Hallie Bulkin advises an "airway first" approach for sleep and breathing issues, highlighting evaluation of tonsils and adenoids and possible referral for a sleep study. She links airway problems to sensory/regulation difficulties—such as avoidance of oral input, dental/orthodontic distress, food avoidance, and inconsistent therapy responses—and recommends occupational therapy for sensory regulation while airway-focused treatments (expansion, MYO) are pursued.
Chapters
I want you to think about airway. Airway first, always tonsils and adenoids. And maybe the child or adult needs a sleep study. That might be where they're headed next. Okay. That's sleep and breathing. Next would be sensory or regulation. So avoidance of oral input. So like anybody who's avoiding putting anything in their mouth, maybe they're avoiding just any kind of oral input. Maybe they don't actually like going to the dentist or the ortho because they feel like they, it's like an attack on their nervous system. Right. They have a hard time regulating how they feel with that. Maybe they are avoiding putting certain foods in their mouth. Maybe they're. Whatever may be going on, maybe they also are showing some inconsistent responses to therapy. And you're like, well, one day they seem really regulated, the next day they don't. That can be airway related. That can improve over the course of like expansion or MYO or you know, improving the, the airway in general. But in the meantime, to help them really function well and be functional in day to day, an OT referral might be really, really helpful to help give them strategies on regulating their nervous system, their sensory system. Right. Like kind of getting that sensory processing under wrap.
