Q&A with Kyrsten Theodotou, Pediatric Rehabilitation CCC-SLP at University of Minnesota

Kyrsten Theodotou (MA, CCC-SLP) works as a pediatric Speech-Language Therapist at the University of Minnesota Pediatric Rehabilitation Clinic. Prior to this, she served on the Pediatric Brain Injury Team and the Growth and Nutrition Team at Hennepin County Medical Center in Minneapolis. Kyrsten talked to us about what inspired her to become an SLP and how she’s thrived in a number of diverse roles in the field in the years since.

Q: What first drew you to speech language pathology? Is there anything special about it that might make current students find this to be a career fit?

Kyrsten: My mom is a speech pathologist so I’ve been exposed to speech [therapy] most of my life, and when I was little I was going to school with her, so I always had…interest in it. I just decided to declare it as my major in college and the more I got involved in my program the more I realized that there was so much more to speech pathology:…I could work with kids [or adults] in the hospitals and the schools or in a clinic setting.

So I was first drawn to it just because of my environment but then fell in love with it as I learned all of the different areas that I could potentially work in.

Q: What surprised you about this field of study?

Kyrsten: The first thing that surprised me was the pediatric feeding…it is such a small niche and group of people that do it…I had no idea that speech pathologists did that.

Q: Are there any other areas that are special interest areas of you?

Kyrsten: Birth-to-three and three-to-five year olds, so preschoolers….They’re so pliable at that age and teachable. Birth-to-three is when the brain grows the most, so to be able to promote that…and not just do it between me and the child, but to incorporate the family, I really like that teaming aspect of it.

Q: During your graduate fellowship and early work you spent time in the NICU. Could you explain your experience there and the role of an SLP in the NICU?

Kyrsten: I first trained in the NICU at the Cincinnati Children’s Hospital so I could do outpatient feeding therapy. The philosophy behind that was [that] you kind of need to see where kids are coming from when you treat these complex feeding cases.

I moved to Minneapolis and worked at Hennepin County Medical Center and got more involved in the NICU…[where] the most important role of the speech pathologist is to make sure the child is protecting their airway and not aspirating…aspiration would make them sick.

So then our role is to assess that and then help with different strategies to help make them functional so that they can get all of their nutrition and hydration through the mouth so they don’t need a tube.

You also heavily collaborate with other disciplines [in the NICU] like other occupational therapists or physical therapists to work on the different positioning strategies.

Q: Does collaboration involve working together at the same time with a baby?

Kyrsten: Collaboration varies from patient to patient.

In my previous setting…I would work on the bottling and the occupational therapist would help with maximal positioning, because sometimes [the infant’s] success in bottling was based on their positioning. So we are both there at the same time.

Other times it’s more just a discussion in capacity, so it kind of depends on the needs of the infant.

Q: When you’re doing inpatient with kids in the NICU what types of issues are kids coming in with?

Kyrsten: It’s really all over the map. Previously it was a lot of brain injury that I’d see, so it was an event that brought them into the hospital, so then we’re doing more cognitive and language testing. With feeding kids it could be that they were admitted to see if they could even gain weight.

Currently when I’ve covered inpatient as a casual staff member it has been to check up on their oral motor feeding skills or their bottling skills because they have…a genetic syndrome or have had surgery (like cardiac surgery), or recent extubation from another surgery and they’re not able to progress to a regular diet typically like you would expect. So it’s variable.

Q: Can you share a bit about your role as a speech language pathologist on the Pediatric Brain Injury Team?

Kyrsten: We worked with infants to eighteen years. It’s a really strong team…we work with the pediatric ICU attending physicians and then the social worker was the coordinator of the teams. So she made sure we were able to follow up with our patients and then coordinate care plans together.

And then your occupational therapists, physical therapists, and speech pathologists provided inpatient services and really our goal for speech was to assess them and see: What are their rehab needs? Do they need ongoing services while they’re in the hospital to get them to go to acute rehab, like a place like Gillette [Children’s Hospital]? … Or do we just recommend follow up as an outpatient? Or are they functioning at the same level that they were prior to coming in? So it’s a lot of teasing that out.

We’ve relied heavily on the neuropsychologists and the psychologists because they can help process trauma…The neuropsychologist can help differentiate what is baseline versus what is a new onset from a mild brain injury or a concussion…maybe there was some underlying depression and anxiety but now those things are exacerbated. They’re such a huge part of what we do and how we guide after their inpatient stay.

And then we saw children with mild brain injuries—also known as a concussion—all the way up to severe brain injuries. Anywhere from a car accident, a fall, a pedestrian versus vehicle…so it kind of covered the range of injuries.

Q: It sounds like these were some tough situations families were facing. How did you deal with that?

Kyrsten: That’s where we relied a lot on social work and Child Life and the chaplain to help bridge that gap between therapies and the family’s experience, because it’s such a sudden incident for those families. You’re then essentially going into rehab mode with kids, whereas when I see children with developmental delay issues you’re just kind of habilitating them and working then up to normal; so it’s a lot of empathy and discussion and conversation with the family.

Q: Share a little bit about your involvement with the growth and nutrition team.

Kyrsten: Nutrition is a big deal because you want to make sure the kids are meeting their nutritional needs. So, relying a lot on what the dietitian thinks the child needs, what the doctor feels is important…[these things help] guide my therapy.

So if I feel like a child is at an adequate weight and so does the rest of the team then I felt I could be a little more liberal in telling families “It’s ok, you don’t need to feed them all of the time or let them snack all of the time.”

But if they were low weight I would…rely a lot more on the dietitian to give me the go-ahead on what I want to do in therapy.

So the role of the speech pathologist is to look at the oral motor skills and how that’s impacting their nutrition. Speech pathologists will also look at the sensory component and the behavioral component because eating is not just one thing, it’s a lot of different factors.

Q: Over the course of a week what is a normal number of patients or individuals that you would interact with?

Kyrsten: That’s a tricky question, just because you have what’s expected of you, and then you have who actually comes. Weather makes it difficult for families to come; when you’re working with children who are really sick and there are frequent hospitalizations and complex medical histories they are at a higher risk for not coming just because you don’t want them to get sick.

I would say [in] a week you probably see like 25 patients (scheduled heavier than that).

Q: How much of a child’s success do you think is dependent on the parent and how the parent is involved?

Kyrsten: I think it’s huge. And there’s research and data to support that. Even in, like, little little kids who are hospitalized. As an outpatient you need to have parent buy in, because I can see a child every day of the week for therapy but I’m not home with them and executing it in their home environment so its really important to have parents buy into what you’re doing and working with them in what is achievable at that time.

Families are going through different things, whether it’s [that] they have other children they have to attend to, sometimes you know maybe they’re just trying to look for housing or where their next meal is coming from.

Your have to keep in mind where the family is but it’s really important to have the parents buy into what you’re doing and then modify strategies…so that they can be successful in whatever environment they’re in.

Q: How might you modify a strategy when working with a parent?

Kyrsten: Just something as simple as getting a child exposed to different foods who are g-tube dependent…[and those who have] multiple complex medical issues. So just getting the family to put whatever they’re eating on the tray for exposure.

{Normally] I’d say “yep, everybody sits at the table at the same time”. Well, if mom’s coming home from work, dad’s out the door to go to work, siblings are coming home from school… it’s really hard for families to have that sit down time so maybe say stat with something small: ok, on weekends when you’re all together do this meal together; [or] anybody who’s in the house at the same time comes to the table for snacks. So it’s modifying what I would kind of see as ideal to fit the family’s situation.

Q: Is it common for someone in your position to spend all of your time focusing on just feeding or just speech, or do you do a little bit of both?

Kyrsten: Yeah, it depends on the child’s needs…So for like a 12-13 month old child when I’m working on feeding therapy I probably won’t do language therapy unless it’s glaring that they need it or they are hearing impaired or need more language stimulation.

Also, to formally address both of those in therapy you need to have two separate evaluations.

Typically the youngest I would evaluate a child for speech and language would be 15 months. I think working on both of them is very appropriate for some kids and you can incorporate language into your feeding therapy session just by talking about what you’re eating and using it as vocabulary expansion and having them request more or eat or using different signs…So you kind of organically put language into it without having it as a goal.

Q: Tell me a little about how you’ve worked out the timeline of managing school, family, and work? What has made it possible for you to continue to be a therapist and have kids at home?

Kyrsten: My path to school and starting a family: I started dating my now husband when I was a second-year grad student and throughout that whole process I always knew I wanted to be a speech pathologist…I highly value family, so I always knew family will always come first. (And that’s me personally.)

I strive very hard currently to have a very clear balance and separation of “this is my work life and this is my family life”.

My husband was supportive of that but at the time I had to do things to advance my career to get to where I wanted to be. I did an internship at Cincinnati Children’s Hospital, came back for an internship at Fairview, but the doors were not open anywhere in Minneapolis, and this is where my now husband was established.

So the opportunity came for me to do my clinical fellowships year at Cincinnati Children’s Hospital and I took advantage of that knowing that it would be hard to do long distance. But, you know, you have the ultimate goal in mind, you want to be back home close to your family, so it’s taking that leap of faith and trusting that the right doors will open at the right time.

Sure enough they did. When I finished my fellowship year I was able to come back home and I worked for Hennepin County Medical Center for five years.

During that time we got married and had our first child (and we have a second one on the way) and then it was a matter of what stetting will be most appropriate for me to continue a better work life balance. I was full time at HCMC and I had the opportunity to cut back more quickly a the University; but I still keep my connections at HCMC and I still work there casually and on call.

I’ve always been one to get my documentation done at work and then go home so I can have time with my family, because that’s a value…I value faith, family and friends over…over everything. And I think it’s really easy in speech—it’s very competitive— it’s really easy to lose sight of what you personally find important.

Even at your first job: It’s kind of hard to land [it] and let go of that [intense mindset]…I just encourage students who are wanting to have that family and work-life balance to set your boundaries.

I saw it first hand with my parents…my mom was able to work in the school and then pickup some casual hours a the nursing home in the summer…I saw the flexibility that my mom could provide to our family…I see that with my husband and I now. He’s a teacher. I can work part time now; he’s home in the summers; so we are able to have a balance of work, together, and life.

Q: What are important personality traits for someone who wants to work as in some of these specialized areas you mentioned, like brain injury and the NICU?

Kyrsten: The personality trait in general of speech pathologists or someone in healthcare needs to be empathetic and listening to the family. And you just need to realize that you may have goals for the kid and the family may not be at those goals yet. So it’s really being a team member with the family and letting them be a part of their child’s planning…and getting families to the point where you want them to be.

My supervisor in grad school, during one of my practicums, told me: “You can teach someone the skills for feeding, for brain injury, for language, but you can’t teach someone how to be caring and empathetic and compassionate”…especially in these really challenging situations.

Q: What would you say has been the most difficult part of your job?

Kyrsten: I think the most difficult part of the job is…[that] you can’t do it all. Because you’re in a profession where you want to help people and when you don’t see that progress and that barrier to progress is outside of your control that is probably the most challenging and difficult part of doing it.

Q: What is the most rewarding part?

Kyrsten: I think the most rewarding part is when you have a breakthrough with a family. Whether it finally clicks with them [and] they start following through, you have a child who now is saying more words…or they are starting to look and point to their parents to get them to do something…it’s really rewarding when a kid starts finding enjoyment in eating and the parents see, “oh, they can do this”…it’s those little moments that make it the most rewarding.

Q: Is there any last advice you would give to graduate students or new practitioners?

Kyrsten: Take advantage of opportunities that are given to you. Especially early on. Because those are pathways to finding out what you really love and what you want to continue doing.

My generation, you know, you don’t find one job and stay there forever…I mean, it’s rare to find that, so really embrace the different opportunities; whether it’s going to a conference or an opportunity to learn more or hear a speaker…or a job that may be far away from home but that would really be a stepping stool for where you want to go.

I’d just encourage students to take advantage of that because they don’t always come along…we always say short-term pain long-term gain!