Pediatric Speech-Language Pathology in Health Care One of the best aspects of the field of speech-language pathology is that there is the opportunity to work in a great variety of job settings with very different clinical populations. A new graduate in the field can choose to work exclusively with adults or only with children. For those ... On the Pulse
Free
On the Pulse  |   October 01, 2003
Pediatric Speech-Language Pathology in Health Care
Author Notes
  • Ann W. Kummer, is director of the speech pathology department at Cincinnati Children’s Hospital Medical Center, and professor of clinical pediatrics at University of Cincinnati Medical Center. Contact her at ann.kummer@cchmc.org.
    Ann W. Kummer, is director of the speech pathology department at Cincinnati Children’s Hospital Medical Center, and professor of clinical pediatrics at University of Cincinnati Medical Center. Contact her at ann.kummer@cchmc.org.×
Article Information
Speech, Voice & Prosodic Disorders / On the Pulse
On the Pulse   |   October 01, 2003
Pediatric Speech-Language Pathology in Health Care
The ASHA Leader, October 2003, Vol. 8, 2-12. doi:10.1044/leader.OTP1.08192003.2
The ASHA Leader, October 2003, Vol. 8, 2-12. doi:10.1044/leader.OTP1.08192003.2
One of the best aspects of the field of speech-language pathology is that there is the opportunity to work in a great variety of job settings with very different clinical populations. A new graduate in the field can choose to work exclusively with adults or only with children. For those who prefer pediatrics, there are opportunities in school settings, outpatient clinics, private practices, or health care settings.
Although statistically, pediatric speech-language pathologists in health care settings make up only a small percentage of the ASHA membership, this subgroup of specialists tends to be passionate about the profession and its work setting. Turnover tends to be low, and job satisfaction tends to be high. This type of setting offers unique challenges, but also very unique rewards. As one of my staff members once said, “This is the worst job I have ever had, but it is definitely the best job I have ever had!” (I guess it all depends on the day!)
There are certainly advantages and disadvantages of working in each type of setting—pediatric health care, adult health care, and schools. The sidebar on the right provides a cursory comparison of the characteristics of working in pediatric health care settings with the other two settings.
Typical Populations
The typical population in a pediatric health care facility differs from that of an adult hospital and also from a school setting. Unlike the adult arena, strokes and laryngectomies are not commonly seen in children. In pediatrics, common inpatient diagnoses include head trauma (particularly in teenagers), feeding disorders/dysphagia due to a history of prematurity or neuromuscular disorders, birth defects, tracheal stenosis, or bronchopulmonary dysplasia. Trachs and vents are commonly seen by inpatient pediatric SLPs and those who provide pediatric home care. Patients who require long-term hospitalizations (i.e. hematology/oncology or transplant patients) are commonly seen by SLPs due to developmental issues. Finally, psychology units usually provide a population of patients with language disorders, particularly in the area of pragmatics.
In the outpatient arena, SLPs in a pediatric health care setting commonly treat patients with speech and/or language disorders of unknown etiology. In this setting, however, there are also a large number of patients with developmental disabilities secondary to a history of prematurity, traumatic birth, or neurological problems. Many of the patients are medically fragile. Other common medical diagnoses include hearing loss/cochlear implants, vocal fold nodules/dysfunction, and cleft palate/craniofacial anomalies. Without a doubt, the fastest-growing populations in pediatric health care include patients with apraxia, autism, or feeding disorders.
For more on what makes pediatric speech-language pathology different from adult health care and school settings, see my top 10 list at the right.
Conclusion
The practice of speech-language pathology in a pediatric health care setting is not for everyone. It requires a great deal of intellectual curiosity, a need for a challenge, a willingness to work long hours, and a desire for continuous learning. More than anything, however, it requires a love of children. The rewards are not always monetary. Instead, sometimes the best reward is a child’s smile and hug at the end of a session.

Ann Kummer’s Top 10: What Makes Pediatric Speech-Language Pathology Unique in a Health Care Setting

  1. Kids are not just small adults. Kids are different from adults in many ways: physically, mentally, and emotionally. For example, those professionals who are used to doing video swallow studies (modified barium swallows) on adults are often surprised to find that the pediatric anatomy is not only smaller, but it is also different. An understanding of the differences in anatomy and physiology is important. In addition, kids do not think or behave like adults. When kids are unhappy, they often express this by crying or even screaming. In this type of setting, the SLP must have a certain amount of tolerance and patience to be effective.

  2. There are developmental differences. The communication skills of adults don’t vary from age to age. In pediatrics, however, what is normal at one age may not be normal at another. Therefore, the pediatric SLP needs to not only be an expert in speech-language pathology, but must also be an expert in development. Working with an infant one moment and an adolescent the next requires a big shift in approach and techniques based on developmental aspects. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recognized that these developmental differences must be understood by pediatric health care providers for effective care. As a result, the demonstration of age-appropriate competencies is now required for all staff for JCAHO accreditation.

  3. Energy “blackouts” are not allowed. In pediatrics, you have to be entertaining and “up” all the time. Although the clinician usually receives energy from the child, the child also zaps a great deal of energy from the clinician. This can result in a negative balance so that a full day of pediatric patients can result in a very tired clinician at the end of the day.

  4. I just want to play! Most kids do not respond to an all-business approach. Instead, they just want to have fun. If children are not having fun, they are less likely to cooperate...even if you say “please.” (After all, kids are usually not in treatment by their own choice.) Therefore, the pediatric SLP must find a way to motivate the child by making the treatment fun. This requires the SLP to be well versed in interesting games and activities that will help accomplish a goal, while keeping the child entertained. Knowledge of popular icons (i.e., SpongeBob SquarePants) also helps when interacting with the child. Prizes (a.k.a. bribes) are a must for hard work during the session.

  5. One size does not fit all. Kids come in all shapes and sizes. Therefore, the size of the furniture is a consideration in pediatrics. For infants, mats on the floor or high chairs can be used. There are many devices and chairs that are designed for children of all sizes who have stability problems. Small children require small chairs where their feet will touch the ground. Therapy tables also must be sized so that the child can put his elbows on the table. This requires certain furniture adaptations, such as risers or _platforms in order to put the child at the clinician’s eye level. Most pediatric therapy tables also are specially designed with a cutout for the child. When the table is pushed against a wall, the restless or active child is contained.

  6. How long can they last? Although hour sessions are often best for reimbursement and most efficient from a scheduling perspective, they are not always best for young children. In pediatrics, the session length is often determined by the length of the child’s attention span.

  7. “Time out” is not just for basketball. With kids, you have to know behavior modification techniques...really well! Unfortunately, there is no way to force a child to talk when he decides he doesn’t want to. Getting the child to cooperate is often an art, as well as a science, and it requires the pediatric SLP to be armed with a bag of many psychology tricks.

  8. It’s a package deal. When you work with a child, you also must work with the family. Whether the child is an inpatient or outpatient, the parent is usually with the child and very invested (not just financially) in the child. They demand, and rightly so, to be involved with the treatment process. Therefore, a primary responsibility of a pediatric SLP is to teach the parent to be the therapist at home. On the other hand, family and social issues become the responsibility of the SLP if there is a suspicion of abuse or neglect. In a pediatric setting, these types of social issues commonly result in inpatient admission or a delay in discharge.

  9. Sometimes it’s sad. It is often hard to see sick kids, particularly those with a poor prognosis. It’s difficult to see what families go through in dealing with their concerns, fears, and grief. In working in this type of setting, the SLP has to be prepared to encounter many sad and tragic situations. Although it’s important to remain empathetic, it’s also important to learn to leave those worries and concerns at work.

  10. Kids can be brutally honest. Pragmatic skills, including the skill that we call “tact,” are usually not well developed in young kids. They say what they think, sometimes at inopportune times. If you are having a particularly bad hair day for example, this is likely to be graciously ignored by an adult, but painfully pointed out to you or others by a child.

0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
October 2003
Volume 8, Issue 19