Fierce, Kind Mama of Multiples
This podcast is for anyone raising multiples (twins, triplets or more). I speak to inspiring parents of multiples who have healed from unexpected pregnancies and birthing experiences and who candidly share the highs and lows of raising multiples. I also speak to the professionals that work with multiple birth families. Together, we cover the practicalities of raising more than one baby at a time as well as enhancing the emotional wellbeing of caregivers and children alike.
Fierce, Kind Mama of Multiples
Do Twins, Triplets and Higher-order Multiples Have Their Own Secret Language? Expert Insights from Speech Pathologist Dr Sandra McMahon
In this episode, I speak with Dr. Sandra McMahon, an experienced speech pathologist with specific expertise in multiple birth children, about the unique challenges and considerations in language development for twins, triplets or more.
Sandra discusses the importance of early intervention in speech pathology, emphasizing that while some children might naturally outgrow certain communication difficulties, early support is crucial for better long-term outcomes. She highlights how addressing feeding issues early on can impact speech and language development, given the coordination required for both tasks.
She highlights three key areas for parents and educators to be mindful of when thinking about the language development of multiple birth children and offers practical advice for parents concerned about their children's communication skills.
Sandra also clarifies the popular view that multiple birth children have their own secret language and explains what is happening when multiple birth children seem to speak their own language.
This is a must-listen episode for anyone raising multiples who wants to learn more about how to support their children’s language development.
How to connect with Dr McMahon:
Facebook:
https://www.facebook.com/SpeechNetSpeechPathology
Website:
Thanks for listening! If you are a soon-to-be or current parent of multiples, be sure to head over to my website http://www.fiercekindmama.com to get my FREE resources designed specifically for you!
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00:00:06 Dr Cristina Cavezza
Welcome to the fierce kind Mama of multiples podcast. This podcast is for anyone raising multiples, twins, triplets or more. I speak to inspiring parents of multiples who have healed from unexpected pregnancies and birthing experiences and who candidly share the highs and lows of raising multiples.
00:00:27 Dr Cristina Cavezza
I also speak to the professionals that work with multiple birth families. Together we cover the practicalities of raising more than one baby at a time, as well as enhancing the emotional well being of caregivers and children alike.
00:00:41 Dr Cristina Cavezza
Come join us as we laugh, cry and share our personal and professional wisdom on all things multiples. I'm your host, Dr Cristina Cavezza, and I am a fierce kind Mama of multiples.
00:00:59 Dr Cristina Cavezza
Welcome to today's show. I'm your host Dr Cristina Cavezza, and I'm joined today by Doctor Sandra McMahon. Sandra is a pediatric speech pathologist with several years of experience working in a range of settings, including early intervention childhood settings. And she is the past director of speech.
00:01:19 Dr Cristina Cavezza
pathology at the Brisbane Children's Hospital and currently the owner and director of Speech net speech pathology, which provides pediatric, multidisciplinary allied health services in Brisbane, Australia.
00:01:34 Dr Cristina Cavezza
For children up to the age of 16 years. They work with children with feeding issues such as breast bottle and solid eating difficulties. They provide early intervention for young children and services to school age children. The children that they work with may present with a range of underlying concerns, including
00:01:54 Dr Cristina Cavezza
Delayed and disordered language, speech delays, literacy issues and those children with a specific diagnosis, such as autism.
00:02:06 Dr Cristina Cavezza
Sandra has a long term interest in supporting the speech and language development of multiple birth children, and in this episode you're going to hear her talk about her PhD research, which was focused specifically on multiple birth children and the early speech and language development of twins, triplets, and.
00:02:26 Dr Cristina Cavezza
Higher order multiple birth children.
00:02:28 Dr Cristina Cavezza
She will explain to us how the communication development in children involves three key areas and how the unique learning development of multiple birth children can affect all three of these areas. So I'm really glad that Sandra agreed to offer her time.
00:02:49 Dr Cristina Cavezza
And expertise to share with you today, I think this episode is going to be really useful for anyone who is expecting multiples or already has multiples at home.
00:02:59 Dr Cristina Cavezza
And who wants to better understand how to support their children's speech and language development. If you have any questions for Sandra or myself after listening to today's episode, feel free to get in contact with us. Our contact details will be in the podcast show notes for you, and I hope you enjoy this episode.
00:03:22 Dr Cristina Cavezza
So today I am joined by Doctor Sandra McMahon. Sandra, lovely to have you.
00:03:26 Dr Cristina Cavezza
here.
00:03:28 Dr Sandra McMahon
Thank you very much, pleasure to be here.
00:03:30 Dr Cristina Cavezza
I know you've done some really interesting research on the communication development of multiple birth children, so I'd love for you to give us some insights into that. How that kind of came about and and.
00:03:42 Dr Cristina Cavezza
What what you learned from that research?
00:03:45 Dr Sandra McMahon
Yeah, definitely. Look, I originally graduated as a paediatrics or as a speech pathologist in Adelaide many years ago now and began working in the early childhood arena and over time I became inundated with new referrals relating to children that were late talking or.
00:04:05 Dr Sandra McMahon
Presented with very severe difficult talking skills.
00:04:08 Dr Sandra McMahon
And so many of these were also multiple birth children.
00:04:13 Dr Sandra McMahon
That is, I was finding a large percentage of my caseload were twins, triplets, quadruplets, and I even had a few quintuplets on my caseload. So I started looking into the research in about the speech clarity and the speech development of multiple birth children. And the data was very vague and I really wanted to understand what were the underlying issues.
00:04:35 Dr Sandra McMahon
And how best to help families? So I contacted one of my past lecturers and said what do you know, what do you... What's the answer? And she said I have the answer for you.
00:04:46 Dr Sandra McMahon
I was like, excellent, she said. The answer is you do your PhD in research and answer these burning questions and that's kind of like the journey I started. She was in Brisbane, so I even had to move cities to look into this interest in multiple birth children. But basically my passion for
00:05:06 Dr Sandra McMahon
Helping multiple birth children really consolidated with that thesis. It's actually called early speech and language development of twins, triplets and higher birth children.
00:05:19 Dr Sandra McMahon
And you know, but my interaction with multiple birth didn't actually stop with the PhD because it was really. I'm finding it's quite a passion. I over time, I eventually was the director of speech pathology at Royal Children's Hospital and hence supported many multiple birth children's in the developmental clinics as babies and young children.
00:05:39 Dr Sandra McMahon
Though you know my interest in the in the multiple births definitely
00:05:44 Dr Sandra McMahon
Has had a long journey and now.
00:05:46 Dr Sandra McMahon
As I've got.
00:05:47 Dr Sandra McMahon
A A independent private practise. I work with a team of speech pathologists and OTs called speech net speech pathology and we have a notable number of percentage of multiple birth children on our caseload. So my passion and interest in the area has had longevity.
00:06:05 Dr Sandra McMahon
Yes.
00:06:06 Dr Cristina Cavezza
Amazing. And I love the way that your research was really kind of informed by your clinical practise. You were you were on the ground sort of seeing what was happening around you and that was like, you know, I need to know more about this. And then you amazing that you pursued a PhD in it on one level. But the amazing that you also, you know followed.
00:06:25 Dr Cristina Cavezza
Your
00:06:26 Dr Cristina Cavezza
Your lecturer to Brisbane. Just what a what an amazing journey. What do we know then about the communication development of multiple birth children?
00:06:36 Dr Sandra McMahon
Yeah. Look, I like to answer that question by putting on my speech pathology hat and clarify what communication development really means.
00:06:49 Dr Sandra McMahon
A basic explanation is that communication involves three key areas, and those three areas impact on each other. The first area is understanding skills, that is understanding what others are saying and can we understand if they're talking to us. Our receptive language skills. The second area relates to our talking.
00:07:08 Dr Sandra McMahon
Skills. What is expressive language or the ability to say words and sentences, and how clear is that talking?
00:07:16 Dr Sandra McMahon
These first two areas will impact on each other. If I don't know an Apple is called an apple, I'm not going to give it the name or say Apple.
00:07:27 Dr Sandra McMahon
Now that 3rd circle links the understanding of language and the talking skills and we call it the social use of language, I can name a picture of an apple. I can ask what an apple can I eat my apple now? I can talk about there's a Big Apple and a little apple.
00:07:46 Dr Sandra McMahon
So I'm using the word apple socially.
00:07:48 Dr Sandra McMahon
So when you asked me to tell you about the communication development of multiple birth children, we need to consider all of these three aspects because the unique, unique learning environments of multiple birth children can impact an all three of these areas.
00:08:09 Dr Sandra McMahon
Our initial research primarily did look at the early communication of development in two to four year olds and it did show that their communication development particularly
00:08:20 Dr Sandra McMahon
their talking skills and their speech clarity skills were at risk for as a group. It was particularly noted that they often had shorter or immature sentence usage, and yeah, so they're at risk of presenting.
00:08:40 Dr Sandra McMahon
Quite significantly delayed or compared to the Singleton population that we compared. In fact, 79% of the twins and 73% of the triplets presented with at least a mild developmental speech language delay.
00:08:59 Dr Sandra McMahon
So the expressive.
00:09:00 Dr Sandra McMahon
Difficulties in multiples are shown to be.
00:09:02 Dr Sandra McMahon
More likely as well to persist.
00:09:06 Dr Sandra McMahon
Beyond the preschool age and it can impact on the acquisition of literacy, that's the reading and the spelling skills. We know for all children that early speech and language development impacts our later reading and literacy skills, and that's definitely the same for multiple birth children.
00:09:27 Dr Cristina Cavezza
Yeah. OK. Well, those numbers are quite are quite high to me. Were you surprised by that?
00:09:33 Dr Sandra McMahon
Definitely. And of course, if you look at the literature, those percentages are going to change significantly depending on, as I just said, language or communication has so many factors.
00:09:47 Dr Sandra McMahon
So that percentage of error is going to change depending on what aspect you're actually looking at.
00:09:55 Dr Cristina Cavezza
Yeah. OK. And do we have an understanding or you know does the literature is there hasn't been enough research to understand why multiple birth children seem to have
00:10:04 Dr Cristina Cavezza
This propensity for, you know, greater likelihood of these delays.
00:10:09 Dr Sandra McMahon
Look, I think again, we've got to look at those three factors. So we do know that it is the interaction and the use of language. We know that parenting.
00:10:25 Dr Sandra McMahon
Is one of the main.
00:10:28 Dr Sandra McMahon
Leaders in learning to communicate and that learning environment, as many of your speakers and families are aware, is different in the multiple birth situation, so that impacts on that early communication development.
00:10:43 Dr Cristina Cavezza
Yeah. So what are some of the the differences in the learning environment that you think have an influence?
00:10:51 Dr Sandra McMahon
Look.
00:10:52 Dr Sandra McMahon
I'm going to bring it back to probably a question you everyone will ask me and is there evidence that multiple birth children have their own language? Because I think it links into that.
00:11:04 Dr Sandra McMahon
So some of.
00:11:04 Dr Sandra McMahon
The early research aimed to look at the similarities and differences between siblings within multiple birth sets and investigate
00:11:12 Dr Sandra McMahon
the legitimacy that they have their own language and this was the underlying issue that was impacting on communication development.
00:11:22 Dr Sandra McMahon
Having said that, in a large group of multiple birth children that we looked at in our studies, the speech of the siblings within the multiple sets did in fact come out very similar. If one child had speech problems, such as a phonological delay, which means slow learning of the rules of putting sounds together
00:11:42 Dr Sandra McMahon
to get clear spoken words, so did the other child. In fact, 95% of the twin sets they were both having some sort of communication issue. However, while the multiple birth siblings had
00:11:58 Dr Sandra McMahon
Both had speech errors. Their speech was not actually identical, and you know the case was often people are saying, but do they have their own language? Well, their speech wasn't identical, so it didn't support that own language concept. Frequently one child had more speech disorders
00:12:19 Dr Sandra McMahon
Than the other, and frequently the speech areas that all the children in a set used were a certain set, but then each child had different sound errors that they each individually made.
00:12:33 Dr Sandra McMahon
So you know, that's another reason why the idea that multiple birth children have their own language relates to the type of speech, sound errors that's commonly found in twins and and, you know, and higher multiple birth, sorry the higher percentage of unusual or disordered speech than singletons.
00:12:53 Dr Sandra McMahon
I hope that all made sense, but yeah, the underlying basically they tended to have.
00:12:58 Dr Sandra McMahon
More of a disorder.
00:13:00 Dr Sandra McMahon
In their learning to communicate.
00:13:02 Dr Sandra McMahon
As opposed to a delay.
00:13:05 Dr Sandra McMahon
OK.
00:13:06 Dr Sandra McMahon
Do you want?
00:13:06 Dr Sandra McMahon
Me to elaborate on what disorder versus delayed means.
00:13:10 Dr Cristina Cavezza
Yeah, yeah, that would be helpful.
00:13:11 Dr Sandra McMahon
OK. So look, let's just look at the learning of speech sounds. All children have developmental phonological processes, so there's patterns of speech that typical children do when they're learning. For example, most children, until they're approximately 3 years of age.
00:13:30 Dr Sandra McMahon
Will leave off the last or the final sound in a word. So for example, Cat will be a ca
00:13:37 Dr Sandra McMahon
So all children will do that, including multiple birth children. However, a phonological disorder rather than that delay because they haven't caught up to doing it, saying it right now occurs when the.
00:13:51 Dr Sandra McMahon
Types of errors.
00:13:52 Dr Sandra McMahon
Are different to what most typical children say, for example.
00:13:57 Dr Sandra McMahon
It's not typical to leave the first sound.
00:14:00 Dr Sandra McMahon
Of the word.
00:14:01 Dr Sandra McMahon
So saying Unny for Bunny is not typical, but we saw these non typical errors more commonly in the multiple birth population.
00:14:11 Dr Cristina Cavezza
OK. And that that helps to explain that and do we see that or do we know what that's attributed to like that disorder? So is it that it's an effect of the environment and having limited opportunity to
00:14:28 Dr Cristina Cavezza
Engage as much with parents with language and speaking and that kind of thing in the practise, or because multiples might be spending all their time together speaking to each other. And so they're kind of mirroring each others errors like I'm just kind of saying these things off the top of my head.
00:14:42 Dr Sandra McMahon
Absolutely.
00:14:45 Dr Sandra McMahon
Yeah, yeah, yeah. Look, I think you're hitting on all definitely the areas that we need to sort of consider when we're looking at that because they're not using typical speech that if a younger kid, there's a ca or cat, we're going to guess they mean cat. But because they're not using.
00:15:05 Dr Sandra McMahon
typical speech, sound errors, the adults not understanding them or they're getting misinterpreted. So you.
00:15:14 Dr Sandra McMahon
Know.
00:15:14 Dr Sandra McMahon
That means that.
00:15:16 Dr Sandra McMahon
It it looks more like they have their own language and we're not able to. I'm going to say some families think it's kind of cute or interesting or fun that they're doing that. And so we think, ohh, that's what twins do. They have their own language as opposed to saying ohh, is there an underlying thing we need to address.
00:15:36 Dr Sandra McMahon
Here and actually eliminate that as a concept.
00:15:40 Dr Cristina Cavezza
Yes, OK.
00:15:41 Dr Sandra McMahon
Look, one of our like some of our research did show that multiple birth children understood adult speech more than they understood their sibling speech in our research.
00:15:53 Dr Sandra McMahon
In fact, the multiple birth children only found it easier to understand their brothers or sisters unusual speech, if it closely.
00:16:02 Dr Sandra McMahon
Sounded similar to the adult words.
00:16:05 Dr Sandra McMahon
Interesting, however, that the multiple birth children were able to understand their sibling speech better.
00:16:11 Dr Sandra McMahon
Than other children of this same age.
00:16:14 Dr Cristina Cavezza
Yeah, right. Very interesting.
00:16:15 Dr Sandra McMahon
Yeah. So. So rather than having their own language because they're spending lots of time together and maybe making more familiar interactions, they're more likely that they understand each other's talking as opposed to have their own language. I think it's a bit like, you know, a husband and wife that spent a lot of time together.
00:16:35 Dr Sandra McMahon
They can. Almost.
00:16:36 Dr Sandra McMahon
Guess.
00:16:37 Dr Sandra McMahon
What they're going to say, or what the situation's going to create, it's the same for the multiples. They're often in the same situation from day one or early all the way through. So they almost guess or can read the situation of what the other.
00:16:50 Dr Sandra McMahon
One might think or feel.
00:16:51 Dr Cristina Cavezza
Yes. Yeah. And so as you were talking there, I was thinking back to what you were saying about the three elements or three points and it sounds to me, and please correct me if I'm wrong, because I'm just sort of guessing from what you've explained, it sounds like the multiples don't have necessarily or the problems lie more.
00:17:11 Dr Cristina Cavezza
With the expression rather than the comprehension.
00:17:16 Dr Cristina Cavezza
Is that correct?
00:17:16 Dr Sandra McMahon
Yes, yes, in the in the in.
00:17:20 Dr Sandra McMahon
Generally yes. But again, we have to say generally yes, yes, because factors such as if I'm not listening and attending.
00:17:28 Dr Sandra McMahon
Because we said the social
00:17:29 Dr Sandra McMahon
Circle does impact if I'm not listening and attending. I'm not learning new things, I'm not learning new words.
00:17:30 Dr Cristina Cavezza
Yeah.
00:17:36 Dr Sandra McMahon
Or I'm not really understanding the nuances of a a direction. So while they the talking was stronger, sometimes the understanding needed to be supported and pushed because the other social and.
00:17:52 Dr Sandra McMahon
Expressives can drag that circle down if that makes sense. So when you're looking at family, it's very important to look at the all three areas and understand how one, that's why I do my circle. They all interact. You can't work, don't they? That's OK. If these two are dragging down or impacting.
00:17:57 Dr Cristina Cavezza
Yeah.
00:18:12 Dr Sandra McMahon
They need to work on all areas to if it's great. If the understanding is OK, we want to keep it to be OK. So we need to also give parents ideas that even if they're not saying something, you've gotta say the new things that they're learning, new things, not waiting till they're saying the easy things.
00:18:30 Dr Sandra McMahon
If that makes sense.
00:18:30 Dr Cristina Cavezza
Yes. Yes it does. Yes. And so if we do have multiple children, multiple birth children that have speech problems.
00:18:39 Dr Cristina Cavezza
Should they be
00:18:40 Dr Cristina Cavezza
Separated in certain environments so that their speech problems are not reinforced by each other?
00:18:48 Dr Sandra McMahon
I'm going to say that is like just an enormous question, like all medical and development concerns. There's too many factors to have a definitive answer of what's correct for those children or that family.
00:19:02 Dr Sandra McMahon
However, providing any child with at least some small or regular 1 to one adult time is known to be extremely important, so we aim to give family some techniques that utilise they can utilise when their multiple birth children are separated and techniques that they can apply when they're all together so that we are taking.
00:19:22 Dr Sandra McMahon
Both considerations. If you have some one on one time with children with delayed speaking skills.
00:19:29 Dr Sandra McMahon
It's a great chance to reinforce or model the correct sound in your playing interaction. For example, if a child does, say, tap or car, if it's just the adult and one child interacting, the adult has time to emphasise example, the c sound. Ohh it's a car
00:19:49 Dr Sandra McMahon
It's your car, my car and the child is still focused on you rather being distracted by what the other children or child is doing.
00:20:00 Dr Sandra McMahon
If that makes sense. So yeah. So. So yeah, so having some separate time or interacting one on one is very important for all children and it's.
00:20:12 Dr Sandra McMahon
Harder but is really important if that can be set up for multiple birth children.
00:20:20 Dr Cristina Cavezza
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00:20:26 Dr Cristina Cavezza
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00:20:46 Dr Cristina Cavezza
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00:20:56 Dr Cristina Cavezza
Yeah. Yeah, I agree with that 100%. And I think that that that is the constant challenge, isn't it for many families with, you know, even large families with singletons, you know, find that individual time. But yeah, I can see the importance of that for for language acquisition and development and skill.
00:21:01 Dr Sandra McMahon
It is indeed yes.
00:21:13 Dr Sandra McMahon
Absolutely and. And as I sort of mentioned before.
00:21:16 Dr Sandra McMahon
Because it can be difficult to have extended or regular or frequent one on one with each individual children. Building those early turn taking skills.
00:21:28 Dr Sandra McMahon
In multiple birth families is probably more important than even in Singleton families because they're sort of more natural one on ones, so you know. So we often parents will talk about or one twins more dominant. And we said that one can speak a bit.
00:21:44 Dr Sandra McMahon
Better so it's.
00:21:45 Dr Sandra McMahon
Very important that we as adults in either the education setting.
00:21:50 Dr Sandra McMahon
Or the home setting.
00:21:51 Dr Sandra McMahon
Set up interaction styles so that each child does get a small window. So for example, if Johnny says I want a a blue car, we need to say now, wait, what does Sammy want? Sammy and the you know Johnny saying he wants the red car. Let's wait. It's Sammy's turn to tell you what colour car do you want
00:22:11 Dr Sandra McMahon
Sammy? So that making sure that that's teaching Johnny that Sammy has a turn or chance to say something and it's also allowing Sammy who may have some speech issues, time to work out. Think of the word and say what they're wanting.
00:22:27 Dr Sandra McMahon
So sort of.
00:22:28 Dr Sandra McMahon
Having.
00:22:28 Dr Sandra McMahon
that
00:22:30 Dr Sandra McMahon
Adult lead adult role model of ensuring that those social interactions in multiple birth children are set up very young.
00:22:40 Dr Cristina Cavezza
Yeah, I can see so many benefits to that approach. You know, I can begin the flow on effect from that being able to speak. You know what what you want your needs so so important.
00:22:50 Dr Sandra McMahon
Absolutely.
00:22:51 Dr Sandra McMahon
Yes, yes. And not getting he wants 1. So I guess I must want one allowing, you know, do I really want that or do I not want that? Do I wanna do this or do I really wanna?
00:22:55 Dr Cristina Cavezza
Yes, exactly.
00:23:01 Dr Sandra McMahon
Do that not.
00:23:02 Dr Sandra McMahon
The stronger leading multiple birth, taking the lead all the time. Yeah. So the over speaker, it's great. Let's reinforce them, you know.
00:23:11 Dr Sandra McMahon
Congratulate them for being strong and decision making and all that sort of thing, but not allowing that to be over. Over riding the other children's a chance to build their decision making.
00:23:24 Dr Sandra McMahon
Skills.
00:23:25 Dr Cristina Cavezza
Yes, absolutely.
00:23:27 Dr Cristina Cavezza
And now I've heard, please correct me if I'm wrong, but I've heard some people say that you know some children actually grow out of some communication difficulties, but at the same time and and I know you kind of already highlighted this too, that we know that early intervention is really important for long term outcomes on in many different contexts. But can you?
00:23:47 Dr Cristina Cavezza
Help us understand what does early intervention look like in the context of speech pathology and when is the optimal time to seek assistance from a speech pathologist?
00:23:58 Dr Sandra McMahon
OK, so I'm going to go did I haven't talked to you about how I.
00:24:05 Dr Sandra McMahon
Really worked with children with feeding difficulties. Have I mentioned that yet?
00:24:09 Dr Cristina Cavezza
No, no, you haven't it.
00:24:25 Dr Sandra McMahon
No. OK, so from my perspective, when do I start interacting or supporting children? Because the oral skills for breast bottle and early eating are the same muscles and coordination skill - skills as it is for talking, I do see a lot of multiple birth children and other children for eating skills, and that's getting the oral muscles and coordination set up for later talking skills. So when when people say to me, oh, when should I get, you know.
00:24:45 Dr Sandra McMahon
Twins to see you.
00:24:46 Dr Sandra McMahon
UM.
00:24:48 Dr Sandra McMahon
It's depending on what the concerns are, so if there's early feeding difficulties or they're in neonatal care and there's been sort of, you know, lots of other factors, I would say early is better and you know, work on those feeding skills. So we've got good coordination.
00:25:07 Dr Sandra McMahon
oral skills that impact on speaking, speaking, but from a broader answer, the question when speaking to speech pathologist when should one get support. I think it goes back to what we talked about.
00:25:19 Dr Sandra McMahon
There's, you know, it's key for parents and educators to be aware that multiple birth children.
00:25:24 Dr Sandra McMahon
Are at risk.
00:25:26 Dr Sandra McMahon
And so not accepting that there are delayed as we talk about. So rather than just accepting it, if there are risks, then come in and set up some input or at least get some information, early intervention. Early intervention is extremely important.
00:25:43 Dr Sandra McMahon
For all children, and I think it's even stronger for that.
00:25:47 Dr Sandra McMahon
multiple birth set. So,
00:25:49 Dr Sandra McMahon
The broad answer is if they're not meeting any communication developmental milestones rather than wait and sit. I'm not saying, you know, like a lot of the milestones are broad. So we say two word sentences in the two to three year range. So if we're not saying 2 words.
00:26:04 Dr Sandra McMahon
Sentences right on the age of two. I'm not panicking, but if we're getting into the two year age and we're not seeing two word sentences like, you know, my car, go in coming within that early 2 year range, then I'd be seeking support.
00:26:20 Dr Cristina Cavezza
Yes. OK. Yeah, that's that's. That makes a lot of sense. And when you were speaking about the feeding difficulties, I actually wondered what some of those would be at that early age, what what are some of the things that people present with
00:26:32 Dr Cristina Cavezza
at that very early age.
00:26:35 Dr Sandra McMahon
Yeah, sure. I'm I'm again, because a lot of little ones that are multiple birth may be premature or low birth weight may have had in utero. You know we've got the big one and the little one and there's all those factors. So it's the energy level, it's the oral coordination.
00:26:55 Dr Sandra McMahon
And when we when
00:26:56 Dr Sandra McMahon
We're feeding or breast or bottle feeding. We've got to get that suck, swallow breath coordination. So we need to do the suck, suck, suck, swallow, breath, suck, suck, suck, swallow, breath. So a lot of the.
00:27:10 Dr Sandra McMahon
Time, for whatever reason, they've got tubes in. Then they've got, you know, breathing support. There's been all those other factors there or even their level of attention. Their wake up times and all those sorts of things can impact on coordination. You know yourself, if you gotta coordinate something, play a sport. If you're really tired, you're not gonna coordinate that as well.
00:27:32 Dr Sandra McMahon
As if you're at peak energy levels, so all those factors.
00:27:36 Dr Sandra McMahon
Will impact on on it, yeah.
00:27:39 Dr Sandra McMahon
OK.
00:27:39 Dr Cristina Cavezza
OK, so if mother is breastfeeding and the baby is not taking in the milk, the breast milk.
00:27:49 Dr Cristina Cavezza
Maybe kind of like stopping and spitting. I mean, I'm just trying to get a sense of what, what it looks like when, like, when would a mother or parent caregiver, when would they know? Ohh, this looks like a feeding difficulty, I should see speech pathologist.
00:27:52 Dr Sandra McMahon
Yes, yes, yes.
00:28:03 Dr Sandra McMahon
If, if they've got really poor oral coordination, so they seem to be not, like I said, get that sucks, swallow, breath pattern involved.
00:28:11 Dr Sandra McMahon
If again we and I, because I work in a multidisciplinary team and I wouldn't do it any other way, we need to make sure we got a dietician involved, we may need another review by the paediatrician. You might need an ear nose.
00:28:25 Dr Sandra McMahon
And throat specialist.
00:28:26 Dr Sandra McMahon
To jump in and make sure there's no tongue, tie or you know.
00:28:31 Dr Sandra McMahon
There's no milk regurgitating through the nose and all those sort of factors.
00:28:36 Dr Sandra McMahon
And then when it's here and down, you may need respiratory issues or the gastro team to come and play. Because if it's maybe, it's not that it's going, it's going in, OK. It's just the speechie helping. But once it's in, then we've got other issues that are causing it feels yucky. It's hurting some, refusing to feed. So.
00:28:56 Dr Sandra McMahon
You know, it's basically I'm trying to do.
00:29:00 Dr Sandra McMahon
Feeding or this dysphagia 101 here rather than. It's such a big area. I think the main thing I want to take away is that if there are concerns then start with your GP, or paediatrician, and frequently.
00:29:05 Dr Cristina Cavezza
Yeah.
00:29:16 Dr Sandra McMahon
Asking for a speech pathologist specialist in feeding is a good next step.
00:29:23 Dr Cristina Cavezza
Yeah. So seeking out a specialist in feeding is going to be important and that multidisciplinary approach getting all the the child or the children examined by different professionals to to, to rule out other things that could be.
00:29:31 Dr Sandra McMahon
Absolutely.
00:29:38 Dr Cristina Cavezza
At play.
00:29:38 Dr Sandra McMahon
Absolutely. Yeah. And like, because we're we're talking feeding, sorry, we're going down that feeding track. But again we know that.
00:29:46 Dr Sandra McMahon
You know, multiple births might want to share foods or whatever you're eating. What are you tasting? If I've got difficulty chewing because I still haven't learned how to use my tongue to move food to the side and move it up down to chew, some of the little ones that have late or delayed feeding difficulties, will put it in the mouth and still try to swallow.
00:30:07 Dr Sandra McMahon
Though they might need more lumpy foods and not ready for the chewy foods, but if my sibling, my other twin brother is eating that yummy chunk chewy foods, then that can be very difficult for the little one that can't eat the smooth food. That can only really eat smooth foods. So being aware of the.
00:30:27 Dr Sandra McMahon
You know implications. And So what we all often do is talk about taste and.
00:30:32 Dr Sandra McMahon
We can do other ways to interact with the the joint feeding rather than than feeling rejected or I can't have it and he can or those kinds of things. So yeah. So again, we've gotta think about with feeding, we've got the social, we've got taste and we've got the understanding what the situation is.
00:30:53 Dr Sandra McMahon
To be able to help with that oral motor or feeding difficulties.
00:30:57 Dr Cristina Cavezza
Yes. Yeah, that's that sounds like there again it.
00:31:00 Dr Cristina Cavezza
It's that it's so multi layered and.
00:31:03 Dr Sandra McMahon
Absolutely.
00:31:05 Dr Cristina Cavezza
Complex and there can be many different things that sound like they could be contributing to difficulties that we might see in children who are feeding. But I think the important point from what I'm gathering from you is that that that's an early sign that potentially could affect language development and acquisition and skill. And so it needs to be looked at early.
00:31:24 Dr Sandra McMahon
Absolutely yes. And like there's not a one to one, if you've got feeding difficulties, you're gonna have speech and language difficulty. But the correlation or the implication is let's work on that. So we don't then end up with the speech and language difficulties.
00:31:30 Dr Cristina Cavezza
Yes.
00:31:37 Dr Cristina Cavezza
Yeah.
00:31:39 Dr Cristina Cavezza
Yeah, that, that importance of that early prevention. So I know that many listeners will be listening to this podcast and they might have real concerns. They might have. Their children might be a bit little bit older, maybe preschool, but they might have some real concerns about their children's communication and language language skills.
00:31:56 Dr Cristina Cavezza
And and that can create a lot of anxiety in families. I know I've heard parents say things like, well, you know, I'm worried my child and my children will fall behind at school or they're going to struggle and that, you know, they might not even started.
00:32:08 Dr Cristina Cavezza
School yet but.
00:32:09 Dr Cristina Cavezza
There's that worry because they've, you know, they seem to be showing some difficulties early, so.
00:32:16 Dr Cristina Cavezza
I'm wondering what advice you'd give to parents who might have those thoughts and worries.
00:32:21 Dr Sandra McMahon
Well, look again, I think it's natural for parents to want.
00:32:27 Dr Sandra McMahon
To have the.
00:32:28 Dr Sandra McMahon
Do the best and make sure they're providing the best for their.
00:32:30 Dr Sandra McMahon
Children, so I think.
00:32:33 Dr Sandra McMahon
Take some pressure off yourself and look at the here and now. Am I doing what I need to do here and now? If I'm providing those great foundations for social interactions and talking and.
00:32:48 Dr Sandra McMahon
You know, even the reading and spelling. So looking at things like, are they the same?
00:32:52 Dr Sandra McMahon
Or different the.
00:32:53 Dr Sandra McMahon
Bit per same or different. If I go back and say an apple and a banana, same or different, I'm actually working on skills. I'm going to need for later literacy. So if parents they if I make sure all the foundation skills are going well.
00:33:08 Dr Sandra McMahon
I'm doing the best I can to make sure I'm getting them ready for school.
00:33:12 Dr Cristina Cavezza
Yeah.
00:33:14 Dr Cristina Cavezza
Yeah, that, that's again the importance, I guess, of having that time to connect with your children and.
00:33:21 Dr Cristina Cavezza
Promote this kind of social aspect of language, right? It really is social there. I think that's such an important point to make because we don't just use language for the sake of speaking, right? We we do it often in relation to other people.
00:33:34 Dr Cristina Cavezza
So.
00:33:34 Dr Sandra McMahon
Absolutely. And our speaking skills then directly what? Why do we read? We're reading to get more information. We're reading for entertainment. We're reading for learning. So you know, the literacy and communication, which is why speeches work on both because they are so interrelated. Yeah.
00:33:54 Dr Cristina Cavezza
So where can people go if they want more information and assistance about understanding typical speech and language development in children so that they they can be?
00:34:03 Dr Cristina Cavezza
More aware of?
00:34:04 Dr Cristina Cavezza
If there is a problem in their multiple birth children, where do they go for that kind of information?
00:34:10 Dr Sandra McMahon
Well, look, there are today with the Internet, there are multiple sites that provide some developmental guidelines or steps to learning. And what we should be expecting generally for different ages depending on the different, what we're looking at. I mean even our you know even our website will have some general.
00:34:30 Dr Sandra McMahon
Guidelines are what to expect at what age.
00:34:34 Dr Sandra McMahon
And I think not going down that tunnel too much, but having some general ideas like I said at one we should be saying one word at two, we should be putting two word sentences together at three. We should be able to maintain small conversations and yeah, you know, so having just really.
00:34:54 Dr Sandra McMahon
Let's get big.
00:34:55 Dr Sandra McMahon
Steps to just keep in mind I think is the easiest rather than saying ohh when should they say is versus ahh when should they say are you know so it's. I'm not saying let's go down and say you know cause we I said that because we work with so many children saying we was at the shops so the the grammer the little words.
00:35:15 Dr Sandra McMahon
That's something that we do work on and we do.
00:35:17 Dr Sandra McMahon
See that in multiple birth children that early grammatical expressive language difficulties because the main idea, whether I say we was at the shop or we are at the shop. The main idea is still conveyed, but the grammatical component needs to be sort of supported. So sorry, I'm going totally off track. They're going down that little Ave there.
00:35:38 Dr Sandra McMahon
But the the the fact is, is that it doesn't matter what area you're working on, it does it. It just having some general guidelines, not, you know, specific which grammar should I have at this age. But we should be using sentences and the grammar should be mostly correct.
00:35:54 Dr Sandra McMahon
At say three 3 - 3 and 1/2 that sort of idea having sort.
00:35:59 Dr Sandra McMahon
Of those broad.
00:36:00 Dr Sandra McMahon
Guidelines is what I recommend to parents rather than sort of trying to go right down to the which one should we do doing now?
00:36:08 Dr Cristina Cavezza
Yeah. And so a first point of call might be, you know checking out your website and getting those broad guidelines are there. Do the maternal child health nurses here in Australia, I mean obviously.
00:36:18 Dr Cristina Cavezza
This is an international podcast and that there are people listening from around the world, so this may not be relevant to everyone, but in Australia the maternal child health nurses might might they be another source?
00:36:29 Dr Sandra McMahon
Absolutely yes. Yeah. So again, any milestone cheques with any medico or you know the nursing or education staff.
00:36:30 Dr Cristina Cavezza
OK.
00:36:31 Dr Cristina Cavezza
Thank you.
00:36:40 Dr Sandra McMahon
And even like if you are, you know, having those first interviews with new schools and things, asking questions like, what do you typically want children to be doing when they're entering, you know, grade 3 or primary school or high school? So getting when you're interviewing, asking the, the the.
00:37:00 Dr Sandra McMahon
Medical, nursing or educational staff what they see as key guidelines and then that helps you provide some guidelines or reflection back on your own children.
00:37:12 Dr Cristina Cavezza
Yeah, that's actually a really great suggestion. You know, I was thinking even my.
00:37:17 Dr Cristina Cavezza
Twins are much older now, but I was thinking that that that can be really helpful advice really for parents who are navigating school and going towards, you know, even secondary school and just sort of asking, asking the teachers and the educators, you know what, what are you expecting at this age? And so that gives you a sense kind.
00:37:35 Dr Cristina Cavezza
Of of what to work toward.
00:37:36 Dr Sandra McMahon
Absolutely. Yeah. I mean, if they think of literacy, a lot of parents are thinking they need.
00:37:37 Dr Cristina Cavezza
Yeah.
00:37:41 Dr Sandra McMahon
To be reading before they.
00:37:41 Dr Sandra McMahon
Go to school, you know.
00:37:43 Dr Sandra McMahon
And you know, reading what you know. Are they aware that a letter is a letter and a number is a number? That's great. Do they have to be able to?
00:37:50 Dr Sandra McMahon
Spell hippopotamus you.
00:37:52 Dr Sandra McMahon
Know before they go into kindy, I'd say no. So again the the the spectrum of what's needed at different ages is so overwhelming. If parents narrow it down to some.
00:38:04 Dr Sandra McMahon
Key step points it makes it easier.
00:38:07 Dr Cristina Cavezza
Yeah, great. Thank you.
00:38:09 Dr Cristina Cavezza
Is there anything else you'd like to share with us today that we haven't already covered that you think might be important for listeners to know?
00:38:15 Dr Sandra McMahon
I think we've covered a lot, to be honest. I'm again, if I can just emphasise I'm not pushing that all children should be seen by speech pathologists. All I'm saying is that early intervention has been shown.
00:38:30 Dr Sandra McMahon
To be key.
00:38:31 Dr Sandra McMahon
So being aware of milestones and and going into that.
00:38:35 Dr Sandra McMahon
Is very important and I think just again highlighting the concept of twin speech.
00:38:42 Dr Sandra McMahon
It's often that there's a speech, sound error or disorder, and so rather than letting it be and see if it grows out of it, maybe at least getting a touch base with a medico or a speech pathologist to confirm. Yet that's OK for now or.
00:38:58 Dr Sandra McMahon
No, it's not.
00:39:00 Dr Cristina Cavezza
Yeah, I think that's such an important point because.
00:39:02 Dr Cristina Cavezza
Is really. There's really no harm, right? And even just getting an initial initial consultation, putting your name on a wait list and then just having that initial consultation if you are concerned about something, just to get that kind of confirmation and support if it's required.
00:39:15 Dr Sandra McMahon
Like like.
00:39:17 Dr Sandra McMahon
Yeah, yeah. And again, I'm not saying go on.
00:39:19 Dr Sandra McMahon
Every wait list just in.
00:39:20 Dr Sandra McMahon
Case because you're probably aware.
00:39:21 Dr Cristina Cavezza
Now.
00:39:24 Dr Sandra McMahon
Many states in Australia there are long wait lists to see speech pathologists, so it's if red flags or concerns pop up then I'm saying yes assess it and see if that the issue not let's do it just in case, yeah.
00:39:38 Dr Cristina Cavezza
Yeah, absolutely. So we'll definitely put your website and details on the podcast show notes for people. It was lovely to connect with you today. Thank you so much for being here.
00:39:48 Dr Sandra McMahon
I hope I've given some useful information and not overloaded.
00:39:52 Dr Cristina Cavezza
Not at all. Thank you. It was wonderful. Thank you.
00:39:54 Dr Sandra McMahon
Thank you very much. That was very good. Thank you.
00:39:56 Dr Sandra McMahon
Cheers.
00:40:01 Dr Cristina Cavezza
Thanks for listening to today's episode. If you like what you've heard and please follow and.
00:40:06 Dr Cristina Cavezza
leave a review.
00:40:07 Dr Cristina Cavezza
So that other expectant and current parents of multiples like yourself can find this podcast and the valuable information it contains, I'd be so very grateful if you left a review and share this with anyone you think could benefit from listening.
00:40:20 Dr Cristina Cavezza
If you have a particular topic you'd like me to cover on this podcast, feel free to reach out to me via my website fiercekindmama.com
00:40:28 Dr Cristina Cavezza
New episodes are released every second Wednesday, so see you back here real soon. Any advice and information on this podcast is general only and has been prepared without taking into account your particular circumstances and needs. For tailored, individualised advice please
00:40:48 Dr Cristina Cavezza
Consult with a qualified professional.
