Pediatric Swallowing and Feeding: The Essentials…no other course like it….

  comprehensive 2-days of interactive learning covering essential information/skills for  pediatric practice and problem-solving

   neonates/premies through school age

   development of the swallow from birth on: impact on your therapy  

  oral-motor

   TOTs

   sensory, sensory-motor

    airway

   tools of the trade (bottles, nipples, spoons, cups, biters/tethers etc. and the “why” behind when to use them)

   tube feedings and how to wean

   trachs

  preemies: assessing and treating after discharge

  swallow studies: physiology to inform your day-to-day clinical decisions

  a wide variety of interventions and the “why” behind them

  latest research made practical

  whole infant/child family-focused approach

multiple learning levels for both highly experienced therapists and new grads

a bound handout for future reference with detailed PowerPoint and extensive reference list for you

I promise you a learning experience that you will always remember!

Click here for Catherine Shaker Seminars 2026 Brochure

Click here for Site/Location Info

 

I just returned from teaching in San Antonio Texas! What a beautiful and innovative part of the US. Engaged and passionate rehab professionals (SLPs and OTs)  from across the US and a wonderful Pediatric Pulmonologist from Qatar joined me for this practice-changing event.

• a conference center full of clinical wisdom and intellectual curiosity
• deep dives about the latest research
• critical thinking about our common clinical and professional challenges
• actively problem-solving complex clinical presentations
• and a sense of renewal … new lasting friendships ignited….

Here I am with some of the attendees, celebrating each other as lifelong learners, and a common thread…our passion for feeding and swallowing….and for the children and families who trust their care to us! 

Your final opportunities to learn along with me are in Fremont CA  (in September) or McKinney TX (in October)…my Dallas seminars are all sold out.

I promise you a learning experience that you will always remember!

Click here for Catherine Shaker Seminars 2026 Brochure

Click here for Site/Location Info

 

Click here for Catherine Shaker Seminars 2026 Brochure

Click here for Site/Location Info

Sharing a link to the webinar I presented on May 5, 2026, for Dr. Brown’s:

Complex Swallowing/Feeding in the NICU:

Where’s Your Magic Wand When You Need It?

Catherine Shaker
M.S./CCC-SLP, BCS-S, NDT/C

Click on this secure link  to access the one hour webinar:

https://www.drbrownsmedical.com/webinars/complex-swallowing-feeding-in-nicu-wheres-your-magic-wand-when-you-need-it/

Overview

The journey to successful oral feedings for many preterm and sick infants and their families in the Neonatal Intensive Care Unit (NICU) can be arduous. This live interactive webinar is designed to capture the dynamic problem-solving process that underpins the infant’s journey to safe and successful feeding both in the NICU and beyond. There can be multiple roadblocks, such as sequelae from medical co-morbidities, well-intentioned actions that create risk, and worrisome clinical presentations that require a thorough differential, critical thinking, and consideration of risk-benefit at every juncture. Collaboration, especially with parents, and the entire care team is essential to truly support infant-guided feeding, and positive protective feeding experiences.

I hope you enjoy this learning opportunity~

Congratulations to our colleague, Jenny Reynolds SLP, for her recent publication  on dysphagia in preterms – such a wonderful addition to our evidence-base. Thank you, Jenny!

Reynolds, J., Suterwala, M., Desai, S. et al. Incidence and factors associated with dysphagia in infants born very preterm or very low birth weight. J Perinatology (2026).

Abstract

Objective

To determine the incidence of dysphagia and define the associated co-morbidities in infants born very preterm (VP) or very low birth weight (VLBW).

Study design

This is a retrospective cohort study evaluating 158 VP or VLBW infants born over two years. Forty infants diagnosed with dysphagia confirmed by flexible endoscopic evaluation of swallowing were compared to 118 infants with no dysphagia.

Results

The incidence of dysphagia was 25%. After adjusting for gestational age and birth weight, dysphagia was associated with morbidities such as necrotizing enterocolitis, bronchopulmonary dysplasia, and intracranial hemorrhage. Regression analyses indicated that dysphagia was associated with higher central line days and longer hospital length of stay. Feeds were thickened in 38 infants (95%) before discharge and 3 infants (7.5%) needed gastrostomy tube.

Conclusion

Dysphagia is an important morbidity affecting a quarter of the infants born VP or VLBW. Significant associations with other major morbidities were noted.

 

So excited for the hundreds of therapists (and a few MDs and nurses too!) already registered to learn along with me this year. What wonderful discussions we will have!

If you are thinking of joining us, make a plan to register soon ☑️

No matter your age, most of us have ideas of things we would love to do at some point. A bucket list is comprised of experiences or achievements that a person hopes to have (or accomplish) during their lifetime. It usually consists of things that someone hopes to do before it’s too late.

   Join me for the last locations on my final tour this year…San Antonio TX, Fremont CA, McKinney TX      ***Dallas location SOLD OUT***

     As always, I promise you an exceptional learning opportunity to:

• Advance your clinical reasoning in neonatal/pediatric swallowing and feeding
• Integrate the latest advances and research in evidence-based diagnosis and treatment
• Gain confidence in differential diagnosis and discussions with the PCP, neonatologists, radiologists and specialists
• Problem-solve complex patients from neonates to school-aged children, mine & yours
• Network with colleagues from across the US and the globe who share your passion and daily challenges face to face
• Ignite your passion for continued learning, research and patient advocacy

I hope our paths cross in this year!

Click here for Catherine Shaker Seminars 2026 Brochure

Click here for Site/Location Info

 

 

 

 

 

 

Hazkani, I., Valika, T., & Thompson, D. M. (2026). Congenital Laryngomalacia: Pathophysiology, Clinical Spectrum, and Holistic Management. Otolaryngologic Clinics of North America.

I hope that this just-published paper on congenital laryngomalacia informs your infant feeding practice and critical thinking like it did mine. It is from the amazing physicians at Lurie Children’s in Chicago. Reading the literature designed for our physician colleagues helps us speak from a perspective of knowledge when we advocate for the infants we care for.

Feeding difficulties are common in this population, and often include color change, inspiratory stridor, wheezing and recurrent respiratory infections. Depending on the setting of their co-morbidities, these infants are often worrisome for silent aspiration as a consequence of co-occurring anatomic and neuromuscular differences and inflammatory mechanisms. There is an interactive relationship between the infant’s dynamic airway obstruction, resulting changes in pressure gradients throughout the aerodigestive system, and altered respiratory regulation that combine to disrupt the swallow-breathe interface swallow-breathe interface. Resulting crying and physiologic stress provoke further risk for airway invasion. Multiple papers have reported a resulting high risk for aspiration, often silent, and chronic airway inflammation. The authors note that:  “Given the high prevalence of silent aspiration, the threshold for ordering swallow studies should be low, and dysphagia assessment should be incorporated into routine evaluation.”

KEY POINTS quoted from the abstract

• “Congenital laryngomalacia is a multifactorial disorder in which structural laxity, neuromuscular immaturity, and inflammation interact to produce dynamic supraglottic collapse and feeding–airway discoordination.
• Clinical severity reflects the combined burden of airway obstruction, dysphagia, and aspiration risk, with comorbidities significantly influencing outcomes.
• Given the high prevalence of silent aspiration, the threshold for ordering swallow studies should be low, and dysphagia assessment should be incorporated into routine evaluation.
• Flexible laryngoscopy remains the diagnostic gold standard, while instrumental swallow studies and laryngoscopy and bronchoscopy provide essential adjunctive evaluation in complex or atypical presentations.
• Conservative therapy, particularly feeding modifications, is effective for most infants; acid suppression lacks evidence of benefit and should be used selectively.
• Supraglottoplasty yields rapid, durable improvement in severe cases, enhances feeding and family quality of life, and remains the cornerstone of surgical management”

 

Congratulations to our NICU colleague Deborah Levine-Kotin for her recent publication regarding positive impacts of reusable bottles versus disposable in the NICU. So many takeaways that inform our NICU practice. From the wonderful benefits of partnering with nursing authors to look at and improve practice, to improved LOS with predictable feeding experiences , and improved LOS with reusable bottles… these are all outcomes many of us have noted clinically that now have data to support them.

Haynes, A., et al (2026). Impact of reusable bottle nipples compared to dis posable bottle nipples on infant feeding outcomes in the NICU. Pediatric Nursing, 52(1), 7-12, 51.

From the Abstract: Research has shown that variability of disposable bottle nipples impacts infant feeding experiences. Negative feeding experiences impact time to full feeds and length of stay (LOS). At the time of this study, utilization of reusable bottle nipples from the initiation of oral feeds had not been examined in relation to infant outcomes. This study examined the impact of reusable bottles on time to full feeds, LOS, and feeding stability when compared to disposable bottles among infants born 28 to 35 weeks. Chart reviews were completed on a pre-intervention group of 50 patients and post-intervention group of 50 patients. Data were collected through chart reviews of the primary outcomes: time to full feeds, LOS, and feeding stability score (FSS). The repeating measure of FSS was collected on 25 pre intervention and post-intervention charts. Secondary outcomes included hospital costs and sustainability measures. When adjusted for gestational age, LOS in the post-intervention group was 3.59 days shorter (p = -0.13) than infants in the pre intervention group. Nipple change alone was not an indicator of decreased FSS or decreased LOS. Rather, infants with any bottle brand change during their stay regardless of group went home 2.4 days later (p = -0.06). Change to reusable bottles saved 1130 pounds of plastic waste annually. Findings from this study support the use of reusable bottles from the initiation of oral feeds to decrease LOS.   

• Feeding Stability
  • Score was based on use of Br Brown’s  IDF documentation
  • After a bottle brand change, infants had a 75% higher likelihood of having a decreased Feeding Stability Score. This makes sense given the unique designs and mechanics of each bottle brand
• Length of stay:
  • infants with any bottle brand change (disposable to reusable or one reusable brand to
    another)  during their hospital stay went home 2.42 days later than infants who used the same bottle brand throughout their stay.
  • infants who received a reusable bottle nipple from the initiation of oral feeds had on average
    went home 3.6-days sooner

Catherine’s Key Takeaways:

• For preterm infants in the NICU, consistency and predictability matter when it comes to learning to orally feed

• The impact of nipple flow changes was not explored in this study but is a critical dynamic in supporting safe and successful PO feeding in the NICU and  after discharge. Its potential to alter the swallow-breathe-interface and airway protection is worrisome.

• Data continue to reinforce  the multiple benefits of Dr. Brown’s nipples for neuroprotective  infant-guided feeding for preterm infants.

Join Catherine in 2026 on her final tour…….

for advanced clinical learning opportunities….in the remaining locations 

 Fremont CA, San Antonio or McKinney TX 

• Advanced Infant/Pediatric Dysphagia: Problem-Solving Complex Patients and Practice Issues
• NICU Swallowing and Feeding: In the Nursery and After Discharge in EI
• Pediatric Swallowing and Feeding: The Essentials
• Pediatric Video Swallow Studies: From Physiology to Analysis

An interactive welcoming learning environment……with multiple planned times for dialogue and questions, problem-solving your patients, sharing our collective wisdom, discussing the evidence-based research…and our shared clinical challenges.

Our discussions will include critical thinking for all our patients, no matter the age. It’s not just learning “what to do” clinically but thoughtfully considering what not to do and why.                                           Because every feeding experience matters………

Click here for Catherine Shaker Seminars 2026 Brochure

Click here for Site/Location Info

I think many of us reading this article might find the beginning overwhelming. unless you are very into complex neurobiology. I am nerdy and I still felt that way in the beginning. But if you skim along in the early parts and hang in there until you get to about page 10, from there on you can extract key little nuggets that can inform our practice. These little nuggets I hope will help us speak from a perspective of knowledge and advocate for intervention,  and make better sense of the infant’s/child’s history before us, seeing them through a different lense.  I hope these nuggets inform your feeding/swallowing practice, whether in the NICU, EI or even in the adult world—yes, there are enduring sequelae from prematurity. Even if you don’t work with preemies, our former preemies land on our doorstep as toddlers, children and indeed adults whose presentation may be related to early cerebellar  dysfunction.

Muehlbacher, T., Dudink, J., & Steggerda, S. J. (2025). Cerebellar Development and the Burden of Prematurity. The Cerebellum, 24(2), 39. (Full text available on Google Scholar)

Here are some takeaways I found when they finally highlight the implications for function:  particular co-comorbidities increase cerebellar risk; the connection between an increased incidence of autism in former preterms and cerebellar dysfunction; the association of h/o NEC with smaller cerebellar volume; that corticosteroids for CLD — often a common form of treatment in the NICU — slows cerebellar growth (and  clinically both in the NICU and beyond, our infants with CLD seem to have the most challenges with suck-swallow-breathe coordination); the potential correlation between hypoxia-induced  white matter injury affecting cerebellar volume and complexity of dendrite formation in animal models; large PDAs resulting in altered blood flow associated with cerebellar hypoplasia and changes in cerebellar micro-structure; a prospective study in very preterm infants showed that nutrition via  breast milk compared to formula-fed milk improved cerebellar volumes; that there is increasing evidence for the importance of early brain activity for development of neuronal survival and formation of brain networks;  a follow-up study of former preterm infants with isolated cerebellar injury demonstrated on MRI at three years of age an impaired growth of several cerebral regions affecting both gray and white matter— and the impeded remote cortical development after isolated cerebellar injury was linked to domain-specific functional deficits in neurodevelopment; intrauterine cerebellar growth reaches its peak during the third trimester, from 24 weeks to around term equivalent age  —after preterm birth, cerebellar growth is still rapid, but several studies using ultrasound or MRI have reported that postnatal cerebellar growth in very preterm or extremely preterm infants is impeded, resulting in a ‘cerebellar hypoplasia of prematurity’; several neurodevelopmental outcomes at seven years including IQ, receptive language and motor function were positively associated with cerebellar volumes at term equivalent age and at seven years, and increased cerebellar growth was correlated with better neurodevelopmental outcome at seven years;  A small study compared a cohort consisting of 22 preterm infants born between 28 and 33 weeks and without major comorbidities (considered as “low-risk” for neurodevelopmental impairment) with 24 term controls–the “low-risk” cohort still had smaller cerebellar and hippocampal volumes and a smaller corpus callosum on MRI at nine years of age which correlated with worse attention and executive functions in the preterm group;  autism spectrum disorder has a high prevalence in preterm infants and core autism symptoms are associated with regional volume changes in the cerebellum; perinatal cerebellar injury is the largest non-hereditary risk for autism with a 36-fold increase while prematurity < 32 weeks still increases the risk 7-fold;  adults formerly born preterm had  persistent cerebellar dysfunction up to adulthood  in a study, even in the absence of early direct cerebellar lesions.

 

 

QUESTION: Currently have a 6 y/o pt on an inpatient rehabilitation unit.  She is trach and vent dependent following necrotizing pneumonia.  She is allowed to have cuff deflated 3x/day and can use a PMV while cuff is deflated although she is only tolerating for approximately 30 minutes a day. Getting ready to do an mbs, would you assess pt with cuff down and speaking valve on in addition to cuff inflated?  Do people generally wait until a pt is able to tolerate speaking valve for a certain amount time prior to taking pt to mbs.  Is it always safer for a trach patient to eat/drink with speaking valve inline?  We are having some disagreements on the treatment team.  Thanks for your advice/opinions.

CATHERINE’S ANSWER: We don’t know much about her history and other co-morbidities, which might affect next steps and treatment plan. But given what we know: it’s great that she is tolerating cuff deflation and is tolerating the PMV for 30 minutes at a time apparently with adjustments in  ventilatory support. While in radiology, I would also observe her with the cuff deflated and the PMV in place. That will give you some objective data about the effect of the PMV on swallowing physiology in comparison to physiology without the PMV in place. Typically in pediatric patients we do often observe better driving force on the bolus and better pharyngeal clearing, likely associated at least in part with restoration of subglottic pressure. Also, the restoration of taste and smell is critical for our pediatric patients to help either normalize or enhance the oral-sensory system, which is such a critical variable in both healthy and medically fragile pediatric patients. Even to initiate safe tastes, and hopefully brief/small PO feedings, this data will be invaluable. If your RTs are closely involved with PMV, keeping them a spart of the problem-solving team will be beneficial.

The most recent study that looked at this specific question was in Laryngoscope 2013 (Ongkasuwan et al, “The effects of a speaking valve on laryngeal aspiration and penetration in children with tracheostomies”) concluded the PMV did not demonstrate a decrease in laryngeal penetration or aspiration. However, this was small sample with quite varied ages and indications for tracheostomy. Most unfortunately, the study only looked at occurrence of aspiration and penetration. As Bonnie Martin Harris has so wisely stated, aspiration and penetration are neither sufficient nor necessary for a swallowing impairment.

So for this discussion, it reminds us that in radiology with this child it will be important to look beyond the effect of the PMV on just “aspiration” and “penetration”. Consider its effect on her swallowing physiology, and its components, which underlie safe bolus transport.

Let us know what your impressions are, Stephanie, so we can further inform our clinical wisdom.