Pediatric Speech-Language Pathology Services

The Milton J. Dance, Jr. Head and Neck Center offers speech-language pathology services for children of all ages.

What is a speech-language pathologist?

Speech-language pathologists diagnose and provide treatment for children and adults with a variety of speech-language, cognitive, voice, and feeding/ swallowing problems.

Typical family concerns:

Speech/ Articulation:

I can't understand what my child is saying most of the time. My child seems to have trouble saying certain sounds correctly.

Receptive Language (Understanding of Language):

My child doesn't understand me most of the time. My child has difficulty understanding directions. The teacher says my child has difficulty rhyming and hearing differences between sounds. My child doesn't seem interested in stories... I am not sure he/she understands the story.

Expressive Language (Speaking):

My child doesn't seem to talk as much as other children his/her age. My child only says a few words... is that normal? My child has difficulty answering questions.

Voice:

Why is my child's voice hoarse? My child's talks so loudly all the time... can this hurt the voice box?

Fluency:

My child is stuttering... is that normal?

Written Language (Reading and Writing):

My child has trouble sounding out words. My child has trouble understanding what he/she has read. My child has trouble organizing thoughts and writing them down.

Attention and Memory - Thinking Skills:

My child has trouble following directions. My child doesn't seem to remember things. My child's attention span seems very short.

Tongue Thrust:

Is it normal for my child to push his/her tongue out when speaking? The dentist said my child has a tongue thrust and needs treatment before braces.

Feeding/ Swallowing:

I have trouble feeding my child. My child is having problems transitioning from a bottle to table food. My child has difficulty sucking through a straw or taking food from a spoon. My child seems to resist certain types of food. My child chokes, gags and coughs a lot during meals. My child drools a lot - saliva and during meals. My child spits up a lot during and after meals.

If your child is exhibiting one or more of the above problems, or if you have other concerns, an evaluation by a speech-language pathologist may be appropriate.

What happens during speech-language, cognitive, or voice evaluations?

Prior to the evaluation

• Parents complete a questionnaire regarding their concerns and the child's medical, developmental, and educational history. 
• We will request medical information from the child's pediatrician, and may also request information from other medical or educational professionals who have evaluated the child.

During the evaluation

• Your child's medical, developmental, and educational history is carefully reviewed.
• Parents are interviewed regarding their concerns and the child's history.  This information helps the speech-language pathologist identify areas to evaluate more closely.
• A variety of methods, including formal and informal tests, observation, parent/caregiver interview, and play-based activities will be used to evaluate your child's speech, language, cognition, and voice. Selection of testing methods is based on your child's individual needs.
• Parents are encouraged to observe during the evaluation.

Following the evaluation

• Initial results of the evaluation and recommendations are reviewed with you (and your child if age appropriate).
• A written report detailing evaluation results will be mailed to your home and to your child's physician.
• If your child has a speech, language, cognitive, or voice delay or disorder, a treatment plan will be developed and included in the written report.

What is a treatment plan?
A treatment plan is an individualized plan created by the speech-language pathologist to address your child's speech, language, cognitive, and/or voice needs. The plan may include:

• Recommendations for therapy or re-screening/re-evaluation at a later time
• Initial goals to address during therapy
• Referrals to other professionals (e.g., audiologist, medical specialist, occupational/physical therapist, etc.)
• Referral to other community services, such as an early intervention program
• Suggestions for parents/caregivers and educators

What are feeding and swallowing disorders? 

Children with feeding and swallowing disorders may present with a variety of symptoms including:

• Refusal of different textured foods
• Prolonged feeding times
• Excess drooling or spilling of food and liquids from the mouth
• Frequent spitting up
• Wet, gurgly voice or breath sounds
• Coughing or gagging during meals
• Recurrent pneumonia and/or respiratory infections
• Slow weight gain
• Younger children may demonstrate stiffening of body, irritability, and/or lack of alertness during feeding

(American Speech Language and Hearing Association, 1997-2003)

What happens during a feeding and swallowing evaluation?

Prior to the evaluation

Parents complete a questionnaire regarding their concerns and the child's medical, developmental, and educational history. 
We will request medical information from your child's pediatrician, and may also request information from other medical or educational professionals who have evaluated your child.
You may be asked to keep a food diary for several days and bring this on the day of the evaluation.

During the evaluation

• Your child's medical, developmental, and feeding history is carefully reviewed.
• Parents are interviewed regarding their concerns and the child's history.  This information helps the speech-language pathologist identify areas to evaluate more closely.
• Your child will be provided with an age-appropriate snack (you may be asked to bring in favorite foods and feeding utensils from home).
• The speech-language pathologist will assess your child's oral structures and movements, sensory responses to food and touch, posture and positioning, oral movements during eating and drinking, swallowing, and behavioral responses.
• Parents are encouraged to observe during the evaluation.

Following the evaluation

• Initial results of the evaluation and recommendations are reviewed with you (and your child if age appropriate).
• A written report detailing evaluation results will be mailed to your home and to your child's physician.  The report will include a detailed analysis of your child's feeding/ swallowing behaviors.
• If your child has indications of a feeding/ swallowing disorder, an individualized plan of care will be developed with you, your child, and the physician.
• The plan may include recommendations for special instrumental diagnostic tests to further evaluate your child's feeding/ swallowing.
• Treatment varies greatly depending on the causes and symptoms of the feeding-swallowing problem.

Specialized Diagnostic Evaluation and Treatment Modalities

State-of the art diagnostic and treatment modalities are available to provide the most effective assessment and treatment to meet your child's speech-language needs. The following are available at our center: Palatography, Computerized Speech Lab, Nasometry, Ultrasound, Endoscopy, and Videofluroscopy.

How do I make a referral?

To make a referral for a speech-language/ cognitive evaluation, voice evaluation, or feeding and swallowing evaluation, please call the Head and Neck Center at GBMC at 443-849-2087.

Greater Baltimore Cleft Lip and Palate Team 

The Greater Baltimore Cleft Lip and Palate Team provides interdisciplinary medical expertise to families of children with congenital malformations (birth defects) involving the head and neck.

Milton J. Dance Jr. Head and Neck Center at Greater Baltimore Medical Center 6569 North Charles Street, PPW., Suite 401, Baltimore, MD 21204 443-849-2087 | Barbara Messing | Webmaster: Sharon Thielicke © 2010 The Milton J. Dance Jr. Head and Neck Center. All rights reserved.