The Untethered Podcast™

Healthcare is undergoing a radical paradigm shift. For orthodontists, pediatric therapists, and airway specialists, delivering transformative patient care requires moving far beyond basic mechanical interventions to treat the whole patient - and their family’s underlying nervous system regulation.

In this episode, Hallie Bulkin sits down with Dr. Catherine "Cathy" Murphy, DDS, MSD, a pioneer in holistic, patient-centered orthodontic consulting and collaborative care. Dr. Murphy reflects on her transition from traditional orthodontic practice to a holistic model rooted in connection, clinical intuition, and interdisciplinary partnership.

Dr. Catherine (Cathy) Murphy, DDS, MSD, is an orthodontist, practice consultant, and advocate for holistic, patient-centered healthcare. She partners with orthodontic facilities across the country to establish and enhance collaborative care models and specialized patient-focused programs. Dr. Murphy is passionate about interdisciplinary collaboration, nervous system regulation, preventing clinician burnout, and empowering families through education.

• Transitioning to Holistic Care: Shifting from standard mechanics to a whole-body, patient-centered model that prioritizes root-cause health.
• Combating Clinician Burnout: Implementing practical self-care strategies, self-awareness, and clear clinical boundaries to sustain high-level practice.
• Harnessing Clinical Intuition: Understanding how subconscious pattern recognition allows experienced providers to process complex clinical data rapidly.
• Nervous System & Family Dynamics: Recognizing how parental stress and emotional regulation directly influence a child’s progress and appliance compliance.

• 01:51 - Dr. Catherine Murphy’s Evolution from Traditional Orthodontics to Patient-Centered Care
• 05:36 - The Reality of Clinician and Parent Burnout
• 11:00 - Integrated Care vs. Simple Interdisciplinary Collaboration
• 14:10 - Managing Patient Anxiety and Family Nervous System Dynamics
• 17:48 - Why Dr. Catherine Murphy Reframes Standard "Airway" Terminology
• 20:54 - The Role of Appliances in a Holistic Treatment Model
• 28:26 - Setting Healthy Professional and Personal Boundaries to Prevent Compassion Fatigue
• 39:22 - Patient-Centered Communication: Addressing the Child Directly in Care
• 43:40 - Daily Self-Care Practices for Long-Term Practice Sustainability

• Connect with Dr. Cathy Murphy: Explore practice consulting, books, and resources at CatherineMurphy.com.
• Follow Dr. Cathy on Social Media: Connect on Instagram @drcatherinemurphy.
• Fast Myo Screening Tool: Identify functional, structural, and airway red flags during intake at FastMyoScreening.com.
• Go beyond traditional continuing education with clinical mentorship, expert-led trainings, collaborative case discussions, and a community of SLPs, OTs, and PTs committed to treating the whole child. Explore https://theintegratedtherapist.com/

The Evidence Based Research Behind Tethered Oral Tissues with Richard Baxter, DMD, MS (Ep 137)

Episode 137: The Evidence Based Research Behind Tethered Oral Tissues with Richard Baxter, DMD, MS

Why Some Cases Stay Stuck: The Clinical Thinking That Changes Outcomes (Jul 20, 2026)

Why Some Cases Stay Stuck: The Clinical Thinking That Changes Outcomes

STAY CONNECTED

💬 Join the Conversation: Connect with Dr. Cathy on https://www.instagram.com/drcatherinemurphy/ or visit https://drcatherinemurphy.com/ and Follow with Hallie for weekly clinical takeaways, case study breakdowns, and program updates on Instagram | Facebook | LinkedIn.

If Dr. Cathy's perspective on holistic orthodontics, clinician burnout, and nervous system regulation resonated with you, please take a quick moment to leave a review! Your support helps us share these vital clinical conversations with therapists and providers everywhere.

Hosted on Acast. See acast.com/privacy for more information.

In a digital age where social media posts and quick photos often drive clinical discussions, it is easy to mistake an anatomic tether for a definitive diagnosis. However, looking at a static picture of a lingual frenulum tells you almost nothing about how that tongue functions in real time during feeding, speech, or sleep.

In this solo masterclass, Hallie Bulkin revisits the nuanced and evolving landscape of pediatric tethered oral tissues (TOTS). She breaks down why clinical decision-making must always prioritize functional limitations over visual appearances.

Hallie explores how children build compensation strategies, when those compensations become exhausting or harmful, and how restricted tongue mobility interacts with underlying airway and sleep architecture. She also outlines a child-centered framework for pre- and post-release therapy, informed consent, and knowing when a surgical referral is truly warranted.

• Anatomy vs. Function: Why a photograph or visual inspection alone can never determine whether a tongue tie requires surgical release.
• Evaluating Compensations: Identifying when a child's compensatory movements are masking deeper motor fatigue, inefficient feeding, or speech breakdown.
• Airway & Sleep Interplay: Understanding how restricted lingual mobility coexists with mouth breathing, high-arched palates, and compromised sleep quality.
• The Clinical Reasoning Checklist: Asking what isn't functioning, what evidence exists, and whether targeted therapy alone can achieve functional goals.

"You haven't seen how the tongue moves if you're only looking at a picture - function always trumps anatomy."

"True clinical confidence isn't knowing how to spot a tie; it's understanding what the patient actually needs to function efficiently."

"Ask yourself: what isn't functioning, what evidence do you have, and how does this affect the child's whole system?"

• 00:00 – Reflection on Episode 184 and Evolving Clinical Reasoning
• 00:37 – Introduction to The Untethered Podcast
• 01:14 – Shifting the Focus: Assessing Function over Anatomy
• 01:46 – Moving Beyond the "Tongue Tie Debates" and Binary Mindsets
• 02:23 – Defining Ankyloglossia (Tongue Tie) vs. Tissue Appearance
• 03:41 – The "Function, Form, Impact, Decision" Framework
• 04:00 – Evaluating Tongue Mobility and Function
• 04:50 – Analyzing Compensatory Strategies in Patients
• 05:33 – Assessing Functional Impact on Feeding and Speech
• 07:18 – Airway Considerations and Coexisting Factors
• 08:38 – The Connection Between Speech Sound Disorders and Tongue Ties
• 09:30 – Recognizing When Therapy Progress Hits an Anatomical Ceiling
• 10:35 – Effective Interprofessional Collaboration and Referral Workflows
• 11:53 – Pre- and Post-Release Rehabilitation Care
• 12:33 – Individualized Care vs. Standardized Protocols (Infant & Pediatric Considerations)
• 14:34 – Putting the Patient (Not the Tissue) at the Center of Care
• 14:51 – Practical Key Questions to Ask in Your Clinical Practice
• 16:44 – The Ultimate Goal of Integrated Clinical Reasoning
• 17:16 – Tongue Tie Boot Camp & Ep. 184 Listener Challenge
• 18:12 – Outro & Legal Disclaimer

• Become the Pediatric Feeding Therapist Who Knows Exactly What to Do With Every Child https://www.feedthepeds.com/.

• Episode 184: Not All Ties Need to be Released.
• Why Some Cases Stay Stuck: The Clinical Thinking That Changes Outcomes.

💬 Join the Conversation: Connect with Hallie for weekly clinical takeaways, case study breakdowns, and program updates on Instagram | Facebook | LinkedIn.

If Hallie's insights on functional assessment and clinical reasoning gave you a fresh perspective on tethered oral tissues, please take a quick moment to leave a review! Your support helps us share these vital clinical frameworks with therapists everywhere.

Hosted on Acast. See acast.com/privacy for more information.

When pediatric therapists treat feeding and speech in isolation, critical underlying root causes are easily overlooked. From jaw instability and retained primitive reflexes to phonological processes that are actually unaddressed motor speech deficits, true clinical progress requires an integrated, whole-system framework.

In this episode, Hallie Bulkin welcomes back returning guest Samy Hernandez, M.S., CCC-SLP, TSSLD, ASDCS, CPFT™, a pediatric speech-language pathologist at B Well Tots. Samy reflects on her clinical evolution since becoming one of the very first Certified Pediatric Feeding Therapists™ and making the pivotal decision to integrate Orofacial Myofunctional Therapy (OMT) and Oral Placement Therapy (OPT) directly into her practice.

Samy Hernandez is a licensed and certified Speech-Language Pathologist, Certified Autism Spectrum Disorder Clinical Specialist (ASDCS), and Certified Pediatric Feeding Therapist™ (CPFT™) at B Well Tots, where she provides neurodiversity-affirming, child-led therapy built through trust, play, and curiosity.

• Two Sides of the Same Coin: Why pediatric feeding therapy and myofunctional therapy (OMT) cannot be separated when treating complex oral-motor and airway challenges.
• How OPT & OMT Enhance Practice: Integrating Oral Placement Therapy (OPT) and myofunctional tools to strengthen diagnostic precision and treatment outcomes.
• Rethinking Speech Sound Hierarchies: Questioning traditional phonological processes and exploring how motor speech hierarchies provide a clearer roadmap for children with PFD and OMD.
• Interdisciplinary Team Care: Structuring seamless collaboration between SLPs, OTs, ENTs, and bodyworkers working toward shared goals for the same child.

"Pediatric feeding therapy and myofunctional therapy were never two separate things - they are two sides of the same coin."

"When you evaluate speech through a motor speech hierarchy, you realize how many 'phonological processes' are actually unaddressed jaw instability."

01:25 – Guest Introduction: Hallie Bulkin introduces speech-language pathologist Samy Hernandez.

02:14 – Clinical Practice Updates: Samy Hernandez shares updates on moving to Philadelphia and incorporating myo therapy into her daily practice.

05:00 – Airway & ARFID: Samy Hernandez and Hallie Bulkin discuss addressing root airway issues before treating feeding disorders.

16:50 – Motor vs. Phonology: Hallie Bulkin and Samy Hernandez explore how speech errors often stem from motor constraints rather than phonological processes.

26:03 – Jaw Stability & Speech: Samy Hernandez and Hallie Bulkin detail how jaw grading directly impacts speech sounds like /r/.

34:47 – Neurodiversity-Affirming Myo: Samy Hernandez explains adapting myofunctional therapy for autistic children using sensory movement and play.

• Connect with Samy Hernandez on Instagram @happyhandsSLP : Book an appointment, explore clinical services, and view practice resources at B Well Tots.
• Become the Pediatric Feeding Therapist Who Knows Exactly What to Do With Every Child https://www.feedthepeds.com/.

• Seeing It vs. Understanding It: The Gap in Myo Training.
• Why Some Cases Stay Stuck: The Clinical Thinking That Changes Outcomes.

💬 Join the Conversation: Connect with Samy on Instagram @happyhandsSLP or at B Well Tots and follow Hallie for weekly clinical takeaways, case study breakdowns, and program updates on s on Instagram | Facebook | LinkedIn.

If Samy's insights on jaw grading, motor speech hierarchies, primitive reflexes, and neurodiversity-affirming care broadened your clinical perspective, please take a quick moment to leave a review! Your support helps us share these vital clinical conversations with therapists everywhere.

Hosted on Acast. See acast.com/privacy for more information.

Navigating healthcare billing is about to undergo a massive structural shift. For speech-language pathologists, feeding therapists, and private practice owners, the sunsetting of long-standing core CPT codes requires proactive preparation, documentation adjustments, and clear system updates.

In this episode, Hallie Bulkin unpacks the upcoming 2027 CPT code overhaul for speech and feeding therapy services. Most notably, standard CPT code 92507 will be replaced by five distinct, specialized codes covering fluency, speech sounds, language, combined speech and language, and voice upper airway dysfunction.

Hallie breaks down how to report multiple services provided on the same day, navigate payer-specific policies, apply modifier 59 correctly, and utilize time-based add-on codes using midpoint timing rules. She also discusses the business and clinical importance of building internal feeding therapy expertise to optimize patient care and ensure long-term practice sustainability.

• The Replacement of CPT 92507: Preparing for 2027, where 92507 will split into five targeted codes for fluency, speech sound disorders, language, combined speech-language, and voice/upper airway dysfunction.
• Same-Day Multiple Service Reporting: Understanding how to accurately report distinct clinical services on the same date of service without triggering claim denials or unbundling errors.
• Applying Modifiers & Timing Rules: Utilizing modifier 59 effectively and calculating session midpoints for time-based add-on codes to secure appropriate reimbursement.
• Navigating Payer Reductions: Managing payment adjustments, commercial insurance policies, and Medicare guidelines when billing multiple codes per session.
• Building Internal Feeding Skills: Expanding internal clinical skill sets to keep pediatric feeding care in-house, reducing unnecessary external referrals while growing practice offerings.

"CPT code 92507 will be replaced by five distinct, specialized codes in 2027—preparing your documentation systems now is essential for practice compliance."

"Timing rules and session midpoints dictate when add-on codes can be reported to support accurate, defensible reimbursement."

"Understanding payer-specific policies and modifier applications allows you to protect your practice against underbilling or accidental unbundling."

• 00:00 — Introduction: Reporting Speech and Feeding Together
• 00:26 — Welcome to The Untethered Podcast & Oral Rest Posture Reminder
• 01:02 — Upcoming CPT Code Changes: Goodbye 92507, Hello 10 New Codes for 2027
• 02:21 — Code Bundling vs. Reporting Distinct Services on the Same Day
• 03:06 — Current Billing Landscape: Speech (92507) and Swallowing/Feeding (92526)
• 04:28 — 2027 Session Examples: Midpoint Timing Rules with Speech and Feeding
• 07:06 — Comparing Combined Speech-Language Codes vs. Separate Treatment (Speech Sounds & Voice)
• 11:56 — Expanding Pediatric Feeding Services in Your Practice & Team Mentorship
• 14:27 — Free 3-Day Training Announcement: "Screen the Peds to Feed the Peds"
• 15:43 — Episode Disclaimer, Review Call to Action, and Outro

• FREE TRAINING: Screen The Peds to Feed The Peds Training.

WORTH A LISTEN: CONTINUE YOUR JOURNEY

• What Myofunctional and Feeding Therapists Need to Know About Scope, Coding, and Documentation (Ep 386).
• Screening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference (Ep 380).

💬 Join the Conversation: Connect with Hallie for weekly clinical takeaways, case study breakdowns, and program updates on s on Instagram | Facebook | LinkedIn.

If this episode helped clarify the upcoming CPT code changes and billing rules for your practice, please take a quick moment to leave a review! Your support helps us share these vital business and clinical insights with therapists everywhere.

Hosted on Acast. See acast.com/privacy for more information.

When a baby struggles with infant feeding, weight gain, or subtle airway restrictions, parents are frequently told to "wait and see." Yet, waiting often turns minor early red flags into complex speech, feeding, and oral-motor challenges down the road.

In this episode, Hallie Bulkin sits down with Mackenzie Shiba, M.S., CCC-SLP, CMT®, pediatric speech-language pathologist, certified myofunctional therapist, and founder of Communication Blooms Speech Therapy. Mackenzie shares her personal transition from clinician to a late-night searching parent when her own son faced unexpected feeding and growth struggles. That journey revealed a critical gap in early pediatric guidance and inspired her to build The Blooms Blueprint - a comprehensive roadmap for parents spanning six age windows from birth to age two.

Together, Hallie and Mackenzie discuss why "the mouth that eats is the mouth that talks", how to differentiate between common infant behaviors and true structural airway red flags, and why a parent's gut instinct is valid clinical data. They unpack actionable strategies for empowering caregivers, facilitating early interdisciplinary care, and shifting from reactive diagnoses to proactive developmental support.

Key Topics & Takeaways

• The 2 AM Googler Reality: How personal experience with infant feeding and growth struggles drives the need for clear, proactive parental guidance.
• Retiring "Wait and See": Shifting the clinical and pediatric culture from passive waiting to active, supportive observation and early action.
• The Interconnected Mouth: Understanding why feeding, oral-motor function, airway patency, and early speech are fundamentally linked ("the mouth that eats is the mouth that talks").
• The Blooms Blueprint Framework: Breaking down six key developmental windows from birth to age two to help families spot small red flags early.

Soundbites

"We need to retire 'wait and see' because it leaves worried parents sitting at home carrying that heavy burden alone."

"The mouth that eats is the mouth that talks—feeding, airway, oral motor, and early speech development are completely interconnected."

"Airway is the conversation nobody is having with new parents, but common isn't the same as fine."

Timestamps

• 01:16 Guest Introduction: Mackenzie Shiba, M.S., CCC-SLP, CMT® 
• 02:16 From Clinician to 2 AM Googler: Mackenzie's Personal Journey 
• 05:44 Shared Experiences: Navigating Low Percentiles, Triple Feeding & System Gaps 
• 12:44 Having Non-Alarmist Airway Conversations with Parents 
• 25:00 Root Causes of Speech Patterns: Motor Patterns vs. Phonological Processes 
• 27:00 Hidden Red Flags: Maternal Oversupply & Missed Airway Signals 
• 38:08 Practical Action Steps: 1-Minute Daily Hacks for Caregivers 
•  43:03 How Myofunctional Therapy Shifts Clinical Practice 
• 47:40 Clinicians as Community Leaders: Disrupting the Status Quo 
• 55:24 Where to Connect with Mackenzie Shiba & Access The Blooms Blueprint 

Links & Resources

• Connect with Mackenzie Shiba: Explore resources and follow Mackenzie on Instagram @thebloomsblueprint and @communicationblooms.
• Access The Blooms Blueprint: Get the guide for infant and toddler developmental milestones at The Blooms Blueprint Guide.
• FREE TRAINING: Learn how structural airway limits directly affect feeding in our free Screen The Peds to Feed The Peds Training.

WORTH A LISTEN: CONTINUE YOUR JOURNEY

• Why Some Cases Stay Stuck: The Clinical Thinking That Changes Outcomes.
• Mouth Breathing vs. Nasal Breathing: Changing Lives Through Early Airway Intervention.

STAY CONNECTED

💬 Join the Conversation: Connect with Mackenzie on Instagram @thebloomsblueprint and follow Hallie for weekly clinical takeaways, case study breakdowns, and program updates on s on  Instagram | Facebook | LinkedIn.

If Mackenzie's proactive approach to infant feeding and airway health empowered your clinical practice or parenting journey, please take a moment to leave a review! Your support helps us share these vital early intervention frameworks with families and providers everywhere. 

Hosted on Acast. See acast.com/privacy for more information.

One of the biggest hurdles clinicians face when transitioning into pediatric feeding therapy is realizing that traditional graduate coursework and isolated weekend seminars often leave massive gaps in clinical application. Too many training programs treat pediatric feeding as if it were simply adult dysphagia scaled down—focusing strictly on oral-motor mechanics while ignoring the child's entire developing system.

In this episode, Hallie Bulkin dives into the structural gaps of traditional feeding education and explains why treating a child requires an integrated, whole-system lens. She breaks down real-world case examples to demonstrate how behaviors like extreme texture selectivity or mealtime refusal are frequently symptoms of underlying postural instability, airway restriction, or sensory overload.

Hallie offers practical strategies to help clinicians move away from single-lens troubleshooting and develop the deep clinical reasoning required to connect isolated observations, uncover root causes, and create transformative intervention plans.

• Pediatric vs. Adult Dysphagia: Why pediatric feeding cannot be treated as scaled-down adult management and requires a developmental, whole-body framework.
• The Training Gap: Unpacking why standard feeding courses teach disconnected techniques rather than showing clinicians how to synthesize complex data.
• Systemic Interconnectedness: Understanding how posture, airway, sensory processing, and nervous system regulation directly dictate oral-motor performance.
• Redefining Clinical Reasoning: Shifting from "What exercise fixes this behavior?" to "What is this behavior telling me about the child's underlying system?"
• Root-Cause Assessment: Transitioning away from symptom chasing to evaluate foundational barriers and build defensible, effective treatment plans.

"Pediatric feeding isn't adult dysphagia scaled down—it is a complex, dynamic, developmental system."

"Traditional training teaches isolated pieces of the puzzle, but rarely shows clinicians how to connect them at the evaluation table."

"Effective feeding therapy requires us to look at the child's whole system. Symptoms are just clues pointing us toward the underlying root cause."

• 00:00 - Is What You See the Actual Problem?
• 00:44 - Welcome to The Untethered Podcast
• 01:20 - Why Grad School Didn't Prepare Us for Pediatric Feeding
• 02:26 - When 12 Complex Feeding Cases Land on Your Case Load
• 03:50 - Pediatric Feeding vs. Adult Dysphagia: A Different Operating System
• 05:00 - The Gap in Training & Connecting the Dots
• 06:41 - Case Example: Is It Sensory Refusal or Motor Difficulty?
• 08:24 - Looking Beyond Behavior to Find the Underlying Cause
• 09:03 - Avoiding "Hammer Lenses" (Airway, Sensory, & Motor Silos)
• 10:13 - Being Licensed Doesn't Magically Create Competency
• 11:27 - Why Continuing Education Alone Isn't Enough
• 13:13 - Developing True Clinical Reasoning
• 13:41 - Screen the Peds to Feed the Peds (Free 3-Day Training)
• 15:10 - Actionable Challenge for Your Hardest Case
• 16:16 - Episode Disclaimer & Outro

• FREE TRAINING: Learn how structural airway limits directly affect feeding in our free Screen The Peds to Feed The Peds Training.

• Why Some Cases Stay Stuck: The Clinical Thinking That Changes Outcomes.
• Screening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference.

Hosted on Acast. See acast.com/privacy for more information.

In this episode, Hallie Bulkin sits down with Shayla Bollman, MA, CCC-SLP, CPFT, CLC, to discuss her journey as a pediatric speech-language pathologist and how earning her Certified Pediatric Feeding Therapist (CPFT) credential transformed her clinical evaluation process, treatment approach, and referral network.

Shay shares practical strategies for responsive feeding, differentiating gagging from choking to ease caregiver anxiety, and managing pre- and post-operative care for tongue-tie releases. She also breaks down how blending lactation counseling with feeding therapy strengthens family advocacy, builds caregiver confidence, and creates sustainable, in-home support for complex infant feeding cases.

Shayla (Shay) Bollman is a licensed Speech-Language Pathologist with seven years of clinical experience in outpatient pediatric settings. She is a Certified Pediatric Feeding Therapist™️ (CPFT™️), Certified Lactation Counselor (CLC), and holds an interdisciplinary autism certification. Shay specializes in pediatric and infant feeding, tethered oral tissues (TOTS), bottle refusal, and supporting families through complex feeding transitions. Her clinical approach is responsive, family-centered, and focused on the whole child.

• The CPFT Certification Impact: How advanced clinical training shifts diagnostic reasoning, evaluation depth, and interdisciplinary referral strategies.
• Pre- & Post-Op TOTS Care: Why comprehensive pre-surgical preparation and targeted post-operative wound management are vital for successful release outcomes.
• In-Home Care & Parent Advocacy: Empowering families with practical, sustainable mealtime strategies and bridging communication between pediatricians, specialists, and caregivers.

"Holistic assessment is crucial for effective feeding therapy—we have to evaluate the entire developmental picture, not just the mouth."

"Building a collaborative team and offering in-home family support makes a profound difference in a child's feeding progress."

"Helping parents understand the clinical difference between a gag and a choke is essential for mealtime safety and peace of mind."

01:04 - Guest Introduction: Shayla Bollman, MA, CCC-SLP, CPFT, CLC

02:00 - Impact of CPFT Certification on Diagnostic Reasoning & Practice Growth

07:06 - Empathy in Infant Feeding: Transitioning to Infant Clinical Care

12:16 - Understanding Feeding Refusal in Infants

15:15 - Blending Lactation Counseling (CLC) with Pediatric Feeding Therapy

19:08 - Assessing Tethered Oral Tissues (TOTS): Bodywork & Functional Milestones

22:08 - Pre- and Post-Op Care for Tongue-Tie Releases

46:20 - Raising Intuitive Eaters: Long-Term Impacts of Mealtime Support

49:38 - Interdisciplinary Advocacy: Partnering with Pediatricians & Specialists

53:42 - In-Home Care, Caregiver Classes & Launching Private Practice

58:02 - Connecting with Shayla Bollman

• Connect with Shayla Bollman: Follow Shay’s clinical tips, private practice updates, and caregiver resources on Instagram @shaybollman.
• FREE TRAINING: Learn how structural airway limits directly affect feeding in our free Screen The Peds to Feed The Peds Training.

• Episode 137: The Evidence Based Research Behind Tethered Oral Tissues with Richard Baxter, DMD, MS.
• Screening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference.

💬 Join the Conversation: Connect with Shay on Instagram @shaybollman and follow Hallie for weekly clinical takeaways, case study breakdowns, and program updates on  Instagram | Facebook | LinkedIn.

If Shay’s insights on responsive infant feeding and parent advocacy helped clarify your approach to complex cases, please take a moment to leave a review! Your support helps us share these vital clinical frameworks with therapists and families everywhere.

Hosted on Acast. See acast.com/privacy for more information.

When feeding therapy stalls, it is rarely because a clinician lacks exercises - it is usually because intervention began before the child’s foundational systems were fully understood. Trying to fix oral-motor mechanics without addressing postural stability, airway integrity, or sensory overload is like building a house on sand.

In this episode, Hallie Bulkin shares a structured, child-centered framework for pediatric feeding therapy that moves clinicians away from reactive "symptom chasing" and toward deep clinical reasoning. She breaks down the critical distinction between preliminary screening and comprehensive assessment, explaining how to connect isolated clinical observations into actionable patterns.

Hallie highlights why posture, breathing, and nervous system regulation must be evaluated before asking the mouth to perform. She also discusses how to prioritize barriers based on the whole child, collaborate effectively with medical providers, and implement proactive strategies that build lasting trust with families.

• Foundation Over Function: Why postural alignment, airway patency, and sensory processing must be stabilized before targeting oral-motor skill development.
• Pattern Recognition vs. Symptom Chasing: How to connect individual clinical observations into cohesive patterns that reveal the true root cause of feeding difficulties.
• Screening vs. Comprehensive Assessment: Understanding where screening ends and formal diagnostic assessment begins to avoid premature intervention plans.
• Proactive vs. Reactive Therapy: Shifting from session-by-session troubleshooting to a clear, milestone-driven roadmap.
• Interdisciplinary Medical Collaboration: How and when to bring in medical partners (ENTs, GI, bodyworkers, dentists) to address systemic barriers to progress.

"Feeding does not happen in a silo - it requires the synchronized support of posture, airway, sensory, and nervous system regulation."

"Assess the child's foundation before asking the mouth to perform. If the body is fighting for balance or air, feeding will always be secondary."

"Symptoms are information, not the starting point. Our job is to trace those symptoms back to the underlying root cause."

• 00:01:43 - The Need for a Structured Clinical Framework
• 00:02:35 - Case Example: Why Feeding Does Not Happen in a Silo
• 00:04:34 - Connecting the Dots in Feeding Evaluations
• 00:05:08 - Assessing the Child's Foundation (Postural, Airway & Regulation)
• 00:06:13 - Functional Feeding Assessment vs. Isolated Screening
• 00:07:36 - Prioritizing Barriers and Building a Clinical Plan
• 00:08:29 - Clinical Decision Examples (Posture, Airway, Trauma & Skill)
• 00:10:12 - Stop Chasing Symptoms: Ask What the Behavior is Showing
• 00:11:20 - Moving From Reactive Care to Proactive Care
• 00:12:02 - Building Pattern Recognition & True Clinical Confidence
• 00:14:42 - Key Takeaways for Feeding Therapists
• 00:15:18 - Feed The Peds Training Announcement & Waitlist

• FREE TRAINING: Learn how structural airway limits directly affect feeding in our free Screen The Peds to Feed The Peds Training.

• Why Some Cases Stay Stuck: The Clinical Thinking That Changes Outcomes.
• Screening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference.

Hosted on Acast. See acast.com/privacy for more information.

When a child presents with sleep-disordered breathing, chronic mouth breathing, or persistent feeding challenges, evaluating the upper airway becomes a top priority. However, determining when conservative management is sufficient versus when surgical intervention - like a tonsillectomy or adenoidectomy - is required can be complex for both parents and providers.

In this episode, Hallie Bulkin sits down with pediatric ENT specialist Dr. Ariel Grobman to break down the clinical nuances of pediatric airway evaluation. Dr. Grobman shares expert insights into physical examination techniques, the practical role of nasoendoscopy, and when sleep studies are truly necessary versus when visual and functional markers dictate action.

Together, they explore post-surgical recovery expectations, adenoid regrowth, secondary causes of nasal obstruction like enlarged turbinates, and the critical link between airway dysfunction, ear infections, and feeding difficulties. Dr. Grobman also emphasizes the essential role of interdisciplinary collaboration between ENTs, myofunctional therapists, and airway-focused orthodontists.

Dr. Ariel Grobman is a board-certified Otolaryngologist (Ear, Nose, and Throat surgeon) specializing in pediatric and adult airway management, sinus disorders, and head and neck surgery. Dr. Grobman is dedicated to taking an integrative, patient-centered approach to airway health, helping families navigate complex decisions regarding tonsillectomy, adenoidectomy, and nasal airway procedures. He works closely with multidisciplinary teams of speech pathologists, myofunctional therapists, and dentists to ensure comprehensive, root-cause care.

• Airway Risk Assessment: Why establishing danger and the severity of airway restriction is the primary step in evaluating pediatric sleep issues.
• Surgical Indications & Outcomes: Understanding real-world expectations, recovery protocols, and regrowth potential following tonsillectomy and adenoidectomy.
• Interdisciplinary Collaboration: Why optimal patient outcomes rely on close coordination between ENTs, airway-focused orthodontists, and myofunctional providers.

"Assessing danger and functional impact is always the most important first step."

"A detailed physical exam combined with clinical history can often replace the need for a cumbersome sleep study."

"Nasal endoscopy is quick, minimally invasive, and gives us immediate answers about structural obstructions."

• 01:03 - Guest Introduction: Dr. Ariel Grobman
• 02:46 - Assessing Tonsils & Adenoids in Pediatric Patients
• 06:51 - Indications for Pediatric Sleep Studies
• 07:11 - Physical Examination & In-Office Nasal Endoscopy
• 15:54 - Adenoidectomy vs. Tonsillectomy: Procedures & Recovery
• 20:40 - Tissue Regrowth & Root Causes of Adenotonsillar Hypertrophy
• 22:13 - Addressing Persistent Mouth Breathing & Role of Myofunctional Therapy
• 36:56 - Managing Complex Pediatric Airway & Feeding Cases
• 40:29 - Indications for Middle Ear Fluid Drainage & PE Tubes
• 44:34 - Airway-Focused Orthodontics & Palatal Expansion
• 49:09 - Where to Find Dr. Ariel Grobman & Closing Remarks

• Connect with Dr. Ariel Grobman: Learn more about his practice and patient resources at Ariel Grobman MD.
• Fast Myo Screening Tool: Identify structural airway red flags and breathing compensations at FastMyoScreening.com.

• Don’t Ignore the Snore: The Hidden Link Between Airway, Sleep, and ADHD.
• Mouth Breathing vs. Nasal Breathing: Changing Lives Through Early Airway Intervention.

If Dr. Grobman's insights helped clarify your understanding of pediatric airway assessments and surgical indications, please take a moment to leave a review! Your support helps us share these vital clinical discussions with providers and families everywhere.

Hosted on Acast. See acast.com/privacy for more information.

For many speech-language pathologists, occupational therapists, and myofunctional providers, billing and documentation feel like navigating an ever-shifting maze. Between selecting appropriate CPT codes, justifying medical necessity, and adhering to strict scope-of-practice guidelines, clinicians often struggle to ensure proper reimbursement while remaining compliant.

In this episode, Hallie Bulkin breaks down the essential mechanics of billing for myofunctional therapy services. She addresses common points of confusion around core codes - such as CPT 92526 (treatment of swallowing dysfunction and/or oral function for feeding) and 92507 (speech/language treatment) - and offers practical strategies for documenting functional gains accurately.

Hallie also previews upcoming CPT code updates slated for 2027, shedding light on how these structural changes will impact private pay practices, electronic health records (EHRs), and clinical workflows. Whether you are navigating insurance reimbursement or operating an out-of-network practice, this episode equips you with the clarity needed to code with confidence and integrity.

• Deconstructing CPT 92526 vs. 92507: Clarifying the distinct clinical applications for swallowing/feeding dysfunction versus speech and language treatment.
• The 2027 CPT Code Shift: Preparing your practice, EHR templates, and clinical documentation for upcoming coding structure changes.
• Scope of Practice & Provider Eligibility: Understanding state licensing, board regulations, and billing qualifications across different therapeutic disciplines.
• Defensible Documentation: Crafting objective, function-focused clinical notes that justify medical necessity and withstand insurance audits.
• Out-of-Network & Private Pay Strategies: Equipping cash-pay practices with accurate super/ superbill documentation to help patients seek reimbursement seamlessly.

"A CPT code isn't just a billing number - it is a translation of your clinical documentation and direct scope of practice."

"When preparing for coding changes, proactive documentation systems protect both your practice and your patients."

"Bill for what you treat, document what you see, and ensure every note clearly establishes functional necessity."

• 00:00:00 - 3 Verification Steps Before Coding
• 00:04:23 - Deep Dive: Myo & CPT Code 92526
• 00:06:37 - Reporting 92526 & 92507 Together
• 00:09:45 - Provider Scope & License Boundaries
• 00:13:47 - Dental Hygienist (RDH) Reimbursement Reality
• 00:15:53 - Strong vs. Weak Documentation Examples
• 00:18:16 - Private Pay & Superbill Responsibilities
• 00:19:42 - 2027 Deletion of 92507
• 00:20:47 - Why 92507 Was Flagged by AMA/CMS
• 00:26:26 - Private Practice Transition Strategy
• 00:27:43 - Clinical Reasoning vs. Endless Exercises
• 00:29:01 - Immediate Action Plan

• Fast Myo Screening Tool: Streamline your intake documentation and baseline evaluations at FastMyoScreening.com.

• Screening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference.
• How Root Cause Assessment Changes Feeding and Speech Outcomes.

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