The Untethered Podcast™

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

In this episode, Hallie Bulkin dives into the structural gaps of traditional feeding education and explains why treating a child requires an integrated, whole-system lens. She breaks down real-world case examples to demonstrate how behaviors like extreme texture selectivity or mealtime refusal are frequently symptoms of underlying postural instability, airway restriction, or sensory overload.
Hallie offers practical strategies to help clinicians move away from single-lens troubleshooting and develop the deep clinical reasoning required to connect isolated observations, uncover root causes, and create transformative intervention plans.

Key Topics & Takeaways

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

Soundbites

"Pediatric feeding isn't adult dysphagia scaled down—it is a complex, dynamic, developmental system."
"Traditional training teaches isolated pieces of the puzzle, but rarely shows clinicians how to connect them at the evaluation table."
"Effective feeding therapy requires us to look at the child's whole system. Symptoms are just clues pointing us toward the underlying root cause."

Timestamps

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

Links & Resources

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

WORTH A LISTEN: CONTINUE YOUR JOURNEY

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

STAY CONNECTED

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

If Hallie's perspective on pediatric feeding education and clinical reasoning gave you a fresh lens for your practice, please take a moment to leave a review! Your support helps us share these vital clinical frameworks with therapists everywhere.
Hosted on Acast. See acast.com/privacy for more information.

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

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

About the Guest: Shayla Bollman, MA, CCC-SLP, CPFT, CLC

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

Key Topics & Takeaways

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

Soundbites

"Holistic assessment is crucial for effective feeding therapy—we have to evaluate the entire developmental picture, not just the mouth."
"Building a collaborative team and offering in-home family support makes a profound difference in a child's feeding progress."
"Helping parents understand the clinical difference between a gag and a choke is essential for mealtime safety and peace of mind."

Timestamps

01:04 - Guest Introduction: Shayla Bollman, MA, CCC-SLP, CPFT, CLC
02:00 - Impact of CPFT Certification on Diagnostic Reasoning & Practice Growth
07:06 - Empathy in Infant Feeding: Transitioning to Infant Clinical Care
12:16 - Understanding Feeding Refusal in Infants
15:15 - Blending Lactation Counseling (CLC) with Pediatric Feeding Therapy
19:08 - Assessing Tethered Oral Tissues (TOTS): Bodywork & Functional Milestones
22:08 - Pre- and Post-Op Care for Tongue-Tie Releases
46:20 - Raising Intuitive Eaters: Long-Term Impacts of Mealtime Support
49:38 - Interdisciplinary Advocacy: Partnering with Pediatricians & Specialists
53:42 - In-Home Care, Caregiver Classes & Launching Private Practice
58:02 - Connecting with Shayla Bollman

Links & Resources

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

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

STAY CONNECTED

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

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

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

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

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

Key Topics & Takeaways

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

Soundbites

"Feeding does not happen in a silo - it requires the synchronized support of posture, airway, sensory, and nervous system regulation."
"Assess the child's foundation before asking the mouth to perform. If the body is fighting for balance or air, feeding will always be secondary."
"Symptoms are information, not the starting point. Our job is to trace those symptoms back to the underlying root cause."

Timestamps

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

Links & Resources

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

WORTH A LISTEN: CONTINUE YOUR JOURNEY

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

STAY CONNECTED

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

If Hallie's structured approach to pediatric feeding gave you actionable insights for your practice, please take a moment to leave a review! Your support helps us share these vital clinical frameworks with therapists everywhere.
Hosted on Acast. See acast.com/privacy for more information.

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

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

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

About the Guest: Ariel Grobman, MD

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

Key Topics & Takeaways

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

Soundbites

"Assessing danger and functional impact is always the most important first step."
"A detailed physical exam combined with clinical history can often replace the need for a cumbersome sleep study."
"Nasal endoscopy is quick, minimally invasive, and gives us immediate answers about structural obstructions."

Timestamps

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

Links & Resources

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

WORTH A LISTEN: CONTINUE YOUR JOURNEY
Don’t Ignore the Snore: The Hidden Link Between Airway, Sleep, and ADHD.
Mouth Breathing vs. Nasal Breathing: Changing Lives Through Early Airway Intervention.

STAY CONNECTED

💬 Join the Conversation: Connect with Dr. Grobman on Instagram and follow Hallie for weekly clinical takeaways on Instagram | LinkedIn.|Facebook.

If Dr. Grobman's insights helped clarify your understanding of pediatric airway assessments and surgical indications, please take a moment to leave a review! Your support helps us share these vital clinical discussions with providers and families everywhere.
Hosted on Acast. See acast.com/privacy for more information.

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

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

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

Key Topics & Takeaways

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

Soundbites

"A CPT code isn't just a billing number - it is a translation of your clinical documentation and direct scope of practice."
"When preparing for coding changes, proactive documentation systems protect both your practice and your patients."
"Bill for what you treat, document what you see, and ensure every note clearly establishes functional necessity."

Timestamps

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

Links & Resources

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

WORTH A LISTEN: CONTINUE YOUR JOURNEY

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

STAY CONNECTED

💬 Join the Conversation: Catch behind-the-scenes business tips, billing insights, and daily clinical pearls on Instagram | Facebook | LinkedIn.

If this episode helped clarify your billing, documentation, or CPT coding practices, please take a quick second to leave a review! Your support helps us share these vital business and clinical insights with therapists everywhere.
Hosted on Acast. See acast.com/privacy for more information.