippy cup drinking.  In fact, I know parent’s who agreed…but use the “bad sippy”.  Some might say…well that’s why seeing the SLP is necessary…to get that information.  Truth is, some people who need an SLP may never see one because they have no idea of our professional breadth or width.  With this, we should be unafraid to freely give the information so that our current population and potential population can see us (SLPs) as a value add.  I was further disappointed with the quote ” I truly shouldn’t be so bitter, though – in my professional opinion, over-use of sippy cups is keeping me employed as a feeding specialist and I should be thankful for job security”.   Uncomfortable.  If a BCBA stated their job security relative to the prevalence of autism, we’d gasp and be appalled.  If a police officer stated job security relative to crime rates, we’d be offended.  True or not…those are inside thoughts.  If you think I’m being judgemental…I am in this moment.  Parents found it harsh too.

But getting back to the sippy cups…

I asked parents why they did not use straw cups (by the way when you research sippy cups…the results include straw cups)…ALL  of the parents stated that they believed straw cups to be for older children.  These parents also stated that they were aware that sippy cups were not recommended, but continued to use them because of ….CONVENIENCE, BUT if they were aware of straw cups being suitable for their young children they would use them.  When I then explained that a better sippy cup-straw cup could be as high as $15.00 there was a pause…but when the explanation then included less probabilitiy of speech and swallowing challenges and support appropriate development, the answer was an overwhelming YES.

It’s true, sippy cups were not around when I was growing up and I made it just fine.  So trust me, my son Adam is learning to drink with a regular glass or cup…hand over hand-very slowly.  Messy is my reality…and I’m busy. 🙂

In short, adding Value is giving information so that people are better for having known you.  Parent training can never be filled with NOs…and then whispering about how they never follow through while thanking God that they are not following through… because it keeps your schedule  and funds flowing.

This REAL life faced by families must come from the place of Let Me Show You How and Here is Why…trust me your schedule will be more bountiful because of the Value Add.  In the words of Sandi Krakowski #BEMORE

No More Tongue Depressors…Let’s Use Food

As a child, I have never ever liked tongue depressors.  In fact, I recall as a child the mere presence of them and watching them come towards my mouth would result in severe gagging and occasional regurgitation.  Tongue depressors were a norm for me as a child as I was always a casualty of October strep throat.  Even as an adult, every September and October…I get a bit of a cold (when I fall off of my healthy eating regime).  I did  quickly learn, as a youth, to open wider and verbalize to the doctor that I did not require a tongue depressor.

As a speech language pathologist working primarily with children with autism, I get their perspective quite frequently.  For those verbal, vocal, and nonverbal…I understand that often times you just don’t want to share, you just want to relax and not work, and you just don’t want the tongue depressor.  I have been fortunate to attend awesome schools and have extraordinary mentor SLPs in my young career.  These SLPs pushed me to the limits and today I am forever grateful.  One in particular, in the North surburbs of Chicago (Andrea, SLP), taught me how to reduce use of tongue depressors, horns, and the like to elicit speech and use real things. Andrea was the district consultant for Assistive Technology for children with Intensive Learning Needs in this special education school district.  First day, I was given assignments and told that my job was to make children better…get going.  She did not hold my hand at all (very different from the training and supervision a lot of new SLPs now want…is this generational?!? hmmm)!

I was taught to reimagine how I could elicit the target sounds and integrate Anatomy, Nerve Function, Physiology with Real food/real objects.  Real: items that are part of the child’s everyday world or exposure and accessible to families.  I quickly learned that the Twizzler wrapped in gauze (for weight) and dipped in applesauce (or any other flavor) can give a wonderful impact for placement cues for lingual back sounds (k, g).  I utilize P.R.O.M.P.T. and other tactile cues to support…but let’s face it, food is much more appealing and welcoming when we think of objects that should come towards our face and mouth.

This week I have been working with a youngster trying to achieve bilabial placement for the production to [m].  We have some real coordination and placement issues.  I pulled out a trusty cracker.  and we held it with both lips at the place where the lips should be meeting for the production of the sound.  We did not over place this food item, but quickly transferred that placement cue to the production of the sound.  And he’s got it.

Social Emotional Learning is important when it comes to supporting motor speech disorders.  He likes crackers.  From a behavior analysis standpoint, I paired the “like” with the goal I am trying to achieve, and now I am shaping speech.  Communication connects people.  The tools we use to elicit these motor patterns, oral motor placement cues, must also support the transference of the connection to the desired movement.  Yes it takes thought and a great deal of time, especially if the youngster has aversions to textures, tastes, and the like.

For those that are more Finicky Eaters, it is a wonderfully messy task to play with food from the feet up.  In Speech Therapy, Occupational Therapy, and ABA Therapy we are rolling our car toys over crackers and pudding, playing in foam, steping on fruit snacks and then moving up to the mouth.  Motor begats motor.  Sensory Motor processing supports speech therapy.  Both are important.    This week I have worked more than a sweat in treating children and loving every minute of it.  I just wanted to thank a school SLP who was my graduate mentor for a full semester while at Northwestern because I went back to the basics.