Gastroesophageal Reflux Disease

What is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease, also known as GERD, is a backward flow of stomach contents into the Gastroesophageal Reflux Diseaseesophagus—causing a chronic pathologic condition.

What are some symptoms of Gastroesophageal Reflux Disease?

The primary symptoms of gastroesophageal reflux disease in children and teens are regurgitation of predigested foods/drinks and heartburn- a burning discomfort in the chest. In babies, and young children, gastroesophageal reflux disease can lead to problems during or after feedings including: frequent regurgitation or vomiting following a feeding, choking/wheezing, wet burps or wet hiccups, spitting up that persists beyond a child’s first birthday, irritable or inconsolable crying after eating, eating only small amounts or refusing to eat, and possibly failure to gain weight.

How does Gastroesophageal Reflux Disease progress?

GERD can cause permanent damage to the esophagus, larynx, and oral cavity if not medically treated. It can also increase the risk of ulcers, cancer, and swallowing difficulties. In babies and young children, it can lead to food refusal and subsequently difficulty gaining or maintaining weight.

How can I help treat my child’s Gastroesophageal Reflux Disease?

A medical professional can diagnose gastroesophageal reflux disease and provide pharmacological and lifestyle interventions to help treat the reflux. Several medications are available to treat the acidity of reflux, and various diet changes can contribute to decreased symptoms of the condition as well. Keeping your baby upright during and following feedings/meals could minimize GERD. Additionally, avoiding certain food in children and teens can reduce the symptoms or gastroesophageal reflux disease. These foods include: citrus fruits, garlic and onions, spicy foods, chocolate, tomato based food items, anything containing caffeine, fried foods, and peppermint.

Our approach to Gastroesophageal Reflux Disease at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our multidisciplinary feeding team offers the most comprehensive treatment approach for children with gastroesophageal reflux disease. Our specialized team features a speech-language pathologist, occupational therapist, and licensed professional counselor trained to deal with all aspects of gastroesophageal reflux disease. Therapy often involves making the appropriate medical referrals and treating other areas of the child’s feeding development.

Speech consultation


What is Dysphagia?

Dysphagia is a swallowing disorder often associated with chronic or acute medical conditions that affect the central nervous system. Dysphagia is more commonly diagnosed in the elderly, however infants and children may also present with this disorder based upon the severity of the primary neurological insult. Individuals diagnosed with dysphagia may demonstrate challenges getting ready to eat, chewing their food and appropriately swallowing their food. The disorder directly impacts the preparatory, oral, pharyngeal, and esophageal phases of eating; therefore, individuals with the condition may have various weaknesses extending from their mouths down to their stomachs.

What are some symptoms of Dysphagia?

Dysphagia is often a side effect of various neurological disorders, so it is important that your child be Dysphagiadiagnosed fully, as soon as possible. In terms of his swallowing problems alone, your child may present stiffening of the body and increased irritability when eating, as well as weaknesses managing food and liquids in his mouth. Children with dysphagia may cough and gag during meals and demonstrate difficulties chewing and coordinating breathing while eating. Over time, your child may also develop aversions to various textures of food, and he may refuse to eat or drink things he once enjoyed.

How does Dysphagia progress?

Individuals with the condition lose the skills to eat and swallow that they once had. As a result, the individual is at an increased risk for undernourishment, dehydration, aspiration, and pneumonia. While the severity of the disorder may vary from patient to patient, all individuals with dysphagia have poor oral, pharyngeal, and esophageal functioning.

How can I help treat my child’s condition?

Treatment for dysphagia varies based on the age of the individual, as well as the severity of the cause and symptoms of the disorder. A speech-language pathologist plays an important role in teaching your child to feed and swallow as he once could. Your child’s previous medical history, nutritional information, and current level of functioning will be assessed in order to create a functional plan for him. Prior to starting treatment, your child may need to undergo an endoscopy to further evaluate his condition and the path for improvement.

Our Approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, we use a multisensory approach to therapy. Our speech-language pathologists work with a feeding and swallowing team to maximize treatment strategies for your child. An occupational and/or physical therapist, nutritionist, and neuropsychologist will also evaluate your child in order to provide the most comprehensive treatment plan available. Our speech-language pathologists will focus on increasing oral-motor functioning as well as improving your child’s ability to tolerate various foods and liquids to ensure safety while eating and swallowing. When appropriate, feeding programs such as the Sequential Oral Sensory Approach to Feeding (SOS) may be used in combination with traditional dysphagia treatment methods to increase your child’s ability to tolerate and manage an increased variety of foods.



What is Dysarthria?

Dysarthria is a neurological disorder caused by damage to the central or peripheral nervous system. This Dysarthriacondition negatively impacts one’s muscular and motor control. Dysarthria specifically affects face muscles, vocal quality, and breath control. There are five categories of dysarthria: flaccid, spastic, hypo kinetic, hyperkinetic, and ataxic.

What are some symptoms of Dysarthria?

Dysarthria significantly impacts speech, and deficits involve accuracy, speed, and coordination of the oral-motor structures. One may have trouble with articulation, intonation, resonance, phonation, and respiration. Difficulties managing food and swallowing are also common, as are changes in the quality of voice.

How does Dysarthria progress?

Dysarthria occurs suddenly following damage to the brain. Therefore, individuals with dysarthria require immediate attention in order to increase functional communication skills. Since speech-motor control is significantly impacted, treatment focuses on motor movements to improve quality of life (e.g. to increase feeding and swallowing skills).

How do I help treat my child’s Dysarthria?

Treatment for dysarthria begins following an evaluation with a speech-language pathologist to determine the severity of the problem and recommend an appropriate course of treatment. Therapy sessions may include oral-motor activities to increase coordination with the lips and tongue, and respiration and breath control therapy to increase vocal quality and speech production. The primary goal of treatment is to improve overall communication skills by targeting a variety of functional areas including rate, breath support, oral-motor strength, and articulation skills.

Our Approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our team of dedicated speech-language pathologists will work with your child to improve his oral-motor structures and quality of speech. We will implement various treatment strategies using multisensory therapy techniques in coordination with a team-based approach. We work closely with your family to improve interactions and communication skills within the home environment. Family members are encouraged to be a part of the treatment process, and the speech-language pathologist will create home programs that your family can implement outside of the clinic to help generalize therapy objectives.


Celiac Disease

What is Celiac Disease?

Celiac Disease is a life-long digestive, autoimmune disorder in which the intestines become damaged and Celiac Diseaseunable to absorb nutrients as a result of an autoimmune response to the consumption of food containing the protein gluten.

What are some symptoms of Celiac Disease?

A child with Celiac Disease will most likely thrive until gluten is introduced into his diet, at which time he may become irritated, listless and refuse feedings. Some children may experience diarrhea, abnormal stools, or continual vomiting. Many children lose weight from the condition; symptoms vary and often present differently from one child to the next.

How does the condition progress?

While symptoms may come and go from week to week, Celiac Disease is a chronic condition. An individual with Celiac must maintain a gluten-free diet to avoid damage to the intestinal tract.

How can I help treat my child’s Celiac?

Celiac Disease is treated by simply avoiding gluten. This can be difficult because gluten is present in many foods, including breads and cereals. Celiac sufferers must maintain a gluten-free diet in order for the small intestine to heal; any consumption of gluten, however small or sporadic, will trigger an adverse response and negative symptoms.

Our Approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our licensed dieticians are specially trained to treat children with Celiac. Our dieticians will provide delicious recipes and healthy food choices for your family. Additionally, we will educate your family on the condition and suggest simple strategies to implement so your child can lead a healthy life-style. We recognize the psychological needs of children diagnosed with Celiac disease and will work with your child to promote independence by empowering him with the tools to make healthy food choices throughout his life.

New Call-to-Action

Body Dysmorphic Disorder

What is Body Dysmorphic Disorder?

Body dysmorphic disorder is a psychological condition most likely to develop in adolescence and is equallyBody Dysmorphic Disorder common in both females and males. This disorder is characterized by a significant concern that there is something wrong with the shape or appearance of one’s body. This disorder can cause devastating results, as individuals with the condition may go through painful medical procedures in order to correct their what they dislike about certain body parts.

What are some symptoms of the condition?

Symptoms of the condition include severe psychological problems, a preoccupation with an imaginary defect or excessive concern about a slight physical anomaly. This preoccupation causes significant distress and often impairs one’s work, social and personal life. Signs of distress or dysfunction are similar to those of extreme self-consciousness. This may include prolonged grooming and staring in mirrors, dressing in concealing garments, or seeking repeated alterations for perceived flaws.

Those with body dysmorphic disorder may seek reassurance for their perceived flaws or may try to hide them entirely. If an individual does try to hide his imperfections, this can likely result in an avoidance of social and public situations to the extent that the inflicted individual remains indefinitely housebound.

How does the disorder progress?

Body dysmorphic disorder affects both men and women who are relatively young. Currently, little is known about what happens to inflicted individuals as they age. We do know, however, that sufferers of this condition also tend to suffer from depression or anxiety as well. If left untreated, the condition can also lead to adult mental health disorders like obsessive-compulsive disorder (OCD), dysthymic disorder, social phobia, panic disorder, or PTSD.

How can I help treat my child’s condition?

Treatment often begins with an assessment of anxiety and depression. Treating these, or any other mood disorders, first is most effective. This may include cognitive-behavioral therapy (CBT).

Psychotherapy is useful in providing sufferers the stable, accepting, empathic relationships they need to sort through their challenges. Psychotherapy also includes stress management and may include collaboration with a physician to attend to medical aspects of physical complaints.

Our Approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our neuropsychologist and licensed professional counselor will design a psychotherapeutic treatment plan based on the overall evaluation of the sufferer’s mental health.


Binge Eating Disorder

What is binge eating disorder?

Binge eating disorder is a condition defined by periods of serious overeating (often in relatively short periods ofBinge Eating Disorder time) paired with feelings of loss of control. This disorder shares its diagnostic category with Anorexia Nervosa and Bulimia Nervosa; however, those with binge eating disorder usually do not engage in purging behaviors after eating, which distinguishes them from those with bulimia. Additionally, many binge eaters are overweight, which further distinguishes them from those with anorexia.

What are some symptoms of binge eating?

Binge eaters act on compulsive cravings for food–often foods which these individuals consider “forbidden.”

Periods of overeating may be triggered by specific events and are often followed by feelings of severe discomfort and self-condemnation. While engaging in overeating, individuals often feel intense anxiety, and soon after their binge is over, depression sets in.

Binge eaters often have psychological distress including stress, conflict, low self-esteem, and poor body image. Individuals who experience high levels of criticism or pressure, more often present binge eating symptoms.

How does the condition progress?

In general, binge eating disorder seems to be more common in younger, overweight females. This disorder is chronic and is no less severe than for those who purge. The resulting consequences for body image and body dissatisfaction can lead to mental health disorders, like depression and substance abuse.

Binge eating disorder puts the inflicted individual at risk for childhood/adult obesity. Binge eaters may also be at risk for developing severe medical complications.

In some groups of children and adolescents, binge eating can develop before dietary restraint or purposeful weight loss is learned. In other groups, the concept of dieting is learned and practiced years before binge eating begins.

How can I help treat my child’s binge eating?

Treatment for binge eating disorder is multidisciplinary and includes a dietician and psychotherapist.

The most effective approaches for treating binge eating disorder include behavioral therapy and cognitive-behavioral therapy in both an individual and group setting. Other highly beneficial types of psychotherapy include assertiveness training, interpersonal skills, and stress management.

When binge episodes decrease or cease, health maintenance depends on a personally effective weight-management program and long-term counseling approaches.

Our Approach At North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our licensed professional counselor will identify factors and situations that predict and maintain unhealthy eating behaviors and will work to relieve psychological distress. Our licensed dietician will design a personalized weight-loss program to be conducted alongside cognitive-behavioral therapy.

Eating disorders can also take a toll on the family, creating high levels of stress and conflict. That’s why we work with all members of your family by incorporating family therapy sessions to help make the home an environment which promotes a speedy, optimal recovery.

New Call-to-Action

Vestibular Processing

Vestibular Processing HomeworkWhat is the Vestibular System?

The vestibular system detects movement and gravitational pull, and it provides information regarding the position of our head in space and acceleration and deceleration of movement. It is the first sensory system to fully develop in utero and is located in the inner ear. The vestibular system has strong neurological connections in the brain and is a major organizer of varied sensory input.

This system is considered the most influential sensory system and has tremendous impact on one’s ability to function daily. Directly or indirectly, the vestibular system influences nearly everything we do. It is the unifying system in our brain that modifies and coordinates information received from other systems, and it functions like a traffic cop, telling each sensation where and when it should go or stop.  Read a blog on the Vestibular Senses by clicking here.

How does this system function?

This system affects aspects of physical function like posture, balance, movement, coordination, attention, arousal level, impulsivity and behavior. The vestibular system works with tactile, auditory, and visual information to give us our perception of space and our position and orientation within that space. Children affected by poor vestibular processing may be perceived as inattentive, lazy, overly anxious, or seeking attention. They may have trouble reading or doing simple arithmetic. Functioning at school, going out into the community, performing routine daily tasks, or just getting out of bed in the morning may be difficult for children with vestibular difficulties.

What causes poor vestibular processing?

Poor vestibular processing (or vestibular dysfunction) can occur for a variety of reasons; often, however, children develop a vestibular disorder for no known reason. Possible causes for poor vestibular processing include: premature birth and a fairly long period of incubation after birth, exposure to excessive movement or invasive sounds as a fetus or infant, neglect (little handling and moving) during infancy, repeated ear infections or severe ear infections, maternal drug or alcohol abuse during pregnancy, or general developmental delay and immature development of the nervous system.

What are some symptoms of poor vestibular processing?

Symptoms and functional difficulties of poor vestibular processing include:

  • Over-arousal or under-arousal
  • Excessive movement
  • Avoiding movement at all costs
  • Difficulty maintaining attention
  • Motion sickness (car, boat, airplane), dizziness or nausea caused by watching things move
  • Excessive spinning or excessive watching of things spin
  • Inability to read or write in cursive
  • Decreased auditory processing
  • Inability to sustain listening without moving or rocking
  • Problems with balance (static or moving) and/or vertigo
  • Difficulty walking on uneven ground, and difficulty navigating stairs
  • Head banging
  • History of traumatic brain injury, shaken child syndrome, ear cuffing, etc.

Why is this system important?

The vestibular system primes the entire nervous system to function effectively by sending messages to the higher centers of the brain. When the influences of vestibular stimuli fail to reach their destinations, they cannot adequately contribute to sensory integration. One result of depressed vestibular processing is hypotonicity (low muscle tone); when this system is not integrating information as it should and muscle tone is decreased, it is difficult to initiate movement or to maintain muscle tension during movement, resulting in significant difficulties in fine/gross and oral motor coordination.

The vestibular system also tells us where we are in relation to the ground, giving us a confidence that if we jump, swing, or somersault, we know we will hit the ground on our way down. This knowledge is called “gravitational security,”and with this basic sense of stability, children develop emotional security.

A child with dysfunctional vestibular processing, who does not possess “gravitational security,” tends to be inflexible, fearful and controlling due to the fact that he lacks control over the world around him and how he moves through it. This child often suffers from social problems as well, as he feels vulnerable to unpredictable situations caused by those around him.

Our approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, we treat poor vestibular processing with occupational therapy. Treatment strategies include bombarding the sensory systems with a variety of intense sensory input through the use of swings, obstacle courses, trampolines, therapy balls, auditory and visual activities that incorporate movement.


Type I Diabetes

Type I DiabetesWhat is Type I Diabetes?

Type I diabetes is an autoimmune disorder in which the body fails to produce insulin. Insulin–a hormone produced by the pancreas—is crucial to the process of breaking down glucose and converting it into a useful source of energy and fuel for the body. Individuals who do no produce insulin, thus, cannot properly break down necessary sugars, which in turn prevents them from obtaining necessary nutrients, and results in glucose build-up in the blood. Type I diabetes most often occurs in children and young adults, but can appear at any age.

What are some symptoms of this condition?

Symptoms include: extreme fatigue, unusual weight loss, constant hunger, blurred vision, increased thirst and urination, nausea, dry mouth, and frequent yeast infections.

How does the condition progress?

After a diagnosis of type I diabetes is made, a doctor will discuss treatment options to control blood sugar levels. There is no cure for type I diabetes, but the condition is highly manageable if the inflicted individual carefully monitors his diet and medication. Without careful self-management, type I diabetes can cause major long-term complications like heart disease, kidney damage, nerve damage in the feet and legs, eye damage, osteoporosis and bacterial or fungal infections. Physical activity, a healthy diet and good medical care greatly reduce the risk of such complications occurring.

How can the condition be treated?

Treatment includes insulin supplements, regular exercise, healthy eating, and monitoring blood sugar levels. Individuals with type I diabetes take insulin every day, either by injection or pump. By means of a small needle or insulin pen, insulin injections deliver insulin to the body quite quickly. An insulin pump is worn outside the body and connects to a catheter inserted under the skin near the abdomen. The pump automatically injects the body with insulin at a steady rate to regulate the sugar in the bloodstream.

Our approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, we offer a variety of beneficial services for individuals with type I diabetes. Our registered dietitians and licensed professional counselors work with clients to create healthy meal plans and identify coping strategies, since we knowhow important it is for people with type I diabetes to make their physical and emotional health a priority.

New Call-to-Action

Sensory Defensiveness

What is sensory defensiveness?

Sensory defensiveness is a “fight or flight” reaction to a stimulus that most people would not perceive as negative. Children with sensory defensiveness over-respond to sensory input and react by displaying negative emotions or behaviors. Children who over-respond to sensory input may inefficiently process sensory information from the auditory, olfactory, visual, vestibular and tactile systems.

What causes sensory defensiveness?

Sensory defensiveness indicates a low neurological threshold–it takes very little for the brain to respond to sensory information. For example, a child may be lightly touched while standing in a line with peers and may respond by acting out aggressively. Sensory defensiveness is frequently linked to poor limbic or reticular system processing.

How does this condition affect my child?

Sensory defensiveness affects the daily functioning of children at home, school and in all social Sensory Defensivenesscircumstances. Children with this condition may avoid, withdraw, or even lash out at any stimulus they perceive to be negative. These consistent patterns of behavior may limit opportunities for exploring their environment, interacting with peers, or communicating their needs to others. The following are a few examples of sensory defensiveness:

  • Auditory defensiveness: fearful reactions to noise, such as covering ears to loud noises (leaf blower, train, vacuum, etc.)
  • Tactile defensiveness: aversive reactions to tags in clothing, light touch, brushing of hair and avoidance of play activities that involve body contact
  • Visual defensiveness: hypersensitivity to light or avoidance of eye gaze
  • Olfactory defensiveness: distress to certain odors that others do not seem to mind
  • Vestibular defensiveness: aversive sympathetic nervous system reactions to swinging or other forms of vestibular-proprioceptive input, such as nausea or vertigo, or fearful emotional reactions (also known as gravitational insecurity)

How can I help treat my child’s sensory defensiveness?

Sensory integrative strategies are commonly used to treat sensory defensiveness. Sensory experiences are introduced slowly and gradually so the child does not react negatively to the introduction of the stimulus. It is important to communicate safety and comfort to the child during the introduction of these stimuli, so he does not feel threatened by these therapeutic experiences.

Our approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our occupational therapists provide a rich sensory environment for your child, which meets his specific needs. For example, our therapists might introduce your child to interaction and play with sand, water, and finger paints, which may help decrease extreme reactions to tactile experiences. We might also utilize a sound-based intervention called “Therapeutic Listening,” which improves auditory regard. Our therapists will accommodate your child’s needs in a safe and secure environment, and we will work to improve his sensory processing both in our facility and in his every day life.



What is Perseveration?

Perseveration is an uncontrolled response–such as a word, phrase, or gesture–perpetuated to an Perseverationexceptional degree despite termination of a stimulus. Perseverative acts include object perseveration, action perseveration (includes ritualistic behavior), verbal perseveration (includes topic and content), grammatical rigidity and deviant repetitive language. For example, repeating a word or phrase, lining objects up for hours, or becoming fixated on a certain topic might be considered preservative behavior.

What causes perseveration?

Perseveration is a method for regulating the nervous system. Children use such behaviors as coping mechanisms in response to their environments. When they feel overwhelmed, they use perseverative methods to remain in control of that which surrounds them. They feel safe and comforted by the repetition of the action of which they are in control.

Perseveration is one of the key diagnostic criteria of autism. However, perseveration is not specific to autism. Children with other disorders also exhibit perseveration, including those diagnosed with Down Syndrome, obsessive-compulsive disorder and Fragile X Syndrome.

How do I help treat my child’s perseverative behavior?

Applied Behavior Analysis (ABA) therapy and occupational therapy are useful in treating perseveration.

Our approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our occupational and behavior therapists will help your child fulfill his needs through a variety of behavioral, social and sensory strategies. They will help facilitate positive coping skills to environmental challenges and help reduce or eliminate your child’s perseveration habits. By exploring his environment in a safe setting, your child will learn new ways to deal with unfamiliar circumstances at home, school, and in any social situation in which he may find himself.