As a speech-language pathologist, I frequently work with children who have a variety of feeding and speech sound disorders in the toddler/preschool years. Often these problems are due in part to oral motor deficits. These can be detected even before children begin speaking their first words by looking at their feeding abilities. Around 6-9 months, infants should begin to munch on easy to dissolve solids (e.g., cereal puffs) and should be finger-feeding with these items as well as pureed solids. By 9-12 months, infants should begin to attempt cup drinking and eating more lumpy/mashed textures. The motions required to manage these changes in solid textures as well as control liquid from a cup are closely related to the motions required for speech clarity. For example, if a child is unable to control the liquid coming out of a cup with his/her lips, then he/she probably also has difficulty producing sounds that require lip rounding such as /w/ and /b/.

Another big feeding milestone is straw drinking. Children should be able to drink from a straw by around 14-16 months without biting on the straw or putting more than ¼-½ inch of the straw in their mouths at a time. If they are unable to wean from the bottle and/or "sippy" cup to achieve this level of straw drinking, this is an indicator of possible problems separating control of their tongues from control of their jaws, otherwise known as tongue-jaw dissociation. When children cannot separate control of their tongues from their jaws, then they are also at risk for speech production problems including difficulty producing /k/ and /g/ sounds (which require use of the back of the tongue), /r/ and /l/ sounds (which require a complex series of fine approximations of the tongue to the roof of the mouth) and/or possible lisps.

Good tips for mealtimes:

• -Introduce a variety of tastes and textures from an early age.
• -Provide a low-stress environment where feeding is fun.
• -Encourage weaning from the bottle around 12 months.
• -Allow your child to independently feed him/herself as much as possible.
• -Encourage straw drinking as early as possible rather than relying on a "sippy" cup.

If you have any additional questions or concerns, please contact Kim Stone at Jodie Schuller and Associates Speech, Language and Educational Services (858.509.1131) or visit our website at www.speak4success.com.

The Philadelphia Department of Public Health has announced that five cases of Haemophilus influenzae type b (Hib) invasive disease occurred in children in Pennsylvania since October 2008, resulting in two deaths. All of these cases were in unvaccinated or under-vaccinated children.

These cases, along with the five cases of invasive Hib disease reported in Minnesota in 2008, are a reminder of the severity of Hib disease and the risk to children who are unimmunized or partially immunized. The resurgence of invasive Hib disease has occurred during a nationwide Hib vaccine shortage that began in December 2007 and may have resulted from an increase in Hib carriage with transmission to non-protected children. Therefore, it is critically important that children receive the primary three-dose Hib vaccine series on schedule during this shortage.

The interval between the 2 and 3 year old well child visits can seem like a long time. Potty training, behavior, discipline, language, feeding, sleep and social skills issues can present a lot of questions from parents. The American Academy of Pediatrics (AAP) is now recommending a 30 month (2 1/2 year old) well child visit. This can be an important time to identify developmental concerns and address them. Please call our office to schedule this important check up.