Shaker Seminars adds new location for 2018

I am pleased to announce I will  be presenting at UC Davis in Sacramento CA  in June, 2018. See the attached brochure for date specifics. UC Davis Health is a nationally ranked 627-bed acute care teaching hospital and is home to a top-ranked comprehensive children’s hospital. We will be in the Betty Irene Moore School of Nursing, a new state of the art learning center. More details to come soon under Lodging and Directions TAB.


Seminar Schedule for 2018…

I am pleased to announce my Seminar Schedule for 2018. I am thrilled to be crossing the US this year again, and looking forward to meeting many new and familiar faces. All of us with one thing in common….helping our babies feed safely with infant-guided support and helping our kids eat in ways that build skill and joy in eating for a lifetime. So much exciting new research I am looking forward to sharing, and bringing my key learnings from my many patients over the past year. Our pediatric hospital continues to grow, and with it, so many opportunities for me to work with physician specialists, and infants and children through teenage years with complex feeding and swallowing problems. Many babies, kids and families touched my heart this year and I am thankful for the year ahead to continue to discover, teach and inspire. As my 2018 schedule fills in I will be adding dates for June and July, so keep in touch. As I celebrate 41 years as a pediatric SLP, I am grateful for you and your dedication to our kids. I hope our paths cross in 2018!

I am offering my unique and guided NICU training,  my Pediatric Feeding/Swallowing seminar that provides the essentials for practice, my Video Swallow Studies seminar that brings a dynamic approach to the pediatric swallow pathway. Also offering my Cue-based Feeding seminar which will feature a train-the-trainer focus this year with tons of infant feeding videos and discussion for learning.  New will be a one day Advance Pediatric Dysphagia seminar that brings together interactive case studies and complex problem-solving to make you a stronger clinician. Hope you can join us!

Click on the secure link below to take a peek at my 2018 Seminar Schedule.

2018 Catherine Shaker Seminars


Research Corner: Assessment Tools for Evaluation of Oral Feeding in Infants Younger Than 6 Months

Britt F. Pados , PhD, RN, NNP-BC ; Jinhee Park , PhD, RN et alAdvances in Neonatal Care • Vol. 16, No. 2 • pp. 143-150 (2016)

Abstract: Eighteen assessment tools met inclusion criteria. Of these, 7 were excluded because of limited available literature or because they were intended for use with a specific diagnosis or in research only. There are 11 assessment tools available for clinical practice. Only 2 of these were intended for bottle-feeding. All 11 indicated that they were appropriate for use with breastfeeding. None of the available tools have adequate psychometric development and testing.

 Implications for Practice: All of the tools should be used with caution. The Early Feeding Skills Assessment and Bristol Breastfeeding Assessment Tool had the most supportive psychometric development and testing.

 Implications for Research: Feeding assessment tools need to be developed and tested to guide optimal clinical care of infants from birth through 6 months. A tool that assesses both bottle- and breastfeeding would allow for consistentassessment across feeding method.


Research Corner: GE Reflux and NG Tubes in Infants

Take a look at this article hot off the press:

Murthy, S. V. et al  (2017). Nasogastric Feeding Tubes May Not Contribute to Gastroesophageal Reflux in Preterm Infants. American Journal of Perinatology

Findings: The presence of a 5-French NG tube is not associated with an increase in GER or acid exposure in preterm infants. In fact, it appears that infants fed through an NG tube have fewer episodes of GER.

This is surprising to me, and brings us new information to inform our practice with infants.

Hope you enjoy it as much as I did.


Problem-Solving with Catherine

I had a friend send me a video of her 10 month old eating puree by spoon. The baby presents with a tongue thrust with some anterior bolus spillage. The baby is currently being treated by PT due to Torticollis, and her PT suggested an SLP feeding evaluation. I treat adult dysphagia, so this is not my area of specialty. Should this Mom seek an eval now at 10 months or wait a few months to see if the tongue thrust diminishes naturally?

Answer: An evaluation will be beneficial now, and would be concerned that without intervention, this atypical oral-motor pattern is unlikely to resolve. It is not uncommon for infants with torticollis to develop associated maladaptive oral-motor patterns and/or to have GER/EER issues that may contribute to adaptive behaviors that unfortunately become maladaptive. We don’t know anything else about this infant (possible medical co-morbidities, potentially pertinent birth or developmental history, prior/early feeding history) which would be informative. Unclear whether he accepts only purees and has this been a pattern from the beginning, how effective his oral-moor skills are with the bottle (which would provide good data to examine), whether the apparent tongue thrust is a refusal behavior (related to GER/EER) or truly a lack of oral-motor skill (perhaps use of tongue extension instead of expected thinning and cupping?) Lots of possibilities that could be explored in an evaluation. This is not typical at this age and is likely to block further development of oral-motor skills and texture progression, and reinforce maladaptive neuro-motor mapping without focused diagnostic therapy.

Keep us posted. Mom is lucky to have you in her corner!




Wanted to share this fascinating article just published about the neonatal microbiome. Abstract below. Article attached. Some take a ways: Important that we advocate for and facilitate KMC ( kangaroo mother care) and use of expressed breastmilk when possible. And advocate for our involvement early on for those fragile infants for whom weaning respiratory support will  be a prominent initiative, and safe and successful feeding remain the most complex task required for discharge to home.

Hope this informs your practice like it did mine.

Nursing care of the neonate in the neonatal intensive care unit (NICU) is complex, due in large part to various physiological challenges. A newer and less well-known physiological consideration is the neonatal microbiome, the community of microorganisms, both helpful and harmful, that inhabit the human body. The neonatal microbiome is influenced by the maternal microbiome, mode of infant birth, and various aspects of NICU care such as feeding choice and use of antibiotics. The composition and diversity of the microbiome is thought to influence key health outcomes including development of necrotizing enterocolitis, late-onset sepsis, altered physical growth, and poor neurodevelopment. Nurses in the NICU play a key role in managing care that can positively influence the microbiome to promote more optimal health outcomes in this vulnerable population of newborns.


Rodriguez, J. et al  (2017). The Neonatal Microbiome: Implications for Neonatal Intensive Care Unit Nurses. MCN: The American Journal of Maternal/Child Nursing, 42(6), 332-337.


Wrapping 2017, Looking Forward to 2018

Wrapped up a busy teaching year at Johns Hopkins in Baltimore where they
have an amazing inpatient team that services infants and children from
NICU to burns to psych. Pediatric therapists from around the US joined me
and my colleague, Theresa for a dynamic 5 days of problem-solving,
learning and networking. Now a break for  the holidays and focus on
finalizing my 2018 teaching schedule, which will include Atlanta and
Austin, and likely the  NJ/NY area, Chicago area, and California. Will be
teaching a one day Advanced Pediatric Dysphagia Seminar in Atlanta along
with the Cue-Based Feeding seminar I co-teach with Suzanne Thoyre, RN/PhD,
which includes training on the EFS. The Pediatric Swallowing and Feeding, NICU
Swallowing and Feeding, and the Pediatric Videoswallow seminars will be
offered at all other sites.

Stay tuned for updates. I hope our paths cross in 2018!


The Early Feeding Skills Assessment Tool (EFS) now available

I am pleased to announce that through my collaboration with Suzanne Thoyre, RN, PhD The Early Feeding Skills Assessment Tool (EFS) is now available for download and use with you babies in the NICU and through adjusted age 6 months.

The EFS is a tool to help us:

The EFS has evolved over the years as a wonderful guide to cue-based feeding in the NICU. I especially am proud of it because it looks at feeding from the infant’s perspective and is grounded in physiology. It reflects how I conceptualize feeding in the NICU, which I refer to as “infant-guided”, i.e., a dynamic approach based on contingent co-regulation between infant and caregiver. That maybe a parent/family member, a nurse, or a therapist.

The tool is also based on dynamic systems theory (that multiple systems synergistically affect each other during feeding) and these systems are assessed dynamically throughout an entire feeding, to arrive at a gestalt. Capturing variability across the entire feeding is a critical part of the analysis/integration of information. The items are designed to capture the variability in the infant’s learning of the foundational components of feeding skills, the continuum of that learning, and the emergence of skills; so it assesses  whether component skills are not observed, are emerging, or are indeed consistently expressed. It is often used serially to capture developmental progress in feeding over time.

The EFS leads the caregiver, by the nature of how it is designed, to the interventions that naturally flow from the results of the assessment. It profiles interventions to support adaptive function during feeding and swallowing, and therefore interventions for safety.

The EFS is user friendly in that it is not focused on understanding and identifying only isolated oral-motor components but rather making sense of what all caregivers “see” every day when they feed preterm infants–the infant’s communication/cues during feeding. It provides a common language about feeding terminology (such as what do we mean by an infant is “pacing” himself, or what is “coordinated”, for example) to help all team members, including families, get on the same page, so conversations and report have common meaning. Psychometrics have been completed and published soon.

Join us in Atlanta on August 15-16, 2018 for a live learning event on utilizing the EFS in support of Cue-Based Feeding in the NICU. Stay tuned for details on my website soon!

Use this link to register and download the EFS

Shaker ASHA Blog: Preparing for the NICU

Do you hope to get a coveted pediatric placement during graduate school or for your clinical fellowship experience? Are you interested in an even more specialized subset of pediatrics? Working as a speech-language pathologist in the neonatal intensive care unit (NICU) requires many specific skills. These tiny patients and their families are fragile. The family-centered care we provide as SLPs, in support of neuroprotection, communication and safe feeding, create the foundation for a thriving parent-infant relationship.

Read more here: Preparing For Grad School or CF Placement In The NICU: Part One 

Teaching at Children’s Medical Center of Dallas

My colleague Theresa and I were pleased to welcome therapists from across the United States and Canada to our seminars in Dallas Texas. Children’s Medical Center has several campuses in the Dallas Metroplex and provides services for a wide range of infants and children. Our Children’s House and Specialty Clinics are unique and serve populations in need of specialized expertise in swallowing and feeding. We continue to be amazed by the critical thinking of the therapists we meet at our seminars. Problem-solving case studies and learning from each other provides opportunities for clinical growth and networking. We look forward to returning to Texas in October 2018 for our seminars in Austin!

Problem-Solving with Catherine

Question: I have been treating a 24-month-old little girl that has had a complicated medical past including prematurity (27 weeks gestation with a birth weight of 2.2 lbs. oz..), Down syndrome, AV canal defect, ventricular septal defect, duodenal atresia s/p repair, and respiratory distress in newborn requiring intubation at birth. Additional diagnoses included: bilateral sensorineural hearing loss, GERD, VUR/urinary reflux, anemia, and hypothyroidism.  I started seeing her nearly a year ago and referred her for an OPMS due to frequent upper respiratory illness although she had no outward signs/symptoms of aspiration.  She was found to be aspirating thin liquids and the recommendation was for honey thick liquids and fast flow nipple.  She has done well in therapy and has transitioned to a variety of table with liquids by cup and bottle.  She is returning to pulmonology soon and the doctor wanted to know how she is doing with thin liquids.  I’ve been hesitant to recommend going back to thin liquid without a follow up due to the history of silent aspiration.  Do I try distilled water with nursing to check of O2 saturations to give the doctor feedback? I think I would still want a repeat instrumental since the history of silent aspiration and respiratory illness. Any other thoughts or possible suggestions?  Parents are very nervous with feeding although she has done very well in treatment and the overall frequency of respiratory illness has decreased.

Catherine’s Answer: Sounds like a child with multiple complex co-morbidities that are likely combining to create the etiology for her feeding challenges. From what we understand about her, we don’t know what the etiology of the silent aspiration events was. Without the etiology(ies) and understanding her swallowing pathophysiology, it must be hard to fully understand what to work on to improve her swallow function. That also would inform our problem-solving as to the contributing factors, the nature of the swallowing impairment and potential for improvement, in the context of her medical co-morbidities and multi-system differences. Contributing factors seem to be cardio-respiratory and GI, as well as postural tone, oral-motor and sensory. These likely combine to create risk for uncoupling of swallowing and breathing. The lack of clinical suspicion prior to the original instrumental assessment followed by silent aspiration creates increase risk for her, given her pulmonary status. So, your concerns are appreciated. I think it is uncommon to have infant on honey thick liquids because the risk to aspirate, given such impaired physiology, remains, despite the thickening to honey. And if she does aspirate honey thick liquids, that may create significant challenges for her lungs, given the history we know. That said, she has been on thickened liquids of a year. We typically reassess physiology much sooner in the developing infant with multiple co-morbidities.

Depending on the original data gleaned in radiology, at that time pacifier dips of thin liquid would have been an avenue to allow for purposeful swallows that activate the fast twitch fibers and promote interval sensory-motor learning with tiny amounts of thin liquids. That way when she returned to radiology to relook at physiology, we would be less likely to have an artifact -i.e., lack of careful recent sensory-motor experience with thin liquids that can create a predisposition perhaps to mis-direct the thin liquid. So, dipping the spoon in thin liquids for some tiny tastes may help at this point to safely prepare her while minimizing risk. Of course, there is risk to aspirate the trace tastes used for purposeful swallows, but one must weigh the need to set her up for success with recent sensory-motor experience for a brief period and then take her very soon for a repeat instrumental assessment. With a focus on physiology during the swallow study, and not just whether she aspirates, current data can be provided to guide her treatment. Hopefully interval improvements in the underlying co-morbidities and your good intervention may allow for safe advancement of her liquid diet, even if only in a therapeutic situation, A year is a long time to be on honey thick liquids., and that is not without its own attendant sequelae. You are asking good questions. Keep us posted.


I hope this is helpful.

Outcomes of Congenital Heart Disease

For those of you who provide support to a pediatric cardiovascular intensive care unit, I wanted share this insightful article on outcomes for this unique and special population. It reinforces the breadth of services that as SLPs we can provide and the critical nature of our broad assessment post-op and careful follow-up. I hope it informs your practice as much as it has mine. A fascinating read. Please share it with your cardiologists.

Excerpt: “The risk factors for poor outcome include type of CHD; presence of genetic conditions; fetal and neonatal neuroimaging abnormalities; pre-, peri-, and postoperative factors associated with hypoxia and hemodynamic instability; prematurity; male sex; and family socioeconomic status and resilience. In utero, CHD may affect cerebral blood flow and oxygenation with resultant slower brain growth, delayed brain maturation, and white matter vulnerability. Pre- and peri-operative instability may cause brain injury, such as white matter injury, microhemorrhages, and stroke. Operative factors, such as deep hypothermic cardiac arrest and cardiopulmonary bypass, played a minor role in determining long-term outcomes. Postoperatively, prolonged hospital stay and severity of illness were predictors of worse outcome.”

Outcomes of CHD

I hope this is helpful.