Melanie Cole (Host): If your child has a speech disability, speech therapy can play a very important role in their development. My guests today in this panel discussion are Kathryn Hess. She’s a speech and language pathologist with rehabilitation services, and Sarah Richards. She’s a speech and language pathologist in cleft and craniofacial services, both at Shriners Hospital for Children Chicago. Kate, I’m going to start with you, tell us a little bit about speech therapy. What are some conditions that would lead a parent to seek it for their child?

Kathryn Hess (Guest): Yeah we see patients that have a wide variety of diagnoses and different needs related to receptive and expressive language disorders, speech production disorders, and also feeding. Feeding and swallowing is an area I think a lot of people don’t realize falls under speech and language therapy, and also as you mentioned, Sarah works in our cleft lip, and palate team and so we also specialize in seeing patients with cleft lip and palate issues.

Melanie: Sarah, what is the approach at Shriners Hospitals for Children Chicago in regards to speech therapy?

Sarah Richards (Guest): Yeah so we see kids from the start when they’re very young, as early as just a couple of days old and speech therapists play a role as Kate said in both feeding and the development of speech sounds. So if you have a cleft of the soft palate, you have difficulty building up pressure in your mouth to make specific sounds, so we want to make sure that once that palate is repaired, that they’re developing the sounds appropriately, how any other kid would develop them, to know that that palate repair was successful.

Melanie: Sarah, I’m going to stick with you for just a minute because you mentioned feeding. So people think oh a speech therapist at the beginning of child’s life, I don’t understand that, but feeding is obviously the most important thing at that point in life. How can a speech therapist help with that?

Sarah: Right, and for our kids who have a cleft palate, they come to us when they are just a few days or few weeks old, and a lot of times when we introduce ourselves as speech therapists, families say well – but they’re not talking yet, but when you have a cleft of the soft palate, you can’t build up that pressure to suck like babies with a typical palate has, so you can’t do any sort of breast feeding, you can’t suck from a normal bottle. So they have made different types of bottles where you don’t need that suction so that babies can efficiently feed. So at the early stages of their life, we’re monitoring and evaluating how they’re feeding to make sure it’s effective with those bottles.

Melanie: And Kate, can patients come to Shriners just for speech therapy or are they mainly there if they receive services as part of an overall care for another condition they may have.

Kathryn: The vast majority of our patients do come in as patients with other needs who see our specialist physicians here and that makes up the bulk of our patients, but for speech in rehab, we do take some direct referrals depending on if we feel like we’re able to help them here, and if that’s the case, they do still need to come in under our clinic. We have a specific clinic for speech. They would still need to come in and meet with our physiatrist and our team in order for us to do a bit of a screening in the clinic to determine if therapy services are going to be appropriate.

Melanie: So Kate, speak a little bit about the technology that’s used in speech therapy. We’re going to get a little bit more into cleft lip and palate in a minute but the technology, and as Sarah mentioned, the types of feeding devices and bottles that are available, what other technology do you use to help children with speech disorders?

Kathryn: We use a wide variety of different devices and different techniques that range from low tech all the way to very high tech, very sophisticated devices that are dedicated just for communication. It is an area that has really come a long way. Each and every year there’s just tremendous improvements with it, and I would say that at this point right now, technology is more accessible than ever. So it’s been really a nice change. Everybody’s used to using phones and tablets and computers a lot more than they were years ago, and so even the dedicated communication devices seem a lot friendlier and easier to use for people that hadn’t seen them before, but we use everything from different kinds of switches to help operate any number of appliances or to give single messages, double messages. If they want to say more or all done, they can choose between those. The more complicated systems, they can have literally hundreds and hundreds of vocabulary words to choose from and it can be as sophisticated as touching the pictures on a computer like device in order to say the message aloud or it can be as complicated as using an eye gaze to make the selections on a computer.

Melanie: Isn’t that cool the technology that can help so many children. Sarah, what are some of the speech issues that arise with cleft lip and palate and craniofacial conditions, how does speech therapy, aside from feeding with the little guys, play a role in their development?

Sarah: Yeah, so babies that have a cleft palate, as I said, they can’t build up that pressure in their mouths, both to suck but also to produce specific speech sounds, so those sounds are “puh”, “fuh”, “tuh”, “duh”, “kuh”, “guh”, and then there’s even later developing sounds like “s” and “v” and “f”, “z”, “shsh”, “ka”. So the palate repair is typically around 9-12 months of age, so before that repair, you want to make sure that you’re not encouraging the babies to produce those sounds in their babbles and early word attempts and babies are actually very clever and they come up with other ways to produce a similar sound using their nose or their throat, and so we want to make sure we’re not encouraging and reinforcing that because that’s what needs additional speech therapy later on in order to break that habit. After the palate is repaired, we listen for the development of the six earliest developing high pressure consonants, so that’s “buh”, “duh”, “guh”, “puh”, “tuh”, “ka”. In words like dada, or baba, bottle, gaga. We have parents encourage those developments at home, and if we don’t hear those developments, then we refer them for early intervention services or for therapy here at Shriners targeting those sounds to make sure that, that palate repair surgery was successful.

Melanie: Kate, what’s a speech therapy appointment like? What’s it like for the parents watching their children learn some of these sounds, and what’s it like for the child and especially as children get older and the early intervention, the 3 and 4-year-olds, and even as they get into the tween years, what is an appointment like?

Kathryn: The most interesting thing is that every hour is really different because everything is very individualized. We do an assessment and we determine that particular child’s strengths and their areas of need and so everything is very individualized and directed just to that child based on what they need. The great part is here that we’re able to have the parents very involved. So we really encourage them to stay in the sessions with us and observe and see what’s going on. So many times they’ll say, oh I learned so much just by watching how you responded to him or how you cued her or different things like that, and that’s really important because, especially when you have an outpatient who only comes once or twice a week, for the parents to be able to feel comfortable carrying things over at home that’s really going to make all the progress. So it’s great when we get to have the parents in the room with us. One of the changes that’s different, when patients are used to being in early intervention, it’s very family oriented and the parents are really involved, and then when children turn 3 and transition to school, the parents aren’t as involved in the therapy that goes on at school, and so when they get to come for outpatient and they get to actually sit in the sessions, it’s really beneficial.

Melanie: Sarah, since speech therapy isn’t a quick fix. It takes hard work over many months or even years, you have the first last word here, what would you like parents to take away from speech therapy at Shriners Hospitals for Children Chicago, and specially cleft lip and palate and what you want them to know about the hope that’s on the horizon for their children as they grow and even become teenagers and adults to have this very good articulation and be able to make themselves understood.

Sarah: Yeah, I think in general for any parent who has a child with a speech or language impairment, it’s important to remember that every child is different and no child is going to make progress at the same rate as another child, so it’s important to just communicate with the SLP working with your child and make sure, as Kate said, that you’re incorporating those things that are being worked on in therapy at home as well, and for cleft and craniofacial especially, you want to make sure that if you are working with a child or have a child who you suspect might have a cleft or craniofacial difference, that you’re communicating with the team and with the team speech pathologist to make sure that you guys together are coming up with the best treatment plan possible.

Melanie: So Kate, I’d like you to wrap it up for us with a little information for parents about what a speech and language pathologist really is and how you can help kids with so many speech disorders as they grow.

Kathryn: Speech pathologists are really specialists in communication and feeding, and so what they’ll do is they’ll form a relationship with the child and learn the best ways to help that child to be able to communicate their wants and needs and to be able to interact with the people around them in order to be able to participate more in what’s going on, and to be able to feel comfortable and confident. As Sarah said, and I totally agree, it’s important for parents to recognize that progress is different with every child and how communication might look is going to be different with every child, and as I mentioned earlier, now more than ever, we have a lot of ways to help assist with communication, whether it be through some technology, through use of signs and gestures and of course speech and speech clarity is a big focus.

Melanie: What do you love about working at Shriners Hospitals for Children Kate?

Kathryn: Oh my goodness, I love everything. This is a wonderful place to work. It’s really so great to build the relationships with the parents and the families and the team here and the rehab department is really strong, but beyond that just the whole hospital has a lot of strengths and it’s a really very supportive and wonderful place.

Melanie: Sarah what do you love about working at Shriners Hospitals for Children in Chicago, because you work with a very specific subset of children and you much feel such gratitude when you see these children grow and thrive, what do you love about working there?

Sarah: Yeah as Kate said, I love everything about working here. It’s just such a welcoming and warm environment. Every employee here is always so happy and smiling and we all really want what’s best for each individual child and for our team, I love working with all the individuals on our team such as psychologists and audiologists to make sure that we’re looking at the whole child as we’re treating the child and also communicating and working with the parents as well. And lastly, I just love watching – you know as I said, we see the babies when they’re just a few days or a few weeks old, so I really like watching them grow up and make huge gains in their development.

Melanie: Thank you ladies for joining us today and sharing your expertise and explaining speech therapy in children and what’s available at Shriners Hospitals for Children Chicago. This is Pediatric Specialty Care Spotlight with Shriners Hospitals for Children. For more information, please visit shrinerschicago.org, that’s shrinerschicago.org. This is Melanie Cole, thanks so much for listening.