Stephanie Landis (00:06):

Hello and welcome to Unbabbled, a podcast that navigates the world of special education, communication, delays and learning differences. We are your host, Stephanie Landis and Meredith Krimmel, and we’re certified speech language pathologist who spend our days at the parish school in Houston helping children find their voices and connect with the world around them. Hey, this is Stephanie jumping in really quickly to tell you about our sponsors soccer shots. Houston, The Parish School has been lucky enough to have a group of students participate in soccer shots right here on our campus for the past couple of years, and it has been an amazing way for our students to be a part of a team. Soccer shots began programming in Houston in 2009 with a goal of positively impacting children’s lives and supporting their learning of their favorite game soccer. Their program was formed under the guidance of childhood education specialist, professional soccer players, and experienced and licensed soccer coaches.

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They use a developmentally appropriate curriculum that meets children where they are, and the coaches place an emphasis on character development and skill building. The coaches use words like respect, confidence, and determination in their weekly classes. To learn more about soccer shots, visit their website@www.soccer shots.com/houston. Again, that’s www soccer shots.com/houston. As parents, we know how important it’s to find someone you trust to care for your children’s dental needs Kids 360 Pediatric Dentistry is a family, family-owned boutique practice where your little ones can truly feel safe and at ease while receiving the highest quality of care. Located in Richmond, Texas, Dr. Maori ADI is a board certified pediatric dentist specialist with a decade of experience with compassion and honesty. She and her team provide care for infants, children, teens, and patients with special healthcare needs. In their nurturing environment. Every child will receive personalized treatment tailored to their unique needs.

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In addition, they specialize in operating care for children with physical, emotional, developmental, cognitive, and sensory challenges. Dr. Parity is always ready and willing to listen to questions and concerns, to share some laughter, and to partner with you to care for your children. For more information, visit their website at www kids 360 pediatric dentistry.com or email them at info at kids 360 pediatric dentistry.com to get all your kids’ dental needs met. In this episode, we sit down with pediatric physical therapist, Melissa Howard to talk about the basics of physical therapy. Melissa is the owner of Bloom for All physical therapy, a private practice right here in Houston, Texas. She received a doctor of physical therapy from Texas Tech University Health Science Center in 2011, Melissa is board certified as a neurologic specialist and certified in neurodevelopmental treatment. Throughout the episode, Melissa explains what physical therapy is signs a child may benefit from physical therapy, how it differs from occupational therapy and ways she collaborates with other therapists. While many areas she discussed were familiar to us, such as developing an efficient gait, building strong core rehabbing muscles after injury, one specific area was surprising to learn about working on a child’s pelvic floor muscles and how it relates to potty training, constipation and incontinence. Melissa spends time in this episode discussing ways physical therapists can help children of all ages with those difficulties. It was truly a pleasure to chat with Melissa and learn more about ways physical therapists support children.

Melissa Howard (03:41):

Welcome. We’re so excited

Stephanie Landis (03:43):

To kick off our new season and we have our guest is a physical therapist, Melissa Howard, welcome.

Melissa Howard (03:49):

Hi. So glad to be here. I don’t think we’ve

Stephanie Landis (03:51):

Talked to a physical therapist yet. No, not yet.

Melissa Howard (03:54):

Yay. That’s awesome. We talk a

Stephanie Landis (03:56):

Lot about all of these different fields and kids needing them, but we haven’t spoken directly with a physical therapist, so I’m very excited. I have so many questions.

Melissa Howard (04:04):

Great. I can’t wait to answer some of them, but

Stephanie Landis (04:06):

Before we do, would you like to tell us a little bit about yourself?

Melissa Howard (04:09):

Sure. I opened my own practice two years ago called Bloom for all physical therapy and we help kids tackle gross motor milestones as well as constipation and urinary incontinence. Outside of work, I love baking, cooking, growing flowers, spending time with friends, and I’m a foster parent so I stay busy with lots of different things, but love quality time with people is probably the number one thing I enjoy.

Stephanie Landis (04:35):

Well, hopefully we’ll have some quality time here.

Melissa Howard (04:37):

Yes.

Stephanie Landis (04:38):

Can you tell us a little bit about physical therapy realm with kids?

Melissa Howard (04:43):

Yeah, so I would say physical therapy is going to work on more of your big milestones, so walking, running, jumping, crawling, so things that you are trying to move from Point A to point B, that’s what physical therapy is best at in the most part.

Stephanie Landis (04:58):

What age ranges do you work with?

Melissa Howard (05:00):

I work from newborn all the way up to 18.

Stephanie Landis (05:03):

Those little bitty newborns,

Melissa Howard (05:04):

They’re the best,

Stephanie Landis (05:06):

Which I think sometimes parents don’t think about newborns needing gross physical movement. What are some of the things that you do with the younger ones?

Melissa Howard (05:14):

Yeah, so with the infants we’re often working on torticollis or head preference. If say your child is born with down syndrome, we can start early to really make sure that they’re hitting those motor milestones, gaining the strength that they need, and mostly just educating parents on how to play with their kids, how to help them thrive and making sure that they have the tools that they need to help their kids hit all those milestones.

Stephanie Landis (05:39):

As far as the little kids, like the pre walkers, what kinds of things should parents be looking for that might indicate physical therapy is warranted?

Melissa Howard (05:46):

I would say making sure that they’re moving symmetrically, so rolling both ways that they’re crawling with both legs on the floor. They’re not always coming up to stand with the right foot, let’s say, but really using both legs, both arms at the same.

Meredith Krimmel (06:02):

I’ve heard a lot about skipping, crawling as a milestone.

Stephanie Landis (06:06):

Some

Meredith Krimmel (06:06):

People saying it doesn’t matter and some people saying it’s an important milestone if you skip it, it could have effects long-term or down the road. What are your thoughts on that

Melissa Howard (06:13):

Hot topic right now with the C D C?

Stephanie Landis (06:14):

We’re jumping right in,

Melissa Howard (06:16):

But I would say crawling is key for those fine motor skills, hand strength, and something most people don’t know is crawling helps start to shape the pelvic floor for potty training, so a lot of kids I see who are having trouble potty training ages three through 10 may have skipped crawling and they don’t have the right shape to their pelvic floor for it to function properly.

Stephanie Landis (06:39):

That’s interesting. I’ve heard the occupational therapist talk about the cross body. I’m probably totally

Meredith Krimmel (06:47):

Saying it wrong,

Stephanie Landis (06:48):

But just talking about making sure that your body is moving your legs and your arms at the same time, but never the pelvic floor development. Does any of that have to do also with the muscles and the hips for the W sitting?

Melissa Howard (07:01):

Absolutely, so it’s huge for core strengthening and bringing those hips in, teaching them how to move in that plane of motion, so it’s a little bit different, but crossing the body is huge also for coordination later on and learning how to use the left side and the right side together so it really crawling pulls so much together. I think it is one of the most valuable milestones actually,

Meredith Krimmel (07:23):

And I want to go back. You said W sitting and that. I just want to explain what W sitting is.

Stephanie Landis (07:27):

Thank you.

Melissa Howard (07:28):

Yeah,

Meredith Krimmel (07:28):

W sittings when you sit on the ground with your legs splayed out to the left and right in the shape of a W, instead of sitting in your criss-cross or mountain or mermaid, which are your legs together in front or to the side,

Melissa Howard (07:39):

And kids do that because typically they don’t have enough core strength to sit properly and so kids are so smart, right? Kids are compensating because they don’t have the strength to sit crisscross applesauce, so that’s something to also watch out for in the first year.

Stephanie Landis (07:52):

So you

Meredith Krimmel (07:53):

Brought up potty training. At what age should a parent be concerned and maybe seek medical advice or physical therapist for potty training?

Melissa Howard (08:00):

First, let’s say we don’t want to start potty training until at least 24 months, so kids can start to feel that they have the sensation of a wet diaper around 18 to 20 months, but they don’t actually have control until 22 to 24 months. We want to start after the age of two. I would say if you’ve had multiple attempts of trying to potty train using different methods and your child’s still having a lot of accidents or unable to poop in the potty, which is a big one, then I would go ahead and seek pt. We can give you some helpful tips to help make it an easier journey. Don’t struggle on your own for too long, so come on in. We can give you some tips and tricks to implement early on.

Stephanie Landis (08:43):

Are there some other early indicators that kids are ready?

Melissa Howard (08:47):

Absolutely. So pooping at the same time every day, staying dry at naps because that tells you that they can hold their bladder for longer periods of time. You want them to be ideally walking because that makes sure you have the core strength and coordination for potty training. Those are a few things to look for,

Stephanie Landis (09:06):

So I found it so interesting that you work on constipation and incontinence. I really had never put the two of them together with physical therapy. I just always thought it was internal meds or I don’t know. I told you earlier, my daughter was a preemie and we were working so hard on all those early milestones and we’re checking those off and as we’re working on those, I also, she was constipated a lot as a little one and I never thought to put it two and two together. We just gave the poor girl so many prunes when she was

Meredith Krimmel (09:39):

Little.

Melissa Howard (09:40):

Yes, I’m sure she loved them. Not that

Meredith Krimmel (09:44):

Bad actually.

Melissa Howard (09:46):

No, my little foster baby right now gets a lot of prunes.

Stephanie Landis (09:51):

Are there certain things, what are parents looking for that might make them think it’s not a dietary thing, but it might be something that a PT could help with for constipation?

Melissa Howard (10:01):

Absolutely. So if your child is routinely needing medication such as MiraLax, which is often recommended in order to poop, then we should figure out why do they need that? Is there a physical reason why your child’s constipated and let’s tackle that instead of just adding in medications. I know so many parents want to go the natural route, and so PT would be the natural route and we can figure out why are they constipated? Do they not have the core strength to actually help the poop all move and maybe that’s why, or

Meredith Krimmel (10:30):

They don’t

Melissa Howard (10:30):

Have enough hip strength so their pelvic floor is really tight, so there’s a lot of odds and ends that kind of go together with that. That is very complicated in some ways, but overall, if your kid needs MiraLax to poop, you should see a PT if your child’s fearful of pooping in the potty, so maybe they only poop once a week because holding it in because they really don’t want to let it come out or when they are pooping, it’s really painful and so then they’re not wanting to do it. All of those are reasons to seek out a physical therapist.

Stephanie Landis (11:00):

That is so interesting. I guess I never mean those are the muscles that you need to use to go to the bathroom, but I just never really connected it. Is that just for younger kids or have you seen older kids benefit from it as well?

Melissa Howard (11:14):

Yeah, I see kids all the way up to probably age 13 with incontinence, so sometimes it can start in adolescence when we start playing soccer or jumping when they jump, they can’t hold their pee in and there’s other kids who still are not potty trained at the age of 10 to 12 and have just continued to struggle and it’s been a cycle and so lots of ages benefit. I could talk about this for hours.

Stephanie Landis (11:38):

I’ve never really thought of that for physical therapy before.

Meredith Krimmel (11:41):

Yeah, I know I’ve heard people talk about maybe OT for the sensory part, but it makes sense that all the muscles involved with any sort of toileting would be physical therapy related. My sister-in-law’s a physical therapist, but she works with adults. She’s a pelvic floor therapist, so I am very aware that pelvic floor muscles after childbirth can sometimes lead you to physical therapy. I know that’s a lot of her patients, so it makes sense that it would be the same for kids.

Melissa Howard (12:04):

Yeah, it’s very interesting. So I’m sure there’s lots of moms listening in and I’m sure you’ve maybe been to PT for having a diastasis after having a baby, something most people don’t know. All kids are born with a diastasis and if it doesn’t close by the time we start potty training, then it’s really hard to push out your pee and your poop from your stomach and so then they start compensating, and so a lot of times I’m seeing kids in order to close that diastasis

Meredith Krimmel (12:32):

And can you explain what a diastasis is?

Melissa Howard (12:34):

Yeah, so basically it’s a separation in the rectus muscle, so the front muscle of your abdomen in that it doesn’t close all the way, so you’re not getting that constant pressure across your stomach.

Meredith Krimmel (12:46):

So

Stephanie Landis (12:46):

Glad I learned something new today, but it makes sense. I mean so many other parts of your body when you’re born, they’re still connecting even after birth and growing in muscles that your stomach muscles are too. So babies go to PT to work on their core strengths

Meredith Krimmel (13:00):

And build those pelvic floor

Stephanie Landis (13:01):

Muscles just like moms after birth, so we’ll just sign the whole

Meredith Krimmel (13:04):

Family up.

Melissa Howard (13:05):

That’s right.

Meredith Krimmel (13:06):

Everyone can benefit. So shifting off of potty training a little bit, what are some of the things that you would work on with elementary age students in physical therapy or what are some signs that a parent of an elementary age student would look for that would be an indicator that their child could need physical therapy?

Melissa Howard (13:21):

Absolutely, so something that we do in our clinic is we offer intensives, and so that just means you come in every day for a week or two. So this summer I saw a lot of elementary school kids to work on running coordination or the inability to jump, maybe your child’s falling a lot on the playground and they can’t keep up with the other kids, and so we can work on getting faster moving balance, all of those things. I would say those are the hot topics from this summer was running and jumping.

Stephanie Landis (13:52):

I know we still have a few kids on campus and my gosh, I did it through elementary school, was toe walking?

Melissa Howard (13:57):

Yes, yes. So I saw a couple kids this summer for toe walking. One was 13, had always walked on his toes and all it took was three sessions and now he’s walking flat-footed, so you’re not signing yourself up for a lifetime of therapy if you’re a toe walker. There are things that we can do to help get those feet flat. It just takes some diligence at home

Stephanie Landis (14:18):

And man, that’s something I wish I would’ve done because I have a lifetime of really

Meredith Krimmel (14:21):

Tight calf muscles

Stephanie Landis (14:23):

Now.

Meredith Krimmel (14:23):

I was going to say, can you talk about the benefits of walking flat-footed and trying to get off the toes?

Melissa Howard (14:28):

Absolutely. So we could take it back to potty training a little bit. If you walk on your toes, it actually makes your pelvic floor contract, which leads to a hard time relaxing for pooping and peeing. So we want that heel contact because it helps with overall balance coordination and just your whole body functioning properly. If you’re up on your toes all the time, your base of support, which is where your body is over your feet is really narrow and so it’s really hard to balance and it leads to abnormal posture. So often kids who walk on their toes don’t use their abs at all because they’re leaning back to try to stay upright, and so it really is more than toe walking. It really does affect the whole body, and so it’s something to not necessarily ignore and think will just go away.

Meredith Krimmel (15:18):

I know someone who’s an adult who stole toe walks and he’s very athletic, so I was always surprised, but he does have very tight calfs like you were saying, Stephanie,

Melissa Howard (15:26):

Yes, I see lots of toe walkers going around Walmart all the time. You can still be very functional, but there are things to help as well.

Stephanie Landis (15:34):

Sure,

Meredith Krimmel (15:34):

Yeah,

Stephanie Landis (15:35):

No, I mean as an adult it’s affected my calves, my hips, my back and I’m like, oh my gosh. And my sister-in-law’s an occupational therapist, she was like, it’s probably because you were a toe

Meredith Krimmel (15:43):

Walker. And I was like, oh, they didn’t know about that in the eighties. Oh man, I was a W sitter bab and I have hip issues, so if your kid w sits, you should correct it. All of

Stephanie Landis (15:54):

These things. But it does, I mean it sets up your body hole physically and your development and the way your muscles develop young carries with you into an adult

Meredith Krimmel (16:05):

Just

Stephanie Landis (16:05):

Shows

Meredith Krimmel (16:05):

You how everything is so intertwined. Who would’ve thought potty training and toe walking were connected? I wouldn’t have.

Melissa Howard (16:10):

Yeah, absolutely. It’s amazing how our bodies are made.

Stephanie Landis (16:14):

What are some of the reasons a kid would toe walk?

Melissa Howard (16:17):

So sometimes it’s simply they have a tight calves. Sometimes it’s because they are trying to hold their poop in and so they toe walk in order to do that and then it becomes a habit. Sometimes it can be sensory so they don’t want their whole foot on the floor because it’s overwhelming for their body. That was me. I’m sure you all know about that. That’s probably the most common that’s talked about is for sensory issues.

Stephanie Landis (16:40):

That sounds like quite a few reasons. What are some other signs that a child might need or benefit from physical therapy? We’ve talked about difficulty on the playground or stumbling. Are there any big milestone ones that we want to make sure that the kids are hitting other than crawling like these milestones and they might need physical therapy after

Melissa Howard (17:01):

That. So we want to make sure by the age between five and seven is when typical walking and running should come about. So your kid’s going to start running around the age of three-ish, let’s say potentially, and it always looks super uncoordinated when they start running. It’s not going to look great and that’s how it’s supposed to be. We have to practice and learn, but around the age of five to seven, we really want to start seeing that more typical walking pattern and running pattern. So it should start to look more coordinated. And if you’re not seeing that there might be a question as to why not and you can always get an evaluation from a pt. Doesn’t mean you’re going to see them and just ask some questions, get some exercises to do at home and see if there is a reason that they’re not quite coordinated yet. So I think coordination’s a big topic when it comes to elementary school ages

Stephanie Landis (17:56):

And same thing with the early childhood.

Melissa Howard (17:58):

Absolutely.

Stephanie Landis (17:59):

Okay.

Meredith Krimmel (18:00):

Yeah. And I am wondering as you’re talking about all these different things with coordination, how that can impact a child’s academics or learning in a classroom, do

Stephanie Landis (18:07):

You

Meredith Krimmel (18:07):

See any kind of impacts on sitting at a desk or working on schoolwork and if a child has not received physical therapy, who might’ve benefited from it?

Melissa Howard (18:15):

Yeah, I think when coordination’s involved, they have a hard time sometimes sitting still at a desk in order to focus all day at school or they’re working so hard to sit up or use their arm to reach across to grab some scissors. All of that takes so much effort that then they actually are missing the academic part because they’re so focused on the physical part. And so if we can make that a little bit easier, it will help them succeed academically.

Stephanie Landis (18:40):

I see that especially with it being hot and the kids getting so physically

Meredith Krimmel (18:45):

Tired

Stephanie Landis (18:46):

That by two o’clock

Meredith Krimmel (18:47):

You can see all of the

Stephanie Landis (18:48):

Kids are just slouched and hunched and in

Meredith Krimmel (18:52):

The morning they’ve got enough strength and they’re ready and they’re sitting up by the end of the day, they’re

Stephanie Landis (18:56):

All just limp noodles on the desk

Meredith Krimmel (18:58):

And we’re like, wait, we still need you to look up here and think about us.

Stephanie Landis (19:01):

And some of them I’m like, well, you physically can’t. So we try and give them different seating options.

Meredith Krimmel (19:09):

Are there other

Stephanie Landis (19:09):

Things you suggest to help us? I

Melissa Howard (19:11):

Would say making sure that they’re getting good water intake in the afternoon and taking some time to add in some getting up and moving around at the end of the day so it’s not all stationary because you’ll lose them if they’re just sitting in a chair at the end of the day when they’re tired.

Stephanie Landis (19:28):

We try and use some flexible seating and even just little things where I’m like, okay guys, if you can’t sit up in a

Meredith Krimmel (19:33):

Chair regularly, flip

Stephanie Landis (19:34):

It

Meredith Krimmel (19:34):

Around and straddle it so that at least if you’re leaning forward, the

Stephanie Landis (19:38):

Chair’s

Meredith Krimmel (19:38):

Semi propping you up.

Melissa Howard (19:40):

Those are great ideas.

Stephanie Landis (19:42):

You mentioned if parents are concerned that they can reach out and get a physical therapy evaluation, what’s the best way for parents to be able to do that? Do they need to see their pediatrician? Can they contact you directly?

Melissa Howard (19:52):

So actually you don’t have to go to the pediatrician in order to see a physical therapist in the state of Texas. You can simply call up a PT and ask to get an evaluation so you can contact me directly. We schedule the evaluation and then afterwards if we decide that your child does need pt, then we can reach out to your pediatrician and get the order signed and all of that.

Stephanie Landis (20:15):

So for speech pathology for elementary aged children, they can go through the school and get an evaluation. Do schools do physical therapy evaluations or is most of it in a private practice or clinic?

Melissa Howard (20:27):

Schools do physical therapy evaluations, but I would say that it’s mostly tailored towards can your kid get around school, whether it’s in a walker or a wheelchair, can they access their environment? And that’s kind of the PT realm at school so to speak. It’s not necessarily working on improving how your child’s or different things like that.

Stephanie Landis (20:49):

So the best route would be like a clinic, a hospital?

Melissa Howard (20:52):

Absolutely. Yep. Clinic, private practice or a hospital that offers outpatient therapy services.

Stephanie Landis (20:58):

Other than Googling, is there a trusted source for parents to be able to find a good physical therapist near them? Do you have a national board where they can go in and be like find a physical therapist near me, or is it usually word of mouth and friends and

Melissa Howard (21:15):

Pediatricians?

Stephanie Landis (21:16):

I would say

Melissa Howard (21:16):

The number one referral source for me is word of mouth or pediatricians. You can look online to find who has their pediatric certification or certification in physical therapy and find a provider near you. But in terms of just finding a great pediatric physical therapist, there’s not a great search engine for that unfortunately. Maybe I should come up with one. There

Stephanie Landis (21:39):

You

Meredith Krimmel (21:39):

Go. Million dollar idea. You talked about going to a clinic to get an evaluation and did you mention that you have a free clinic?

Melissa Howard (21:46):

I do. So the first Saturday of every month I set aside a couple slots to see kids for free. So if you for some reason can’t get into therapy with your insurance or you can’t pay the cash pay rates, I truly believe your kid should still get physical therapy. All kids should be able to bloom and thrive, and so we’d love to see you. So the first Saturday of every month you just call and make an appointment and we’ll get you in for a full evaluation. And we try to give lots of tips and tricks to do at home over the next month. If you need another appointment, we’ll see you again. We’ll figure out what your child needs and go from there.

Meredith Krimmel (22:20):

That’s amazing.

Stephanie Landis (22:21):

Yeah, the insurance thing, man,

Melissa Howard (22:23):

So hard.

Stephanie Landis (22:24):

It’s so hard for parents and you said that with your intensivess and other things, you do a fair amount of short term, so when people are coming for physical therapy, they’re not looking for unless there’s a large full system issue. Typically do you see kids for three months, a year or two months? It just depends.

Melissa Howard (22:45):

It does depend, but my average is six to eight visits to meet your goal for your child, and so it’s shifted between seven and eight for the most part of the last two years. And so usually we’ll see kids either once a week for eight weeks or maybe eight days in a row and then their goals are met and we take a break and maybe they come back and see me or maybe they never do. So

Stephanie Landis (23:08):

For the

Meredith Krimmel (23:08):

Potty training, do you find that the eight days in a row or the intensive is the way to go

Melissa Howard (23:12):

For potty training? I feel like if the child has a lot of fear or behavior, there’s a lot to work through. And so doing a once a week and giving steady things to do at home, like sitting on the potty every day, just having fun and not making it about success of pooping or peeing, but just sitting can really help. So more prolonged once a week going back to insurance. So I have a foster child and she has Medicaid and the amount of time I spend on the phone talking to different providers to see who takes her specific Medicaid, it has been so challenging. I know cash pay can be, I feel like a lot upfront to pay for your child, but in the end if it’s quicker you’re not going as often. I do think it can be really beneficial if you’re only paying for six visits full rate versus going to a hospital where your Medicaid is taken, but you go for six months to get the same result. So I do think there is some benefit and ease to cash pay if that’s possible for you.

Stephanie Landis (24:20):

When parents are looking for a physical therapist, is there anything that they should be looking for

Meredith Krimmel (24:26):

That it’s like,

Stephanie Landis (24:26):

Oh, this physical therapist will be a great fit for me, or maybe they don’t have the type of background that I need. I know for speech there’s so many different things that could be going on with the child that sometimes certain people specialize in certain things. Is it the same way with physical therapy?

Melissa Howard (24:41):

I would say it is the same way. I would definitely inquire and ask when you’re calling, what are the normal age ranges that are seen at that clinic? Because some clinics really just see the babies or just the older kids, and so making sure that they’re familiar with your child’s diagnosis and that age bracket, you can always ask about their certifications or their training. Have you been to classes specifically regarding torticollis or cerebral palsy? And just kind of ask about what do they normally do for treating and see if they can talk about it. If they can’t talk about what they do, then that’s probably not a good fit for you. And so they should be able to explain how they’re going to help you meet your child’s goal.

Stephanie Landis (25:23):

Yeah, that’s great advice.

Melissa Howard (25:24):

So don’t be scared to ask.

Stephanie Landis (25:26):

Your clinic specifically is just physical therapy. Do you often

Meredith Krimmel (25:30):

Collaborate with other

Stephanie Landis (25:31):

Disciplines like speech or occupational therapy?

Melissa Howard (25:34):

Absolutely. I would say I coordinate a lot with speech and OT in regards to feeding, but also posture and breathing. So there is a certification or a type of treatment called N D T and I took that maybe five years ago. So it’s basically a way that you treat, and I was a lot of speech therapists in the room and so how we sit affects how we swallow and breathe and eat. And so I think there’s so much room for collaboration and I love talking to speech therapists for the kids that I’m working with.

Stephanie Landis (26:08):

Awesome. That breath support and the posture is a huge part of it.

Melissa Howard (26:12):

Absolutely. If you’re holding your breath when you’re moving, then you’re not going to be very successful. It’s going to be really hard. And so I think there’s so much room for speech and PT to work together.

Meredith Krimmel (26:22):

Absolutely. And with lots of different things, not just posture and breathing, but back to the potty training,

Stephanie Landis (26:27):

Communication is required for potty training, physical

Meredith Krimmel (26:30):

Development is required, occupational therapy with the fine motor movements of undressing and redressing that all disciplines can be involved and should be involved.

Melissa Howard (26:37):

Absolutely. It’s a full body experience and journey.

Meredith Krimmel (26:41):

Absolutely.

Stephanie Landis (26:42):

I did not know this morning that my day was going to talk about potty training so much when I have children who are fully body trained myself.

Meredith Krimmel (26:49):

I mean, I had an idea we would touch on it, but everything kind of kept coming back to it.

Stephanie Landis (26:53):

I know,

Meredith Krimmel (26:54):

Honestly, and I think that will help a lot of people. I mean I think potty training is such a source of frustration in a lot of households, especially of children with developmental delays and communication delays. So I think hopefully this will help a lot of people.

Melissa Howard (27:08):

Absolutely. And I think people are so scared to talk about it because embarrassing, my kid’s still not potty trained in their five. It’s okay. There’s so many more people struggling. So if you talk about it, I guarantee one of your friends’ kids is also struggling with it. I find that so often is the case. And so it’s nothing to be embarrassed about. It’s not your fault. There’s nothing to be ashamed about.

Stephanie Landis (27:31):

I think there’s kind of a new-ish feel of a push in the parenting world that’s like, wait until your kid’s ready and follow their lead. But I feel like even when my kids just a few years ago were potty training, it felt like you got a reward

Meredith Krimmel (27:44):

If your kid potty trained at two and

Stephanie Landis (27:46):

If you

Meredith Krimmel (27:46):

Waited until three, it was

Stephanie Landis (27:47):

Like your kid’s never going to get into Harvard.

Meredith Krimmel (27:51):

I love my pediatrician told me at one point, no one’s going to ask you on your college application when you potty trained. Doesn’t matter. It was really a relief. Nobody’s going to care when it happened and it’s going to happen.

Melissa Howard (28:05):

Yes. It’s the same with motor milestones. We put so much pressure on when did your kid meet this? When really every kid’s on their own journey, their own timing and milestones are great to know when about they should do it, but it’s just a guideline. Every kid’s different. And so we cannot put pressure on our kids based on a sheet of paper.

Stephanie Landis (28:26):

That was one thing that I was thinking earlier when you were talking about like, ooh, a hot c d C topic in the speech world, a hot C d C topic is kind of, they looked at milestones a little bit differently and now parents are doing a little more of a wait and see. But as a speech therapist, it’s always hard for me because one, I don’t want to wait and see, but there are milestones there for a reason, but milestones have a range. And so even when talking to parents about when they should be concerned, it’s difficult. I’m sure with motor milestones, it’s the same that a kid could start walking at 10 months maybe, but a kid could also walk at 18 months and there’s not really a reward for your kid walking right when they hit one. But how long is too long of a wait and see for some of these milestones? Or is it kind of case by case or does it look more at like, well, what is the reason that your child isn’t walking? Is that how you approach milestones with the motor aspect?

Melissa Howard (29:27):

Yeah, I think it is a case by case basis and I would say trust your gut. If you’re concerned about your kid, then seek out some advice and an opinion. If you’re not concerned, then that’s okay. But I would say around, so if your kid’s not walking by 15 or 16 months and they don’t have low tone or there’s not another underlying issue, then I would seek out help. So if they’re three to four months past when they should be hitting things, that’s when you want to start to say, maybe I should get this looked into.

Stephanie Landis (29:59):

I love the advice of trust your gut. That’s what I always tell my friends when they’re asking about their

Meredith Krimmel (30:03):

Own children,

Stephanie Landis (30:04):

Should I get an evaluation? Usually if you’re a mom or a dad and you have a concern, there’s a reason for that concern. And the worst thing that’s going to happen is they’re going to say, no, they’re fine. You don’t need to come back and you spend a little bit of time and a little bit of money, but you got a lot of information

Melissa Howard (30:18):

And then you’re not as concerned or worried about it or stewing on, is this okay? And it can hopefully bring a peace of mind.

Stephanie Landis (30:24):

I think that’s a really balanced approach to it. So it’s not like, oh no, you shouldn’t be freaking out because they still have another month or you’re only a month behind the milestone, whatever it is. But it’s like, yeah, if you’re concerned, then look into it. Absolutely. Alright, well, at the end of every podcast, we ask our guests the same question we ask. If you had one piece of advice to give to our listeners, it can be related to physical therapy or it can just be general life advice. Like always wear sunscreen, eat your broccoli. What would your piece of advice be? We like to put people on the spot.

Melissa Howard (31:02):

I love it. I like to put

Stephanie Landis (31:03):

People on the spot.

Melissa Howard (31:04):

I would say we’re going to give a potty training tip because everybody wants one.

Stephanie Landis (31:09):

There we go.

Melissa Howard (31:09):

If your child is having trouble relaxing on the potty, whether it’s because of sounds or they’re nervous or whatever, bring in a can of bubbles. Have them blow bubbles while sitting on the potty and that can be a real game changer.

Stephanie Landis (31:24):

Interesting. Makes sense for the breath support.

Melissa Howard (31:27):

Yep. Help them relax, get that pelvic floor moving, diaphragm moving we’ll help immensely. And

Stephanie Landis (31:34):

He doesn’t love bubbles.

Melissa Howard (31:35):

That’s right. And I mean bubbles in the house. You know what, parent doesn’t love that

Stephanie Landis (31:41):

Advice. Sorry. In advance. It’s better than saying bring in some glitter.

Melissa Howard (31:45):

That’s right.

Stephanie Landis (31:46):

That’s a great tip. Better than wear. No, I still like wear sunscreen. No. Well, thank you so much for taking time to chat with us today. I really did learn a lot and I’m excited for everyone else to hear this and learn too.

Melissa Howard (32:00):

Thank you all so much for having me. It was fun to

Stephanie Landis (32:02):

Chat.

Meredith Krimmel (32:06):

Thank you for listening to the Un Babbled podcast. For more information on today’s episode, please see our episode description. For more information on the parish school, visit parish school.org. If you’re not already, don’t forget to subscribe to the Un Babbled Podcast on your app of choice. And if you like what you’re hearing, be sure to leave a rating and review. A special thank you to Andy Williams, Joanna Rissmiller, and Molly Weisselberg for all their hard work behind the scenes. Thanks again for listening.