This is what meals should look like.

Today was a good day, I suppose.   I returned to work this week following a two week medical leave.  Today was a first visit with a new family.  I am their third speech therapist, and their child is 2 years 4 months old.  He has Down’s.  As I gathered therapeutic history, I asked at what age Noah* began therapy.  Mom responded that his first therapist came when he was about 6 months old.  That’s great, I thought.  “but” mom continued, “she said she wouldn’t do anything with his mouth.”  So, after a month of watching the therapist shake rattles at Noah, mom ended therapy.  Strike 1.

I continued with therapy history.  The second therapist came in when Noah was just over a year old.  He was not gaining enough weight.  He wouldn’t eat, had tremendous difficulty with texture, and often vomited.  At one point he had bouts of diarrhea.  Mom reported that she was happy the second therapist was going to address Noah’s feeding problem, someone would help him with his oral skills.  Mom said that it only got worse.  Therapist #2 said that Noah should learn to eat more solid food, and suggested moving to stage 3 & 4 baby foods.  Eating became an unpleasant daily occurrence for Noah and the family.  Therapist # 2 began to force feed him, holding Noah’s arms down, insisting that his behavior was a stage and it would pass.  Therapist #2 insisted that Noah could not go to school eating baby food.  I sat listening to mom, taking the information in, thinking how horrible for Noah.  Mom continued to explain that she was concerned watching therapy sessions.  Noah would cry as soon as food was brought out.  She felt meals were becoming a punishment to him.  She brought her concerns to her GI during a visit.  The GI confirmed that force-feeding was not the solution and agreed to consult with Therapist #2.  Mom said that after the consult, Therapist #2 did not force Noah to eat for the next session.  Then things returned to the same.  Mom ended therapy shortly after.  Strike 2.

Unfortunately, this is not the first family I have taken on as clients with poor therapy experiences.  I suppose they won’t be the last.  I am acutely aware of how much trust we, therapists, inherently acquire when we begin services.  We are the experts in our field.  Most families have little or no knowledge of treatment or materials.  They take our recommendation, most times without question.  That’s a lot of power to wield.

To families that have had less than stellar therapy experience I say this: All therapists are not created equal.  It is in your right to end treatment, seek another therapist, and to question what goes on in your session.  A good therapist will explain why he/she is doing what he/she does.  That person will welcome your questions and provide you evidence based treatment choices.  The goals treated should be based on what YOUR FAMILY wants and needs.   The child he/she is treating is YOURS after-all.


To my fellow therapists, I encourage you to grow.  I encourage you to research.  I also encourage you to change professions or populations if you are just showing up.

If your vision and heart aren’t in your practice, then why are you doing this job?  There is no room for adequate therapy, mediocre treatment, or rattle waving.  Turn in your rattle.  Have the integrity to decline a client because you are not familiar or comfortable treating that child’s disorder or syndrome.  Refer out.  Make connections with other therapists.  Excuse yourself.  If you find yourself in a position that does not hold your client’s well-being of utmost importance, discharge yourself from the case.  Read your ethical code.

I think I’m done venting.  It was a good day, for the most part.