Making Sense of Selective Eating: Ep 1 
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[00:01:04] Madi Metcalf: Welcome to the first episode of the SpeechTherapyPD. com miniseries, Making Sense of Selective Eating. My name is Madi Metcalf, and I'm a speech language pathologist with an interest and passion for pediatric feeding disorders. I'll be your host for this podcast, Making Sense of Selective Eating. This evening, we will have Stephanie Cohen joining us for our first guest.
[00:01:26] Today's course is one hour and will be offered for point one ASHA CEUs. If you're part of the ASHA registry and want your CEUs reported, you must have your ASHA number and address in your speechtherapypt. com profile. Please allow one to two months from the completion date for your CEU to be reflected on your ASHA transcript.
[00:01:45] Now without further delay, I'd love to welcome Stephanie Cohen, MA, CCC-SLP, CLC. Stephanie is a speech language pathologist and a certified lactation counselor in private practice who has worked with children with complex medical needs and their families for more than 20 years. Stephanie has advanced training in pediatric feeding and specializes in working with the birth to three population.
[00:02:07] She is passionate about helping families of children with feeding challenges find ways to make mealtimes more successful and enjoyable. Stephanie has a Bachelor of Arts and Master of Science degree from Northwestern University. She maintains a private practice in Illinois and is a credentialed evaluator and provider in the Illinois Earlier Intervention Program.
[00:02:28] Stephanie regularly presents on a variety of topics including typical and atypical feeding development. responsive feeding, and trauma informed feeding assessment and treatment. Her work can be found through the Get Permission Institute, Chicago Feeding Group, TalkTools, and the American Speech Language Hearing Association.
[00:02:45] Stephanie enjoys mentoring and has been invited lecturer at Northwestern University. Stephanie is the author of my first Learn to Talk board book series. Most importantly, Stephanie is a mom of three who lives in Illinois with her family. My financial disclosures are that I receive an honorarium for hosting this podcast.
[00:03:05] And Stephanie's are that she maintains a private practice and is a co founder of the Get Permission Institute. She receives an honorarium for participating in this talk. Woo! And for participating in this podcast, Daphne maintains a social media account on Instagram, YouTube, and TikTok. It's at Learn to Talk With Me.
[00:03:23] I'll post it in the chat where she occasionally receives compensation from feeding supply companies when sharing products she recommends related to pediatric feeding. Daphne receives royalties from her board book series, My First Learn to Talk. Books. My non financial disclosures are that I'm a volunteer for Feeding Mounders, a member, or a member of ASHA and ARCSA, and a member of SIG 13.
[00:03:44] And Stephanie's is that she's the co founder and co director of the Chicago Feeding Group, a 501 organization. Welcome, Stephanie. Welcome to Making Sense of Selective Eating. 
[00:03:55] Stephanie Cohen: Thanks, Madi. I'm so glad to be here. Thanks for that wonderful introduction. I just want to say, I think that the lineup and learning experience that you have put together is really incredible.
[00:04:07] So I'm just really excited to watch it unfold. 
[00:04:10] Madi Metcalf: Oh my gosh, thank you so much 
[00:04:12] I'm really excited. I definitely kind of crafted this series to be what I needed when I was starting out with pediatric feeding, because it's such a complex area, and I had no idea what I was getting into when I said, I want to work with feeding disorders. So, super excited. Well, shall we go ahead and jump right on into the good stuff? 
[00:04:33] Stephanie Cohen: Yeah. You know what, Madi, can I ask a question before we do that? Sure. One of the things that I always love, because I always feel like these virtual platforms are a little impersonal. I would just love to see if the attendees would mind throwing in the chat where they're from and what their discipline is.
[00:04:48] I just like to know who I'm talking to. 
[00:04:50] Madi Metcalf: Oh, I love that idea. Yeah. So if you all don't mind, that'd be great. Okay, sorry. And I'll get started. I am a speech therapist in Arkansas. I'm somebody from New Jersey. Hi, Erica. Yay. Texas. Olympia, Washington, San Diego, California, SLPN, Southern California, New York, North Dakota.
[00:05:16] So happy. There's so many people here from all over. 
[00:05:19] Stephanie Cohen: Yay. 
[00:05:20] Thanks for coming everyone. 
[00:05:21] Madi Metcalf: Yes. Thank you so much. Currently in the sniff setting. Maybe you'll learn some good stuff. Also because I don't know. I just think there's. I think there's room for carryover. 
[00:05:31] Stephanie Cohen: Hey, Liz, I'm glad you're here to learn. This is incredible.
[00:05:35] I'm so happy. We need more good feeding therapists, Madi. This is like a much needed workshop. 
[00:05:40] Madi Metcalf: Absolutely. So excited. There's so many from all over. What's everybody's experience with pediatric feeding? Just also out of curiosity. 
[00:05:48] Stephanie Cohen: Oh, good question. 
[00:05:49] Madi Metcalf: You want to throw that in the chat? Are you just getting started?
[00:05:51] You've been doing it for freshen up. 
[00:05:57] Stephanie Cohen: I see Liz is brand new to feeding, which I saw just a moment ago. So that's great. 
[00:06:02] Madi Metcalf: No experience. Miriam, hopefully you'll learn a lot. Oh, this is experience in this area yet. Okay. 
[00:06:11] Stephanie Cohen: You all, this is the best area of practice. I know I'm bias. Nothing brings me more joy after 23 years than sitting at a table with a family and just like getting to know them and helping to make things easier.
[00:06:25] So you're in the right place. 
[00:06:27] Madi Metcalf: Awesome. Well, it makes me happy that we have some new people. Hopefully this will be a good roadmap for you as you, you know, navigate this working with some new clients. And hello to the one that's been doing it for a while, but looking to learn more. We love a good lifelong learner.
[00:06:43] Stephanie Cohen: Yes. 
[00:06:44] Madi Metcalf: Okay. So, Stephanie, can you define the terms selective or picky, or selective eating for us? Okay. 
[00:06:53] Stephanie Cohen: So I can try Madi. One of the things you and I talked about at length when we were just getting to know each other and thinking about what we were going to talk about today is that, you know, historically in our field and in other fields that also help support kids with feeding challenges and their families.
[00:07:12] There have been lots of different terms. That have been used over the years and selective eating is one of them. I think of picky eating, extreme picky eating sensitive eaters. There's so many different ones. And so when I think about what a selective eater is, I guess. My first question when I hear that term is I asked the person using it.
[00:07:34] Well, what does that mean to you? I think that a lot of these terms a lot of these names that we sort of have for kids and their feeding patterns language is powerful. They sort of, Communicate maybe a sense of like something being wrong, right? Pathologizing an eating pattern. And while we know that lots of the kids and families that make it to us are in fact really struggling in lots of ways, I am not sure that these terms really give us any meaningful information besides, They are coming to us for help because they feel that things are challenging for them.
[00:08:12] I think selective eating is just sort of one of the possible terms that we might hear when a family comes to us to ask for help with mealtimes. 
[00:08:23] Madi Metcalf: How important do you think it is that we use a uniform word for this among, like, disciplines and other professionals? 
[00:08:33] Stephanie Cohen: That's such a good question. 
[00:08:34] Madi Metcalf: I know we didn't touch on that one.
[00:08:35] I just thought of it. 
[00:08:36] Stephanie Cohen: Yeah, but I think a lot about it and I think It's really important. And so I, of course, was really glad to see the pediatric feeding disorder diagnosis introduced and adopted by lots of practitioners. The thing I really love about having that as a unifying diagnostic term is it prompts us to think of people.
[00:08:58] all of the ways that feeding challenges can impact a child's life and functioning, right? We know like medical, psychosocial, skill, and nutritional status, it's, you know, all those domains can be impacted. So I think it's really valuable to use a common term or a diagnostic term that prompts us to think holistically and from lots of different perspectives.
[00:09:23] I do struggle, I have to say. I struggle because I think that as we grow as a field and as we listen to folks who have had their own journeys around eating in lots of different ways and learning about food, I have been approaching my work a bit differently and starting to kind of avoid the labels just in my everyday practice because I feel like it sometimes narrows my focus and sends me down a path where I may be looking for certain things or pathologizing a certain pattern.
[00:09:55] So I think it's really important for lots of practical reasons like insurance and medical documentation and collaboration on a multidisciplinary team because if You know, I do an evaluation and you get a report from me and it says pediatric feeding disorder on it. You have an idea of, you know, some of the questions you're going to ask, right.
[00:10:15] And what you're going to be curious about. But I think that as a field, we all are still learning what terminology is the most supportive to kids and families. 
[00:10:28] Madi Metcalf: I, and just for like, so everybody knows why I chose the name, making sense of selective eating for this podcast. So, I used to just call it picky eating.
[00:10:36] And after reading some really great books I think, I'm not sure if it was Shari Fraker or Marsha Dunclan, but one of them said, I don't like the term picky because they're being selected because they are choosing foods for a specific reason to them. So they are selecting their food. They're not just being stubborn and picky because they are like temperamental.
[00:10:57] There's, they're communicating something to us. They are selecting that for a reason. Yeah. And while selective eating is part of like, a bigger picture of Pediatric Feeding Disorder, most of the time I get a kiddo with a PFD on my caseload, PFD short for Pediatric Feeding Disorder because selective eating is the primary, like, symptom that kind of gets picked up on by doctors or the parents are like, I can't get them to eat anything besides one brand of chicken nuggets.
[00:11:23] And so that is where the name of that podcast came from. 
[00:11:26] Stephanie Cohen: I love it. And I will tell you, I was talking to Marcia Dunklein yesterday about this conversation tonight, and it was her, because one of the things that I always hear, I always hear her voice in my head, like throughout my whole life, cause she's incredible.
[00:11:40] And I've learned. Yes. But specific to this topic I hear her. Saying, you know, exactly what you just said. This child is selecting what is working for them in this moment. And they may be selecting it because they can't breathe when they drink from that bottle versus this bottle, or because, you know, they're allergic to something and it's not working for their body.
[00:12:02] So I think you picked the right term. And I think that as a field, it's our job to remind ourselves that selective. Just means they're choosing. It doesn't bad or good or, you know, limited in some way. 
[00:12:18] Madi Metcalf: That's an important thing to remember. 
[00:12:20] Stephanie Cohen: Yeah. 
[00:12:21] Madi Metcalf: Can you explain a little bit about the difference between typical and atypical selective eating?
[00:12:26] Stephanie Cohen: That's another good question. 
[00:12:28] Madi Metcalf: I know hit me with the real big doozies tonight, Stephanie. 
[00:12:31] Stephanie Cohen: You know what? I actually love that we're having this conversation at the sort of start of this series, because I. When I meet a family you know, I do a lot of listening at first and my job is to get to know the caregivers and get to know the child and really get to know them as a dyad or as a family unit.
[00:12:56] And one of the things I think a lot about is why. Is this caregiver worried? Why is this child worried? And so I think that, you know, yes, we have our specific diagnostic criteria. If we're looking at something like a pediatric feeding disorder diagnosis, but if we're thinking about selective eating, you know, I think it is hard to make a specific and definite differentiation between typical and atypical selective eating, just because it means different things.
[00:13:27] To so many people. However, what I will say is if a family is coming to us and they feel stress about their child's experiences at mealtimes and their family's experiences at mealtimes, it obviously warrants our attention and our support. So I guess maybe the way to think about it is there are probably lots of selective eaters walking around and maybe the ones that make it to us are the ones for whom.
[00:13:53] The challenges rise to the level that this family says something's not right, we need help. 
[00:14:01] Madi Metcalf: I love the emphasis that you put on like parental stress and feelings towards that because I know in my practice, I've, the way that the parent feels about the mealtime, the way they approach that mealtime can have such a big impact on the child as well.
[00:14:18] Can you talk a little bit about why it's so important? Like just dive into that a little bit more about why it's so important to Approach eating through like that family focused lens. 
[00:14:27] Stephanie Cohen: Oh, absolutely. This is one of those things I could talk about for many hours. So as you know from your learning and as those of you who are here and who are listening on demand can find out and dive into, there is so much research on the lived experience of caregivers when they are raising a child who is struggling around mealtimes for some reason.
[00:14:51] And we have learned so much about what increased stress can do. And worry the impact that that has on caregiver feeding practices. So, you know, I am a responsive feeding practitioner. I prioritize relationship and believe that you cannot separate feeding development from the context of a relationship because children and adults learn in that context together and their interactions Are bi directional right.
[00:15:22] And every, everything that happens at a mealtime impacts the response of the other participants. So we really are working with, as I said, a dyad or a family and not just. A child who were trying to get to eat. So to speak, there were quotes for those of you who are listening on the podcast. My hands were in quotes because I, I know that.
[00:15:44] And believe and share that. It's not our job to get kids to eat. It's our job to help children feel safe and feel trust within their mealtime relationships so that they are able to eat so that they feel ready for learning. So Probably the most important piece of that is helping parents understand their children, because I think a lot of times parents who make it to us, they're pretty worried and pretty frustrated and they have tried everything that they can think of to help their child to eat.
[00:16:16] And we know from the research that when feeding challenges are present, there is mealtimes, there's increased conflict in relationships families feel isolated, Families feel confused and overwhelmed, and there is there's a lot of strain in a lot of different areas. So, we really need to think about a child in the context of their family and their environment and their community, so that we can make sure we're thinking about all of the different variables that impact their feeding development, and their experiences every single day.
[00:16:53] Madi Metcalf: I love that my practice chain. When I first started off, I was like, okay, I'm a therapist. I'm going to take them back. I'm going to work my magic. We're going to look, let's care at five times. We're going to have a great session.
[00:17:05] Like my session focused on getting the kid to eat. And when we learn and we know better, we do better.
[00:17:12] And so, whenever I started shifting my practice to focusing more on that, like, relationship based, understanding the child, understanding the parents, and not just looking at the child as my patient, but the family as a whole as my patient, that was whenever I saw such a shift in my practice. And I started making, like, actual progress that we all felt good about it.
[00:17:34] Stephanie Cohen: I love that. My favorite part of what we do is when and hopefully we get to this point is when you get to a point where a parent says, Oh, my gosh, things feel so much better at the mealtime. And You know, we are so lucky as clinicians to have so many researchers that are looking into these lived experiences.
[00:17:56] I think of, you know, Dr. Britt Paytos and Dr. Meg Simeone at Harvard and so many others Maureen Black and Frances Abood, Leanne Birch, so many people, I'm happy to provide a list of references that, you know, I have learned from, and so we. When we think about our work, integrating the knowledge we have from all of these different papers and studies that have been done, we really can understand just how pervasive the impact is on family members when a child is struggling, when they're worried.
[00:18:29] Madi Metcalf: Yeah. We had somebody ask a question. They said, I once worked with a young boy who could eat past feeling full, so the one on one aide had to portion his meals every day. I was told his brain didn't tell him he was full. He was on the heavy side to be only second grade. Would that be considered an eating disorder?
[00:18:44] If so, what is the official name? 
[00:18:47] Stephanie Cohen: So, there is a diagnosis, a syndrome called Prader Willi syndrome, and part of that condition is a lack of sensation of satiety. And so those kids receive very specific types of treatment. That would be something that we would refer to a medical provider and collaborate.
[00:19:10] So that's one possibility. There are other things that might cause a child to well, I guess the question is, how do we know that that child is eating enough? Because if we think about the goal. Of supporting kids to be able to eat. We're not really thinking about it in terms of what's their body size.
[00:19:28] We're thinking about that child as is this a child who is learning to be able to tune into their internal sensations and eat when they're hungry, eat the foods that their body is telling them that it needs and then sense when their body says I've had enough. Fuel for, for this mealtime. So I think that's a complicated question in the absence of that specific diagnosis that we know that that's a significant part of it.
[00:19:55] Otherwise, I think we might ask ourselves, how do we know that he was eating past the point of satiety? You know, how do we know he wasn't hungry? I mean, there are some kids who just have a bigger appetite who grow in larger bodies. And so, I think that those are some of the questions that I would ask.
[00:20:10] Madi Metcalf: Yeah, I have my current same train of thought. I was like, there are pretty early what skills was going on. The other thing I want to touch on is that they use the term eating disorder. So there is a difference between eating disorder and feeding disorder. So eating disorder is going to fall under That like psychological domain be treated by like mental health providers, whereas like pediatric feeding disorder falls under ours.
[00:20:34] The one little kind of like overlapping area would be avoidant restrictive food intake disorder, which is ARFID. But there's lots of really interesting research coming out on that right now. Feeding Matters has a consensus group going on to figure out like what that overlap looks like. So that's something to just be mindful of as you're thinking about like eating and feeding disorders and all that good stuff.
[00:20:54] Stephanie Cohen: Yeah, they're doing some great work. They had a great I really enjoyed their workshop in this year's conference. 
[00:21:00] Madi Metcalf: Yes, it was so, it was very interesting and I felt just a lot more clear on what art it was. Okay, so since that one, I feel like that little case study that we did kind of led us in nicely than just now talking a little bit about feeding matters.
[00:21:13] So can you start off by explaining, since we do have some people that are new to feeding that are on, can you kind of explain what the four domains of PFD is? 
[00:21:23] Stephanie Cohen: Yeah, would it? I know that some of us are live and some of us are listening on demand, but one of my favorite resources to better understand this is the family guide from feeding matters.
[00:21:36] And so I encourage the, all of you SLPs to take a look at that because it really breaks it down in such an easily understood way. So there's the medical domain and that just prompts us to think about. all of the different, you know, parts of our functioning that support our ability to eat. And, you know, all of the different things that could potentially go wrong or be happening in a child's body that could interfere with their ability to eat and enjoy eating and feel comfortable.
[00:22:09] I think feeding matters has a list of over 300 different Diagnoses that could potentially be associated with pediatric feeding disorder. So that medical domain is a big one and things that fall under the medical domain are things like, you know, aspiration malnutrition is on the nutritional domain, but that certainly can be connected with some of the diagnoses that a child might have.
[00:22:32] You know, I think about the kids that make their way to us with cardiac conditions or who are premature and have a diagnosis of bronchopulmonary dysplasia or chronic lung disease. There are so many different underlying medical conditions that impact a child's learning experiences around eating and their body's ability to eat safely.
[00:22:52] So when we think about the medical domain, we're really thinking about who are those medical specialists on the team that can help us answer some of those questions and collaborate with them. Us as the speech language pathologist, as we're supporting, you know, what we see at mealtimes and helping to keep that child safe.
[00:23:10] The nutrition domain is just what it sounds. So a child with pediatric feeding disorder certainly could have you know, issues because they're not consuming adequate caloric or calories to support their growth and weight gain. They could have deficiencies in different nutrients and micronutrients.
[00:23:28] So we I feel in almost every case need to be collaborating with our registered dietician colleagues who can really help us understand this specific child's body and their needs and help us to understand and really actually help parents to better understand what it is that their child needs. So that's the nutrition domain.
[00:23:50] And really you can probably already begin to see how much we all overlap. The feeding skill domain is very much where we sit as speech language pathologists and our OT colleagues as well. And that's, you know, exactly what it sounds like. How is a child chewing? How are they self feeding? How are they swallowing?
[00:24:10] You know, sensory processing and sensory functioning falls into that domain as well. So those are the things that impact whether a child is able to manage certain foods or manage a specific flow rate from a bottle or you know, do well with breastfeeding or chest feeding. So, Those are the things that we probably focus on the most in our discipline, but you know, psychosocial, the fourth domain, I think is also what we need to be thinking a lot about as we collaborate with our mental health colleagues, being pretty careful to stay within our scope of practice.
[00:24:44] The psychosocial domain, it's somewhat, There are, there are some different parts to it. So I, when I think about the psychosocial domain, I think about what are, what's the emotional impact, what's the psychosocial impact of having a child who struggles to eat. And we think about the impact on the parent or the caregiver, on the child, and then on that relationship.
[00:25:06] We do also know that there are certain psychological conditions that can impact. Mealtime learning and the feeding relationship to the extent that that could be the primary driving factor in, you know, causing a child to have feeding challenges or, you know, having, you know, a situation in which that child is continuing to have feeding difficulties.
[00:25:30] So, There are lots of different pieces to that psychosocial domain. And it's really, really important for us to understand as speech language pathologists, when the appropriate time is to make a referral to a mental health practitioner. And, you know, in a lot of ways, you know, I, I work primarily within the early intervention program here in Illinois, and we're lucky enough that mental health practitioners are part of the early intervention programs.
[00:25:54] I do a lot of advocacy and education and just outreach around helping people. The administrators and sort of the gatekeepers, like the service coordinators understand why it may be important to bring up mental health support from the beginning and really de stigmatize it for families as they're coming into the system and starting to understand all of the different Ways that we're going to be thinking about the challenges that they're bringing to us.
[00:26:21] So I hope that, I hope that helps by a little bit, but definitely check out that family guide. I know we're all professionals, but the family guide is great. I think it gives us the language to be able to communicate everything that I just talked about to families and family friendly language and feeding matters has just created like such a wonderful resource.
[00:26:39] And obviously there's also lots of resources geared just towards, not just, but geared primarily towards professionals as well. 
[00:26:46] Madi Metcalf: And so for anybody that's on the live, I did attach links to the article that was written by Dr. Godet and a really awesome team in 2019 that gave us our consensus definition for PFD, which led to us getting the ICD 10 codes for the pediatric feeding disorder and then I also attached a link for the family guide and then like a what is PFD with like the four domains where it's a really nice little graphic where it has like an orange circle in the middle that says pediatric feeding disorder and then four little bubbles on the outside showing medical, nutrition, feeding skill, and psychosocial.
[00:27:22] Had another really great question that I'll ask really quick. So when do you use R1311 for the dysphagia oral phase code versus like R63. 31 or R63. 32, which is the chronic PFD or the acute PFD codes? And if you have any tips on how to distinguish between the two? 
[00:27:42] Stephanie Cohen: Yes, for sure. So. ASHA has a really nice article page in their practice management portal, if you're a member of ASHA talking about ICD 10 coding and how to figure out which one is appropriate to use.
[00:27:58] I have been using the pediatric feeding disorder code, and the one thing that we didn't mention, Madi, is that there is There's a distinguish, there's a distinguishment between acute and chronic. So there's two different codes. And so I would recommend taking a look at feeding matters information about coding and the information on the ASHA practice portal when you're looking to make decisions about which one to use. 
[00:28:22] Madi Metcalf: And so now that we've covered the four domains of PFD, can you kind of talk about how the four domains can impact selective eating? And how like that might show up among the four? 
[00:28:35] Stephanie Cohen: Yes. Okay. So As you might imagine, lots of the things that I talked about as I was going through the different domains can impact a child's functioning, right?
[00:28:48] A child's ability to eat when the opportunity is offered sense hunger, tune into their internal sensations, and then eat enough for their body to feel satisfied at a given opportunity, right? And so, you know, if we think about the medical domain where, you know, a child may have been premature and has a diagnosis of chronic lung disease and has difficulty as a result coordinating their sucking and swallowing and breathing, you know, that may lead to that child being very selective about what works for them during the mealtime experience.
[00:29:24] It may not work for them to to take a volume. Of formula or human milk at a mealtime. And as they transition, you know, I think that when we're thinking about those younger kids, like young infants I'm not sure if selective eating is really the term that I would use, but I think that with kids who have these types of medical challenges, things that happen to them, or even just maybe not a diagnosis, but negative experiences around eating that starts that young.
[00:29:54] Sometimes it leads to challenges when they transition to solid foods. And I think that stage where kids are learning to manage solid foods, starting in the second half of the first year of life and onward, that I think is when we start to think about some of these terms like selective eating or picky eating, because we have this perception that a child should be trying lots of foods and eating a variety, right?
[00:30:18] And when I old For whatever reason has difficulty with a specific situation, opportunity, food, consistency, they then will select what works for them. So in that way, any number of medical diagnoses, diagnoses that impact digestion, that impact cardiac function, that impact breathing, that impact sensory functioning, that impact muscle control, right?
[00:30:46] All of those things for each individual have the potential to lead to positive or negative experiences with specific foods or eating experiences, right? And so as a child. Learns from those opportunities and figures out what helps them to feel safe and what causes them to feel unsafe, they're going to start to select the things that work for them.
[00:31:13] So, I think that's probably the best way to conceptualize it. And, you know, as we think about the intersection between the medical domain and the psychosocial domain and the skill domain, I think a lot about then how The impact of whatever the original sort of thing was the first thing, the first experience, the first disruption in learning around mealtimes and bonding and attachment and strengthening of that relationship and establishing trust, right?
[00:31:46] That child's ability to trust their own body, to trust food, to trust the people who are feeding them or the people who are offering them the opportunity to eat. You know, I think it gets, it gets very, very layered. So, it. It could change day to day. And I think it often does what the driving factor is in a child's selectivity.
[00:32:07] But, you know, as we think about how many mealtimes families have over the course of a day and a week and a month and years you know, all of that learning is so powerful. And it, it just can lead to, it can lead to very, very specific preferences that children have in order to feel safe. So I, I, that was sort of a big answer and not as specific, but I sort of think it's a broad question that doesn't just have one answer.
[00:32:40] I think any of the things that we might see in any of the four domains can impact a child's Selectivity over time based on what's working for them in a given moment. 
[00:32:50] Madi Metcalf: I, yeah. And what I really liked about your answer is that you just like really touched on, like, it's not just like the medical domain exists on its own in isolation and the feeding skill is this on its own in isolation, like it's all so interconnected and intertwined and it really takes an interdisciplinary approach to like effectively treat a PFD.
[00:33:12] Yeah. And so I think that yours was like really touched on that. Another thing that I thought was really interesting is how you talked about how there can be so much variability and like meal to meal day to day and what our kids are eating. And it made me think of of course I went to an ASHA last year by Kelsey Thompson.
[00:33:28] She presented on like dynamic systems theory, and it was basically just saying there's so many, I think there was like six or seven different variables that can go into changing how we are developing like a new skill, and that can like significantly impact feeding. But that just gave me a really good lens to look at through my patients, because I'd have patients that came in and we would have an amazing session.
[00:33:49] And then the next day we, they'd come in and it'd be like, wow, this is a train wreck. We didn't get a whole lot done, but you know, there's just so much variation in where that child is, where they're coming from, what their sensory experience has been like that day and all that stuff. And then Going back to whatever lived experiences that they've had that could have been triggered or something before they got to you in that moment.
[00:34:11] Stephanie Cohen: You're so right, Madi. And you, you, as I was listening to you, I started to think about something else that we haven't really talked about yet, but I think is an important part of the answer to the question that you asked and what we're talking about now. And that is what a child shows us on a given day, what they actually do.
[00:34:29] And, you know, I think sometimes when we think about words, Or labels like selective eating or picky eating or problem eating, you know, we think we might think about it or some, some folks might think about it as something a child does. right as behavior. And as a responsive feeding practitioner, I'm always thinking about a child's actions as communication.
[00:34:53] So the problem is not that the child is refusing, quote unquote, my, my finger quotes are up again. Thanks. The problem is, The problem is not a child refusing to take a bite or refusing to eat a quantity or refusing to my fingers are up. They're going crazy. But when a child shows us, no, this is not working for me right now.
[00:35:13] It is communication. 
[00:35:15] And oftentimes, at least with the kids that I see, the little babies and toddlers, and even, even though school age kids, and maybe even older, you know, they don't often have the words to understand their experience. All they know is I don't feel safe. This isn't working for me right now.
[00:35:29] And so. The reason I love thinking about, one of the reasons I love thinking about the different domains and the intersection and the layers with relationship is that our job is not to do the thing to get the child to do the thing, right? It's not our job to get kids to eat. And I think the, the first person I heard put it this way is Jenny McLaughlin, who I'm so excited that you're having in one of those.
[00:35:52] And so I always think about her words and you'll know, you'll hear lots of folks. I'm saying this right now, including Marcia Dunn Klein, but it's our job to help a child feel safe and comfortable and ready for learning when it's right for them. And so, I don't even remember where we started with this question but but the thing you said that made me think about this is yes the variability that's what it was.
[00:36:15] You know our job is to say who is this child or wonder who is this child in front of me right now today and who is this parent in front of me right now today what kind of day are they having what kind of week have they had what other stressors are going on in their life right has there been a death in the family job loss has there been travel has there been another type of stress or financial instability so many things that impact a family's life and functioning you And so our job is really to look beyond that surface of the actions of the child and maybe the caregiver and be curious and be sort of a, a person who helps families feel like, you know, we are there for them as a strong relationship and a support to help them to maybe find a little bit of stability in whatever's going on in their life.
[00:37:07] So our job is we have to think about a lot of different pieces when we're working with families. 
[00:37:12] Madi Metcalf: I love what they get that you like hit on that like family piece and talking about like being that source of stability for them, because I've definitely found sometimes with my feeding kiddos.
[00:37:23] I. A lot of times, like I have to play the quarterback and like, I have a kiddo on my caseload that had cystic fibrosis. And her mom told me the other day, she said, Madi, like my, we were talking with her CF team and, you know, me and mom, like after working with her for a little bit and not having a lot of progress, it's like, I really think we should refer to GI our volume is so low and the team was like, Oh, that's just a typical thing with kids that have CF.
[00:37:50] It's fine. You don't need to go to GI, but like mom was like, everything that you've said in my gut is telling me that we should go through, and I already have the appointment and she went and we started on a appetite stimulant and we got reflux medicines because the endoscopy found that we had like chronic inflammation and her esophagus.
[00:38:06] And so it sent us down this little path where we made a lot of good progress. And I. You know, playing that hat and kind of stepping into those other domains to make that referral and have those hard conversations with mom um You know, it felt a little bit at times when I was like maybe stepping a little bit outside of my scope, but it's because I knew enough about PFD and where we needed to get those referrals and no one else was there to have that conversation with mom.
[00:38:34] And so sometimes like we do have to be the one that kind of has the rapport and the relationship with that family where they will allow us to have those conversations and facilitate those referrals. Because, you know, we can't just stay in our one little feeding skill domain when we're working with PFD.
[00:38:50] We really have to. reach out and make those connections to provide that interdisciplinary care to like fully and effectively treat their PFD. 
[00:38:58] Stephanie Cohen: When I, that was such a great story because when I, when I was listening to you describe this experience, one of the things that I remembered as we're talking about team collaboration and making appropriate referrals and helping families understand how other.
[00:39:14] Experts or providers might be able to support this journey. One of the things that I was thinking about is that oftentimes we end up being a bit of a team leader, I think, in this in this area of practice. And one of the things that I say to families is I can't. Tell you what it is, but I am here meaning like an underlying maybe medical cause but I can help you maybe either think about some questions to ask or, you know, really what we're doing is listening to parents concerns and the parents intuition and helping them understand how do we get these questions answered.
[00:39:51] How do we think about this in a way that helps us to communicate to others that we really do need to take this step and I don't know about you, but with a lot of families I work with, sometimes it just it takes a lot to actually reach out and make that medical appointment right for a number of be it like resources, access to care disparities in access to care medical care.
[00:40:12] But I think we can be there as. And so I think it's really important that as a parent that we have someone who helps parents reflect and we can help empower parents to ask those, those good question. That was a great story. Thanks for sharing that. 
[00:40:25] Madi Metcalf: Yeah. And I also love like how you touched on like supporting a parent and following their intuition.
[00:40:30] Cause I've had a lot of patients, parents on my case, patients on my case. So with parents who've said, I've been telling my doctor this for years, but nobody would listen to me. And it's like, mama, I hear you. I hear you like having this, like paying the story and like, I agree. Let's dig this in. Like, let's.
[00:40:45] Let's let's write a really strong referral letter and and convince your PCP to send that referral on because I don't know, a parent's intuition is so strong and so always like listening to that and validating it and being there for them is so great. So we had a question that aligns perfectly with our our next plan question.
[00:41:07] What is your treatment philosophy when working with selective eaters? 
[00:41:12] Stephanie Cohen: My treatment philosophy. So as I mentioned a bit earlier, I consider myself a responsive feeding practitioner. My lens is responsive feeding and there is a wonderful white paper and then an updated version of that white paper that were that was written by a group of folks that Can give you in detail, an explanation of what is responsive feeding.
[00:41:38] But what I can share with you is that there are specific responsive feeding values that they share in those papers. And one of them is autonomy that we prioritize a child's autonomy, right? Their ability to decide for themselves based on how they're feeling in a given moment. What is going to work for them? We prioritize relationship. So I've already talked about that quite a bit, but as a, as a responsive feeding practitioner, I approach families. who come to me with a lens of holism, thinking about that child within their family, within their environment, and then also more narrowly within the relationships and people they share a mealtime with. You know, I think that one of the other things that's really, really important is that we are also supporting competence and skill development. So we are offering a child experiences Within which they can find and discover enjoyment, which drives internal motivation, another responsive feeding value, and definitely check out these white papers.
[00:42:46] This information is from those papers. But intrinsic motivation is just, what does this child love? What motivates them when they feel good physically, when they feel safe? Right when we as practitioners work with parents to identify how to help a child start from the point of safety and trust we can then help them to have experiences that are internally motivated.
[00:43:11] So they are exploring and learning and maybe tasting, maybe chewing and swallowing because. They want to not because someone else is compelling them to write or rewarding them for doing it or punishing them. Hopefully that never happens. For not so we really prioritize that intrinsic motivation as the driver, Marsha Dunn Klein talks a lot about a positive tilt.
[00:43:36] And that's really something we see physically when, you know, if you, if you can just picture in your mind, maybe a parent and a toddler sharing a mealtime, maybe the parent is eating, I don't know a sandwich and that baby or toddler leans in and tries to grab it, or the parent holds something out and that child leans in.
[00:43:53] So it's a coming together between it's a coming together either emotionally or physically around a food or an experience. Contrast that with leaning away. So I am always, always, always looking for how to, how do these Family members come together with this child around eating and how does a family member understand that child understand their skills, understand the just right offer, meaning what are we offering this child in terms of the opportunity to learn right now?
[00:44:24] Are we offering them a spoon to figure out how to use it? Are we offering them the opportunity to look at the food across the table? Are we offering them the opportunity to be in a room with food? Are we offering them the opportunity to explore a cup? Where do we see that child's potential? Internal motivation, drive them to lean in and explore.
[00:44:42] And as we figure out what those just right opportunities are for that child and that family on that day, in that way, we support a child in being able to develop their skills. Right, driven by internal motivation. So you've all probably seen kids who, you know, grab for a utensil when someone's trying to feed them.
[00:45:03] They want the utensil and they don't do it right. They don't do it efficiently. Right. I actually shouldn't have said it right probably because right is just whatever way is working for that child at that time. But as. The grownups at the table, you know, some of us may think, Oh gosh, like this is not efficient.
[00:45:19] But if we take a step back and think about that child is building their skills, you know, I think that helps us to allow this child's learning to happen at their own pace. And then over time as a child becomes more skilled, their confidence builds and that leads to a volume of intake. So my approach is thinking first about that foundation of trust and safety.
[00:45:41] What are those just right opportunities for learning that parents and myself and other members of the team can come up with together, the things that work for that family. And then where do we see internal motivation from that child and enjoyment? And then how do we offer more of that so that they can build their skills?
[00:46:01] And then eventually they get to volume and maybe diet expansion as they figure out what's just right for them. So That in a very small nutshell is my approach to to my work with children and families. 
[00:46:14] Madi Metcalf: Hold up those white papers. I had not heard of them before. I'm so excited that you shared. I know what I'm going to be reading this weekend. And so I put them in the link, but for anybody listening, if you go to responsive feeding pro. com, it'll take you to their website and if you search responsive feeding pro white papers. It'll pull up the first one and the revised version two, but I just wanted to read this really quick. On the version two, they have three goals listed out and I love, love, love, love, love these goals.
[00:46:44] So number one is to prioritize felt safety and nervous system regulation. Number two is to support and optimize children's relationship with food and their bodies. And number three is to provide individualized care. Which I just think is. So beautiful and like definitely what I'm finding to be like a strong foundation in my feeding there because if you don't have those three things, it's really tricky to move past where we currently are.
[00:47:13] Stephanie Cohen: Yeah, you know, Jenny was one of the early contributors to these papers. So I'm sure she will have much more to say and much more specific information to share about them. But these are, these are really informative papers. 
[00:47:25] Madi Metcalf: Oh, and I love it too. They're very like multidisciplinary. So they have like lots of different disciplines that kind of participated at it.
[00:47:32] That's so cool. 
[00:47:33] Stephanie Cohen: Yeah. 
[00:47:34] Madi Metcalf: So I like, I want to kind of touch on, you said that, you know, we want to focus on skill and then volume increase and maybe diet expansion. So it's diet expansion, not always a goal when you're working with selective eaters. 
[00:47:49] Stephanie Cohen: So the way I think it really depends on the situation, right?
[00:47:55] You've got a child who we meet who is able to eat one food. You know, it's pretty clear that there is most likely a nutritional challenge going on and a nutritional impact. And so in that case, diet expansion absolutely would be a goal approached by first thinking about why is a more varied diet not working for this child in this moment?
[00:48:19] Why hasn't it worked in the past? What are their experiences and how did they get to this place? Right. Can we start by understanding and helping parents understand However, I would contrast that with some other folks who might make it to us because someone else thinks their diet is a problem because they eat, you know, maybe what some would judge to be a very short list of foods.
[00:48:41] But I think that. You know, we all need to remember and learn from people like Laura Helfeld and other folks who are sharing their lived experiences that it is very possible to be well nourished, only eating a handful of foods. And so I think that, you know, you and I talked about in our conversation.
[00:49:03] Prior to this conversation fact that the other thing that is central to my approach to my work with families and a responsive feeding approach is that last point that you made that last goal of individualized care. I. almost never start out with an end goal of, Oh, we've got these like target foods. I would say I really don't.
[00:49:27] My hope is that through work with children and families, that a child will have the skills and the tools and the felt safety and the comfort. To be able to try new foods if and when it's right for them. And so my hope is that if they enjoy trying new foods or they discover things they enjoy that and they want to that they can continue to do that.
[00:49:51] But it is not, we've got to get to 30 foods, 40 foods, right? Or it's not that we've got to, you know, have, you know, foods from this group in this group, in this group, in this group, this is where collaboration with registered dietitians is really, really helpful because I think a lot of times when parents come to us, they have been given so much information through the media, perhaps from medical professionals, from friends and family.
[00:50:17] That the ideal is a child who will eat anything or eat most things or try most things and decide if they like it or don't like it. And so I think that as we as a field shift our perspective from this sort of ideal diet outcome and that eating should look this one perfect way, we can help families have a deeper understanding of this individualized approach and think about, you know, where, where are we going?
[00:50:45] Together, and how are we collaborating to find the best ways to support this child's learning. And then I think we discover along the way as we make offers and see how a child responds, right? And what, you know, what they're able to engage with we start to learn what's going to work for them. I've got kids who I work with who really only Enjoy and feel comfortable with dry, crunchy foods for the most part.
[00:51:14] And they drank milk and, you know, but those kids, you know, there is this idea that they've got to learn to manage all these different foods and. Yes, it would be nice. It would be easy. It would be less stressful, right? But there are a lot of crunchy foods that offer a lot of great nutrients, right? So, I don't know.
[00:51:35] I think diet expansion, if it's right for that person at that time, if they want to, then great. And it looks different for older people. People than it does for toddlers. Marsha tells this story about someone that I think it was like a friend of the family. You'll have to ask her about this story who wanted to try salmon.
[00:51:55] I think it was because her partner really liked to eat salmon, but she was a very self described like restricted eater. She had certain things that she. That she liked, she felt safe with, and that was, you know, how she functioned and she was doing quite well, but she wanted to try salmon cause she wanted to eat it, I think with her partner.
[00:52:12] And so she came to Marsha to learn how, how do I do this? Like I. It wouldn't have been probably the best approach for her to take a big hunk of salmon and just eat it. Right. So one of the things Marsha helped her do was think about, well, you could take a little teeny tiny taste of salmon and put it on the sandwich so that it's not a big, huge, giant smell.
[00:52:33] So it's not a big, huge, giant taste. And maybe we pair it with things that we know well and feel safe with. So it's just this idea of all these different stages of development. Can we help children and adolescents and adults have the tools and the skills that they need if they meet a food or a situation that they would like to be a part of or like to try. 
[00:52:56] Madi Metcalf: Definitely love using those like little Kind of food chaining with like sandwiches like small bites masking flavors and like building up. To A bigger flavor salmon is one of my foods that I also want to try need to try those tricks Jennifer, I love your comedy that she said parents are in and it's been a long day, guys.
[00:53:17] Is that inundated? Yeah, moving on with what healthy is for their children. They often feel like they fail when their children are selective eaters. I love how your approach helps caregivers be empowered to get to know their child and be able to figure out what healthy means to them for their child.
[00:53:31] Stephanie Cohen: Jennifer, you got it. That is it. That is it. Because what you are Hopefully, I think seeing and feeling and hearing is that the language we use is so impactful. And I think it's, it's so impactful when we think about the labels we're giving to children or how we think about foods. I have conversations with every single family I work with about Healthy foods and junk foods and, you know, carbs and snack foods versus and 1 of the things you know, Karen Dilfer and I, Karen's an occupational therapist.
[00:54:06] She's the other 3rd partner in the get permission approach, which is our online platform where we. Teach about this. We teach about lots of different aspects of feeding based on marshes. I get permission approach, but Karen and I just finished up a 23 hour on demand course. That's a whole nother story. It was not supposed to be that long, but we couldn't stop talking.
[00:54:26] You spend a lot of time talking about language and the power of words and the power. That words have on our perception and our interpretation of actions and events and experiences. And it's not just the labels that we assign to a pattern of eating or a person, right? But it's also how we think about and describe foods and how we value foods.
[00:54:52] And so. It is so important to think about the words that we choose at every step of the way, including in our verbal feedback and written reports. You know, we have a responsibility to make sure that our language is nonjudgmental, unbiased, and simply describes what's happening. And you know, when parents say to us, well, gosh, my child only likes processed foods and junk food and snack foods.
[00:55:16] It might be that we help a parent understand, well, you know, lots of those foods are always the same. So they become a very predictable experience for your child and maybe for your child, that type of food helps them to feel safe. So instead of thinking about the label, right, the junk food, the packaged food, you know, we help parents understand and maybe help adults understand about their own bodies and their own eating why something might work for them in that moment.
[00:55:43] And maybe what some other opportunities are that we might want to offer to see if that person, wants to explore things a little differently, but I think at a certain point, we have to accept the person who's in front of us, right? Obviously we're thinking about underlying medical issues. We are obviously primarily concerned with health and medical safety, but I think we get into we get to a point on our journey many times where maybe we don't think we're at the goal.
[00:56:12] And we. Maybe, maybe we could be at a place where we're, we're okay, right? Maybe, maybe we're at a place where we can accept who the child is and where the child is at a given moment. And that's different for every child in every family. But as we are being responsive and offering very individualized support.
[00:56:32] I think we all have to consistently and repeatedly reflect on, you know, where are we right now? Is this okay? Do we accept this child for who they are in front of us at this moment? And do parents accept their child for who they are in this moment? And that's that psychosocial domain where we overlap with our mental health providers in helping families navigate all of the emotions that are layered on top of medical challenges, nutritional challenges, and feeding challenges. 
[00:57:00] Madi Metcalf: Jennifer has two other questions. I think they're both really great. So I know there's a lot of factors for this, but as a responsive feeding practitioner, how do you know a child is ready to be discharged? That kind of fits really nicely with what you were just saying. 
[00:57:12] Stephanie Cohen: Oh, another hard one. Ready to be discharged.
[00:57:15] So, you know, obviously we're thinking about growth and those parameters, right? We want to make sure that a child is not in like a danger zone in terms of growth and weight gain and just overall health, right? But I think that over time families start to feel like they can handle the everyday, you know, decisions that they make about those just right opportunities for their child.
[00:57:41] They understand their children. You know, Marsha talks a lot about not only opportunities, that's the Marsha Dunklein word opportunities being the experience that we're offering on a given day. Right. But she also talks a lot about pivoting in a moment. So if we offer an opportunity and a child.
[00:58:00] It doesn't work for them. It's not the right choice on that day. And as therapists, we will make the wrong offers over and over and over again. You have to Tell families that too, because we want them to think that we don't want them to think that, you know, as they're learning, they have to worry about us watching them and saying, Oh goodness, we know the right offer.
[00:58:17] And you're just, that's not it. One of the conversations I have all the time is even with parents is I, my goal is for you to feel empowered as your child's mealtime partner. Such that if something isn't going as expected, if something is not working that you know where to go from here, you know how to pivot how to modify to either help your child feel safe again, or give your child something that they can fill up on and feel good with.
[00:58:46] And that that child is able to have learning experiences and mealtime experiences that feel good more consistently than not. So it's really a team discussion based on how the parents feel about how mealtimes are going in their house. And what we together observe about how much a child is struggling.
[00:59:07] There are some validated measures that are really, really helpful that we can use to measure progress. And that certainly should be part of the equation, right? It's our clinical expertise is important and parent input is really important, but it's really helpful to measure progress in some way. So I really like the family impact scales and the family report tools that are on Dr.
[00:59:31] Brick Pedos website, and that is infant feeding care or infant feeding labs is the professional one. She has a number of parent report tools that are validated and those are really great tools to use to help us To help us sort of understand the change that's happened over time and determine when it might be time to maybe either take a break or, or say, you know, we've reached our goals.
[00:59:58] I think the other thing to think about is that we should not be in feeding therapy once a week with a child forever. If that's the case, we're not doing it. We're not doing something right. You know, maybe we have worked with a family and we've made it, the child has, has felt good enough and competent enough to make lots of change or to come to a place where they're comfortable and they feel good.
[01:00:20] And maybe there are still some areas. to work on, but maybe it's time for a break, right? Maybe the family needs a break. Maybe the child needs a break. Maybe something else can be focused on for a little while. Like, I don't know, family life, like going out and like enjoying life. And so it can, feeding therapy can look a lot of different ways, but I think that we also need to think about if we're going, going, going once a week and for months and years, you know, is there, do we need to kind of rethink maybe what our, what our stopping point is or what our end goal is?
[01:00:52] Madi Metcalf: And then last question did you go through a special training to be a responsive feeding practitioner? And if not, what is the kind of pathway to being able to call yourself a responsive feeding practitioner? 
[01:01:05] Stephanie Cohen: Oh, that's such a good question. 
[01:01:07] Madi Metcalf: There's been some, this one's Jennifer again. Jennifer is on it with the question.
[01:01:10] Stephanie Cohen: Jennifer, thank you. So I should say being a responsive feeding practitioner is not a certification. I didn't finish like, A one course. But, you know, I have learned from a lot of people over the years, starting with Marsha Dunn Klein and Suzanne Evans Morris, who have been talking about relationship based feeding and responsive feeding for decades.
[01:01:35] I have learned from Catherine shaker, whose work in the neonatal intensive care unit. taught me and countless others about Q based feeding, which is, you know, is in this sort of same world. I've learned from Ellen Satter who talks about helping children become competent eaters in the division of responsibility.
[01:01:54] I learned from Jenny McLaughlin. I've learned from Heidi Moreland and Jennifer Berry and so many people that teach With a responsive feeding lens. And then of course, Katja Rowell and the other authors of the responsive feeding white papers. And so I wish there, I wish I could say there's like a track.
[01:02:15] I really like to think that in, in our get permission Institute courses, we offer really comprehensive training from a responsive feeding perspective. And so, you know, right now. It really is about curating your own learning and just making sure that you have the skills to really understand responsive feeding to understand what that looks like at a mealtime.
[01:02:42] How to help a parent understand that? But no, really it's seeking out continuing education opportunities. that feel that feel responsive, that prioritize relationships, that prioritize internal motivation, that prioritize autonomy, right? Not doing the thing to the child, that prioritize communication and not just surface behavior.
[01:03:06] And you know, and And approaches and courses that aren't aimed at getting a child to eat, but rather supporting them on their journey. Oh yeah. I think that like a, a big sort of issue in our field is there isn't even. One sort of certification to be a feeding therapist, right? We have varied experiences in our graduate programs, by and large, as.
[01:03:33] Those of us who become feeding therapists and practice in this area continue to learn. We're really curating our own experiences. And so I, I know that's something a lot of people are talking about and thinking about. 
[01:03:46] Madi Metcalf: Absolutely. I, well, I think feeding matters right now is currently like asking, that was a question that came up a lot during the feeding matters conference was like, who do you think should be in charge of like creating like a coursework for a little bit more of like a standardization of care and who can call themselves a pediatric feeding therapist?
[01:04:04] And then For, so that'll be really exciting to see where that goes. And then for myself, the books that I read that kind of got me thinking of this responsive feeding framework was Marcia Dunn Klein's anxious eaters, anxious meal times. I'm currently taking her anxious eaters course on the get permission approach.
[01:04:19] I think I would highly recommend they have like a whole module over trauma and like how trauma impacts the body, which so many of our feeding kiddos to have trauma around feeding from negative experiences. So highly recommend that one. And then the other book that was so enlightening for me and gave me a little bit more perspective, like, What the parents are going through and how to counsel the parents was Jamie McLaughlin and Katya Rowell's book helping your child with extreme picky eating.
[01:04:45] And then there was a few, like a little bit more of like a subtitle that I can't think of at the moment, but both of those were like, they, they are my guidebook. 
[01:04:53] Stephanie Cohen: So great choices. 
[01:04:57] Madi Metcalf: So we did have a question. Somebody asked if this was a series. It is a series. We have nine episodes. This was the first one.
[01:05:02] So we have eight more episodes. We're going to be covering all four domains of pediatric feeding. We're doing feeding in the schools next week. We have so many amazing guests coming on. So make sure to check the speechtherapypd. com page. You can also follow me at MadiMetcalfe underscore SLP on Instagram.
[01:05:19] And I have it all lined out in a post on my Instagram. I attached Stephanie's Instagram at learn to talk with me and then you can also follow the get permission approach at get permission Institute. And yeah, this was so amazing. Stephanie, thank you so much for coming on and sharing your expertise.
[01:05:41] This was the perfect way to kick off this series. 
[01:05:44] Stephanie Cohen: And I plug the Chicago Feeding Group real quick. 
[01:05:47] Madi Metcalf: Please do. I love the Chicago Feeding Group. 
[01:05:49] Stephanie Cohen: Just you all. I know that we're bumping up against the end of our time together, but the Chicago Feeding Group, as you said, Madi, it's a 501c3 nonprofit organization, and we offer a variety of low cost, but very high quality products.
[01:06:02] Educational opportunities webinars as well. And you know, our workshops are free for parents and like 5 for students. So our mission is to offer information in a way that's accessible and affordable to a lot of people. And then also we have a big community on Facebook. Of professionals and parents to sharing information and expertise and collaborating.
[01:06:22] So we would love to have you join us there. Our webinars are super low cost as well, because we just believe everyone should have access to high quality education as they learn about feeding and supporting families. 
[01:06:34] Madi Metcalf: Yes, I've taken some Chicago feeding course group Chicago feeding group courses.
[01:06:38] They are fabulous. Highly recommend. And their Facebook page is so great. And you can ask a question and it'll be answered so quick. It's a great community to be part of. Okay. Well, thank you so much everybody for joining in. I'm so excited for this mini series and can't wait to see you guys again next week.
[01:06:54] We'll see you next time on the next speechtherapypd.Com live course. 
[01:06:58] Stephanie Cohen: Thank you, Madi. I can't wait for the rest of this series. Take care. 
[01:07:01] Madi Metcalf: Thanks, you too. Bye, Stephanie. 
[01:07:02] Stephanie Cohen: Bye. 
[01:07:04] 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.
[01:07:33] Please allow one to two months from the completion date for your CEUs to reflect on your ASHA transcripts. 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. Each episode comes with an accompanying audio course on SpeechTherapyPD.
[01:07:55] com Available for a 0. 1 ASHA CEU. And just for our listeners, get 20 off any subscription with promo code SLPLearn20. SpeechTherapyPD. com is run by SLPs for SLPs. They've got the largest library of ASHA CE eligible courses out there, and they're adding fresh content every week. Remember, it's free. Use the code SLPLearn20 to get 20 off access to over a thousand courses for an entire year.
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