The Untethered Podcast™

Navigating the world of tethered oral tissues (TOTs) can often feel like wading through murky waters. With so much conflicting information out there, it’s incredibly easy for clinicians to fall into the trap of letting a visual anatomical structure dictate their entire treatment plan. But looking at a tongue or lip tie doesn’t tell you the whole story.

In this solo episode, Hallie Bulkin dives deep into the complexities of diagnosing and treating tethered oral tissues during feeding evaluations. She pulls back the curtain on why presence does not automatically equal cause, and why a systematic, function-first approach is the only way to truly help your pediatric patients.

Whether you are feeling the pressure from families to provide quick answers or trying to differentiate between a primary and secondary driver of a feeding challenge, this episode is a crucial masterclass in clinical decision-making. Tune in to learn how to move past the anatomy trap and build ultimate confidence in your functional assessments.

Key Topics & Takeaways

The Murky Waters of TOTs: Why diagnosing and treating tethered oral tissues has become a clinical minefield, and how to navigate it safely.
Presence vs. Cause: A critical reminder that just because an anatomical tie exists does not mean it is the primary driver of the family's feeding struggles.
Common Clinical Traps: How relying solely on visual anatomy can lead to incomplete treatment plans and poor patient outcomes.
The Function-First Framework: Why evaluating dynamic feeding function is the only way to give structural anatomy its true meaning.
Primary vs. Secondary Drivers: Learn how to decipher when a tie is the root cause of a feeding issue versus when it is simply an incidental finding.

Soundbites

"Don't let anatomy lead your feeding plan."
"Presence does not equal cause."
"Feeding function gives anatomy its true meaning."

Timestamps

00:00 – Introduction to Tethered Oral Tissues and clinical challenges.
01:24 – The murky waters of diagnosis and the role of anatomy.
02:32 – Understanding feeding challenges as multifactorial.
03:02 – Limitations of relying solely on anatomy.
04:22 – Common clinical traps in tethered oral tissue cases (Traps 1 & 2).
05:11 – Trap No. 3: Treating the restriction instead of the feeding pattern.
07:13 – Trap No. 4: Skipping a full feeding assessment because the tie feels explanatory.
07:50 – Pressure to provide quick answers and the importance of function.
08:15 – Shifting focus to feeding function over anatomy.
09:21 – Feeding function as the key to meaningful anatomy interpretation.
10:00 – Primary vs. secondary drivers of feeding difficulties.
11:50 – When ties are incidental and not the main issue.
12:10 – Assessing functional impact and developing confidence.
13:30 – The value of structured feeding assessment training.
14:37 – Empowering clinicians with feeding function knowledge & final wrap-up.

Links & Resources

Dive deeper with Tongue Tie Bootcamp

WORTH A LISTEN: CONTINUE YOUR JOURNEY

Episode 348: Tongue Ties, Sleep Apnea & More: The Patient-Centered Approach to Airway Dentistry
Episode 363: Tongue Ties, Oral Habits & the Future of Airway Health

STAY CONNECTED & GROW YOUR PRACTICE

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If this show has impacted your clinical practice, please leave a review. Your support helps us reach the therapists and families who need these answers most!
Hosted on Acast. See acast.com/privacy for more information.

If you’ve ever felt like you were "guessing" your way through a feeding session, you aren’t alone. In fact, many clinicians enter the field with a passion for OT or SLP, only to realize their foundational schooling barely scratched the surface of pediatric feeding.

In this episode, Hallie is joined by Courtney Lewis, MOT, OTR/L, CPST, a pediatric feeding specialist and owner of NOSH Pediatric Feeding Therapy. Courtney opens up about her "long and winding road" to feeding—a journey that began with an 8th-grade project and evolved through home health, clinics, and hospitals.

They discuss the pivotal moment when Courtney realized she needed more than just general experience to truly help her families. From the "regulation lightbulb" moment that changed how she views patient behavior to the deep empathy she brings as a former "picky eater" herself, this conversation is a masterclass in why specialized training and clinical reasoning are the keys to professional confidence.

About the Guest: Courtney Lewis, MOT, OTR/L, CPST

Courtney Lewis is a pediatric occupational therapist, feeding specialist, and the founder of NOSH Pediatric Feeding Therapy. With over a decade of experience across various settings, she specializes in transforming mealtime struggles into joyful family experiences using a holistic, play-based approach. Courtney is a Feed The Peds® graduate and a dedicated mentor within The Pediatric Feeding Hub™.

Key Topics & Takeaways

The Accidental Specialist: How pediatric feeding "found" Courtney and why every previous setting—from home health to hospitals—was a necessary stepping stone.
The Missing Link in Education: A candid look at why most therapists feel underprepared and how to fill the gaps that grad school leaves behind.
The Sensory Lived Experience: Courtney shares how her own history as a picky eater allows her to advocate for her patients with a unique, firsthand perspective.
44,000 CFA Points: The story behind Courtney's "Regulation Lightbulb" and how understanding the nervous system changes everything in the clinic.
The Power of "The Hub": Why having a community of mentors and peers is essential for preventing burnout and ensuring clinical excellence.

Soundbites

"I didn't choose feeding therapy; it chose me. Every setting I worked in was leading me here."
"You go from feeling like you're guessing to actually having a clinical 'why' behind what you're doing."
"When you understand the nervous system, you stop looking at the behavior and start looking at the child."

Timestamps
000:00 – Overcoming imposter syndrome and the "stuck" feeling in feeding therapy.
02:22 – Courtney’s Journey: How pediatric occupational therapy "found" her.
05:47 – The Confidence Catalyst: Helping a breastfeeding infant transition to solids in 10 weeks.
06:34 – The Foundational Gap: Why standard courses like SOS and Beckman sometimes leave therapists wanting more.
23:40 – How Feed The Peds® provided the framework to finally "connect the dots."
29:10 – Lived Experience: How being a former "picky eater" shapes Courtney’s empathy as a therapist.
38:20 – Mentorship: Transitioning from student to leader within The Pediatric Feeding Hub™.
42:15 – Closing thoughts and where to find NOSH Pediatric Feeding Therapy.

Links & Resources

Visit Courtney’s Website: noshfeeding.com
Follow Courtney on Instagram: @NoshFeeding
Feed The Peds®: Join the 3-Day Screen The Peds to Feed The Peds Challenge
THE HUB: Become a part of The Pediatric Feeding Hub™

WORTH A LISTEN: CONTINUE YOUR JOURNEY
Episode 369: The 4 Layers of Feeding: How to Finally Know Where to Start
Episode 361: Why Two Therapists Get Different Feeding Outcomes (And How to Fix It)

STAY CONNECTED & GROW YOUR PRACTICE

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If this show has impacted your clinical practice, please leave a review. Your support helps us reach the therapists and families who need these answers most!
Hosted on Acast. See acast.com/privacy for more information.

In this solo episode, Hallie Bulkin dives deep into a common pitfall in pediatric feeding therapy: treating red flags as a diagnosis rather than a starting point. Many clinicians feel the pressure to jump straight into treatment the moment a concern is raised, but skipping the foundational steps often leads to stalled progress and clinical uncertainty.

Hallie clarifies the critical distinction between screening, assessment, and treatment. She explains why red flags should be viewed as "decision points" and how a structured screening process can transform your clinical decision-making. Whether you are navigating complex sensory issues or safety concerns, this episode provides a systematic framework to help you move forward with clarity and intention.

About the Host: Hallie Bulkin

Hallie Bulkin, MA, CCC-SLP, CMT®, CPFT™, is a pediatric feeding and orofacial myofunctional therapist and the founder of Elevation Movement. With years of experience in pediatric feeding, myo, airway, and tethered oral tissues, Hallie is dedicated to empowering clinicians with the tools they need to provide life-changing therapy for children and their families.

Key Topics & Takeaways

Red Flags as Decision Points: Understanding why a red flag is a signal for more data, not a roadmap for immediate therapy.
The Power of Structured Screening: How a checklist removes the guesswork and identifies specific risks.
The Clinical Sequence: Why the order of Screening → Assessment → Treatment is non-negotiable for successful outcomes.
Avoiding Common Pitfalls: Why relying solely on parent reports or mislabeling limited variety as "just sensory" can hinder progress.
Building Confidence: How a systematic approach reduces "imposter syndrome" and helps you know exactly what to do next.

Soundbites

"Red flags are decision points, not treatment plans."
"Screening answers the vital question: Is further assessment even needed?"
"Jumping straight to treatment skips the assessment phase entirely."

Timestamps

00:00 – Red Flags: The Doorway to the Next Step
00:36 – Introduction: Meet Your Host, Hallie Bulkin
01:52 – The "Now What?" Moment in Feeding Therapy
02:54 – Why Structured Screening is Not Optional
03:48 – Screening vs. Assessment: Solving the Sequencing Issue
04:22 – Mistake #1: Treating Parent Concern as the Only Data Point
05:27 – Mistake #2: Equating Limited Variety with Sensory Issues
06:17 – Mistake #3: Skipping the Safety & Airway Layer
07:22 – What a Strong Feeding Screening Checklist Actually Does
08:24 – The 3-Step Sequence: Screening, Assessment, and Treatment
09:34 – Case Example: Moving from Red Flags to Clarity
10:30 – Building Confidence & The "Screen The Peds" Free Training

👉 Join the free 3-day Screen The Peds to Feed The Peds training

WORTH A LISTEN: CONTINUE YOUR JOURNEY

Why Two Therapists Get Different Feeding Outcomes (And How to Fix It)
The 4 Layers of Feeding: How to Finally Know Where to Start

STAY CONNECTED & GROW YOUR PRACTICE
💬 Join the Conversation: Catch behind-the-scenes insights and daily clinical tips on

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If this show has impacted your clinical practice, please leave a review. Your support helps us reach the therapists and families who need these answers most!
Hosted on Acast. See acast.com/privacy for more information.

In this interview episode, Abigail Kemp shares her honest journey through her Clinical Fellowship Year (CFY) and into the world of pediatric feeding therapy. Like many new clinicians, Abigail quickly realized that academic knowledge alone wasn’t enough—especially when faced with the complexity of real-life feeding cases.

She opens up about the challenges of navigating unclear expectations, limited mentorship, and the pressure to perform early in her career. Through these experiences, Abigail discovered the power of self-advocacy, continuous learning, and finding the right support system to grow as a clinician.

This episode offers a grounded and relatable perspective for therapists who feel overwhelmed or unsure—reminding you that confidence isn’t about knowing everything, but about learning how to think, adapt, and take action.

About the Guest: Abigail Kemp

Abigail Kemp, M.S., CCC-SLP, is a speech-language pathologist who began her clinical career in 2024, gaining experience across pediatric clinics, preschool and daycare settings, elementary schools, as well as adult outpatient and acute care.

While she had strong academic exposure—particularly in dysphagia—her early clinical experience in pediatric feeding therapy presented unexpected challenges. During her CFY, Abigail was faced with feeding cases that pushed her beyond her comfort zone, often without the level of mentorship and guidance she needed.

Abigail continues to expand her expertise in feeding therapy and hopes to further specialize in the field. She encourages new clinicians to advocate for themselves, ask questions, and trust that growth takes time—but is always worth the journey.

Key Topics & Takeaways

The Reality of CFY Challenges:
Why many new clinicians feel unprepared—and how real growth happens after graduation.
The Power of Mentorship & Community:
How the right environment can accelerate your confidence and clinical development.

Building Confidence in Feeding Therapy:
Why confidence comes from action, not perfection.

Self-Advocacy in Clinical Practice:
How speaking up and seeking support can transform your career trajectory.

Individualized Feeding Therapy:
Why no two clients are the same—and treatment must reflect that.

Soundbites

“I realized how little I knew about feeding.”
“Treatment strategies must be individualized.”
“Support and mentorship are crucial in our field.”

Timestamps
00:00 – Introduction to Abigail Kemp
01:43 – Early Career and the Clinical Fellowship Year (CFY)
03:39 – Navigating Expectations in a New Pediatric Clinic
05:39 – Challenges of Remote Mentorship and the First 4 Months
06:56 – Finding a New Setting & The Power of Self-Advocacy
08:21 – Facing the First Pediatric Feeding Client (approximate transition based on the flow of setting change)
10:58 – Discovering "Feed The Peds" and Pediatric Feeding Courses
17:16 – Balancing Practice in School and Clinic Settings
21:38 – Navigating Ethical Dilemmas and Professional Integrity
25:20 – Practical Application: Using Clinical Knowledge at Home
47:24 – Final Advice for New Clinicians & Closing Remarks
If you’re feeling unsure where to start in pediatric feeding, Screen The Peds to Feed The Peds is the perfect next step.
Join me for this free 3-day training, where I’ll show you how to screen feeding cases clearly, confidently, and with intention — so you know what to do next.

👉 Join the free 3-day Screen The Peds to Feed The Peds training

WORTH A LISTEN: CONTINUE YOUR JOURNEY

Why Two Therapists Get Different Feeding Outcomes (And How to Fix It)
When Imposter Syndrome Shows Up in Pediatric Feeding Therapy (and What to Do Next)

STAY CONNECTED & GROW YOUR PRACTICE
💬 Join the Conversation: Catch behind-the-scenes insights and daily clinical tips on

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If this show has impacted your clinical practice, please leave a review. Your support helps us reach the therapists and families who need these answers most!
Hosted on Acast. See acast.com/privacy for more information.

In this solo episode, Hallie Bulkin dives deep into the "noise" of complex feeding therapy. When a child presents with multiple overlapping issues, it’s easy for clinicians to feel stuck. Hallie explains why the secret to better outcomes isn't working harder or using more strategies - it’s prioritization.

By breaking feeding down into four essential layers, Hallie provides a framework for identifying the "primary limiter" and building a treatment plan that actually moves the needle. Whether you’re a seasoned therapist or new to the field, this episode will help you trade confusion for clinical confidence.

Key Topics & Takeaways

The Four Layers of Feeding: Understanding the hierarchy of physiological stability, oral motor skills, sensory processing, and behavior.
Cutting Through the Noise: Why treating every issue at once often leads to plateaued progress and clinician burnout.
Identifying the Primary Limiter: How to determine which factor is actually holding the child back from reaching their next milestone.
The Foundation First Approach: Why skipping foundational stability for high-level skills is a recipe for failure.
Clinical Confidence: How mastering decision-making skills changes the way you show up in the therapy room.

Soundbites

"The problem isn't effort, it's prioritization."
"Not everything is equally urgent. If we treat everything like a priority, nothing is a priority."
"Clarity in your plan builds confidence—not just for you, but for the families you serve."

Timestamps

02:09 – The Real Problem: Effort vs. Prioritization
03:19 – The Confusion Loop: Why Feeding Cases Feel Complex
04:22 – Identifying the Primary Limiter in Feeding
05:05 – Layer 1: Physiological Stability
05:54 – Layer 2: Oral Motor Skills
06:25 – Layer 3: Sensory Processing
07:01 – Layer 4: Behavior and Learned Patterns

If you’re feeling unsure where to start in pediatric feeding, Screen The Peds to Feed The Peds is the perfect next step.
Join me for this free 3-day training, where I’ll show you how to screen feeding cases clearly, confidently, and with intention — so you know what to do next.

👉 Join the free 3-day Screen The Peds to Feed The Peds training

WORTH A LISTEN: CONTINUE YOUR JOURNEY

Why Two Therapists Get Different Feeding Outcomes (And How to Fix It)
Why Pediatric Feeding Therapy Feels So Hard and What’s Been Missing

STAY CONNECTED & GROW YOUR PRACTICE

💬 Join the Conversation: Catch behind-the-scenes insights and daily clinical tips on
Instagram | Facebook | LinkedIn

If this show has impacted your clinical practice, please leave a review. Your support helps us reach the therapists and families who need these answers most!
Hosted on Acast. See acast.com/privacy for more information.