Happy PFD Awareness Month! And shout out to the depths of Instagram for introducing me to Bri Miluk, a.k.a. @pediatricfeedingslp. Bri is an AMAZING pediatric feeding therapist and emerging leader in our field. When I discovered that we are the same age, I guffawed. In her short career, she has already done SO much to better our field and build a community of practice for those treating pediatric feeding disorders.
Well, on my rabbit hole of exploring pediatric feeding IG pages, I came across Bri’s handle and, truly, I struck gold. I instantly shared with all my SLP friends. Bri’s feed provides alllllll things PFD from evidence-based recommendations for practical therapy strategies, case studies with an analytical discussion in the comments, to a hilarious compilation of relatable reels that have had me cackling behind my screen. As I learned more about Bri through her social media presence, I realized that she is doing way more than just posting stories and sharing research. She also leads her own Pediatric Feeding Therapy Mentorship Group, which is INGENIOUS and the first of its kind. The PFT Mentorship Group is way more than a CEU course. It is a 4-week program that includes weekly lessons, a huge collection of quick reference handouts for families, and weekly live calls to discuss case studies and real-life application of the concepts. I decided to enroll in the program (yay ASHA CEUs) and absolutely loved it. I learned SO much and left feeling much more confident about my caseload. It also allowed me to connect with so many other feeding therapists in a space where we continue to problem solve challenging cases and brainstorm those hard cases (where I previously felt alone in navigating). Bri identified a need in our field (ongoing mentorship and support for those treading PFD) and took the initiative to create that space. She is an inspiration, and her work is only just beginning. She also recently launched the PSL (no, not the pumpkin spice latte), but the Pediatric SLP Library, which is a gold mine of resources covering a range of pediatric therapy topics, beyond just feeding. Y’all, check out her work, follow her page, and keep reading to learn more about Bri and her unique, inspiring (speech) path!
Bri’s (Speech) Path
Bri graduated from Marshall University with her M.S. in 2017. She completed her CFY at a private practice in Asheville, NC. Today, she is a speech-language pathologist and certified lactation counselor who specializes in pediatric feeding disorders (PFDs) as well as the founder of Pediatric Feeding Therapy, LLC. Bri has extensive experience working with infants and children with feeding and swallowing disorders. She has taken over 100 continuing education courses on pediatric feeding and swallowing, as well as received two ASHA Awards for Continuing Education in 2020. Bri was also awarded Distinguished Early Career Professional by ASHA in 2020. She is currently working on becoming a board certified specialist in swallowing and swallowing disorders (BCS-S). Bri is co-host of The Feeding Pod, a podcast that provides easy to access, evidence-based information on PFDs and interprofessional collaboration. She is the also the Founder and President of the Pediatric Feeding Disorders Foundation, a non-profit with a mission to provide financial and educational support to empower families of children with pediatric feeding and swallowing disorders. Bri has spoken at universities, medical schools, and state and national conventions. She is also a volunteer ambassador with Feeding Matters.
Me: Hey Bri! I am so so excited to feature you, especially for PFD Awareness Month. Who better? Okay so, just to get some background, when did you do your CF?
Bri: Yes! I’ve been an SLP since 2017. I graduated in 2017 from Marshall University in West Virginia. I actually got my BS and MS from there. It was a hard decision because I almost left. Originally, I thought I wanted to work at a school for the deaf. I’m actually fluent in ASL. But, then I got my feet wet in pediatric feeding and have just never gone back.
Me: Dang, I graduated in 2017 too. I feel like you’re doing so much. How do you do it all? You’re a badass!
Bri: I keep myself busy. People are always shocked when I tell them I’ve only been out since 2017
Me: For real. I’m in awe. Do you ever get imposter syndrome?
Bri: Abbbbbsolutely. I have a quote actually that I keep as a background on my computer and on my phone. It’s “Be afraid and do it anyway”. There’s so many things that I would not have accomplished if I let that fear keep me from doing it. So I remind myself all the time that yeah, absolutely it’s gonna be scary. But we have to do it anyway.
Me: I love that. That’s such a great way to start our conversation. I feel that all the time. Like, I’ve only been working for four years… What do I know?!
Bri: For sure. And honestly, being open to learning, in my opinion, is more important than years of practice.
Me: Agreed. So, for those who are just getting started.. What advice would you give to a CF?
Bri: Well, I have two bits of advice. The first one is: give yourself grace. Going from a clinical placement in school to a full time job is a big transition. As much as we want to tell ourselves that our last placement was basically a full time job, it’s not. So give yourself grace that there will be a bit of an adjustment, and that’s okay. My second one is being ready to learn. I know that you’re done with “schooling” now, but the learning is just beginning. You need to be able to observe everything that is going on, but also be skeptical. Check sources. Read the research. Never stop asking WHY. Finding out the why will help you learn exponentially and really, this is where your main learning is going to begin.
Me: That’s so true. We take CFs at our clinic. Sometimes I feel like there’s a sigh of relief that they’ve finished school, but also this overwhelming feeling of “what am I doing?!”
Bri: Right. Because you don’t have a syllabus to follow. The learning becomes so much more independent, and that ties back to giving yourself grace to go through that adjustment. But, ultimately, it’s your responsibility to learn.
Me: Ugh seriously, the learning never ends. My friend from grad school and I have this joke whenever we face a new challenge at work (happens all the time), we say “I didn’t read that slide!” because it’s impossible for all the learning to happen in grad school. It never ends!
Bri: It truly never ends. But that’s the fun part!
Me: So, would you say you have a belief or habit that has significantly impacted your life?
Bri: Well, one of my biggest things is learning to prioritize my responsibilities and leaving work at work. When I first started as a CF, I would take work home and work till 9pm every night. Getting my documentation in, planning this session, doing that. It really took a hit on me. So, what I do now is that I have certain things that are non-negotiables. This is how I prioritize making time for myself and things that fill my cup. For example, on Wednesday evenings I have kickball. And I will probably have kickball for the restttttt of my life because it brings me so much joy. But that’s one of my non-negotiables during the week. More recently, I’ve been telling myself that I have to clear my weekends. I see kids in a clinic and also run my own small business, so it’s really easy for me to work until 10pm every night and all weekend. I have difficulty separating work because I love it. But I know that I also need to make room for things that are important. Learning how to prioritize my responsibilities is the habit/routine that has been really helpful.
Me: Yeah, I was thinking about that because I see all the times that you offer for your mentorship groups. And I’m like.. She must be working ALL the time.
Bri: And like I said, I love doing it so I don’t even realize it. So, making non-negotiables allows me the time for myself no matter what. For me, filling my own cup and allowing myself time to reset allows me to make sure that I’m keeping balance with my work.
Me: Well, I admire you for that. I feel like that can be really hard to do.
Bri: It can be. But honestly, I love what I do so much that my weekends and weekdays bleed into each other sometimes because I’m having so much fun and just really enjoying that I’m doing.
Me: Amazing. That’s the ideal situation, right? So cool. So, where did you complete your CF and was that what you thought you wanted to do long term?
Bri: I completed my CF at a private practice in Asheville, NC. They provided in-home, school, and outpatient clinical services. When I first entered grad school, I was not sure what I wanted to do. I was interested in pediatric feeding, but I honestly thought that I would be working at a school for the deaf. I took ASL classes all through school and was fluent in ASL. But, when I got to grad school… Marshall University is so awesome in that it has a multidisciplinary feeding clinic on site. I ended up getting a placement there and fell in love. In my last clinical placement, I ended up in Asheville and then stayed there for my CF. Honestly, it was the first time where I had to take a lot of responsibility in learning feeding and swallowing on my own. Even though we had that coursework in dysphagia, it was still minimal. So I kickstarted my learning – taking courses and doing as much reading as I possibly could.
Me: Wow, yeah. It’s crazy meeting other clinicians and hearing how little training we get in pediatric feeding. I went to Purdue and we were lucky enough to have a decent course and some clinical opportunities, but honestly that seems rare.
Bri: And those clinical placements are even more important, especially with pediatric feeding. That’s kind of why I created my mentorship program. You need to talk through the information. You need someone to have some nerdy banter with.
Me: Exactly. Pediatric feeding is an area I’m super interested in too, and there is so much need and opportunity here for leadership. So, I’m just grateful that I found you in the webs of Instagram and got to participate in your mentorship program!
Bri: Social media can be great in that way. But we have to be skeptical of what we see for sure. Like I said before, be a skeptic and ask why. It’s important.
Me: Absolutely. This doesn’t have to be specific to speech but it certainly can be, but do you have a book that you frequently recommend or that influenced you a lot?
Bri: Yes. I have three. One is related to feeding, one is related to counseling, and one is just life. My speech and feeding book that I recommend all the time is Joan Arvedson’s Pediatric Swallowing and Feeding.
Me: Ugh yeah. It’s a gem.
Bri: Yep. It’s the holy grail of feeding. If I need to reference anything, I absolutely adore that book. The next book really impacted my way of thinking in terms of family-centered care and counseling. It’s How to Listen so Parents will Talk and Talk so Parents will Listen by John Sommers-Flanagan. In grad school we don’t get a lot of that experience either. Not necessarily that it isn’t discussed, but it just takes time. This one helped me a lot with my counseling skills and to better build rapport with my families. The last book is The Daily Stoic by Ryan Holiday. It basically provides daily, bite-sized meditations and bits of inspiration to use reflectively. If you like journaling, they also have a book that has journaling prompts based on the topic. Honestly, I had a really hard time leaving my last job because I absolutely adored my team and this book helped me to accept and understand that transition. Being afraid and doing it anyway… like I said before. It’s so short. Like less than a page of reading every day. But those bits provide just a little bit of insight and mental clarity into what’s going on in our lives.
Me: That’s awesome. This is my favorite question because I always end up on Amazon after throwing some books in my cart…
Bri: Yesss. It’s a really good one and it’s an easy read.
Me: Added to my cart. This next question is always an interesting one. What’s your favorite failure?
Bri: Ah, well I actually have two. The first one was one of the hardest things that I personally had to do in college. I was a collegiate athlete at Marshall University and played softball. After the first season, it was hard. I was starting to dread a sport that I had loved my whole life. So I made the decision to stop. For anyone who knows me, I don’t “quit” things. I don’t just stop. So, it was really hard for me to take a step back and do that for myself. Even though in my mind that was a failure, it opened up so many more opportunities for me to grow in my clinical practice and as a leader. I instantly became a member of NSSLHA and was vice-president one year and president the next. I started working in an after school program for kids with special needs so I was able to begin learning about that population. I did respite care for another adult. I started to get those tastes of our field. Even if there was that failure of “I couldn’t be a collegiate athlete”, it still opened so many doors for me.
Me: Wow, I’m sure at the time that must have been so stressful. I can only imagine. I wasn’t a collegiate athlete, but I feel like there is a lot of pressure to perform.
Bri: Exactly. At the time it felt like I was a failure for quitting, but it also goes back to my point of prioritizing my responsibilities. I was starting to fall in love with speech-language pathology, and maybe softball just wasn’t as much of a priority.
Me: Well, look at you now…
Bri: The other one that really shaped me as a clinician was learning not to have blind confidence in supervisors. This can be a touchy topic, but we so often feel that those mentors and supervisors around us know everything and know what’s best. I always, any time I have a student, say “question everything”. If I can’t answer your question and follow up with something, then I myself have something to learn. But, previously I was guilty of that – just having blind confidence in what I was told. For instance, oh they need a chewy tube and chew on each side ten times to be able to chew food. I never questioned it. It just seemed to make sense. But now I’m finding out that…actually that’s not super natural, and often if you give them the food first they will chew it as opposed to the chewy tube. So, learning not to have blind confidence because there is a lot of information out there.
Me: Absolutely. And I feel like that takes time. Especially as a student, it can be so intimidating. I felt a major shift between a student being graded versus being independent and approaching things as my own clinician.
Bri: Right. It’s something that needs to be learned post-graduation. It can be done in a professional way. But go research what you’re skeptical about.
Me: I love that. I know we’ve talked a lot about pediatric feeding, but what areas within our field do you see the most opportunity for growth?
Bri: I think there needs to be more mentorship. People take a lot of courses, which is great. But oftentimes, you are left on your own to apply what you learn, especially if you are in a home-health setting. I would love to see state associations and ASHA do more of that. I also think we need to grow in evaluations of feeding and swallowing disorders. A lot of oral-motor assessments aren’t realistic for pediatrics. I think there needs to be more talk about functional oral motor assessments.
Me: Mmm, right. The only oral-motor exam I learned in grad school was the bedside cranial nerve exam, and when I got into pediatric feeding I was like, wait.. This doesn’t translate.
Bri: Nope. Not at all. It’s definitely an area where we need to grow.
Me: Well, speaking of that… Any bad recommendations that you hear in our field?
Bri: The biggest one for me is that you need tools to help a child learn to eat and swallow. Especially doing things that are non-functional like passive exercises or oral motor exercises. We know we need to get as close to the skill as possible. I love comparing this. People always tell me “well, football players go to the gym so they can get better on the field”. And, while that may be true, it’s only because they can’t go out on the field and actively practice tackling a human all day long. If you compare a person who goes to the gym versus someone who actually practices tackling people all day, which one will be the better tackler? Probably the one who did more tackling practice. I’m not saying that using those things will be harmful, but will they get us to do the task as quickly and efficiently as we can? Let’s modify the skill and build up.
Me: I like that analogy. I feel like in therapy, people want a specific exercise or tangible homework. With feeding especially, that “tackle” might take a long time to improve, but the exercises are easy to master quickly. So it feels like you’re doing something, even if it’s not as efficient.
Bri: Right. And how will we get good at tackling if we are never actually tackling? That’s where we can do some of that strength building, but with real food.
Me: I like that. So many sports connections tonight. We’ve got a theme, folks. What about in your career? Do you feel like you’ve had a shift or a change that has impacted your journey?
Bri: After my clinical fellowship year, I had a couple months in a new position. I was learning a lot, but a lot of what I was learning didn’t make sense to me. Like, a lot of tools and non-speech oral exercises. I was doing it, but thinking in the back of my mind.. What am I doing? When I dove into the research of neuroplasticity and family centered care, and connected with like-minded professionals, it was a major breakthrough for me. I feel like my therapy has become way more effective. Kids are making so much more progress. I know that I’m doing evidence based practices to the best of my ability versus doing strategies where I’m like, am I even doing anything? It’s easy to fall into that because when you do those exercises, parents think you’re doing something. But now, I have sessions where I don’t even put gloves on and I just coach caregivers through the session. And doing that makes therapy exponentially better.
Me: Yeah, I feel like that’s been a theme throughout your answers. It’s easy to listen to someone more experienced and just go with it. Do you have any places you go to frequently for research?
Bri: Well, if you can access databases through your university, that’s great. Otherwise, The Informed SLP is amazing. Nobody is paying me to say that, I just genuinely love that resource. Using the university search engine and searching for free access through Google can help, too. Or authors will respond directly sometimes. Also, if you’re curious about something in another field, you might talk to other professionals or colleagues to see if they have access.
Me: Right on. Well, thank you so much for your time! I am so inspired by you and can’t wait to share your journey and advice!