First Bite Ep 278
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[00:00:00] Michelle Dawson: Hi folks, and welcome to First Bite, Fed, Fun, and Functional, a Speech Therapy podcast sponsored by Speech Therapy. I am your host on this nerrd venture, Michelle Dawson, MS, CCC SLP CLC, The All Things Peds SLP. I am a colleague in the trenches of home health early intervention right there with you. I run my own private practice, Heartwood Speech Therapy, in Cullatown, South Carolina.

[00:00:42] Michelle Dawson: And I guest lecture nationwide on best practices for early intervention for the medically complex and fragile child. First Bite's mission is short and sweet. To bring light, hope, knowledge, and joy to the pediatric clinician, parent, or advocate. By way of a nerdy conversation, so there's plenty of laughter too.

[00:01:04] Michelle Dawson: In this podcast, we cover everything from AAC to breastfeeding, 

[00:01:09] Erin Forward: ethics on how to run a private practice, 

[00:01:11] Michelle Dawson: pediatric dysphagia to clinical supervision. 

[00:01:15] Erin Forward: And all other topics in the world of pediatric speech pathology. Our goal is to bring evidence based practice straight to you by interviewing subject matter experts.

[00:01:24] Michelle Dawson: To break down the communication barriers so that we can access the knowledge of their fields. 

[00:01:29] Erin Forward: Or, as a close friend says, to build the bridge. 

[00:01:33] Michelle Dawson: By bringing other professionals and experts in our field together, we hope to spark advocacy, joy, and passion for continuing to grow and advance care for our little ones.

[00:01:44] Erin Forward: Every fourth episode, I join in. I'm Erin Forward, MSP, CCC SLP. The Yankee Byway of Rochester, New York transplant, who actually inspired this journey. I bring a different perspective, that of a new ish clinician, with experience in early intervention, pediatric acute care, and non profit pediatric outpatient settings.

[00:02:05] Michelle Dawson: So sit back, relax, and watch out for all our stories. Hey,

[00:02:20] Michelle Dawson: This is Michelle Dawson and I need to update my disclosure statements. So my non financial disclosures, I actively volunteer with feeding matters. National Foundation of Swallowing Disorders, NFOSD, Dysphagia Outreach Project, DOP. I am a former treasurer with the Council of State Association Presidents, CSAP.

[00:02:43] Michelle Dawson: A past president of the South Carolina Speech Language and Hearing Association, SCSHA. A current board of trustees member with the Communication Disorders Foundation of Virginia. And I am a current member of ASHA, ASHA SIG 13, SCSHA, the Speech Language Hearing Association of Virginia, SHAV, a member of the National Black Speech Language Hearing Association in NBASLH, and Dysphagia Research Society, DRS.

[00:03:10] Michelle Dawson: My financial disclosures include receiving compensation for First Bite podcast from SpeechTherapypPD. com as well as from additional webinars.

[00:03:21] Michelle Dawson: And I received royalties from the sale of my book, Chasing the Swallow: Truth, Science and Hope for Pediatric Feeding and Swallowing Disorders, as well as compensation for the CEUs associated with it from Speech Therapy, PD. com. So, those are my current disclosure statements. 

[00:03:40] Erin Forward: Hi, this is Erin Forward and these are my disclosure statements.

[00:03:44] Erin Forward: I receive a salary from Cincinnati Children's Hospital Medical Center. I receive royalties from Speech Therapy PD for my work with First By Podcast and other presentations. I also receive payment for sales from the First Bite Boutique which I have with Michelle Dawson for non financial disclosures. I am a member of ASHA and a member of Special Interest Group 13.

[00:04:07] Erin Forward: I also am a volunteer for Feeding Matters. I am a contributor for the book Chasing the Swallow Michelle Dawson, which I received no financial gain. I also am a member of the South Carolina Coalition Committee with ICLDIF fulltime. 

[00:04:22] Erin Forward: The views and opinions expressed in today's podcast do not reflect the organizations associated with the speakers and are their views and opinions solely.

[00:04:30] Michelle Dawson: Alright, everybody, we are back. And I don't know about y'all, but Erin and I kind of took a hiatus on all things SLPdom, because well, life was very eventful, which I feel like is my running track line, but it has been. So, I kind of feel like this is the perfect way to come back from a lovely hiatus by sharing joy with another fellow SLP of faith and passion and joy.

[00:05:00] Michelle Dawson: And so, I am excited to come back with a pop and a bang with none other than Miss Madi Metcalf. And she hosts Making Sense of Myo, which is a lovely podcast on Speech Therapy PD. And bless her heart, she does therapy in Arkansas, which the one thing I remember about Arkansas is going to a CSAP conference at Bill Clinton Presidential Library.

[00:05:25] Michelle Dawson: And my sweet friend, Miss New Jersey. She was the president of New Jersey at the time. We may or may not have tied one on and she snuck out a Bill Clinton wine glass in her purse because my purse was too little. I couldn't take, obviously we were going to steal the wine glass, but I couldn't steal it cause my purse was too little.

[00:05:44] Michelle Dawson: So, she long term borrowed it and delivered it to me. The next day. So this is my one experience, a Little Rock in all of Arkansas, but hi. 

[00:05:52] Michelle Dawson: Hello. What a great great memory of Arkansas you have in a little memory item from our, our contribution to the country. 

[00:06:00] Michelle Dawson: And it shattered on the kitchen counter when Goose was doing the dishes and he goes, mom, you remember that fancy wine glass your friend stole for you?

[00:06:09] Michelle Dawson: And I was like, Oh my God. And he goes, Well, it died. I was like, oh my god. Well, that was karma, baby. It's okay.

[00:06:19] Michelle Dawson: Yeah. He, he really likes to hand wash dishes, but sometimes the dishes do not enjoy the experience as much as he does. They get slippery and soapy. 

[00:06:29] Madi Metcalf: You know, accidents happen. 

[00:06:31] Michelle Dawson: Yeah. We're fine. It's fine. Okay. Well, how about you? And tell us about. Therapy in Arkansas and how you got into the world of PFD because you and I met like in person in real life ASHA November of last year, which is crazy because I feel like I've known you longer than that because of like our circles of overlap and joy with Sweet Therapy PD, but yes.

[00:06:53] Michelle Dawson: So how did all of this come to be? 

[00:06:56] Madi Metcalf: Yeah. So, I am a newer SLP. I graduated with my master's in 2020 from the University of Arkansas. So started off in COVID, always had an interest in feeding. It's I started off in my first place and was a independent contractor working in the schools. I said, Hey, I didn't get a lot of experience with PFD in school, but I'm so interested in pediatric feeding and swallowing. They said, great. We have one kid at this one school that has swallowing difficulties. You can see them. And I said, great. So I drive and two hours to this little school had to go there. It was quite the commute. I get there, start seeing kiddos, navigating COVID.

[00:07:35] Madi Metcalf: It's, it's a, it's a trip. And then I realized like whenever I get ready to start seeing this kid with the feeding disorder, they say, Oh wait, actually we're seeing this kid through the school and in school, do you don't treat feeding and swallowing? Cause it's not academically relevant. And I was like, bumpkiss, but okay.

[00:07:53] Madi Metcalf: Okay. It's like me, you know, brand new CF did have the best relationship with my CF supervisor, didn't have a lot of like support or mentorship. So I was just like, well, I'm figuring out so many other things. They didn't have time to dive into that. So just was not a great fit for that job. So I ended up transitioning to a clinic in the middle of my CF. Started my CF over. It's okay. If you have to do that, you're not a failure. 

[00:08:16] Michelle Dawson: Say that again. That is y'all. If it's not the right fit, you can find the right fit. Yes. 

[00:08:22] Madi Metcalf: And you know, I, it was like a hard decision switching in the middle of my CF, but it felt like the thing to do. And so I went to a clinic that I supervised that during grad school.

[00:08:31] Madi Metcalf: school and I said, Hey, I'm super interested in pediatric feeding and swallowing. They said, we would love to have you. Our person that was doing feeding and swallowing just left. So I walked in and I had a whole caseload of feeding and swallowing. And my CF mentor was fabulous, but she had Beckman training, a little bit of dysphagia knowledge, but I was kind of like on my own.

[00:08:52] Madi Metcalf: So. We were either sinking or swimming, and we floundered a little bit, but we kept our head above water. And so that was kind of my introduction. Had a caseload because I had an interest. And, there's just not a lot of people sometimes that want to do feeding and swallowing. And so then I kind of just dove into as many CEs as I could.

[00:09:13] Madi Metcalf: So I started off with Toctal Sensory Motor Approach to Feeding, which was super great for learning just the, the motor functionings that we need to happen while we're eating. We need to have the tongue to lateralize food to the molar so that we can chew. And this is what a rotary chewing is. Cause I didn't even get that in grad school. We like minimally talked about it, but I had no idea. 

[00:09:34] Michelle Dawson: Yeah. 

[00:09:35] Madi Metcalf: And then from there I kind of fell into, I had a coworker that was going through a tongue tie release with her daughter, so that led me down like the tongue tie myofunctional train Kind of hung out there for a minute. I did Making Sense of Mayo.

[00:09:52] Madi Metcalf: But what I kind of kept coming back to was I love helping these kiddos. I love supporting the families and helping the families feel confident and competent and feeding their babies or their school age kiddos or, you know, however old they are. And so I just kind of. Found myself kind of slowly leaving like the Mayo, you know, keeping what I've learned about like craniofacial development and like the importance of having I think it's really important to have a good understanding of the anatomy and physiology of what goes on in like our craniofacial structure and allowing that to kind of help guide what I need to know for feeding skill, but then there's just so much more outside of feeding skill that you have to look at sometimes, even if it feels a little uncomfy and like you're stepping out of your, out of your scope, but you can still advocate and refer and, I don't know, Be a team player in that sense.

[00:10:46] Madi Metcalf: So yeah, kind of a long winded approach of how my, of a brief little snapshot of how I got to where I am. 

[00:10:53] Michelle Dawson: But we all have that story. Like I, I, they gave me all the, those kids, Michelle, there's those kids. And I'm like, You know, I came from I started in the public schools as an SLPA before it was an SLPA, it was an SLT, speech language teacher.

[00:11:08] Michelle Dawson: And then like my actual first certificate was a speech teacher, which is not a thing anymore. Thank God. But then got my master's, went to work in a hospital. Acute inpatient adults. Can you imagine me with adults? Like I was like a freaking hummingbird zipping around all of these old people and bless.

[00:11:27] Michelle Dawson: We had some of the loveliest patients. I really do love the older people, but they just It's not for me And we went to South Carolina and I got into early intervention cause I couldn't find a hospital job and that's how I found where I was supposed to be. And so EI and PEDS and just, and then teaching it.

[00:11:47] Michelle Dawson: But it's funny that you say about you didn't even learn about the rotary too, because I had. One night of PEDS dysphagia in my entire dysphagia class, and that was it. And even now, we have graduate programs that predominantly are, they have a dysphagia class, but it's geared towards adult dysphagia, predominantly taught by adult dysphagia researchers that don't have the PEDS experience.

[00:12:19] Michelle Dawson: And if you look at the course description, the course description does not include the new updated PFD terminology, which I understand academically. If you want to simply change the course description or a course title, it has to get voted on in house within a department. Then it has to go before a faculty Senate to get approved.

[00:12:41] Michelle Dawson: And then it has to wait for the entire new course catalog in conjunction with a new cohort. So it can't even be the current cohort. I didn't know any of that before I got into academia. So it can take a year to two years of forward planning in order to make the shift, because otherwise it impacts the current cohort.

[00:13:03] Michelle Dawson: So if you're changing course description, course credit, course title, it, it takes, but that means we have to be that much more progressive. Yeah. And embedding this in. Okay. So then, shameless, joyful plug to come to ASHA this year what's the SIG? SIG 12 maybe for supervision or SIG 10 for higher issues?

[00:13:21] Michelle Dawson: Oh, I should know this, but we're doing a two part invited talk with them on why pediatric feeding disorder and pedes dysphagia should be taught as well as the clinic and the clinical experiences. But we're doing an analysis globally of what it looks like in different countries, but a deep dive into what it looks like here in the States as a call for action as to why we need this in university clinics.

[00:13:46] Madi Metcalf: Oh man, that is awesome and so needed. I mean, it kind of blew my mind. So being like a new SLP and kind of, you know, not feeling confident in what I was doing, cause I just didn't have the knowledge base yet. And trying to seek out mentors was so tricky because they're just like, wasn't enough people.

[00:14:06] Madi Metcalf: But if we change the education and the exposure that people got in school, how would that change what people go into in the field? Like I've had, since I've started. I started supervising graduate clinicians last year and it is the absolute best. It is so fulfilling, but I had two students come in and they're like, I don't care about feeding.

[00:14:29] Madi Metcalf: I'm scared of feeding. I want to do language. And I'm like, I hear you just, Just, you know, come into it with an open mind. And those are those like clinicians, they left and they're like, I love feeding. I had no idea. This is amazing. And I'm like, I know. And so I call it the feeding bug now. I tell all my students to say, I bet you're going to catch the feeding bug.

[00:14:53] Madi Metcalf: So just buckle up. But, you know, you don't know what you don't know. And so if you don't get the exposure, it is scary. There is like choking risks and so much management and that sort of thing. But there's also so much joy in it. 

[00:15:07] Michelle Dawson: Yes, yes, but it does. You need, we need to create solid mentorships. We need to create solid clinical practicums where they're doing the best practice and And, and the, you were right, extrapolating best practice from different areas and understanding the evolution and change in knowledge.

[00:15:33] Michelle Dawson: Like when I was taught about evolution of mastication, it was everything had to be in place by four. So I, I am a reformed chewy tube Z vibes girl. Haven't used them in years. But I did, I was the queen of all things, I'm going to wake up face up, you know, but that's because I was taught that the mastic, that, that final two had to be in place by four.

[00:15:56] Michelle Dawson: Now we know from Mel and Jackie's lab, I eat that the IE lab out of Purdue, that like that rotary chew pattern doesn't happen for kids until they're typically developing in 12, which is a huge difference. if we didn't seek to understand and pull in new information that there'd be no way we would know.

[00:16:21] Michelle Dawson: So it's crazy. Yes. Okay. All right. We, we somehow got sidetracked right out the gate, but yes. Okay. So where. Talk to me more in depth about about your training, like what classes you took, where your experiences were, and, and what I mean, we, we know where I stand with all of the things, but I mean, I took classes that were pro ChewyTubes once upon a time, but then I took classes that, Tell me a different science base.

[00:16:55] Madi Metcalf: Yes, so I definitely started off, I don't know, I definitely look back at some of my early therapies that I did and I'm like, oh, no. We didn't even do anything with food in that session. Fine. Because when we know better, we do better. My life motto. So I started off, well, actually the very first thing that I got my hands on that was my Bible starting off was Suzanne Morris and Marsha Duns Klein, A Comprehensive Guide to Mealtime Development.

[00:17:26] Michelle Dawson: Yeah. 

[00:17:27] Madi Metcalf: That book got me through so much. I remember my first infant eval that I had on me, I like, took that book home the week before and every night I was like in my living room reading a different chapter to figure out what I was going to be doing with this little infant. And so, that book is just so great on kind of, Outlining what development is, except like the developmental pre feeding checklist, even that I use for assessments a lot of the time, like it has like a rotary to it two years.

[00:17:54] Madi Metcalf: And so just kind of keeping your mind open with new research that comes available to us and that sort of thing. But so that was kind of my first really big help in understanding pediatric feeding and swallowing. I took the TalkTools Sensory Motor course because. It was kind of everywhere. We had the textbook at my clinic.

[00:18:16] Madi Metcalf: And so, like I said, that was a really good introduction for me just to understand, like the sensory and the motor system do work together. There is a certain level of like feeding skill that we need to advance through diet textures and things like that. And I learned like some nifty little therapeutic things like side placement and things like that to kind of help with feeding skill as well.

[00:18:39] Madi Metcalf: And then so much of the other things that I got was like, honestly, speech therapy, PD your podcast. First bite, listen to that all of the time. And I don't know. I definitely was so beneficial getting such you know, you are very vocal about using things that are not vibrating and silicone in the mouth.

[00:19:02] Madi Metcalf: And so that was so interesting because it was such a good. Differing viewpoint from what I had been learning just coming out of like my talk tools course and things like that. And so Taking an information from not just sitting in your camp of oh, well I am a talk tools girl or I am Only going to listen to things from marshall and klein as you get permission institute but kind of taking in information from as many different sources as you can to kind of One fill your tool bag with a variety of different things that you can pull because every child in front of you is going to Be so different But also I feel like that's kind of led me to be able to make my own, well like, take it from the courses, take it from the experts, but then as I'm continuing to read research articles, I can be like, oh, well this is how they came to this, but this is different now, and kind of forming my own opinions. Based on research. 

[00:19:54] Michelle Dawson: Yes. Okay. Bear and I were walking this morning. We, we walk Gypsy Hill Park. It's adorable. They have a duck swan pond in the middle of the park. And so we, you know, goose bear and mommy walk two miles every morning together before school or summer camp. But he made some comment this morning and I was like about how he didn't want to break apart the microwave.

[00:20:17] Michelle Dawson: Okay, folks, out of context, that sounds insane. Maddie and I were talking before we started recording. Summer camp this week is Break It Apart week, where they break apart whatever. Last year they had cabinets and a fan and an old computer. I know we donated a couple of old computers and a keyboard.

[00:20:35] Michelle Dawson: So, it's pretty crazy. Anyways, Bear was like, mom, he's I don't, he's I already learned about a microwave. I don't need to learn about a microwave anymore. I don't need the science behind this. And I was like, Bobby, I was like, if you're the smartest person in the room, get out and get a new room.

[00:20:48] Michelle Dawson: And he looked at me and I said it so quickly. And Goose was like, yup. And I was like, okay, translate what your mother said. But they, they actually got the gist of what I was saying was to be teachable, to be a lifelong learner. But that's, that's just it. If we can be humble to learn from different viewpoints, that is what, that's where our patients thrive is through our humility and being able to extrapolate and being comfortable to learn from the interprofessional practice partners in different disciplines.

[00:21:25] Michelle Dawson: There's still SLPs that don't think OTs have any seat at the table for feeding. And I just can't comprehend because what you just said, it's Sensory and motor grow together. Yeah. So yeah. 

[00:21:38] Madi Metcalf: The, I recently listened to Kelly Mahler. She gave a talk on, if you don't know who Kelly Mahler highly recommend looking into her, she's an occupational therapist.

[00:21:48] Madi Metcalf: But she's very big in like interoception and ARFID. Talking about like how to honor our bodies, like internal cues, like that everybody's You know, for me, when I feel hunger, my tummy rumbles, it feels empty. I get a little like lightheaded and a little hangry sometimes, but that's how I experienced hunger and I can't say I can't put that into my patient's mouth whenever I'm talking to them about their hunger cues, because maybe their body's experiencing hunger in a different way because they, they're like interceptive system processes things differently.

[00:22:23] Madi Metcalf: But she is so interesting and I learned so much from that course. 

[00:22:28] Michelle Dawson: I just found her. All right, y'all on Instagram. It's Kelly K E L L Y underscore M A H L E R, Kelly Mahler. Thank you. This is amazing. 

[00:22:40] Madi Metcalf: She is fabulous, but just kind of touching on that I don't know when you're working in feeding, there's so many other systems that are involved that we have to kind of be willing to listen to and, you know, You know, partake in, because I would have never learned about the importance of interoception and that my kiddos that have eating difficulties might also be struggling with interoception.

[00:23:01] Madi Metcalf: And even being able to identify what hungry feels like for them. So that was, I don't know. Yeah. Just always learning, even if it's not for my discipline, like I didn't get any ASHA CEs for taking that course. But I. The knowledge that I gained from it made such an impact in my clinical practice.

[00:23:17] Madi Metcalf: And so, you know, not thinking it has to be only ASHA CE approved courses or it has to be a course from an SLP, but being willing to think back to those four domains of PFD and realizing it's okay to learn from A GI or an OT or a psychologist because they have so much to bring to the table, too, because you can't just hone in on your one area when you're working with PFD.

[00:23:41] Madi Metcalf: It's so interconnected, and we have to have at least a base knowledge of, The other people that are sitting at the table too. 

[00:23:50] Michelle Dawson: Yes.

[00:23:50] Michelle Dawson: Bowel Sounds by the North American GI Association. That's one of my favorite podcasts. 

[00:23:57] Michelle Dawson: And I have learned so much from that podcast. Just going for a walk, my, you said interception and my stomach literally started rumbling as soon as you started talking about hunger cues.

[00:24:07] Michelle Dawson: Cause it's be me. There's no CEUs attached with it. It's not a formal thing. It's just a bit of awesomeness that, yeah. No, I love that. 

[00:24:16] Madi Metcalf: It was really great. And I think it, she did it with registered dietitian who was or a neurodiverse registered dietitian. So it was this really beautiful course where they talked about the nutritional aspects and the interoceptive aspects and like how we can help kids with specifically ARFID kind of navigate that, but so much of it was also just understanding that's been another big thing in my practice recently that I've been kind of shifting towards is that, you know, we make accommodations and modifications for so many other kiddos on our caseload.

[00:24:45] Madi Metcalf: If we have a spoken language. difficulty, we get them an AAC device, we give them sign language. If we have a kiddo that can't stand the tags in their clothing, we cut the tags out for them, or we allow them to only wear cotton clothing. And so, you know, I've had this big shift from listening to neurodivergent adults kind of share their experiences.

[00:25:07] Madi Metcalf: We have to have that same mindset with PFD too. Sometimes they also need accommodations and maybe that's eating their same foods. And we have to be okay with that. The newest episode of Or the newest season of my podcast is making sense of selective eating. And I pre recorded yesterday with Laura Helfeld.

[00:25:28] Madi Metcalf: She's a neurodivergent adult who has always had selective eating tendencies, but she's also in the healthcare field in the UK. And so she has like a really interesting perspective. But one of the things that we really hit on yesterday was you can eat differently and still be nourished and safe for your body.

[00:25:45] Michelle Dawson: Yes. 

[00:25:45] Madi Metcalf: And that can be a spectrum. Yeah. And so, I don't know, that's been something new that I've been kind of implementing into my practice, but it's led to some uncomfy conversations with parents. 

[00:25:55] Michelle Dawson: Yes, but here's my question, and it's, and the whole food pyramid that you're supposed to eat what's on this food pyramid is a myth.

[00:26:07] Michelle Dawson: This is not a myth. Based, oh my Lord, people paying money to have their products, lobbyists pay money to have the products placed on the food pyramid where it's supposed to be, you don't have to eat what's on the food pyramid in order to be healthy. And there's so much inherent bias and blatant racism and some of the foods that are selected on there, like all of the dairy products that like, this is You can be a vegetarian or a pescatarian and still get plenty of meat or plenty of protein and iron, and it's possible, but this is, I cannot wait to listen to that one, ma'am.

[00:26:49] Madi Metcalf: It was super fabulous. Highly recommend it. We had a great chat yesterday. But yeah, I don't know. That's the, even some of the mentors, like I've sought out in my area and stuff. You know, like I am 100 percent guilty of making goals for, we'll add three new fruits to their diet. We'll add new proteins to their diet.

[00:27:07] Madi Metcalf: We'll add three new vegetables to their diet. And then that's what we work on in therapy and it's really hard to make progress and I think a lot of it comes from the kid isn't like intrinsically which motivated, which is another one of the get permission institutes, like primary and responsive feeding to just one of those like tenants.

[00:27:23] Madi Metcalf: Like we need that intrinsic motivation. They're not intrinsically motivated to eat those things. And so the gold food is my gold food or mom's gold food, but not the child's. And so, I don't know, it's been really eyeopening and it's a little uncomfortable too, because that's, you know. What a lot of what I've learned and have been mentored with is, you know, diet expansion, we need a healthy diet combating through my own beliefs and perceptions on what diet culture has ingrained in me and all of that.

[00:27:56] Madi Metcalf: There's so much unpacking to do in the feeding world. But whenever I am working with foods and therapy, I found that one of the best things I can do if the kiddo is old enough and able to have the conversation is like, what are you interested in trying? What's something that you would be interested in adding to your diet?

[00:28:13] Madi Metcalf: Has there been a food that you've seen your mom or your brother eating that you're curious about? What And one of my friends said peanut butter. She's had so much exposure to peanut butter, but it's something that she doesn't feel comfortable eating. And so we've started exploring with peanut butter and every time we go, we try it in a new way.

[00:28:26] Madi Metcalf: So like last week we made Oreo sandwiches with peanut butter in the middle. 

[00:28:30] Michelle Dawson: Delicious. 

[00:28:31] Madi Metcalf: So good. So good. But you know, that's not a really hungry. Is this torture talking about all the foods? But you know, we've had such productive therapy sessions and it's It's been centered around what she's been interested in exploring, not predetermined by me or her mom, who would choose that it was 15 new fruits and vegetables, but we're starting in her comfort zone.

[00:28:55] Madi Metcalf: And then we're like slowly edging her out by providing with a new mixture, like an Oreo sandwich. 

[00:29:02] Michelle Dawson: I always struggle when the parents want X, Y, and Z, but they themselves don't consume X, Y, and Z or model it. Okay. And it's why are we asking the child to do something that you yourself are not interested in eating or

[00:29:22] Michelle Dawson: Okay, so I want a raised vegetable bed at the new clinic. One for vegetables and one for herbs. To be honest, it's too late in the season for vegetables, but it's still a good time for an herb bed. But As a culture, we don't we don't grow our own like we used to. So food shows up. So, and little ones are not involved in the kitchen.

[00:29:48] Michelle Dawson: They're not involved in the culinary experience. We, it just shows up and it's done. But also I love gardening. That's one of my girlfriends brought me a new sticker. Renee did. Renee. And it says cultivate joy. And it's a I love joy, but she popped by on Friday or Thursday and brought that over.

[00:30:07] Michelle Dawson: But that's getting them in the garden. I would love to see research, a research project on the act of gardening and experiencing it from the beginning to end. And if that if those experiences. changed and modified their intrinsic motivators to want to try it because now they've had

[00:30:34] Michelle Dawson: extrinsic, like they're, from a proprioception perspective, they have felt the dirt, they've smelt the clay, they've, they've picked the herbs, they've muddled the herbs and Does that shift their comfort so that internally all of a sudden they say, I want to try it because of this experience I would love, I don't know how to do a research study on that, but like that to me would be very exciting.

[00:30:59] Madi Metcalf: That would be really neat. And then just like taking it like that step further and like that bigger sensory system, like being outside is such a sensory, like diverse sensory experience. It's like how much more. Just like regulated and grounded with that child be from like having repeated exposure, going out to the garden, working out there, the repeated exposure with knowing they were growing it and all that. I, that is, would be super interesting to see researched. 

[00:31:22] Michelle Dawson: Also, I would love to know what their vitamin D's level do before and after just to get the sun. Yes. Yeah. I mean, honestly, like a lot of our nutrition comes from The environment that we don't, I mean, how often do we truly get two to three hours of sunlight a day?

[00:31:41] Michelle Dawson: Not very rare. I try to hit an hour and then we wonder why we battle depression and I'm like, we need the sun. I say as a heat bubble is over the continental United States. 

[00:31:55] Madi Metcalf: Oh, that's another thing too. A lot of my kiddos that, especially like the more school aged kiddos a lot of them also have like anxiety disorders that they've already had diagnosed or they just seem a little bit more on the anxious side.

[00:32:06] Madi Metcalf: But going back to that vitamin D, like how much of it is like our. You know, they're feeling dysregulated, anxious, a little overwhelmed, and the one thing that they are actually able to control in their life is what goes in their body. Yes. So, oh man, that would be such a great study for so many different reasons.

[00:32:24] Michelle Dawson: Yes. So, you touched on something about the caregivers about like the caregiver and like them wanting to select the food and what they put in the child's body, and there's some stuff coming out of. Northeastern is the one in Boston, right? That's the school up in Boston. I think, I think it's Northeastern about caregivers body dysmorphia and caregiver eating disorder and how it's manifesting in children with a pediatric feeding disorder and where that lumps in under the psychosocial component of PFD.

[00:33:00] Michelle Dawson: And is that the, which it makes me worry And I don't have the research. So I'm just putting this out in the universe are especially our females and to some extent, our males that spend that much time on social media in early childhood. And they're being flashed images of this is the perfect body. This is the diet culture, but they're getting diet culture immersed at 5, 6, 7, 8, 9.

[00:33:32] Michelle Dawson: Where is that?

[00:33:36] Michelle Dawson: How is that showing up? And I mean, I don't, I don't know. It's just something that they're starting to talk about out of Northeastern, but I just, when you talked about the anxiety, I've seen it personally in a handful of cases, but enough that it nudges you in the back of your mind. 

[00:33:54] Madi Metcalf: Yeah. With the caregivers as well, I can't help but wonder how I had a couple of parents that it seems like they have they might not be telling their child. Oh, you're going to get fat. Like they might not be speaking those things to their child, but I can't help but wonder if like subconsciously, if that's the motivator for them being like, well, they have to eat fruits and vegetables. They're eating too much junk food, junk foods in quotations. Because like they have their own internal struggles with body dysphoria. body dysmorphia, or, you know, their past experiences with like diet culture. And so like that worry that they're just kind of projecting onto their child for not wanting to end up. Being overweight or whatever that might be. I've wondered if that plays a role sometimes in because you know It's not the child that goes to the doctor saying hey, I have a problem I'm only eating grits crackers and goldfish, you know, that's coming from their parents voicing that concern 

[00:34:51] Michelle Dawson: Yes, 

[00:34:51] Madi Metcalf: and I think it's so important to honor a parent's like worry and concern and listen to them and you know navigate that but I definitely think it's been to, it's been like to the detriment of the child.

[00:35:04] Madi Metcalf: Sometimes that, that seems that there's such a push for diversity that might not be attainable for that child in this moment. Who knows where there'll be in 10 years, but like what we're currently working towards is wow, those are some really big goals and being able to talk to the parent about that without, but then, you know, So much with one of the things that really shocked me about working with PFD Is it's not just the child that's your patient like you are working with the whole family and as a new clinician That was terrifying.

[00:35:36] Madi Metcalf: I don't have kids yet. Yet. I was sitting here telling this caregiver how to nourish their child and that was a really uncomfy spot to sit in for a long time. It's something that I'm more confident in, but you know, every dynamic is a little different and it can be a little nerve wracking. But that's been one of the hardest things that I've had to kind of work on.

[00:35:59] Madi Metcalf: Having those conversations with parents is finding ways to honor their child with where they are now and accept what they're currently eating. And. kind of resetting their goals to a more realistic place sometimes. 

[00:36:13] Michelle Dawson: Did you ever do any of the early intervention caregiver coaching training, like the birth to three or zero to three series or the FGRBI?

[00:36:22] Madi Metcalf: I have done a little bit of caregiver coaching with Janine Brenner. Who's this? She's done a lot on speech therapy PD. She does a lot with like language and like autistic kiddos and just kind of, but she takes a very like parent coaching based approach to everything. And so I've learned so much from her on like how to fit things into the family dynamic and meet them where they're at.

[00:36:48] Madi Metcalf: Engage in the child's interests and just kind of, you know, supporting the parents you know, not doing the therapy that you're doing with like a magic wand behind a closed door, but inviting the parents in and like encouraging the parents to make this part of their daily routines. So once again, like that crossover, just because I'm interested in feeding doesn't mean I'm not taking courses in other areas because I've learned so much from listening to Clinicians with experience in early language because they have so much goodness to share on One, meeting the child's interests like where they're at, and two, parent coaching.

[00:37:26] Madi Metcalf: But definitely need More in that area. 

[00:37:31] Michelle Dawson: It's, it's, caregiver coaching is so hard and I was pulling her up on the website. Even as a parent, I mean, yes, I've been a parent for, I mean, 11 amazing years, but I know how to parent goose and bear. And sometimes I think I'm like, are we doing okay at this? I wonder.

[00:37:51] Michelle Dawson: But Bear busted out a CeeLo Green classical music song, which is not appropriate. I'm like, guys, are we doing great parenting or is this bad parenting? And they're, and Goose, who's turned into this really cool 11 year old. He's no, this is just true parenting.

[00:38:12] Michelle Dawson: Okay. Make sure you brush your teeth tonight. But but that being said, we know how to parent our own. But giving parenting advice when you don't really know what it looks like. And when you're in a clinic, you can be removed from the natural setting. Because the clinic is still a faux spot. 

[00:38:32] Madi Metcalf: Yeah. 

[00:38:33] Michelle Dawson: So I don't, I don't know. I love doing home health. I am 41 years old. I don't want to drive all over God's green earth five days a week. I will completely admit that I am just too old for that, but that's because I would rather see my tiny humans and then go home to my tiny humans who not so tiny anymore. And I'm feeling I can feel a college around the corner, if that makes sense, right?

[00:39:03] Michelle Dawson: But The ability to have access to telehealth and to do teletherapy for feeding and swallowing is But not all states have it and I know that but that's lovely because it gives me the opportunity to do In clinic a couple times a month and then to also on those other sessions We're in your home and then guide me through what your home looks like and yeah, it's not me there but it's It's, it's a virtual component to it that helps me grow my insight into the caregiver child dyad and where

[00:39:44] Michelle Dawson: filling the gaps so that I can help coach. But caregiver coaching, there's the. zero to three is I just got the book. I haven't read it yet, but that's a really good resource that one of my girlfriends recommended to me Dr. Cherie Harbick. But I, I go back to the family guided routines based intervention from Julianna Woods that now Dr. Francis Burns has inherited and is taking over, but that's just such a spectacular tool. So, yeah. 

[00:40:12] Madi Metcalf: Yeah. I've recently switched from. I went from a clinic that was doing a lot of myofunctional therapy and feeding to a clinic that was doing Well, it's still a private practice, but it's all home based and I'm seeing across the lifespan.

[00:40:25] Madi Metcalf: I love that. Which is really good. So I am still like a newer clinician and I do know that I want to specialize in pediatric feeding and swallowing. But one of the things that I'm doing to kind of work towards that is I'm currently a year and a half into working towards my board certification and swallowing.

[00:40:40] Madi Metcalf: And so super excited about that. It's the doozy of a certification, but you know, I'm going to be somewhere in three to five years, so might as well be somewhere in three to five years with my BCSS. So, I, so I'm working towards that and, you know, in order to pass the test, you need competency across the lifespan.

[00:40:56] Madi Metcalf: And so I thought getting some adult dysphagia experience would be really beneficial. And then I'm also hoping to get a little bit of, I know that adult and pediatric dysphagia is different, but there's just so little for what we can do with it. It's pediatric dysphagia. So I'm hoping to kind of learn a little bit from what I'm doing with adults and see if any of it could be like transferable over to peds.

[00:41:20] Madi Metcalf: And so that was one of my motivators and I'm also getting fee certified, which is super exciting. Oh, that's awesome. So pumped. I'm excited to kind of get a better understanding of the anatomy and physiology of swallowing with my F. E. A. S. training. Anyways, I went down a rabbit hole. So, I'm also working with my pediatric patients, and it's been so eye opening seeing these kiddos in their home versus the clinic.

[00:41:44] Madi Metcalf: It's like I have one kid on my caseload and his mom would tell me like these are he's kind of all over the Place we have to use screens to get through a meal He runs all over the house stirring his snacks, but then he come to the clinic and he is this like quiet reserved Barely gets out of his seat Kind of kiddo and I was like, oh interesting.

[00:42:04] Madi Metcalf: Okay but I had no idea I just didn't know what they were going through. I get into the home. This kid cannot sit still for more than like a minute. And he's two and a half and he is, he is just running one end of the house to the other back and forth, crashing into things, throwing things. Mom is like chasing him around.

[00:42:25] Madi Metcalf: I was like, Is this what your day looks like? Is this kind of like your norm? She's this is all day from the moment he wakes up until the moment he goes to bed, except when we go to bed, I have to put him in the car and drive him around the block so that he'll go to sleep. Cause that's the only way he'll sleep.

[00:42:38] Madi Metcalf: And so it just gave me so much more insight to what they're actually living through. And I. You know, the first three sessions that I was in their house, we hadn't really talked about OT, but we talked about OT and we're getting him set up with an OT evaluation. Yes. I was like, this little kiddo is not regulated in his body.

[00:42:56] Madi Metcalf: No, he's not. And so, and you know, she'd been to other places. Like she's talked to her PCP about this and stuff. And everybody said, Oh, he's, he's your normal two year old. Every two year old gets into things like that, but they saw the same two year old that I saw in the clinic that sat there and was quiet and really reserved because she was like, I don't know shy a little overwhelmed stranger danger not in his natural environment But then I saw what this mom was going through and I was like, yeah mom your intuition was right Like this is not a typical two year old moving around.

[00:43:26] Madi Metcalf: Yes But then like I also had this other friend that would do so amazing at the clinic. He called it miss maddie's house So he would always come to miss maddie's house and we would be like the coolest little food explorer at miss maddie's house We were always super excited to eat. He knew where the snacks were we would go pick out his snack I would pick out my snack And we had a great time.

[00:43:46] Madi Metcalf: Well, I start going to his house, which he's so excited that Miss Madi's at his house. But we don't eat at his house. He doesn't want anything to do with food at his house. And this is matching what mom and dad were telling me that they were seeing at home. I can do nothing about that at the clinic because.

[00:44:03] Madi Metcalf: We were doing awesome at the clinic. And so it's been so interesting to see these differences from the clinic to the home. And I'm really curious to see what kind of progress we can, if the generalization happens a little bit more working in the home versus but yeah, super interesting stuff. 

[00:44:21] Michelle Dawson: I immediately start wondering what trauma has occurred around mealtime.

[00:44:27] Michelle Dawson: For the second one, and then the first one, I wonder about the size and the space. That was something that Irene Ingram mentored me for 18 months, I think I had her as a mentor. And when I worked at her, she's a sensory OT guru, but she does, she's a baby whisperer. Just I don't know how to describe it.

[00:44:50] Michelle Dawson: She's a baby whisperer, but she would always tell me the space is too big, Michelle, you need to think smaller. And, and when a kid has the free reign of their house and they're running, this space is too big. So how do you create a smaller, safer space? That, that, so as soon as I see a kid dysregulated and running around, I'm like, all right, we need to ground them in a smaller, safer bubble.

[00:45:15] Michelle Dawson: Like, where's your bubble? Let's find your bubble. Let's sit in our bubble and be. You know, grounded here. So she always had us do I don't know. It looks like you're running a kid through a tube sock. It's like one of those spandex Lycra things. I can't remember what it's called, but she would have it anchored down on either sides of the clinic floor.

[00:45:34] Michelle Dawson: And we would literally just crawl through. It's smelt not good. They washed it regularly, but I'll admit it smelt not good. But the act of going through and having to crawl your integrating certain reflexes, I don't know what they're called, and then OT, but the OT who is co treating with me could guide it.

[00:45:55] Michelle Dawson: And let me tell you what, once we crawled through and got grounded and we were in a smaller, safer space, watching these kids have this huge shift in their body. It's, it's profound. So I don't know, you're right. There's something to having a clinic perspective and then a home health perspective and being able to marry the two in between because that's, that's, that's what we need. But I love the coaching piece because that if we're not coaching the caregivers, then we're showing up with a magic wand and taking it away. 

[00:46:35] Madi Metcalf: Right. Yeah. Yeah. Yeah. I, so. If you are a new clinician, don't be afraid to put yourself out there and Sign up or present or submit proposals to present at different conferences.

[00:46:49] Madi Metcalf: So, last year I got to present at the Arkansas speech hearing association and I did one just what is a pediatric feeding evaluation? How can we do that up to Medicaid standards? And this year I've decided that I want to look at that, like role of parent coaching on like piece in pediatric feeding disorders and just kind of the importance on that as well.

[00:47:09] Madi Metcalf: But I don't know, whenever I started implementing more parent coaching, that was like another point in my practice. I would say like the big things that kind of pivoted my practice was reading Anxious Eaters, Anxious Mealtimes and understanding like removing pressure. And that book's by Marsha Dunn Klein.

[00:47:26] Madi Metcalf: She also has a wonderful master course that I'm taking right now, but I started off with the book cause it was cheaper and more cost effective. Yes. And so I started that. So like removing pressure. And understanding that we have to have like mealtime peace. And so like I interpreted that as like trust and connection going into the mealtimes.

[00:47:43] Madi Metcalf: The second. Big thing. That was like a big shift for me was implementing parent coaching and realizing that it doesn't matter if I can, you know, support their child and enjoying foods, if they couldn't support them enjoying foods on their own at their home. And I'm at a point in my practice now that I almost think that the parent coaching piece is the most important part of treatment overworking with the kids.

[00:48:07] Madi Metcalf: Sometimes Which is another thing that I'm loving about being in home health, because the kids have safe places that they can go and play independently. So we send them off and then me and mom sits at the kitchen table and we chit chat about what the struggles were last week, what the wins were the last week, where we want to go moving forward and things that we want to start implementing.

[00:48:28] Madi Metcalf: Because like one, I think that helps create more trust. And between you and the parent, which you also need working with feeding, because, again, you might be asking the parent to change the way that they're nourishing their child. And that's one of our core things that you do as a parent. You know, you wanna if you think back to Maslow's Hierarchy of Needs food, water, and shelter, you are, you know, changing that foundational need that that parent is or that caregiver is doing for their child.

[00:48:53] Madi Metcalf: And so, you know, you can't come in and be a bully about it. I always approach it as Hey, me and you are on the same team. I don't want to come in and tell you, Here's what you need to do. I want to make suggestions and let's come up with a plan together. 

[00:49:05] Michelle Dawson: Yes. 

[00:49:05] Madi Metcalf: So like approaching it more collaboratively versus well, I'm the expert here, which I don't feel comfortable calling myself the expert most of the time because there's still so much to learn.

[00:49:15] Michelle Dawson: Same. Same. 

[00:49:18] Madi Metcalf: But yeah, parent coaching is just such an important piece when you're working with PFD. 

[00:49:24] Michelle Dawson: Yes. And there's resources out there that are free that like folks, like I know I talk about the Family Guided Routines based, but like FGRBI, it's all of their resources are free. You can get them directly on their website, grow with them.

[00:49:39] Michelle Dawson: They have tutorials, they have trainings, they have videos. R. A. McWilliams, he's at University of Alabama. He has free resources on this. I mean, there's so many great resources out there. tools to help that won't break your piggy bank to help expand out your clinical skillset. And yes, they do pull from different areas, but they're well needed areas.

[00:50:01] Michelle Dawson: Erin always goes back to the neurobiology of play. That's one of her favorite books and that's on Amazon, but like why and I bought it last year. I bought it a year and a half, two years ago, I haven't gotten to reading it, but I've been reading trashy vampire love novels. Not the kind where you glitter to death because that's stupid. I will stand by that statement. But like real fun, delightful ones that my children should never ever discover mommy reads these.

[00:50:31] Madi Metcalf: I definitely love a little trashy read every now and then. It keeps things light and easy going. Yes! 

[00:50:39] Michelle Dawson: We yes, I'm now blushing. So I'm going to change the topic.

[00:50:46] Michelle Dawson: Dang it. You made me giggle. Thank goodness. I peed. Otherwise that would have been a giggle pee. Okay. All right. So give me some more. 

[00:50:53] Michelle Dawson: If somebody really wants to pursue this, do you, if they want to pursue practicing in P. F. D. and they're, they're newer to the field or maybe it has been thrust upon them and they've been, you know, doing it for a while because, and I will say this trepidatiously because I know I'm part of the, the cause, but for those that were advocating to put P. F. D. in the public schools, it has a place in the public schools and we have all of the, the newest L. S. E. HSS journal from earlier this spring had all of the new articles behind PFD and dysphagia and why it needs to be in the public school and it was based for the public schools. We have the science, we have given the world the how to guide, but now it's the training.

[00:51:39] Michelle Dawson: So even if you're a language expert and now you're being asked to do this, what do you recommend? 

[00:51:46] Madi Metcalf: I would definitely, so I, you know, have a buttload of student loans that I'm paying on and getting my life started with my husband. And so I don't just have loads of excess cash laying around that I can take every single amazing CE that I want to take.

[00:52:04] Madi Metcalf: And a lot of them are really pricey, even though I want to take all of them. I just keep adding to my to be taken list. And so. I am so big and starting off with getting the book because the book one you can go back you can reference to you can make photocopies for parents that there's a really good paragraph you want them to know about.

[00:52:22] Madi Metcalf: And three, it gives you the information. It's a starting point. And so, for me, I, like I said, I loved. So, Morrison Klein's pre feeding skills a comprehensive guide to mealtime development. It was my Bible my first couple of years. Marsha Dunklein's Anxious Eaters, Anxious Meal Time book was revolutionary in my practice.

[00:52:42] Madi Metcalf: That was like a huge pivoting moment for me. She also has her masterclass that I'm taking right now, and I would definitely say if you really enjoy that book to go ahead and take the course because there's so much extra. It's, the book was definitely, I feel, based more or Directed more towards parents, definitely great for clinicians, but the book goes so much more heavy into the research behind everything, which as a nerd, I love that.

[00:53:06] Madi Metcalf: So if you're also a fellow nerd, highly recommend the course as well. Another one that was so influential to me was Helping Your Child with Extreme Picky Eating, a Step by Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorder by Katya Rowell and Jenny McLaughlin. That book was a game changer in how I was able to coach parents, because that one is directed to parents.

[00:53:29] Madi Metcalf: And so, that just gave me a good way to Like it gave me a good framework. It gave me good suggestions. I was able to make some nice little handouts from that book to hand out to parents. And then what I loved about that book is they also have the cycle of worry, which put things in perspective for me that I hadn't before.

[00:53:46] Madi Metcalf: So like with the cycle of worry. that they talk about. It's my child is not eating for some reason. So, I get really stressed and I push more food on them. And then my child resists even more. Then my worry spikes. Then I push food even harder. And so then, it's just this cycle. So you have to find a way to break that cycle. So I find like, and I'm like, I feel like this is where we are. Does this resonate with you? And it usually does. And so then we find a way, how can we stop this worry cycle? But I wouldn't have been able to put that in terminology or have that nice graphic without that book. So, that was super helpful. And so those are books that I've leaned heavily on.

[00:54:26] Madi Metcalf: As for like cost effective courses, I obviously work for speech therapy PD with like my podcast. And I moderate courses for them, but they have been the best platform for quality PFD content. I've taken so many awesome courses from you and Aaron. There was a really great assessment of pediatric feeding disorders. It was like a three or four and a half hour course, and I'm horrible. I don't remember the person that did it, but it was super helpful. And once again, like super cost effective because you pay like a subscription fee and then you have access to all of the content and then ask for courses that I've paid for.

[00:55:02] Madi Metcalf: I've taken the TalkTool Sensory Motor Approach, which was like my starting point, and now I'm in the Anxious Eaters Anxious Mealtimes Master Class. I've taken, I would say if you're looking for a course, like yes, like I've took Beckman, and yes I took TalkTools, but I would say, That if you want to invest in a course, I would find one that really looks more at that, like psychosocial piece and takes that into consideration and follows more child led because while yes, working on the feeding skill is so important, I found them.

[00:55:37] Madi Metcalf: A lot of my kids, well, the ones that are selective eater. So this will be different if you're working with a tube fed kiddo or something like that. But even, even if you are working with a tube fed kiddo that hasn't had a lot of opportunity, it might have like very delayed feeding skill. You still need to be so mindful that you're approaching it from a way that they're like motivated to want to eat that food, that they're interested in that food and still respecting their autonomy for their body.

[00:55:59] Madi Metcalf: And so I would say if you're looking into courses, that would be some primary things that I would want to. That moving forward, I would want to kind of look into and then some courses that are on my list that I think I would really like to take. I'm really interested in maybe like the AEIOU feeding course with Nina Johnson, Kristy Brackett.

[00:56:23] Madi Metcalf: I thought Kristy Brackett did AEIOU, which is also on my list. 

[00:56:28] Michelle Dawson: Yeah. 

[00:56:29] Madi Metcalf: And so those are kind of two that I'm really interested in. Taking again. And I think that Christie brackets can eat is on motivations learning or something like that. But that was 

[00:56:40] Michelle Dawson: Motivations CE. It might've changed the name, but yeah, there's I got to pitch in the feeding matters conference every year.

[00:56:47] Madi Metcalf: Oh my gosh. Feeding matters is so amazing. I went for the first time this year and I can't recommend it enough. It was. That's amazing. 

[00:56:54] Michelle Dawson: That, and, and what I like is the diversity and thought and diversity in, um, subject matter experts. So, you've got specialists from like different fields that are all there to, And I do, I enjoy that.

[00:57:12] Michelle Dawson: But also the, they have the little research blitz, like the five minute research stumps,

[00:57:16] Michelle Dawson: that I love those. 

[00:57:21] Madi Metcalf: the emphasis on parents sharing their stories. Yes. Because sometimes it's really easy to overlook what the parents are going through in the name of research or evidence, like the evidence that's there to support what you're doing or like the treatment approach, listening to the parents, tell their stories and share their experiences, like just puts front and center, like at the end of the day, we're still working with people and we have to like love and honor them as people first before we do anything else.

[00:57:50] Madi Metcalf: And so it was just like a nice perspective shift for me. hearing from parents because feeding matters lifts them up and offers them a seat directly at the table. 

[00:58:01] Michelle Dawson: Yes. Which doesn't normally happen. Right. Yes. I like that one. I try to make an, I say this knowing that I have all of the videos I need to watch and I have, that's on my to do list for today on top of everything else.

[00:58:14] Michelle Dawson: We'll see how it gets done. The American board of swallowing and swallowing disorders. Host a summer learning series every summer. And this will be the second, maybe third year I've done it. But it's not much, it's four courses for maybe 35 bucks. And full disclosure, I do have my BCSS.

[00:58:33] Michelle Dawson: So potential conflict of interest, but I, I love that the speakers. Some of the speakers have their BCSS, but not all of them. But it's a good blend between research and clinic which I like the blend. Yes, give me what your, what new evidence is out there, but like also I need clinical relevance.

[00:58:52] Michelle Dawson: Because It's cool if we know the timeliness of a swallow or a change in this, but like, how is that going to change my, change my clinical practice? That's the piece that I need. So I like that one. And then the SIG 13s when Asha has, and I'm a member there, I don't do anything on the board, but, or any, or I'm not like a volunteer.

[00:59:11] Michelle Dawson: I just, I, Pay to have access to SIG 13 because they do have really cool stuff that comes out and that SIG and then shameless plug. I, with Ed Bice, helped set up the bloody hell, what do we call it? Dysphagia Pediatric Feeding Disorder Special Interest Group for SHOP, the Speech Hearing Association of Virginia.

[00:59:35] Michelle Dawson: So we set this up so that, because traditionally, and I hear this across the country, traditionally state associations are school clinician heavy, right? It just tends to be, they tend not to have a lot of medical clinicians in there, but At the same time, it's your association that represents the all SLPs and audiologists in the state.

[00:59:59] Michelle Dawson: So we have to advocate for all potential like colleagues and something that when we moved back to Virginia, Ed was like, look, we don't have this. We need this. We need to support our our medical base partners. So we set up the special interest group or this group, and we host. By monthly we try to make it monthly, but it doesn't always happen because life because it's just Ed and I pulling it off.

[01:00:23] Michelle Dawson: But we host a free CEU to our members every other month. And it's we had we've got Dr. Aaron Kleiner coming on later this fall to talk about clinical supervision. for Pediatric Feeding Disorder in the NICU in early intervention, which is amazing. It's a free CEU. We had the woman with Gelmix Purithic talking about infant thickening the last time.

[01:00:46] Michelle Dawson: We've got one coming up later this fall with Dr. Lindsay Meyer Turner and Ines Esperanza, Ines, I'm sorry, I mispronounced your last name, on DEIA barriers for service and PFD, but look to your state associations. And call to action, if your state association doesn't have something like this, hint, hint, hint, hint, Maddie make it.

[01:01:08] Michelle Dawson: Because that's really cool. Like I have, these are the courses I have crafted the courses I want to geek out on by inviting all of these people to come speak. So you can, but it's free. Yeah. That is awesome. Lindsay Stevens. It was Lindsay Stevens on the thickener. Sorry, narrow brains connected. 

[01:01:29] Madi Metcalf: And that's another thing too. I recently got involved in Arksha. And so if you are a neuroclinician, don't be afraid so I've been practicing, this is my fourth going into my fourth year, but don't be afraid to like, take that leap and get involved. And granted, I probably wouldn't have done a lot of these things if I didn't have to get more involved for my BCSS.

[01:01:47] Madi Metcalf: But in pursuing that certification, it's pushed me out of my comfort zone and gotten me more involved in. After listening to Michelle's a webinar she did a couple of weeks ago, I immediately sent my like my committee chair, I was like, Hey, here's an idea. Can we get this can we start lobbying to get this parent coaching code approved by CMS?

[01:02:07] Madi Metcalf: Yes. And so if you are involved, you can kind of start bringing those things up even if you are new and I've just, haven't had anything but like positive and kind words from the, you know, Older SLPs that are on the board that are, you know, now kind of becoming mentors to me as I'm, you know, exploring this.

[01:02:24] Madi Metcalf: And so the more you put yourself out there, the more mentors will kind of fall in place and be there to kind of support and help guide you along. So don't be afraid and think you're too new because you're not. 

[01:02:37] Michelle Dawson: Yes. You're our future, honey. I'm so freaking proud of you. But like it is, it's lovely to see that our, our profession is in good hands.

[01:02:50] Michelle Dawson: Cause sometimes the social media tells you otherwise, but like seeing kindness and advocacy through you and your true love for it is utterly wonderful. So thank you for being you. 

[01:03:04] Madi Metcalf: Thank you. Well, thank you for all the amazing resources that you put out because through all the free content, which the First Bite podcast is also a great place to learn cost effectively about feeding I don't know, it definitely helped shape the clinician that I am today, so thank you for always advocating for, you know, good resources and putting out educational content because it's so important, because a lot of this stuff is really pricey, so having cost effective things.

[01:03:32] Madi Metcalf: It just makes the world of a difference, so. 

[01:03:34] Michelle Dawson: That was, that was our, that was my steal. My schpick, schtick, what is the word that you say there? I don't know. I'm not sure. I don't know. I was talking to Darlene when she pitched, we pitched this idea years ago, and I was like, I just, whatever we do, I want to make sure everybody can access it, so it needs to be free.

[01:03:49] Michelle Dawson: And so that's what I love about all of them, is that they are all so free. A maven. That's the bird in Malcolm Gladwell's book. I think it's tipping point, I think, where there's the one bird that like, they sometimes get into mischief, but they love knowledge and sharing the knowledge and Dr.

[01:04:11] Michelle Dawson: Carol Dudding, who was one of my mentors, who's. On the ASHA Board of Directors as the Vice President of Ethics. She's always, she's you are very much the Maven. I'm like, I'll say rhymes with Raven. And if you've ever seen Teen Titans, go, this is me when I murder Matt.

[01:04:31] Michelle Dawson: Yeah. Oh, okay. All right. I'm looking at our time and to be respectful of everybody's time. If somebody wants to learn more from you, how do they find you? Where do they access you? Tell us all the things. Thank you. 

[01:04:44] Madi Metcalf: So you can follow me on instagram at madi metcalf underscore slp and then There you can listen to the Making Sense of Myo or Making Sense of Slective Eating podcast.

[01:04:57] Madi Metcalf: They're all under the Slp Learning Series Podcasts, but if you search making sense of my or make a sense of selective eating on your podcast streaming site, you can listen to those there. And I'm very proud of both of those because I made them the resource that I needed when I was starting out with my functional therapy and then working with like selective eaters or pediatric feeding disorders.

[01:05:17] Madi Metcalf: So, yeah. And thank you so much for letting me come on your podcast today, Michelle. I really appreciate it. I don't feel like I am worthy to be the interviewee on this one, but I'm thrilled and I do think we had some good little nuggets of wisdom to put out there today. 

[01:05:34] Michelle Dawson: Honey, it was perfect. You, you crushed it. Don't fret. This was exactly, but we need to know where to start and that's, everybody needs a good foundation. Absolutely. Yeah. Thank you, honey. All right. Well, everybody check us out on First Bite Podcast on Instagram, on the land of the Facebooks and mine is hidden, but it's Michelle Dawson SLP.

[01:06:00] Michelle Dawson: There's probably some underscores in there. It's private for safety, but if you message me, I will normally say yes. And, but you know, all of those creepy fake AI men robots. I'm like, delete, delete, delete, delete, delete, yeah, but that's, yeah, the AI, it is, it is happening. Yeah, I should never have watched iRobot with Will Smith, because, yeah.

[01:06:25] Michelle Dawson: Okay, let's not end on scary robot joke. Okay, everybody, have fun, huzzah! Okay, thanks a lot. 

[01:06:33] Announcer: Thank you for joining us for today's course. To complete the course, you must log into your account and complete the quiz and the survey. If you have indicated that you are part of the ASHA Registry and entered both your ASHA number and a complete mailing address in your account profile prior to course completion, we will submit earned CEUs to ASHA.

[01:06:57] Announcer: Please allow one to two months from the completion date for your CEUs to reflect on your ASHA transcript. Please note that if this information is missing, we cannot submit to ASHA on your behalf. Thanks again for joining us. We hope to see you next time. 

[01:07:13] Michelle Dawson: Feeding Matters guides system wide changes by uniting caregivers, professionals, and community partners under the Pediatric Feeding Disorder Alliance.

[01:07:24] Michelle Dawson: So what is this alliance? The alliance is an open access collaborative community focused on achieving strategic goals within three focus areas, education, Advocacy and research. So who is the Alliance? It's you. The Alliance is open to any person passionate about improving care for children with a pediatric feeding disorder.

[01:07:46] Michelle Dawson: To date, 187 professionals, caregivers, and partners have joined the Alliance. You can join today by visiting the Feeding Matters website at www. feedingmatters. org. Click on PFD Alliance tab and sign up today. Change is possible when we work together. That's a wrap, folks. Once again, thank you for listening to First Bite, Fed, Fun, and Functional.

[01:08:13] Michelle Dawson: I'm your humble but yet sassy host, Michelle Dawson, the all things PEDS SLP. This podcast is part of a course offered for continuing education through SpeechTherapy PD. com. Please check out the website if you'd like to learn more about CEU opportunities for this episode, as well as the ones that are archived.

[01:08:32] Michelle Dawson: And as always, remember, feed your mind, feed your soul, be kind and feed those babies.