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Alumna becomes noted expert in pediatrics in occupational therapy

For Carissa Peppard Snelling, M.S., O.T.R./L., B.C.P., ’05, perseverance and a constant exploration of new ideas pays off – not just for her, but for the infants and children she has spent her career helping. Snelling, a graduate of Misericordia University’s five-year occupational therapy master’s degree program, led the effort to bring a new, high-tech device that’s helping pre-term infants with feeding challenges learn how to suck from a bottle or breast to Good Shepherd Rehabilitation Hospital’s Pediatric Unit in Bethlehem, Pa. Her work makes Good Shepherd the only rehab facility on the East Coast to use the FDA-approved NTrainer® System.

“You realize how much development goes on in utero and children who do come into the world prematurely don’t have that opportunity to really develop the reflexes and skills they need for bottle drinking,” Snelling says. For babies born prematurely without the readiness to take liquid by mouth, the first method for developing the sucking ability would normally be to use a pacifier or gloved finger to apply pressure to the tongue and stimulate what is called a non-nutritive suck. The NTrainer is more advanced and strategic.

A pacifier is connected to tubing that runs to a computer system. As the baby mouths or sucks on the pacifier, the computer records data and measures the strength and rhythm of the suck. It creates a graph that therapists can analyze and use to develop a treatment plan.

At the same time, as the baby is receiving food via a tube inserted through the nose or stomach, a compressor sends a puff of air to the pacifier to inflate it at a rhythm and intensity that mimics sucking on a bottle or breast. “With that patterning, you’re teaching an infant how to develop that sucking skill,” Snelling explains. “In time we transition the infant off of the NTrainer and on to a bottle or breast. We’re seeing they’re able to use that skill in order to accept formula or breast milk.”Snelling spent the past four years working to bring the NTrainer to Good Shepherd.

The inpatient pediatric unit there is fairly new at just seven years old, and while administrators were interested in it, they were initially unsure if the technology and its high price tag would be viable. “Good Shepherd prides itself as an organization on having leading-edge technology,” Snelling says. “After several years of being open and showing we do take preterm infants who are not ready to go home yet, they recognized that need and accepted my request. It took persistence and patience, but just always knowing this was the right fit for not only Good Shepherd as an organization but also the children we were serving.”Snelling has been at the leading edge of helping infants and children overcome challenges throughout her career. She specialized in pediatrics during her time at Misericordia and is now one of only five occupational therapists in Pennsylvania recognized as having a board certification in pediatrics by the American Occupational Therapy Association, an achievement that requires years of experience and an extensive portfolio to demonstrate a high level of expertise.

Now, Snelling serves as a reviewer for the panel that makes the decisions. Her interest in working with children came early and inspired her to pursue occupational therapy. She was a nanny for a young girl living with cerebral palsy who received early intervention therapy. “She would have an OT come to her house and I would watch, and I was fascinated in how the OT would adapt a paintbrush or a marker so the little girl I was watching could do those things,” Snelling recalls. “After asking a lot of questions and observing different areas of OT, I always kept coming back to children. That was my passion. When I was a student, during an internship I had the most wonderful experience with a pediatric facility and that instilled in me that was what I wanted to do.

”After graduating from Misericordia, Snelling did early intervention therapy in homes with children from birth through 3 with developmental delays, through a government-funded program administered by Easter Seals of Eastern Pennsylvania. She said she put 90,000 miles on her car in the first year covering a five-county area. But it was an experience that informed the rest of her career. “So much of what I do in the hospital setting is based on my early intervention work, having that grounded philosophy that it doesn’t matter what successes the child has in the hospital. It matters what’s happening in their homes,” she says. Snelling went on to join Good Shepherd Rehabilitation Hospital in its then newly created Pediatric Unit.

There she became one of the founders of the Inpatient Feeding Program, where she led the charge to bring in the NTrainer System. “When Good Shepherd hired me, I had a niche in that area and I made it my personal goal and professional goal to really develop a well-recognized, high level of clinical excellence program for infants, toddlers and children with feeding challenges,”she says. The program is an integrated team model with a pediatrician, rehab doctor, therapists, a case manager, nurses, dietician, a family counselor, and a chaplain all involved.

Through her work in early intervention, she recognized how often she needed the expertise of others to address feeding issues. It was important, she said, to have many people of different backgrounds to bring their knowledge to addressing feeding issues. “When you look at a feeding challenge for a child, you have to serve as a detective to understand what went awry and what’s causing them not to eat,” Snelling says. “No one person can make all those observations by themselves nor can they have all the insight into what’s going on. They have to work together as a collaborative to paint this picture of what is going on.’’Snelling was a therapy supervisor, overseeing 14 therapists and ensuring the highest quality of care for children. She recently presented a workshop on pediatric feeding disorders at the American Occupational Therapy Association’s annual conference in Chicago, Ill. In September, she transitioned to a new role as community liaison, providing outreach to health care providers and organizations focused on children’s health. It’s a position she was given because of the enthusiasm she has for the work she and others do at Good Shepherd. And that enthusiasm was fostered at Misericordia. She came to the school the child of a single mom, Kiki Peppard. The family did not have much money and her guidance counselor, a Misericordia graduate, at Pleasant Valley High School in Broadheadsville, Pa., encouraged her to check out the intimate school. It was the only college she applied to, and though the program only accepted 50 students at the time, it worked out as she had hoped.

“It’s such a wonderful place and obviously the reputation in the OT field for Misericordia is just top notch,” she says. “I received financial assistance, a scholarship and everything fell into place.”Misericordia became a place of growth – academically, spiritually, socially and emotionally – for Snelling. She got involved with the Rite of Christian Initiation of Adults (RCIA) program to receive the sacrament of confirmation. And she was challenged in the classroom. She was most enthusiastic about pediatrics. Professor and pediatric coordinator Lalit Shah, Ed., O.T.R./L., she said, could be a tough instructor, but she came to realize it was to make his students the best in their field. “He definitely pushes his students past the point of competency toward excellence.” Snelling says. “I cursed him under my breath constantly, his tests were impossible. But now when I think about it, he wanted us to be equivalent to him as a peer in a professional environment.

It was only to promote the field of OT and advance pediatrics to be recognized as such high quality. I appreciate that and it taught me perseverance.”Her Misericordia experience also influenced her mother’s future. After Snelling graduated, Peppard went on to another college for the first time at the age of 57 and became an occupational therapy assistant. “Misericordia really shaped my life, my mom’s life, my family’s life,” she says, proudly. “I just always look at it as a time of great inspiration, growth, development and nurturing. I love it there. Even though my experience with Misericordia is in the past, I feel like the inspiration is always alive. It’s great to know my experience isn’t unique –it’s really the standard for all students and alumni.”