FB Ep 283 - Fundamental Shifts in Pediatric Feeding Disorder
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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. PD.com I am your host on this NerdVenture, 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, here in Cullatown, South Carolina.

[00:00:43] Michelle Dawson: And a guest lecturer nationwide on best practices for early intervention for the Medically Complex Project. First Bite's mission is short and sweet, to bring light, hope, knowledge, and joy to the pediatric clinician, parent, or [00:01:00] advocate by way of a nerdy conversation. So there's plenty of laughter, too. In this podcast, we cover everything from AAC to breastfeeding, ethics on how to run a private practice.

[00:01:12] Michelle Dawson: Pediatric dysphagia to clinical supervision 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. To break down the communication barriers so that we can access the knowledge of their fields.

[00:01:30] Michelle Dawson: Or, as a close friend says, to build the bridge. 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. 

[00:01:45] 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.

[00:01:55] Erin Forward: I bring a different perspective, that of a new ish clinician, with [00:02:00] 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.

[00:02:44] Michelle Dawson: A past president of the South Carolina Speech Language and Hearing Association, SCESHA. A current board of trustees member with the Communication Disorders Foundation of Virginia. And I am a current member of ASHA, ASHA SIG 13, SCISHA, [00:03:00] the Speech Language Hearing Association of Virginia, SHAHB, a member of the National Black Speech Language Hearing Association in Basel, and Dysphagia Research Society, DRSA.

[00:03:10] Michelle Dawson: My financial disclosures include receiving compensation for First Bite podcast from speechtherapypd. com as well as from additional webinars and for webinars associated with understanding dysphagia, which is also a podcast with speechtherapypd. com. And I currently receive a stipend. Salary from the University of South Carolina in my work as adjunct professor and student services coordinator.

[00:03:45] 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 speechtherapypd. [00:04:00] com. So, those are my current disclosure statements. 

[00:04:04] Erin Forward: Hi, this is Erin Forward and these are my disclosure statements. I receive a salary from Cincinnati Children's Hospital Medical Center. I receive royalties from Speech Therapy PD for my work with First Bite 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.

[00:04:31] Erin Forward: I also am a volunteer for Feeding Matters. I am a contributor for the book Chasing the Swallow of Michelle Dawson, which I received no financial gain. I also am a member of the South Carolina Coalition Committee with ICDL DIF for a time. 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.

[00:04:54] Michelle Dawson: . Okay. All right, everybody, we are back. And I. [00:05:00] I'm in awe of the genuine radiant joy of today's guests.

[00:05:06] Michelle Dawson: Yeah, we have none other than Marsha Dunn Klein joining us today. And she is the guru behind Get Permission Approach. And in truth, she is also one of the most no pun intended, approachable, kindest, most passionate and endearing women you can meet. So, I know that we are a couple of weeks out from the ASHA convention. So I'm hoping that after you listen to her today, you'll make sure to tab your ASHA convention app to come see her invited lecture and part two lecture in Seattle. So, without further ado, I get the honor of introducing, and she's been on Yay, but reintroducing Marsha Dunn Klein.

[00:05:51] Michelle Dawson: So Marsha, hi. 

[00:05:54] Marsha Dunn Klein: Hi, Michelle. I am so happy to be here again. And I can't tell you , what a joy it is for me to be [00:06:00] in this podcast space because you are so, welcoming. , and so thank you for that very, very kind introduction. Introduction. You know, I love what I do and I've been doing it a long time.

[00:06:12] Michelle Dawson: What y'all don't know is we've had numerous conversations about the history of the PFD world before it was called PFD world, like origin backstories and where we are. But and I am not overstating this enough or shouting this from the mountaintops enough. Marsha Dunn Klein was one of the fairy godmothers of the world of peds dysphagia and PFD before we had the terminology that we have now.

[00:06:43] Michelle Dawson: And she is also, One of the leaders that is moving us forward into the acceptance of neurodiversity of forming trauma informed care, like all of these, these buzzwords that you see on the land of [00:07:00] Instagram, but you were there before the land of the Instagram actually elevating and raising autistic and voices that We're not being heard.

[00:07:12] Michelle Dawson: So on multiple levels, you've been a trailblazer. So thank you. 

[00:07:19] Marsha Dunn Klein: Well, thank you. Well, to be fair, I want to say that there, you know, there are certainly people in my life, so yes, I've been around for 54 years doing this, but, you know, my mentor was Suzanne Evans Morris, as you well know, and I have to shout out to all the other people, because I've, it, we, we wrote pre feeding skills early on, 1986 was the first one.

[00:07:41] Marsha Dunn Klein: And. It was based initially then on the work that Suzanne did in her PhD program to look at pre feeding skills. And she looked at the jaw and the cheeks and the tongue and, and she had a small group of kids, but it was the first bit of information that came out there. But why [00:08:00] I'm even bringing that up now is because that sort of launched an area where there wasn't pediatric feeding before then.

[00:08:07] Marsha Dunn Klein: And then it was. I was a speech pathologist. I was an OT. It wasn't anybody's job in particular. But since then we've all had to just keep learning. So, we learned about cerebral palsy. We learned about development. We learned about medically fragile kiddos, which in the beginning of my career, Michelle, we didn't We weren't saving that many when we just started saving more of the tiniest premies in the early seventies, right?

[00:08:31] Marsha Dunn Klein: So we all had to step up to the plate and learn so much more. And we learned more about lactation. We learned more about developmental issues. Selective eating, autism. We, we've just, we've learned about oral motor skills and, and oral motor, oral anatomy. And, and, and we've learned more about lungs and hearts.

[00:08:52] Marsha Dunn Klein: I mean, we've just had to learn so much. So I do feel like, yes, I've been around a long time and I appreciate that you [00:09:00] say that I was a pioneer, but also There are so many people that have influenced my learning, your learning, our learning that I just never want to lose sight of that. And I think sometimes I see people accidentally being in a bubble of their particular personal learning.

[00:09:19] Marsha Dunn Klein: And I want to always challenge us to think broader and to continue to learn from so many areas. And I learned that from Suzanne, who had the most amazing library of, of learning about consciousness. brains perception and music and so many different areas that weren't just feeding. And so I think by learning broadly, we can be better feeding therapists.

[00:09:45] Michelle Dawson: Yes. Yes. That is, honestly, if we stick in our own silos, we have failed before we even begin because this is, it's, there's such an overlap with other professions, but that's why [00:10:00] we have to engage in interprofessional education because we have to know what the other organ systems, what the other the different sensory systems, how all of these pieces interconnect to then be able to effectively engage in interprofessional practice.

[00:10:18] Michelle Dawson: And that's, that's a whole different trajectory that. Honestly, as a society, we're not really taught how to engage in different spheres. And both professionally and personally, we kind of tend to stick to our own little areas, but These babies and these children that we work with, we have to branch out and be comfy cozy in areas that we're not comfy cozy in. So yes, 

[00:10:51] Marsha Dunn Klein: and you, know, you do a lot of teaching and I do a lot of teaching and young people don't learn a lot of this in school. And so [00:11:00] what I want to say about feeding is that I believe feeding is an advanced practice skill because Speech therapists, OTs, we don't learn it in school. We learn some. We learn some but to be good at feeding, you have to be so eclectic, and there's a certain amount of experience and wisdom that really supports the process, right? And so, when I think about feeding in 2024. 2025. In these times, it is so exciting to me. And you say I was around for a lot of years, and I have to say that I look back and I'm not always thrilled with the way I did things earlier on in my life.

[00:11:46] Marsha Dunn Klein: I've had to grow and change. And you said that I've been, you know, sort of newer in the neurodiversity world. I am embracing the neurodiversity information with both arms and both feet, because I wasn't there. [00:12:00] I wasn't great at it. I wasn't even the best at it. But, so when I started, and so I have so much to learn, but I, because I have so much to learn, and because I've been learning so much, and changing so much, I feel it's important to share that shift with, with the pediatric crowd, because And, and be able to say, you know what, I needed to change some things I needed to be different and be able to admit when we know more, we can do more, you know, when we know better, we can do better.

[00:12:30] Marsha Dunn Klein: Thank you, Maya Angelou. One of those areas. So in 2024, we have lots of new brain neuroscience. We know a lot more about neurodiversity. We know a lot more about sensory processing. the depths of sensory processing. We know a lot more about interoception. We know a lot more about coaching and early intervention and, and empathy.

[00:12:54] Marsha Dunn Klein: We, , we know a lot more about responsive feeding and internal motivation as [00:13:00] a, an influencing factor. There are so many more. We know more about connection, relationship, safety. We just know more. So we need to begin to pay attention to those areas in depth. Look at the research that's supporting those and incorporate a lot of those principles into how we prioritize what we do in therapy and why we do it.

[00:13:23] Marsha Dunn Klein: You know, people have come to us. Because they want their kids to eat differently. It's better, more, longer, quicker, less, you know, there's something about the child's feeding that's not working right for that child and parent. So that's why they come to us. . So, I believe it is our job, number one, to be curious and try to understand what is it about this situation, this experience for this child, I do this all the time lately, Michelle, this child [00:14:00] in this moment this child in front of us today, in this moment. What's going on with this child? Why is this working or not working? And what can I do as a therapist to help validate that child, understand what's going on, be curious, and then make some adjustments so that child can be more successful? And in a world where We've been trying to get kids to eat differently.

[00:14:25] Marsha Dunn Klein: Sometimes we go right to feeding food in your mouth today in this therapy session, but really that child's nervous system may not be ready at that moment , in that, and, and so that our great agenda on our plan that we had for our therapy session, wow, isn't gonna work today because the child's

[00:14:53] Michelle Dawson: So, I've got this sweet little booger butt that comes in with his mama and his baby brother. [00:15:00] And mom wants him to eat the foods that the family eats, right? That's typically the goal that they come to us. And this little guy, he's, He's two and change, not quite three yet he has got, he's got characteristics of autism but we haven't had the referral process underlying baseline cardiac conditions, a whole host of known GI components.

[00:15:24] Michelle Dawson: I mean, the kid's been through the ringer already and hasn't gotten into OT yet. We got the referral. So. Okay. But one of the first things I did on my email, I was like, so we're going to see my friend, the OT who's right there. But I was like, let's just take it back to being comfortable with the new foods that we see in the house, because to him, The foods he doesn't eat, they're, they're new.

[00:15:51] Michelle Dawson: And so we have the clinic that I practice at has a fully functional kitchen. Okay. And I don't just mean any kitchen. Suzette, the owner [00:16:00] took her 1910 farmhouse, took her kitchen out of that and put it in the clinic. So when you walk into the clinic, it feels like when you're in the kitchen, like you're in a home, which has I would love to see a study just on the aesthetics of the place and how that has changed each child's interactions, because it's not sterile.

[00:16:26] Michelle Dawson: There's warmth there, right? So it looks like a home, but we have little kid friendly knives and we have simply started with just Cutting foods, cutting things, no pressure to lick it, no pressure to sniff it. Just cut it. And then he likes to feed mom. So mom is eating a lot of things that he's cutting. But I was explaining to her that from an interceptive perspective, I don't think his relationship is still healing internally with himself because of everything that he's gone [00:17:00] through. But what I found was that I don't think I do a good job describing interoception. Cause my analogy is he's learning like proprioception is where my skin starts and how I interact with the world. But interoception is how I feel internally.

[00:17:20] Michelle Dawson: And you use that word when you were describing it, but how do you, How do you describe the concept of interceptive or interception to caregivers? Like what, what analogy do you use for this? 

[00:17:34] Marsha Dunn Klein: You know, I will say that I think about interception as how's the child feeling and that could be I'm hungry, I'm sad, I have pain, I have reflux and all those kind of things but it's also how am I feeling comfortable, emotionally ready to learn and, and I would like to just shout out to Kelly Mahler who's one of my just favorite OTs to learn about interception from [00:18:00] because she's her, her She's got, I don't know, I think 11 books and curriculum and, and, and trainings.

[00:18:07] Marsha Dunn Klein: She's just amazing. And so I, I would say. head your audience in that direction to learn so much more about interoception. But what I want to say about the experience you just described is that you have decided that it is important for this child to have positive experiences and build positive memories and I think, as therapists, if we try to understand the nervous system, system better and the new, newer neuroscience that we're learning. We know that when you have experiences, your brain sets down an experience kind of a pathway, right? This works for me and this doesn't work for me. We know from the work of Steven Porges.

[00:18:47] Marsha Dunn Klein: We know of the work of the, the Shonkoff and Bruce Perry and people in the trauma world. We know that when you have negative experiences. a [00:19:00] wire in a different way and they actually change the way you respond. So if and we know from the newer neuroscience that the work of Dan Siegel and he talks about the window of tolerance.

[00:19:14] Marsha Dunn Klein: When children come to us we want them to be in their window of tolerance. We want them to be in that readiness place, that I'm ready to learn, ready to have a conversation. Michelle, I'm ready to interact with you. And in order to do that, be in that calm window of tolerance the child can't be worried, can't be needing to protect themselves, can't be and we know that a lot of our kiddos that have a lot of worry are wired to go into fight flight.

[00:19:42] Marsha Dunn Klein: So we've met kiddos that sort of get to your therapy session and they already want to. leave the parking lot or not come in the door or push the table away or wonder what you've got hiding behind that screen. What kind of food are you going to pop out today? You know, they worry about us because they don't know what to expect.

[00:19:59] Marsha Dunn Klein: And when [00:20:00] children have had negative experiences and lots of worry, and we know this from all that we're learning about neuroscience in these days, When they're wired to be worried, when you're worried, you become hyper vigilant. So you're like that mountain lion was chasing you, right? You're going to have a higher sense of smell and a more hyper alert sense visually and more hyper alert touch and more hyper alert with sound.

[00:20:23] Marsha Dunn Klein: You're just careful because why? Your nervous system is trying to protect yourself. And when you are not feeling safe, the absolute right reaction is to protect yourself. So here we are saying to kids, just put your hands down. No, don't push the food away. You know, just put it in your mouth. Just take two bites before this happens.

[00:20:44] Marsha Dunn Klein: We have an agenda as therapists because we mean well, we meant well, we want to help that family figure out how to get food in that kid's mouth, right? That's what we meant. But in fact. If the child is responding with, with a [00:21:00] pathway that's been wired because of negative memories, that's wired for hyper worry, our first job can no longer be, this is how you get food in your mouth.

[00:21:11] Marsha Dunn Klein: It needs to be, how can we help you feel safe in this situation, which Michelle is exactly what you did. You didn't say to this child, you need to put it in your mouth. You said, Hey, we're just going to be here. You can feed mom. You can cut it up. You're giving the child the experiences that are positive.

[00:21:26] Marsha Dunn Klein: So you're rebuilding some new memories with food, which is perfect. And you're also being curious and watching him like, Hmm, which of these foods that we're being curious about, are you kind of interested in? Because there might be some the child is willing to interact with a little longer and a little more and show you their curiosity.

[00:21:46] Marsha Dunn Klein: Because when we go at their pace, and let them build that positive memory with their choice, with their internal motivation. Oh my gosh, the changes are different than what we used to get when it was our grown up agenda to make them do [00:22:00] things. 

[00:22:00] Michelle Dawson: Yes. Yes. His face, when he cut that tomato and it went splat, was like, what just happened? It was the funniest thing in the world. He was good. It was a little cherry tomato. He was good when it was solid and he licked it when it was solid and he was curious about it. But when he cut into it and all of the tomato guts, that's what I call them, when the tomato guts went plop, he was like, Oh, I'm done. I'm done. I'm out. 

[00:22:29] Marsha Dunn Klein: Oh, good for you to say, all right, this sweet child in front of me, this child in this moment became dysregulated. Oh, very much. No longer feeling safe in this situation and good for him to be able to say, yuck, it doesn't work for me. And good for you to be able to go, wow, that was a juicy tomato.

[00:22:49] Marsha Dunn Klein: And then maybe change the subject, right. Or move it farther from him. Or help him figure out what does he need to do to help his body feel safer. [00:23:00] And that might, that probably doesn't have anything to do with, you're going to get that in your mouth today, right? So what's happened, I think, in our field is as we've, when we had those grand ideas that we wanted to help parents get food in kids mouths, first off.

[00:23:17] Marsha Dunn Klein: We got our roles a little discombobulated. And I think about my role differently today, Michelle, than I used to. So I think it's not our role to get food in kids because that's an externally motivated thing. I will make you do it. But for me, Michelle, , it would have been in the most loving way. I would have done it sweetly.

[00:23:37] Marsha Dunn Klein: Nobody was gonna cry. I wanted, you know, get permission has always been a kinder, gentler version of therapy because I was being in contrast with what happened earlier on in my career with a lot of behavioral, more compliance based kind of things. So I knew it wasn't going in that direction, but I thought I was being good.

[00:23:54] Marsha Dunn Klein: Because I was being friendly and playful and, you know, I was a cheerleader and all those things. So we made that fun. [00:24:00] But the fact is that I needed to adjust because even in my, hey, do you want to lick it? Hey, you want to kiss it? Hey, do you want to put it in your mouth and spit it out? I was trying to be gentle because I do know that But if you're not willing to smell it, why would you put it in your mouth?

[00:24:21] Marsha Dunn Klein: If you're not willing to touch it, why would you put it in? If you hate the look of it, why would you? All of those things, I know that from a sensory perspective, but I tried to make it so cute that people still interacted with those foods. And, to be fair, many kids ate new foods, loved it, lots of change happened, reinforced me for this way of thinking.

[00:24:41] Marsha Dunn Klein: And I look back now at a number of kiddos that did amazing things in therapy.

[00:24:50] Marsha Dunn Klein: Went home and didn't do any of that at home. And when I look at the kiddos now, what I realized was, even though the parent was there, even though we made it fun, [00:25:00] even though we were building positive memories, that kiddo was masking their true interoception and how they truly felt about it. And so when we know about the window of tolerance with Dan Siegel's perception about how we, we think about readiness, some of our kiddos get hypervigilant.

[00:25:19] Marsha Dunn Klein: But some of our kiddos get hypo reactive, which they get quiet. feel depressed or shamed. Sometimes it frees. But more often we're learning from the neurodiversity community is that, is to talk about masking and that so many of these kiddos would mask truly what was going on with them. Maybe they were masking their disgust or their fear or their worry in order to please because they couldn't get away from the situation and they thought that they needed to please their grown up and Marsha was being so sweet and so nice and and she looked like she was having fun so maybe we'll just go along with this but in fact they'd get home into their safe [00:26:00] environment with their parent and say no way not eating that.

[00:26:02] Marsha Dunn Klein: And I didn't understand that well for a long time, and that's an area that I want to shout from the ceiling or from the mountaintops because it's an area where I needed to rethink. So I did this thing where I used to say, you can smell it, and now do you want to put it on your lips? Now do you want to kiss it?

[00:26:21] Marsha Dunn Klein: Now do you want to give it a little frog lick? Now do you want to, and I had those kinds of things that I would do in the most playful way. And I don't do that anymore. And you and I later on are going to be talking about trying it in a whole podcast, but we, but we're rethinking that. The, in order to rethink that I've had to be learning from so many people who've had these experiences.

[00:26:50] Marsha Dunn Klein: So I'm really making a point to listen to people who have lived experiences. And a lot of autistic adults these days are, are being able to articulate and tell us this is [00:27:00] what it's been like. I if your readers don't know Meg Farrell, Two Sides of the Spectrum. Her podcast is totally amazing. And, and it's, and also Kelly Mahler is also amazing, but, and so many others.

[00:27:14] Marsha Dunn Klein: But, but. Meg Farrell is, interviews many, many different voices and people who've had various different lived experiences in this area. And it's when adults can say to us, this didn't work for me when you did this compliance based thing. This didn't work for me when you made me gag and smell it or eat three things, three bits of Brussels sprouts before I actually got my waffles, right?

[00:27:38] Marsha Dunn Klein: So these voices are powerful and I am seeking them out Noreen Hunani does RDs for neurodiversity and she has a whole course on, on thinking about neurodiversity and feeding. There are so many voices we're learning from. So that is changing how we do things. Absolutely. With, with, We have more research than we did [00:28:00] earlier on in my career.

[00:28:01] Marsha Dunn Klein: So much more research about feeding, about safety, about connection, about relationships and about internal motivation and eating. 

[00:28:09] Michelle Dawson: My Erin just interviewed a psychologist whose research studies and forgive me, I don't remember the woman's name, but she's a psychologist who studies caregiver eating disorders and caregiver ARFID and how it's impacting and presenting in pediatrics? And is it a driving force in the child developing a pediatric feeding disorder? So that's, yeah. 

[00:28:37] Marsha Dunn Klein: I would love to see that, that article or that study. I, I do, we do have research that tells us that ARFID is, there's a genetic bias. Relationship, you know, that, that there are a lot of the, this depth of differences in sensory processing can run in families, but also if the caregiver doesn't.

[00:28:59] Marsha Dunn Klein: You know, [00:29:00] presents with wiping your face off every time you get messy and with only giving you certain foods because they don't like certain foods, then you only have certain experiences. And so there are certainly both sides. I mean, you and I talk all the time about children and parents both bring their, their story to the meal time. Right? And so they are influenced that way. I mentioned earlier about roles and we, so the role of we therapists. I have thought it was our job to get food in. 

[00:29:34] Michelle Dawson: Yes. 

[00:29:34] Marsha Dunn Klein: This is a very large way where I'm changing my thinking about feeding. It's a big shift for me. You know, I, I thought it was my role to show the parent how to do it, to get the parent's kid to try new foods and do it gently.

[00:29:48] Marsha Dunn Klein: And I now think of it as it is not our job to get food in kids. And my really good friend Jenny McLaughlin, a speech pathologist out of Texas is, is the one that, that says [00:30:00] that. loudly and she'll say the only get in feeding should be get permission, right? But I believe it is our job instead, it's the child's job to decide what goes in their mouth.

[00:30:11] Marsha Dunn Klein: They get to have agency over that. They're in charge of their own body and we can help them understand what's working and not working with their body. We can help them feel validated and accepted about that. It's our job to give, to help parents Now how to offer food so that the child can be comfortable and move forward in their learning in a positive way and feel still welcome at the table.

[00:30:35] Marsha Dunn Klein: And you and I know so many kiddos who come to the table feeling like I've disappointed my parent my whole life. Food makes me gag. They want me to eat it. They make me sit here till I I didn't eat until I clean your plate at 10 o'clock and then I didn't eat anyway and these are not bad parents. I'm not in any way judging these parents.

[00:30:57] Marsha Dunn Klein: They just want their kids to learn how to eat and learn how to eat more [00:31:00] and different things. And from the child's perspective, which is where I want us to be. I want us to be looking at it through the eyes of the child. Then if somebody's making you sit at the table till 10 o'clock at night and you still can't get food in because that's not a food you could eat, you know, that's. problematic for that child. And the child learns everybody else comes to the table. Everybody else gets to fill up at mealtime. Everybody else gets to eat enough, but I come here and you're making me eat three brussel sprouts before I get my dinner and I can't and I won't and I'm disgusted I can't, I'm not.

[00:31:40] Marsha Dunn Klein: And so what the child begins to learn and we know so many of these kiddos is that they have sort of minimized self esteem and feeling not accepted and, and I just say to parents, we want your child to feel loved. And include it at the table, no [00:32:00] matter what. And that we get it, sweetheart. We know this is hard.

[00:32:04] Marsha Dunn Klein: We get it. We know it's hard. And so our job needs to be given to give the child opportunities rather than the requirement to eat. We're giving them the opportunity, which is exactly what you did in the study or in the situation you described. You're giving this child the opportunity. You're showing the parent opportunity without pressure.

[00:32:26] Marsha Dunn Klein: You're showing the parent I can accept this child for whatever they can eat or not eat today in this moment and we're going to learn together and that child can still feel loved and accepted not like they're coming to therapy to be surprised and disappoint therapists and mom every time. It's a, it's a shift. It's a big conscious shift. 

[00:32:46] Michelle Dawson: Yes. So many thoughts. One, something that I have evolved in as a practitioner. over the course of my career [00:33:00] is doing a better job of truly seeking to understand baseline. And part of me wonders if it is a I know that it comes from a biasy of this is how our family eats together, right?

[00:33:16] Michelle Dawson: So I grew up, everybody had dinner at the dinner table. As a family, we have dinner table nights four nights of the week for sure. Breakfast almost every morning at the breakfast table. Otherwise we'll bring out picnic tablecloths and eat as a family on Friday night, Saturday night watching a movie, right?

[00:33:35] Michelle Dawson: That is. Our nuclear family and how we function. And I, for the longest time, only saw the world through that lens, right? Assuming that everybody eats at the dinner table when this isn't the case. And. That is something that's so basic that in [00:34:00] hindsight, it's like, how did I not see that? Right? Like, oh, how did I miss that?

[00:34:05] Michelle Dawson: But now when I'm doing my evals and I'm talking about interventions, And, and to what you said earlier, pulling in that caregiver coaching piece, if I truly do a smashing job at a routines based caregiver routines based interview, then I'll understand what it really looks like when the family eats a meal together.

[00:34:29] Michelle Dawson: Like, and not every meal is going to look the same, but it's seeking to understand where Opportunities for exposure in a non-threatening. This is a normal natural pattern for this family. And I have a couple kids that I'm working with right now where their, their practice, their carryover, their support strategies is simply serving the family when they have dinner table dinners.

[00:34:58] Michelle Dawson: Some of them have dinner table dinners [00:35:00] on Sunday after church with fried chicken. Some of them. Sit at the dinner table multiple nights a week. But in those opportunities, it's all right, let's practice simply serving your family members, like put the food on their plate. And we practice doing that, having them, you know, put it on our plates, no pressure for them to eat it.

[00:35:21] Michelle Dawson: But it's, it has shifted my clinical skills set It's shifted how I write my goals because that's a huge I'm not asking them to have a bite. I'm asking, Hey, can you just, I'm writing a goal. Can they serve a caregiver or serve the SLP and it's so neat to watch them. And then the conversations, mommy, you really like that one, mommy I gave you more of this because you like this, but we're doing this at a place of love. But the information also, [00:36:00] because I have so many that have language therapy in conjunction with feeding therapy, the amount of the language opportunities to help describe the foods to, and that gives me insight into what it feels like and what's happening in their bodies with these foods.

[00:36:16] Michelle Dawson: The, there's so many layers to it, but. That's been a fundamental shift in my practice that I've had to walk away from my assumption that everybody eats in a certain way. And again, things that aren't taught, but like you said, we're pulling information from all over. 

[00:36:38] Marsha Dunn Klein: I want to piggyback on that and and that's so important that as a clinician that you've made that change that you've looked at Because so many of us thought you just have to come to the mealtime And that's just how it has to be at a family table and and you're right So many people just eat so differently and I also want to piggyback on [00:37:00] that and say not everybody The mealtime doesn't work For everybody.

[00:37:05] Marsha Dunn Klein: Yes. And so as we're learning more voices from lived experience, from people who've lived the experience, some people will say, when I'm at the table, with a bunch of smells, I can't even eat. Yes. I have to eat by myself, or, or I have to have quieter, less things going on. So we also know that as we look at neurodivergent ways of interacting with the mealtime, the mealtime is highly.

[00:37:32] Marsha Dunn Klein: Sensory time. There's stuff going on. There's noises. There's smells. There's visuals. There may be new foods that look different. There's a lot going on and that works for lots of people and as a therapist, I love it when kids can be around foods they haven't met yet. Because they'll never try something new if they don't meet a new food, right?

[00:37:50] Marsha Dunn Klein: But but that's different than be around a food that I want to get you to eat, right? There's a difference in the way you think about that. So yes, on the one hand, I do think mealtimes are [00:38:00] pretty important to learn about new foods. And at this stage in 2024 and 2025, as we're thinking about the shifting we're making, I also want to add, And mealtimes are not for everybody.

[00:38:14] Marsha Dunn Klein: So as I listen to voices of people who have lived experience, I have an, on, on our Get Permission Institute website, we have two new interviews. We're starting a Voices of Lived Experience series. And, and one of the, one of the interviewees is Yannis and he's a 29 year old man who's Describes himself as autistic and a selective eater his whole life, and he's becoming an OT, so he's got language, jargon, and a history with feeding and, and eating.

[00:38:45] Marsha Dunn Klein: And he says, It's so complicated for me to work during the day. I, I use a lot of emotion, and a lot of, it's complicated to be in a world, With his sensory processing [00:39:00] system and he gets through it and he does a good job But it takes a toll and so he says a lot of nights. I come home from work There's absolutely no way I want to eat with my parents and my family at dinner I want to go up to my room put my three favorite videos on and have my spaghetti and or my spaghetti bolognese or my Domare's stuffed grape leaves, the foods that he knows, the comfort foods for him.

[00:39:25] Marsha Dunn Klein: And it used to be in therapy that or it still is in some situations where we've been focus on compliance. Your this child is eating by themselves or with their screen on in the corner and we have to take away the screen and you must come to the table and we are compliance based in our focus where really I think that one of the shifting things we're thinking about is Who is this child in this moment?

[00:39:53] Marsha Dunn Klein: And does this meal time work for this child in this way? So for example, Michelle, I, I, I know a 13 year [00:40:00] old darling, young boy who is a highly selective eater. And he has, you know, his seven or eight things that he likes that work for him. So he's no longer coming to feeding therapy so that some therapists can say this is how you lick it.

[00:40:14] Marsha Dunn Klein: This is how you taste it. This is how you try new food. He's 13. He absolutely knows new food trying strategies, which we've talked about in a lot of different ways. We teach those on foods he, he knows, right? On the foods he's safe with. We teach him strategies. Now he's got them. What we now talk about every mealtime is, okay, we're having this.

[00:40:35] Marsha Dunn Klein: So come down to the kitchen. This is what the family's having for dinner. And they do buffet style. So there's always his foods. Always, plenty of his foods and the family foods. So they might be having salmon and Brussels sprouts and salad. And there's also his cereal and two kinds of string cheese and an apple that he happens to like.

[00:40:54] Marsha Dunn Klein: Right. So he, he knows there'll be enough, but he comes to the kitchen and the conversation [00:41:00] now, each mealtime is, would you like to join us tonight? Or would you like to eat by yourself? And he'll say mom, I don't like the smell of that salmon. I'm going to eat in my room. And the family goes, no problem.

[00:41:12] Marsha Dunn Klein: So what's happened is, the child is beginning to, as a 13 year old, he lives in a world where people eat things he doesn't necessarily eat. So what he needs to learn how to do is, advocate for himself. This meal today in this moment works for me. And then there are other days when they have foods that that, they have breakfast for, for dinner nights sometimes and everybody's having cereal and pancakes and that might be one that's easier for him to join in on but the shift is instead of i'm going to get you to try brussels sprouts the shift is now how do you advocate for yourself thinking about how is your sensory system working right now In this moment, how are you feeling?

[00:41:49] Marsha Dunn Klein: And then validating it and then helping him make a decision about what do I need to do about that? Cause that's what he has to be able to do when he's 18 and 25 and 40. Right? Yeah. So sitting there, making him come to [00:42:00] feeding therapy, where he would go to, to feeding therapy and COVID and, and there'd be some food on the side of the screen and people would be trying to help him, you know, Trying new things and he would just cry.

[00:42:11] Marsha Dunn Klein: I mean he he just couldn't right? So, you know, he has a diagnosis of ARFID and it's hard for him. He has a differently wired sensory processing system So by forcing him to just go pushing into that where he's not feeling safe and clearly dysregulated that wasn't helping Right? So, what I now say, and there are people in the neurodiversity world that have been saying, well, forget that mealtime stuff, it doesn't work for our population.

[00:42:38] Marsha Dunn Klein: And I want to say, wait, I want to be a voice of reason. Mealtimes have lots of advantages. Children can learn about new foods that they haven't known about. If we do it in a non pressured way, and we're sensitive to the child that's in front of us at the moment, it's And you and I, Michelle, meet a lot of kids when they're one and two and three and their [00:43:00] nervous systems are changing and their developing and changing.

[00:43:03] Marsha Dunn Klein: Many of those kiddos learn to participate in those mealtimes when they feel safe enough that they know there's foods that are comfortable for them and they can learn from that environment. And sometimes that mealtime is not the right situation for a child. And we should not ever be saying, everybody needs to go to the table.

[00:43:21] Marsha Dunn Klein: Everybody needs to be compliant. Everybody needs to start off in that environment where they're already trying to do fight flight. They're trying to protect themselves. They're not feeling safe. They're feeling dysregulated. They're not ready because we're putting them in a situation that their body isn't ready for.

[00:43:35] Marsha Dunn Klein: So that's a big shift for me. And it should be for all of us, I think. 

[00:43:40] Michelle Dawson: Yes. So, just recently, I've started working with more and more ARFID kids. So, which is, is a new, I've had little ones with ARFID over the years, but they would be like sprinkled in over my caseload. But [00:44:00] I have several all of a sudden that are You know, tween teen young ladies that are neurodivergent or have baseline diagnosis of like high anxiety, those kinds of things.

[00:44:12] Michelle Dawson: And the threat that I've seen. is just as you've said, everybody's telling them what to eat, how to eat, when to eat. And one of the young ladies opened up about her home ec class, which they had to be honest, I had completely forgotten about taking home ec. I, and as soon as she started talking about it, I remembered that.

[00:44:36] Michelle Dawson: Almost sewing my finger, learning how to use a sewing machine to make a turtle pillow that is upstairs in my attic in a box, because I kept that turtle pillow. But all I could think about is what an amazing opportunity to learn about food with peers, like through, through class, if it's done in a loving, safe place, right?

[00:44:59] Michelle Dawson: [00:45:00] Like they're getting that in. And I know home ec class is not a classes are still popular in the country, right? It's just, we now live in a very, very rural setting where they also have farm animal husbandry class for six weeks. I didn't know that was a thing. So Goose is really in for it later this year when he has that as his final class for sixth grade.

[00:45:24] Michelle Dawson: But I started talking to her and watching her light up about the cooking portion. And for this child, her. Her carryover, her strategy is she wants to make a meal for her family. That's, that's her motivator is she, she doesn't want to eat it, but she wants to make it and old Michelle would have put the pressure on that she has to eat part of what she, old, old thought process, but new now I'm like, [00:46:00] okay, let's pull out Pinterest.

[00:46:01] Michelle Dawson: So we literally pick out recipes on Pinterest and discuss because she's into vlogging and social media. It's, it's this totally new dynamic of supporting her while she's still getting supports from psychology, psychiatry, her pediatrician her OT. And then, you know, Moose shell rolls in with Pinterest and is like, let's pick out some recipes.

[00:46:25] Michelle Dawson: But it is a shift, a fundamental shift that I don't know if even three years ago I would have been able to wrap my brain around it. So. But that's the joy and giving grace for former ways of practicing and then moving forward. So yeah. 

[00:46:45] Marsha Dunn Klein: Yes, yes, yes. And I know so many young people with diagnoses of ARFID that actually Take cake decorating classes and and and become little little little chefs I know some that that's just [00:47:00] too far away from where their sensory system is But I know a number of them and and what I like about that is when you live in a world where lots of people Eat differently than you are It's nice to be able to figure out how to navigate yourself and figure out for you What works in in that those situations but Michelle our therapy in my in my clinic my old clinic but I no longer have it, but We we would cook all the time.

[00:47:23] Marsha Dunn Klein: Not to get kids to eat, but to make pancakes for the other people in the clinic, to make a fruit salad to take home for the family, to make fruit shish kebabs to take home, to make the salad. So everybody that comes in the afternoon brings a foods and take home things, containers, to, to take home something.

[00:47:40] Marsha Dunn Klein: So the child knows they are, if they're comfortable enough, I mean again, this child in this moment, but they know that in our clinic, we have what we call trust truths. And in our trust truths, one of the top rules is nobody's going to make you eat anything. And you get to, not everybody has to like everything, [00:48:00] and you get to decide what goes in your own mouth.

[00:48:02] Marsha Dunn Klein: So what the child is learning in our clinic is I can be very comfortable the kids who are doing this. They can, we can find where their comfort level is with interacting with foods. And, and help them just be more comfortable in a world of food interactions. For example, a little 13 year old that I know, I said, hey, you like Nutella sandwiches.

[00:48:23] Marsha Dunn Klein: What about if you help make Nutella sandwiches, right? Could you make your own? Because your mom doesn't always make them when you're ready for them, right? And you could make your own because you're 13 and, and he goes, okay. So I was at his house and we got out bread, the same bread he always likes. And the Nutella, the same one he always likes.

[00:48:43] Marsha Dunn Klein: And the bread was right there, and he could not put his hand in the loaf of bread to bring the, the, the bread out. Sensory overload. I didn't know that about him. And so, you realize, if you can't even pick your bread out of the bread bag, [00:49:00] You it, your whole level of angst around food is so different. So yes, what we said was, we have to acknowledge, oh, you're not wanting to touch that today.

[00:49:10] Marsha Dunn Klein: And instead of, let's put it away, I said, what do you think would help you do this? There's tonks, there's gloves, there's these, is there is one of these things. Do you think it would help you? So we taught him to advocate for himself. to what did he need to do to get the bread out of the bread bag. And for three weeks, he put gloves on and he reached the bread out of the bread bag, made his sandwich, careful not to touch any Nutella on his fingers around the edge of the bread, right?

[00:49:38] Marsha Dunn Klein: He made his own. Three weeks into it, one day, he forgot to put the gloves on, reached in, got the bread out and said, Oh, I touched the bread and from then on he could touch the bread. But he did it at his pace, Michelle? Yes. Yes. And he wasn't, he didn't feel judged. We accepted where he was. We acknowledged where he was. We validated his body. He was processing this [00:50:00] differently. We helped him work with us on choices of how, what would be better for your body. He made the choice. He did that. And when he was ready, he didn't need the gloves. Mm-Hmm. . That's the shift in our thinking.

[00:50:18] Marsha Dunn Klein: We have lots to learn, huh? Yeah. And we're still learning it every day. 

[00:50:23] Michelle Dawson: I know. And then I just go to, but how, how do we educate colleagues and caregivers in a non threatening, positive, uplifting way that we can, we can make the shift, right? There's so, we have lots to do, ma'am. Lots to do. 

[00:50:52] Marsha Dunn Klein: We do, Michelle. But you know, part of why I want to talk about this is because, you know, I have been [00:51:00] around a long time. And so when you've been around, around a long time doing feeding, people think, you know what you're doing and you get it right all the time.

[00:51:06] Marsha Dunn Klein: And to be able to say, I didn't get it right all the time. I was kind. I was kind and I did my best. And now that I know differently, I'm shifting. And so number one, role modeling that, that we have to have grace and give ourselves grace and know that we did the best we could because we're in this field because we care and we want to help children and parents.

[00:51:30] Marsha Dunn Klein: And so I am not saying any of these things by way of blaming, I'm taking ownership that I have been trying to do. Also to, to change and, you know, and, and, and really shift in the waters myself, I'm going to ASHA this fall and, and they have invited me and I'm very, very honored to be there. But part of what I'm going to talk about is this topic that all the ways that we are shifting and can shift and I've had people when I've talked about this in the audience. [00:52:00] cry to being sort of overwhelmed and sad. Like, Oh my gosh, what have I done? And, and, and that's not the response I'm trying to elicit. I, I, I really want us to think of Maya Angelou's quote about when you know better, do better, right? You know, do the best you can, but when you know better, do better. So we all have to move forward and, and change as we find things that we can incorporate in what we're doing that seems to work better with what we know now, with our evidence, with our research, with our experience.

[00:52:33] Marsha Dunn Klein: And I When I took my NDT course in 1980, after one week, I sobbed to the instructors. I was in there sobbing, and they said, you know, everybody gets to this point. You're just an overachiever, Marsha. You just got to sobbing, you know, early on. But I thought, I didn't look at the body in that way before, and I thought I knew what I was doing, and now I don't know anything, and I had to put myself back together, right?

[00:52:54] Marsha Dunn Klein: And so I, I'm, I'm always a little bit sad and want to give really big hugs to people that go, [00:53:00] Yeah, but I, I'm sad because I just did these things in some wrong way. And I'm, I'm saying you did the best you could, you wanted to help and just, let's just go forward. That's the best we can do. We have to give ourselves grace.

[00:53:15] Michelle Dawson: I have one family that they're so used to. ABA behavioral based approaches because this is what they know. I mean, when you, when you have a family of and all of your children have, or have been recipients of, or been exposed to that approach, that's what they know. That's what they're comfortable with.

[00:53:37] Michelle Dawson: And, and I know that I know American Academy of Pediatrics last year pulled support for ABA, put it all behind floor time, then rescinded their, resent, and then split their support. That was an interesting week on, in the world of the news. And You know, I've seen, there's a phenomenal ABA practice back in Columbia, South Carolina.

[00:53:59] Michelle Dawson: The [00:54:00] owner of the practice has her PhD and her wife is a speech pathologist and she always laughed and joked about it. She's like, we have the best pillow talk, I'm like, I'm sure you do, but like her caseloads made huge progress, but she didn't do what I would think of as ABA. It was like floor time, just not called floor time.

[00:54:19] Michelle Dawson: And it is difficult. So, when you walk in as a practitioner and I want to help and what the family wants and expects versus how I want to shift and change and there's not tension, but a, but this is what we know and what we're comfortable with. And if you follow this regimented protocol, he'll eventually start doing it. And trying to teach about autonomy and independence and you know, elevating that neurodiverse voice. That's That's [00:55:00] hard to meet both caregiver and child where they are. And y'all, I'm not saying I'm doing it right. I'm pretty sure I'm annihilating and butchering the situation, but I'm acknowledging that right now I'm in the hard, especially with this one family, because I'm having to create trust.

[00:55:20] Michelle Dawson: So that we can move towards the shift 

[00:55:23] Marsha Dunn Klein: You know, when I think about our roles and, and that shift for me, it is not our job to get food in, right? Even though the parents think it's our job to get food in because that may have been the experience that they've had.

[00:55:34] Marsha Dunn Klein: They're doing the best they can also. So we have to get better and better. And better at being able to describe to parents why we're functioning from a different place from the perspective of, I think, empathy is a whole area that we need to continue to investigate. But by we want to understand this child in this moment, we want to understand this parent in this moment, but we also want to focus on how [00:56:00] can we help the parent understand their child's experience, help the parent have empathy for their child.

[00:56:07] Marsha Dunn Klein: , and. And. And to say, I don't do therapy in this way because I want your child to feel loved and accepted and not feel pressure. What we know about the neuro nervous system is that pressure doesn't help. What we know about, you know, and, and, and to give as much of that information as possible. And, Michelle, there have been some families That I have worked with where I've said, you know, you are feeling frustrated each time you come because I'm not doing what you want.

[00:56:39] Marsha Dunn Klein: I'm not doing an AUA approach. I'm not focusing on compliance. I don't want to be your compliance technician. The way I see this is different and I want to help you with it. I want to help your child with it. I want to help you and your child have enjoyable meals at home. And I can't do it that way.[00:57:00] 

[00:57:00] Marsha Dunn Klein: That's not what I believe in. So I might not be the right person for you. And so, you know, if you want to take a break and go somewhere else, please, I support you in that. You need to do what you need to do. And I'm keeping the door open. Because you are always welcome back. And I trust that you need to do what you need to do for your family.

[00:57:21] Marsha Dunn Klein: And so, I've had so many families that have gone away for a month and come back and go, Oh, okay, now I get it. You know, and so I want to give people the love that says, I may not be your person and, and that's okay. There's plenty of kids out there and families that I can help. But, but also help them think through that process of what, why this approach that you and I are talking about, Michelle is so it, the foundation is acceptance and love.

[00:57:48] Michelle Dawson: Yes. So what we're talking, it's attunement and attachment and everybody thinks of attunement and attachment in infancy, right? Like the studies of like, up to a year old, like God, [00:58:00] those awful videos where the child's desperately trying to get the mom's attention and the mom's looking over here on screen and then the child does something.

[00:58:07] Michelle Dawson: And then all I could think of is how are we screwing those kids up that are sitting in those studies? But like the, the, the scary voice in the back of my mind thinks that every time I watch those. But. That's A huge chunk of what we do with even older children is teaching attunement and attachment as a parent and a child, but they could be six.

[00:58:33] Michelle Dawson: They could be seven. I mean, bear has big emotions. My bear, he's nine. We're almost 10 and he's still, he will always be my big emotion child. And there's days where as a mom, I am Exhausted because it's, you know, I've carried big emotions for my patients all day. I mean, and it's, I call it third shift. So as a mom, I have the first shift to get everybody fed, lunch is [00:59:00] packed out the door.

[00:59:00] Michelle Dawson: Second shift is my job. And then third shift is coming home and Lunches unpacked, dinner prepared, going through homework and all of that. And there's moments where I know that I need to work on my attunement and attachment, but I am also emotionally drained from having poured in all day long. Right.

[00:59:19] Michelle Dawson: That's. Y'all, if you're a mom, this is okay to admit. I had one mom tell me I'm over being touched and I'm like, Oh honey, I feel that. But Erin has pointed out to me with love and tenderness. Hey, you, you missed that cue from bear. We're like, she's in town visiting and I'm like, Oh my God, I didn't even see it.

[00:59:42] Michelle Dawson: She's like, no, she's like, you're, you're over here doing this with your brain. She was like, but I just. I thought it would be helpful if you heard it. She's really good at identifying attunement and attachment and has made Us better.

[00:59:57] Marsha Dunn Klein: Know, that, that when I [01:00:00] think about attunement attachment and connection, the connection that's important, you know, what are we doing when the parents are the connected people for these kiddos? They're the ones that can help them regulate. co regulate and we're sending the parent into the waiting room where we go, you know, try to fix their kiddo therapy all by themselves, you know, parents need to be a part of it in order to learn how to do this.

[01:00:23] Marsha Dunn Klein: Right. So, here's one, one more example. And, and a clinician that I know said to me, a family wants to bring hard boiled eggs and try them with their kid. And, and, and I and I told the mom, there's just no way this child's going to eat it was a particularly picky eater with a particularly narrow, selective group of foods, right?

[01:00:44] Marsha Dunn Klein: And so the clinician said, I don't think that hard boiled egg is a good idea. And I said, well, another way to think about that is. The parent wanted to try hard boiled eggs. So, what would happen if the parent [01:01:00] brought hard boiled eggs? So you could interact with the hard boiled eggs in a way that role models when it goes well and when it doesn't go well.

[01:01:07] Marsha Dunn Klein: Because that's the thing the parent needs to know. Not that she got the hard boiled egg in the kid that day, but What could you do with a hard boiled egg? You could roll it back and forth. You could cut it. You could bounce it. You could do it as a soccer ball. You could peel it. You could feel it. How does it feel with the skin on it?

[01:01:23] Marsha Dunn Klein: How does it feel with the skin, the shell off? You could cut it. And so in the session, when they cut it, the child was like, oh my god, that's a big smell. Woo! And the child really reacted as if this was too much. Then, what you could do with that parent and that child is validate the child's response. That is the child's response.

[01:01:45] Marsha Dunn Klein: Not negate it, but oh, that is a response. Notice it. And then, huh, that was a big reaction. There's something wrong with that today, huh? What do we need to do about that? Do we need to move it away? Shall I move it away? Do you want to move it away? [01:02:00] Do you want to move it away with tongs? Do you want mom to?

[01:02:03] Marsha Dunn Klein: You can have a conversation about this was your body's reaction. And what could we do about it? That. is brilliant role modeling with the parent because the parent just learned when I offer a food and it didn't work right or as I expected what could I do about it in the moment and the goal wasn't you need to eat that hard boiled egg.

[01:02:28] Marsha Dunn Klein: Because who cares? If they ate a hard boiled egg bite in therapy, they may never do it again at home. Maybe they'll like it, maybe not. But that's not the big picture. The big picture is, does the parent know how to offer and adjust? Does the child know how to react authentically with what their body's doing without masking it?

[01:02:46] Marsha Dunn Klein: And can the child participate in the discussion about what do we need to do about it? That! It's important therapy, not that the child ate or didn't eat that hard boiled egg. So that was a different way of thinking about that story [01:03:00] because the goal was teaching the parent to be able to offer and adapt at home.

[01:03:06] Marsha Dunn Klein: That's more important than they ate for us in therapy. And that's a big for a lot of people. 

[01:03:12] Michelle Dawson: Yes. But as a parent, to be empowered with that information, that is. Y'all, you might be the smartest person in the room and you might have the best therapy sessions, but if you're not equipping that caregiver for the rest of the week and how to handle the big emotions, the reactions, the experiences as part of their daily routines, we have failed before we have started.

[01:03:41] Michelle Dawson: And that's, I, I love watching the moments click for the caregivers as a mom. I love. When it's presented to me in a safe space so that I can say, Oh, Oh, I see it. I get it. Then I [01:04:00] can, then I am empowered to see my children set for success. And that's what we do at the end of the day. And I love having you on.

[01:04:13] Michelle Dawson: Y'all, this is a, a mini series takeover with Marsha. So this is part one of four. And so she's going to come back for several more iterations to kind of carry this conversation forward because we knew it was impossible to get everything in.

[01:04:32] Michelle Dawson: I'm still forced, not, we're not going to get it all in, but. We wanted to create safe spaces for learning. So can you tell us what to expect in the next three episodes? 

[01:04:45] Marsha Dunn Klein: You know, Michelle, we talked about really thinking about shifting the way we think about trying it. Cause we all are wanting kids to try foods and to do that, we have to take kind of a deeper dive into the sensory systems [01:05:00] in a little bit of a different lens than we, than we traditionally have. So we're going to talk about trying it. We're going to talk about disgust the uniqueness of each, yes, uniqueness of each of our sort of neurodivergent systems, right? We're going to spend another time talking about nourishing the whole child and sort of nourishing beyond food.

[01:05:22] Marsha Dunn Klein: And and then we're Our last episode, we're going to talk about sort of the evolution of feeding therapy and how did we get to this point and this is going to be through the lens of my eyes. And so, I'm looking forward to we have so much to talk about. 

[01:05:37] Michelle Dawson: Yes, and folks, y'all in full disclosure, I was topic chair for ASHA this year for the pediatric feeding and swallowing disorders committee.

[01:05:46] Michelle Dawson: But as a committee, we worked to select and invite members in our PFD world to come and do invited talks that we're going to elevate. Cause that's the theme for Asha this year is [01:06:00] elevate that we're going to elevate our. Our knowledge and skillset. And so the committee voted and requested to have Marsha Dunn Klein come as one of the invited speakers.

[01:06:12] Michelle Dawson: And then she was gracious enough to put in a call for papers for a part two that got voted and approved upon by a council of our peers that were part of the committee. So she's going to do an invited part one and a call for papers part two. And you're speaking on Thursday in Seattle. And I think, I can't remember now, if that's December 2nd hold on, the 5th, the 5th, yes, it's December 5th, and so Thursday morning, your first lecture, I believe, is at 8.

[01:06:42] Marsha Dunn Klein: It is. 

[01:06:43] Michelle Dawson: Bright and early. She's kicking us off strong, y'all. Kicking us off strong. And then we have a break and then you come back immediately after the break for part two. So it's room for everybody to hit the head, use the loo, pump, because there's lactation rooms at ASHA now. I love [01:07:00] this. So bring your boobies, bring your bottles, bring your babies, and come geek out.

[01:07:04] Michelle Dawson: Yay! 

[01:07:06] Marsha Dunn Klein: So I, I'm doing one long talk, but there's going to be a half an hour break in between and it'll be a theme and it'll be about shifting the way we think. And, and you know that I, I've co founded the Get Permission Institute with Stephanie Cohn and Karen Dilfer, and we're, I'm putting a lot of.

[01:07:24] Marsha Dunn Klein: energy into really thinking about this, these ways we're shifting our thinking. And we're shifting our thinking about neurodiversity and the voices of neurodiverse, neurodivergent adults who are explaining about their experiences. We're listening to parents that are talking about their experiences in feeding therapy.

[01:07:42] Marsha Dunn Klein: We're, , we're having invited speakers talking about internal motivation and external motivation. That would be Heidi Moreland and Jenny Berry. We are celebrating that we all have so much to learn from so many places. And so if you would like more about some of these topics, that might be another place you could also find some information.[01:08:00] 

[01:08:02] Michelle Dawson: Ma'am, thank you, truly, for today, for all of it, for just being you, so. Thank you. 

[01:08:10] Marsha Dunn Klein: So much fun. And thank you for all you do to make these kinds of podcasts available for people, Michelle. You, when you're talking about your, your morning, you do breakfast, then there's school and you do work and then you, you do the lunch, unpacking and dinner, and I'm thinking there's a level four, that's the middle of the night when you're on social media.

[01:08:27] Marsha Dunn Klein: 17 boards and doing all this volunteer work. So I don't know where you find all the time. Thanks for all you do. 

[01:08:33] Michelle Dawson: Yes. All right, folks. Take a peek at Get Permission Approach on Instagram follow us on First Bite podcast on Instagram. And if you got a little bit of extra love money may I encourage you to make a donation to Feeding Matters their donations go far and wide to get scholarships for patients.

[01:08:51] Michelle Dawson: And children to get like second opinions that, that would be spectacular. So, everybody, thank you for joining us and we will [01:09:00] be back next week.

[01:09:02] Marsha Dunn Klein: See you next time.

[01:09:04] 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.

[01:09:27] 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. 

[01:09:44] Michelle Dawson: Feeding Matters guides system wide changes by uniting caregivers, professionals, and community partners under the Pediatric Feeding Disorder Alliance.

[01:09:55] Michelle Dawson: So what is this alliance? The alliance is an open access [01:10:00] 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.

[01:10:17] 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.

[01:10:43] 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 SpeechTherapyPD.com. Please check out the website if you'd like to learn more about CEU opportunities for [01:11:00] this episode, as well as the ones that are archived.

[01:11:03] Michelle Dawson: And as always, remember, feed your mind, feed your soul, be kind and feed those babies.