Dr. Richard Baxter on How to Know If a Tongue Tie Is Really the Problem

And I give the example of a shoelace example, which if your shoelaces are tied together, you're not gonna be able to run. You're not gonna be able to run in the Boston Marathon. You're not gonna be able to run even at the track, 400 meters, if your shoelaces are tied together. You can have the best track coach, best running coach in the world, the best speech therapist or feeding therapist in the world, you're gonna struggle. And they can teach you to compensate. You're gonna shuffle. But to really run well, you have to untie those shoelaces and have the structure right to get the proper function.

Welcome to the Untethered Podcast. I am your host, Hallie Bulkin. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up-to-date information in the orofacial myofunctional therapy, airway, tethered oral tissue, and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture.

Tongue up, lips closed, teeth apart, breathe through your nose.

Let's get started.

Hi and welcome back to the Untethered Podcast. Today we have Dr. Richard Baxter joining us. Dr. Baxter is a board-certified pediatric dentist, fellow of the AAPD, and diplomat of the American Board of Laser Surgery. He is an internationally recognized speaker on tongue ties, instructor of the acclaimed online course Tongue Tied Academy, and lead author of the bestselling book Tongue Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More. He's passionate about educating parents and healthcare providers about the effects that a tongue tie half throughout the lifespan. He lives in Birmingham, Alabama with his wife Tara and their 3 girls, Hannah, Noelle, and Molly. He is the founder of the Alabama Tongue-Tie Center, where he uses a CO2 laser to release oral restrictions. He had a tongue-tie himself, and all of his girls were treated as infants, so this field is a personal one. In his free time, he enjoys spending time with his family, running, and outdoor activities. He's a small group leader at the church at Brook Hills and participates in global mission projects around the world. Richard, welcome back to the podcast.

Thank you, Hallie, for having me. It's a joy and a privilege to be back. Thank you.

I'm excited because, you know, when I launched my podcast, you were my my first guest. So I think just by nature of like you being you, but also it being one of the first episodes, it's still the most downloaded episode.

Oh cool.

We're put out— I don't know if we told you that. I don't know that because I think that's, I think that's really cool. But I do think that people also just value the conversation that, you know, we've had. And, and I know you've done a ton of other research that, you know, we can talk about too. But yeah, when I hit record for this podcast, the first guest, you were on the other end. That's funny.

What year was that?

Year the podcast started? 2019. That was like, oh 2019.

Yeah, yeah, our daughter Molly was just born then. She was in February of '19, so yeah, she's 7 now. So awesome.

I love that, I love that. It's amazing. Yeah, so I know our field is like still very hungry for these conversations, so I'd love to dive into one of the topics that I still feel— it still feels very unresolved, which is basically how we treat, like treating based on symptoms as opposed to just like appearance of tethered oral tissues. So I don't know if you want to take it from there or if you want me to.

Yeah.

You know, riff a little bit, but you tell me.

No, for sure. So I mean, every time we're treating patients, an average day, I'll probably see about 10 new patients for tongue tie. So it's like all we're doing, it's almost like an endodontist, right? Like I'm just like root canals. And so I give this example a lot. Like, you know, people come in like, oh, I'm like nervous to laser my baby or my child or whatever. I say, it'd be weird if you did want to just laser them. You know, like it'd be weird if I just wanted to go get a root canal one day. But if, you know, just for fun, like, oh, just pick a tooth, right? No one does that. But if my face is throbbing, I'll be the first one lined up at the endodontist's office. And so, You can look at an x-ray of a tooth and it looks totally fine, but they have all these symptoms. It's waking them up at night. It hurts when they're eating hot, something hot and cold, but the x-ray looks okay. And so that case, you'd still, you know, you tap on it, you do some tests, and then you do a root canal on that tooth versus sometimes you see an x-ray of a filling, a really large filling close to the pulp, and there's no problem at all, in which case you'd leave it alone. And so for dentists, at least, that translates pretty well. I'm sure there's other, you know, examples in speech therapy world, but so some kids have a pretty tight restriction. Like we'll see them on the dental side. They're there just for a, a checkup for a cleaning, and we'll ask the parent, hey mom, do they have any speech or eating or sleeping concerns? And the parent will say, nope, there's nothing there. Now if I really want to pry, I'll be like, well, sleep would be like their mouth is open when they're sleeping, they're tossing and turning, they sleep with their head thrown back like a CPR position. And sometimes they'll say, oh yeah, well, they do that. Like Zoggi will say it's part of, it's like a parental awareness questionnaire. Like they don't realize these things aren't normal because common does not mean normal. And we'll talk about that too. A lot of kids snore. Does that make it You know, speech issues, say, you know, speech delay, trouble with Rs and Ls. A lot of people don't realize like milestones. And then eating, so like slow eating, real picky eating. People think that's, and this is your Feed the Peas, like people just think that's normal for them to have trouble with meat or mashed potatoes. Some kids with tongue-tie love steak. So it's not like a perfect correlation where with babies, it doesn't have to hurt with nursing for it to be a tongue-tie. They don't have to be losing weight. We had several yesterday that were to the tip. Some of them were losing weight. One was in the 1 percentile. It's like failure to thrive. Others were chunky and had forearm rolls on the babies. You know, there's not like a one-size-fits-all with tongue tie. I think that's why it's hard to diagnose. And so that's why I say kind of symptoms and function are more important than the appearance. And I think for our medical colleagues out there, we've had a lot of like pediatricians reach out recently, which is encouraging. Had a neonatologist from Houston last week email us and call us asking about tongue ties. And it's like they want to know more about it. Even last couple years it's gotten better, but it's hard. It's not like your hemoglobin A1c is 6.5, you have diabetes.

Like that's what we all want, right?

Like there's an obvious, like, huge hole in the tooth, like, that tooth needs to come out. Like, a monkey could diagnose that, you know? So this takes more, like, thought, and you have to look through that tongue-tie lens. And so I think a lot for the, like, our pediatric colleagues out there, pediatricians or other dentists, if you're not looking through that lens, you're probably going to miss it. Now, you guys as speech therapists, feeding therapists, you're doing a comprehensive evaluation, so you will more likely pick it up. But even then, it's not taught in speech programs. It's not taught in feeding therapy programs. It's not taught in lactation programs. So medical school, dental school. So yeah, it's really hard. But I think we're getting there. We're getting there.

We're getting there. I know. I'm like, we now have at least 2,700 SLPs and OTs who have gone through Feed the Peets. And so they've worked. But it's still— you go into these Facebook groups or you go into these, whether it's parents or it's therapists, and they're like, oh, look at this picture. Is this a tongue tie? And I'm like, you can't tell in a picture. Are there symptoms? Is there a functional impact? So really just drive home that conversation around, like, there needs to be a functional impact. It's not just how it looks, appearance-wise.

You get those emails all the time too. Is this a tongue-tie? And it's like, well, I can't diagnose over email anyway. You're not supposed to, at least. Find someone local to help you. But like, but the symptoms, here's our symptom sheet. If there's more than a few check marks on here, like, get it checked out locally is basically what we say.

I love that. It makes it functional too, just in terms of like how the therapist approaches it. So how would you want like a feeding therapist to present a case to you? Or, you know, just so that they know in general, like for other referring providers, even maybe the appearance is unremarkable, but feeding itself is a mess.

No, that's true. So I mean, we get a lot of referrals from all over. We have patients, we had someone from Wisconsin last week. We have people from all over. And so sometimes they'll send us like a 30-page evaluation. Like, it's hard to read through that. You know, we'll get those to the pediatrician too. I think they just hit a button and it like faxes it to us and it's just their whole medical record, which is fine. We can sort through that. But in general, like, I mean, one page, I think what you want to get, you know, like one, one page. So whenever we do procedures, we'll send that to the pediatrician or the family practice doc or whoever, to the SLP, OT, the IBCLC. We'll send those out and just a one-page page of here's the symptoms that presented with, here's what we did, here's what to do afterward, call us for any questions, kind of succinct. And so something similar to that, if you're referring a patient to us, like what are the main symptoms they're having, you know, is mom on board with it, what kind of therapy have they done beforehand, have they failed therapy, are you going to follow them afterward, are they moving soon, like any kind of things like that would be interesting for that patient that way you think that the doctor needs to know, the release provider.

So helpful, thank you. And we've actually, we've told people that, it's interesting because like in graduate school We are taught to write these like really lengthy reports and I'm like, I try to tell everyone in our program, I'm like, nobody wants to read those at all regardless who you're sending this to. Now maybe you're doing that cuz you're submitting it to insurance and this will read it and you're gonna get it approved. I don't know. But as far as like other referral, you know, sources, they just need something very—

well, like in the notes. So like I understand that you have to have a certain amount of things, right? Medico-legal protections and like consent and like how much lidocaine was used and like the laser settings. That should all be in the clinical note. But don't just like copy and paste the clinical note. I mean, if you don't have time, that's, that's fine.

But yeah, it's easy for anybody to kind of like, like you said, symptoms, here's our concern, here's why they're coming to see you. Like if there's any other considerations, like they're moving soon, did they do pre-op, were you following them post-op, did they fail in therapy? And I think that's a really good conversation too, because a lot of people ask me, well, how do you know when to send them for a consult? Like if you have concerns, Well, if they've been working with me for 3 to 4 weeks and we are really not making progress, like it's— and I'm concerned and I think there's— there are tethered oral tissues, like it's time. I'm going to set up a consult, but I'm also having that conversation that like, we need to make sure that you're prepared. There may be others involved in this and you need to continue therapy afterwards because releasing this and not following up is not going to benefit anybody.

Like knee surgery and no PT, you know, it's not going to work. And at least half, if not more, it's not just the release, it's the after work, the parent stretching and then exercises. And it depends on the age of the patient, obviously what those are. If it's oral motor or myofunctional or whatever the case is. But yeah, we have a lot of kids come see us and they have a list of symptoms, a ton of symptoms, and like, it's not an obvious tongue-tie. It's like if I saw them on the dental side just for a cleaning, I wouldn't even ask about it. So it's those kids that are falling through the cracks, like the pediatricians, the parents think like, there's something wrong with my child, I just don't know what it is. And they have those speech or eating or sleeping concerns or breathing concerns. And so it doesn't have to be any one of those. They can have perfect articulation, but they could have a lot of feeding struggles and sleep struggles. Or it could be the opposite where they have speech and sleep, but their eating is really good. So that's what, again, what's hard about picking it out. And so you have to look at the whole clinical picture to see like what is in the best interest for this child. If it was my kid, what would I do? And I give the example of like the shoelace example, which like if your shoelaces are tied together, like you're not gonna be able to run. Like Boston Marathon was yesterday, you know, dating the podcast now, but like you're not gonna be able to run in the Boston Marathon. You're not gonna be able to run like even at the track, 400 meters. If your shoelaces are tied together, you can have the best track coach, best running coach in the world. The best speech therapist or feeding therapist in the world, you're gonna struggle. And they can teach you to compensate. You're gonna shuffle. But to really run well, you have to untie those shoelaces and, you know, have the, the structure right to get the proper function.

Yeah. I love that. I love that analogy. I think that's really helpful for parents even to hear because that really puts it in perspective.

Mm-hmm.

A lot of conversations around, well, how do we determine if we should do this procedure or not? And I'm like, well, I can't make that decision for you. I can tell you what I would do as a parent., but I've also already done it. So here's what I do.

If it's easy, it's like, you know, this is like, I'll show the examples. My feet are totally together. I'm like, I'm trying to move my feet. Like they're like, it's that type. What's hard is if it's like, okay, they can move a little bit, like they're like halfway tight, you know, like 50% restriction. I know there's different classifications, so I'll just use like percentages because that's easy for everyone, translates to everyone instead of Carrillo or Kotlow. If it's halfway, some kids are fine with that amount. Others have a lot of struggles. And so it depends on the symptoms, whether you treat that or not, or whether they, you know, send them for the release. Some kids are 10 or 20%. It's not that bad. And so yeah, I would definitely try therapy first and you may be totally fine with that. And then other kids, if you're hitting a wall, you're, if you like feel like you're banging your head against the wall, like why can't this kid eat? Check them again, lift up under the tongue, challenge the tongue. Don't just like check with the tongue depressor and then like make sure it actually like, okay, is it able to lift up all the way the back of the tongue? Not just the front. Sticking the tongue out's the worst test. We always tell people it's the elevation. That's what's critical for speech, for eating, for sleeping, for breathing.

Amazing. Now, going back to what you said, common does not equal normal, because I talk about this all the time and how snoring is also not normal. Can we talk more about that?

Yeah, I think it's like a quarter of kids to a third of kids snore. It's depending on what study you look at. So it's pretty common, but it's definitely not normal. Like from babies up to grandparents, no one should snore. Mouth breathing alone, if you worse quality sleep, I think the statistic is mouth breathing more than 35% of the time, whether day or night, is considered severe mouth breathing. So that's a lot. People are like, oh, my mouth breathes like half the time. It's like, actually, that's considered severe. And so, yeah, all kinds of things like that, like picky eating, like, oh, it's normal. And you know, this can be age appropriate. I know stuttering can sometimes be age appropriate at certain ages. I'm not a speech therapist by any means. But you know, there's all these things like that that, yeah, like spitting up, like a little bit of spit up here and there, that could be normal. But if it's every bottle, like that's probably abnormal. Hiccuping like multiple times a day, that's probably abnormal. Even though it's common. So again, we try to tell parents that, yeah, common does not mean normal. Gas, you know, gassy babies. We see a lot of babies that are gassy and they give them gas drops. They sell gas drops, so it's a common problem, but it's not normal. They shouldn't be full of air ideally. They shouldn't be colicky or spitting up or— and the more of those checkmarks you add on, the more likely there's some kind of a restriction there with the lip or tongue or possibly cheeks.

So. Yeah. Thank you. Thank you for highlighting that. Okay. So you've done research, and I feel like it doesn't get the attention it deserves. Let's talk a little bit about cerebral palsy and the tongue-tie research that you did.

Yeah, so we had, and this just came about serendipitously, we weren't planning on doing research on CP, and it's really just a case series, so there's no control group, but basically, uh, there was 4 kids, they were all female, came in a couple years ago, and it's kind of one after the other, and I was like, we gotta like report this, because they had these crazy results. And so basically, with any kids with special healthcare needs, the primary diagnosis, whether it's Down syndrome, cerebral palsy, autism, like XYY syndrome, someone came to us with that, uh, we've all these like random syndromes you never even heard of. And they're super rare. And there's, you know, there might be a Facebook group for them. Maybe 10 people in the US have it or something like that. So they come to us and that was their primary diagnosis is that, but you can also have a tongue tie. Prematurity kind of also falls in this category. We had one born 21 weeks and 6 days. That's like almost a record. I think the current record is like 21 weeks is like the youngest you can be born and still survive. She came to see us 2 weeks ago. And then a week later, she's, and she was, she's now 14 months old. So she's had all these struggles and they blamed it all on the prematurity. Which is a good guess. She was in the NICU for 7 months, but now she's still having issues with solids, issues with speech, issues with sleeping, breathing, all these things. So we fixed her tongue tie. So we could— she came back yesterday, had like all these good changes now. So again, she did have— yeah, she was born super early. It was really sad. It was like a triplet pregnancy and she was the only surviving one out of the 3. So then, so for her, the tongue tie was impacting. So with these kids with CP. They come see us. One came from Ohio. She was 7 years old. She had like a crazy issue with her heart and she had a heart attack when she was just like, I think a couple months old. And she was, had like 53 minutes with no pulse, you know, is on ECMO, right? They like oxygenate your body out of, you know, oxygenate your blood out of your body with a machine. And then it was like multiple surgeries where they basically said, say goodbye to her. She's not going to make it. She had Tetralogy of Fallot is what happened originally. She was born that way. And then, so she had HIE, she had CP, she had like all these diagnoses thrown at her, like nasal congestion, all these things. And so she was basically, they told her like, you know, she's not going to talk, not going to be able to eat well. Just give her a feeding tube, all these things. And then we fixed her tongue tie and then, and her lip tie. And she had pretty tight cheek ties as well. And the video is like attached to the article. It's also on her Instagram page at Tongue Tie AO. And mom was like in tears, like the same day she was breathing better. She's constipated. My mom had to use suppositories for 7 years. Like, because she couldn't poop. She pooped on her own after the procedure. She was able to eat. She was breathing better. She wasn't snorkeling, mom said. She's on Zyrtec for 7 years for, quote, allergies. She did, um, all these things she was having results from. And then a month later, we checked in on her, still better. And then I was writing the article up, and I think it was like 7 or 8 months later, I'm like, do I want to know how she's doing? Like, what if she got worse, you know? Like, do I want to know? So I reached out to her. She's still doing better. Elizabeth's her name. I can say that. She, mom gave us permission to put the, you know, videos and stuff up. But anyway, so she's doing better. And we worked with a feeding therapist, a New Jersey pediatric feeding. I think, you know, her probably. She has a pretty good Instagram presence. So that's how she heard about us. But anyway, so then that story and then another one of a younger one who was like a year old, had some cool results. Another one who was about, Caroline was probably 2 or 3 years old, had some cool results where she was able to sit on the couch, like unassisted. Afterwards, she was able to pull toys closer to her. So he's even helping movement. Elizabeth's hips were looser, her face was more relaxed. So these musculoskeletal things from the fascia release— so better eating, breathing, sleeping, like fascia results. And I was like, we just have to report this. So Robin Merkel-Walsh and I wrote this up and put it out there, and we got it accepted to Special Care Dentistry, which is, you know, a good journal for, you know, kids with special needs and dental issues. And so yeah, just trying to spread the word that like, okay, if there's another primary diagnosis, like, doesn't mean you they're not mutually exclusive. So you can have tongue-tie and autism, tongue-tie and prematurity, tongue-tie and CP.

Yeah, no, and thank you for this work and for sharing these cases because I think, you know, we get medically complex cases and I know a lot of the therapists that we train into as well, and sometimes people sit there and go, these kids have had so much intervention, like, is this something we should even bring up and talk to you about? Like, it seems to us like it's just a small little thing, but to them it's like a whole nother You know, provider, procedure, like all things, right? Yeah.

Stethoscope is the worst, obviously.

Yeah.

But these kids have been through so much, a lot of them, and it is hard. You have to take that in consideration too. And if there's cardiac issues, like we have kids with like hypoplastic left heart syndrome and like tetralogy, like unrepaired Tetralogy of Fallot. You know, we had one come to us with Pierre Robin sequence. And so we did not do that one because that could be, you know, concerning because one of the hallmarks that, uh, you know, syndrome, it's called sequence, but the tongue flops back, it's called glossoptosis. So if you release the tongue, can make it worse in that case. And the tongue should rest up on the palate. Well, their palate was totally open. It's a U-shaped, you know, cleft palate. And so there's nowhere for the tongue to go. So it would just flop back if we released it. So we could not do that one. But in almost all the cases, like if it's a heart thing, if they're out of the NICU, we get permission from the cardiologist, the pediatrician, make sure it's safe for them, tell them exactly what we're going to do. I would get a letter from them first and then, yeah, we can help them out. But we see some crazy results with kids with, yeah, pretty severe medical concerns. And it doesn't make them go away. Like it doesn't make the autism go away. But at least they can eat a little bit less picky and they're sleeping deeper. That can help with some sensory issues, that can help them not be as clumsy. Sleep affects everything. So we've had kids say mama for the first time and they're like 10 years old, you know. So we see stuff like that too that's super cool and encouraging.

Yeah, no, and I think it's really important to talk about these cases and these, especially the more medically complex ones, or with, you know, obviously these comorbidities, these other diagnoses, because again, it just sometimes feels like a whole nother thing. And I know in our practice as well we've seen it make such a difference in everything you've talked about, even just everything from sleep, breathing, you know, speech at times. I know some people think that's like the whole taboo topic, but no, we do see speech improve drastically.

Yeah, even in babies. So we fix it in like 2-month-olds for feeding reasons. If they're under 2 months, you don't see it as much, but 2 months and up, you see it. A 5-month-old we did yesterday, they start babbling more the same day or the next day. It's not a placebo effect. It's not a coincidence. Yeah. We see all kinds of stuff like that. We can get into that too, like crawling and walking, like, like the same day. Like an 18-month-old not walking, no matter what, you know, the CDC says, like, that's not normal. And so we fix it and then they start walking the same day or next day. It's nuts. Like they start crawling different, like the same day. Like the baby doesn't know. It's not a placebo effect.

It's almost as if we're connected fascially from the tip of our tongue to the tip of our toes or something. Right?

It's almost like, yeah, it's almost like there's this whole thing we don't even think about, but the fascia is.

Yeah. I mean, I know with my own daughter, she was 24 months old when I came home from my first myo course and was like, she's tongue and lip tied. And we got her prepped, took her into the oral surgeon, and she had her tongue tie released. And the next day, she was also pooping on her own because she was— massively struggled with being constipated. And it made me really think back to a lot of my children who are autistic that I work with. And I was like, these kids eating all these beige foods because they're easier to break down, but a lot of them aren't chewing. So when you think about the color of the foods and how they're, you know, digesting these foods or not, I know. They're, you know, they can't possibly.

Yeah. GI doctors, it's like the mouth is over here. It's like just something we have to get through to scope 'em to see what we really wanna see. It's like, no, no digestion starts in the mouth. And even like the wave, like the swallowing is like the peristaltic wave that travels down the GI tract. Puts them more into parasympathetics, like more in rest and digest versus attack mode. Seeing the chiropractor can, can also help with that obviously. And CST and that kind of stuff. But when you release it, I mean, they'll, yeah, often poop like the same day or next day or something. It's pretty cool. I'll have babies that are going, you know, once every 4 days and they'll start going the same day. And they ask the pediatrician, they say it's normal. So it's normal to go up to a week. But then we have babies that come in that's like, it's every 10 days and then say, oh yeah, that's normal too. They can go 2 weeks. And then some people, they said like, we told them it was 17 days between the bowel movements. They said that's normal. It's 30 days. Like, which one is it? You just keep increasing like that no matter what it is. I feel like you could tell me, oh, we go every 60 days. I'm like, yeah, that's normal for a breastfed baby. It's like, no, it's not. Do you go once every, you know, month or something? Like, right. That's not normal. Why? You should go every day or twice a day, you know? So we fix it and it normalizes cuz they can eat better. They're not full of air. They're not so bloated. So anyway, it helps with, yeah, kids, adults, babies. We don't do adults anymore. I'm a pediatric dentist, but yeah.

Well, and I think the thing that's interesting too is a lot of these kids are not available for therapy. So if they do have speech language delays, their digestive issues, they're, you know, maybe they're malnourished just because of what they're eating or not eating, they, they are not physically available to learn in school. Or, you know, and then of course, you know, sleep's impacted. So then that's also another layer of that onion. So it's to me to see what happens with these kids. I mean, I had one kid that was such a drastic tongue-tie case. She was snoring. We said basically— and he said, this is worse than a middle-aged man, like an overweight middle-aged man. They said she was at risk for like death and sleep apnea. So they put her into an emergency surgery, and her tonsils were also enlarged, but she also tongue tie.

Why were they big?

Exactly. So they did reduce the tonsils because of how emergent her case was, and we also did a tongue tie release. And this kid all of a sudden started sleeping better, started responding to her name, started— she was always turned around at circle time because I saw her in preschool, and now she's front and center paying attention to the teachers, all the other kids, learning, speaking, making progress in therapy with all the things because we were working on speech and language and, you know, feeding, all the things. Completely different kid. And within a year or so, the parent was like, she— this kid who was so severely behind was completely on track.

And it's worldwide. It's why it's not just in the States. It's in the UK. It's in Ireland. It's in Japan. They see this. It's in India. They see this. It's in Germany. They see this. In Denmark. Not South Africa. We had a family from South Africa. They don't really do it there. So they flew in to see us in Alabama from South Africa, and they had all these issues. Jayden, he had like a ton of issues, like every check mark basically on the form. And he'd already seen 7 different providers, the pediatrician, the ENT, and everyone says there's nothing wrong with your child. I have this on video too. It's on our YouTube. You can watch it. And then so anyway, we fixed it and he already said like, thank you. She, mom said to the doctor, he said it much better. She's like in tears. And then the 6-month-old was like already taking his bottle better. No leaking from the corners. Seconds after the procedure, breathing better, like not snoring. It's not a coincidence, right? Like if you do it right, and that's the key, like it has to be done right. If you just clip it halfway. It will help some people. It's not going to help all the people though. If we only helped half the people, we'd have a bunch of 1-star reviews, right? And so we try to help the most people possible because that's the right thing to do. Not just for the reviews, but because that's the right thing to do.

Yeah.

So you have to assess it, right? You have to get a good history from the parent. We let the mom tell her story. Sometimes it's 5 minutes, sometimes it's 30 minutes. We have to do, you know, a good exam, like the lip, tongue, cheeks, check the tension of the baby, like check their teeth, like how wide is their palate, you know, that kind of stuff. How big are the tonsils? And then you have to treat it right. So treating it right, you have to do a full release. Doesn't have to be a laser. I use a laser, but people in other countries— I was in Nepal, I used some scissors when I was on a mission trip there. It can— you can do it with scissors. It's a little bit more tricky and there's more blood, but you can still do it. And then the follow-up, like the aftercare stretches, that's super key. So we were talking earlier, if they're older, if they're doing myo, not the babies, but you know, are they— and then follow-up. So you can do stretches well. We've had other dentists come see us. We had physicians even this week come see us. And, you know, they'll come back for a follow-up and they still aren't doing the stretches right. And so they're not pushing hard enough or in the right location. And so that's a huge key is like, and I know there's like lots of debate on how to do it. Not everyone's people who just listening to this on audio. So you may not see it, but essentially we have people do one rep 3 times a day for babies, twice a day for kids for about 4 weeks is how long we found it takes to heal. It's kind of like you get your ear pierced, but didn't wear the earring. It's going to close back up. That's 6-ish weeks, but really it's longer than that in a lot of cases. Because everyone heals differently. But we have people do one slow, firm stretch, like a J-shaped stretch. The key is for the tongue to push it down on the floor of the mouth and then take the back all the way, just one finger right in the middle. If you try two fingers, they're not going to put them together, and then they're going to leave that band of tissue in the middle that gets thick. Again, it helps a lot of people, but not getting like 99% or like as many as you can better. So we've adjusted our stretches over the years, and then we get everyone back for a follow-up, or again, like a virtual follow-up. Email follow-up. So just to check on healing, because it can stick back even with the best stretches. It sticks back some. And again, some kids are fine if it sticks back halfway, but others, it sticks back 5%, they have a bunch of issues.

Amazing. Well, thank you for that update too, because I know there's always debate around like how long and how do you do it?

Yeah, just like one 5-second hold. No one pushes hard enough because you don't want to hurt your child. I don't want to hurt them either. But I also know if it grows back together, we have to laser it again. You can do 4 more weeks of stretches. So that's the second procedure and 4 more weeks of stretches. That's going to hurt even worse. Or if it just reopens, tongue will reopen about 2 to 3 months afterward for a baby, just even like a not that hard pressure. Just obviously warn the parents first and, you know, talk to them first, but it'll just stretch back out. A lip tie on a baby, about 3 weeks, it won't stretch back out. I had to do a revision yesterday, but in our— we've run the numbers, it's about 1% or less than 1% of patients we see we have to laser again. Because we get them back for follow-up and ensure they're doing it right. And we show the parents before they leave how to do stretches. I show them on their hand how hard to push. It's a pretty good bit of pressure. So anyway, there's like all these things that go into it to get the results that we're talking about. Again, if you just clip it halfway, it might help with nipple pain, but they're still going to be colicky, gassy, spitting up. If you didn't address the lip tie or cheek ties, if they're there, still can have issues.

So yeah, well, let's talk more about those cheek ties. So there's a Buckle Tie article as well. Can you— yeah, one of the few doing research in this space, or that has done it. Can you about that a little bit?

Yeah. So basically, I think I was at a conference, I was talking to people, I was like, you know what, there's like no articles on cheek ties. If you can type it in PubMed, there was like 3 or 4 articles that popped up. One was like a denture article on like, you know, you can't get the denture to fit right because the cheeks are so tight, so you have to change your border molding. Like the denture can't go up as high for a good suction. A couple other articles just mentioning cheek ties. They treated the lip and tongue, as mentioned, cheek, but nothing on cheek ties. So essentially what we set out to do was like, let's do a survey because there's no way you could get it past an IRB, Institutional Review Board, to basically, okay, we know the Tongue-Tie works. There's like 6 randomized control trials on that. Lip-Tie, there's a few articles on Lip-Tie that talk about it. There's nothing really good, strong evidence on Lip-Tie, but it's not ethical to not treat the tongue and you could risk the breastfeeding relationship, referring to babies now. And then, you know, like, okay, Mom, we're going to flip a coin. Heads. Okay, sorry, we're not going to do upper tongue today. We're just going to do the cheeks just to see what happens for research. Like, that's not ethical to do. You're not going to get permission to do that study. And so even like a week later, we'll do cheek, you know, tongue and lip. That's, that's not ethical. So the next best thing we thought was let's get like a collective knowledge of what we have. I think it was 452 or something like that healthcare providers that responded to our survey. I did it with Dr. Zaghi with the Breathe Institute. And we looked at all the responses, 15 different countries. We had providers from 15 different countries, I think 7 or 8 different disciplines. So dentists, physicians, lactation, myo, speech, everything, OT, chiropractor, CST, like all the different chiropractors. PT, I think I got them all, but lots of nurse practitioners, lots of different providers. And we say, okay, do you treat cheek ties? Do you assess for cheek ties? What are the symptoms you've seen improve from cheek tie release? Because there are babies that we've done lip and tongue tie on, they've done therapy, they've done body work, and they still have issues. And so maybe a couple months later, they come back to see us. We only do the cheek ties and we see improvements with them. So we've seen that it can individually make a difference just treating the cheeks. So what's hard is like picking out exactly what symptoms those are. So it seems to be seal issues is the general consensus from 450 healthcare providers globally. And seems to be like clicking, smacking, like the milk leaking out. Robin said, you know, with the speech stuff, like ooh sounds, trouble like blowing, possibly trouble straw drinking. Yeah. So like, so that can affect it. Trouble brushing the back teeth. That makes sense. Just like the lip tie in the front, trouble brushing the front teeth. So there's different things. I mean, one lady, and this is when we did adults, but we released her, like left, she cheek tie and her tinnitus, like her ringing in her ear went away. She'd had for like a decade. Wow. Like went away just from the cheek tie release. Wow. So we have like weird stuff like that. So we, that being said, cheek ties is about 10% of the babies that we treat. We'll do cheek ties on. We don't charge for cheek ties. And there's not like that good of research on it. There's one, only one article. And then we made up an acrostic. So like it's B-U-C-C-A-L, buccal, and it talks about like, is it blanching? Is it uncomfortable palpate? Is there a clinical impact? You know, what are the symptoms, I think. And then A is like the attachment, you know, location. Where is it? L is something else that I can't remember exactly, but yeah, we made a little acrostic. And then there's classification. So Class 1 would be in the mucosa. So it's pretty high up. We're not going to treat those. Class 2 is in the gingiva, so the gums. So I basically say if it's in the middle, mom, it might be helpful. You could also wait on it. And sometimes, you know, I'll leave it to the parents. If they want to be proactive, we can treat it. If they want to wait on it, that's also a good option. Kind of depends how far away they are, their individual temperament, you know, so sometimes we'll treat those. And if it's all the way down at class 3, I might probably wanna take care of that. It's pretty low. It's all the way down to the alveolar ridge. So that's a short, a little shortish explanation on cheek ties. And then kids, we don't do a whole lot of them. Occasionally we will if it's causing a problem, but I don't know what on our 50-item child questionnaire would specifically improve from just a cheek tie release. So almost always for kids, it's like lip or tongue, not a whole lot of cheeks in kids unless it's like obviously causing a problem, recession or something like something like that.

Yeah, yeah. I always thought it was interesting to have these conversations around adults because of the dentures and everything and how easily something is released if that's the problem. You know, they could potentially just release some tissue to fit dentures in more easily.

Yeah.

But in a kid, why would we do that if there's functional impact? And I know the cheeks are harder to figure out, like, what the direct connection might be. But if, like you said, if you've already done the lip, the tongue, you know, or the lips and/or, you know, tongue, and there's still something going on, it might potentially be Yeah, and there's some emerging research now.

I was at a conference back in February, American Laser Study Club, and a couple of dentists— and so in adults, they could do this research, but basically they only treated— so they got like a measurement of how wide they could open, and then they only treated cheeks, and then they saw how wide they could open again, and people could like open a good bit wider. Wow. You know, and then they treated the tongue after that, and then didn't increase much, maybe a little bit, and then they treat the upper lip after that, didn't increase much. Then they did it the other way. They do the tongue first to get a little bit wider maximal opening. They did the lip a little bit and then they did cheeks and they got way more. So like maybe like gaping, like how wide your mouth can open.

Yeah.

Could be affected by cheek ties. That was in adults and like teenagers, I think. So older population, but stands to reason that in babies it could help too. So there's some stuff like that. So we just don't know. But the purpose was like, well, people are treating these. We need some research or some evidence a little bit, even if it's just emerging evidence. Because this is being done for, you know, medical legal reasons, you know, defending yourself. But yeah, that's like, that's why we don't charge for it. We don't push anyone to do it. Leave it up to the parents if they want to do it or not.

Yeah. Yeah. Amazing. Thank you for sharing that. So you shared some like seemingly what seem like random associations, bedwetting, constipation, we talked about the delayed crawling or walking you mentioned, but like, let's talk about bedwetting a little bit because I think Parents are always so surprised to hear that there could be a connection, and we've seen bedwetting improve.

Yeah, so I mean, again, we've, we had several of these kids recently, so I'm like, oh, should I do a case series on this again? Because that's easy, low-hanging fruit, just to make people think. Like, the urologist would never think, like, okay, it's like from a tongue tie. That's like, just so these people have tried everything. They've tried setting alarms. They tried don't drink anything after 4 PM. They tried, you know, waking them up and getting them to go to the bathroom. There's like a mat, it gets wet, buzz and stuff like that. So they've tried all these things and they're 10 years old, they're 12 years old, they're 15 years old, and they come see us and they often have other issues too. So they're tossing, turning, snoring, grinding teeth, mouth breathing. And what happens is when they have sleep disorder breathing, it puts stress on their heart. So their sympathetic activation, and then your heart secretes— it's a peptide. Peptides are popular now, like insulin's a peptide, you know, Ozempic, they're talking about this. So basically the— it's a peptide, it's called atrial natriuretic peptide, or ANP. Your heart makes it, your atria. But what it does, it's a diuretic. So you literally make more urine and then they'll have to pee more. And so if we can get them to sleep deeper, so they're more in parasympathetic, they're more chilled out, their heart's not stressed out. They can, cuz they're breathing better cuz their tongue is not flopping back and choking them anymore in conjunction with myo. Then what we see is they'll stop wetting the bed like the same night or like the next night. It's like pretty drastic. Or even in like 3-year-olds or 2-year-olds, so they're potty trained during the day. Parents will say they have like a dry pull-up. Used to be soaking through. They were soaking through. Soaking wet. We had one, I think it was a week or two ago, that was like, they're having to change the sheets every night. And then the often like well-meaning pediatricians are like, oh, it's like a laundry issue. They told us that with our daughter Hannah, who was spitting up so bad. It's a laundry issue. It's a cosmetic issue. Like, no, like her twin sister's like a pound or two heavier than her. Like they started the same, you know what I mean?

Like there's something else going on here.

Yeah. Um, and so that was Hannah. We, we were trying to be conservative with Hannah, change up a little bit. We only did her tongue, we didn't do the lip, and she had like terrible reflux and spitting up and gas. And, and, uh, she got to be a year old, she had a big gap in her teeth, ended up fixing it anyway. So all that to say, like, your lip tie can affect that stuff. And they put her on Zantac, which like, oh, now we know that, you know, sorry, yeah, they say it causes cancer now. So they took it off the market. And then they put her on like Nexium, that can cause bone fractures. So all these things like used off-label for babies, but it seems like, oh, you know, it's, it's helpful and it's not surgery. They think it only needs to be done if they're losing weight typically, but that's not true. So many babies come see and they have every check mark, but they're gaining weight because mom's on a treadmill. You know what I mean? Like mom's doing everything possible to compensate for the baby or she has a massive oversupply or something. Yeah. Yeah. All I say, there's all these weird associations like that. Uh, like constipation, like bedwetting. We often see resolution with, but if I guarantee it, it won't work. So I always make that clear. It's like, I'm not gonna guarantee it. We hope and pray for the best, but we're not gonna guarantee, guarantee it.

Yeah. Yeah. And I mean, it was like my, my first, who's now almost 11 years old, she was on her own growth curve, but never passed the first percentile in weight.

It's not a thing.

I know. And the pediatrician would be like, but she's on her own growth curve. Like, she's keeping up. And I was like, but I can't keep a pair of pants on her. Like, she is so tiny. And she clearly, like, she didn't look malnourished, but she also— I was like, she's tiny. She's like, you know, very, very tiny. So anyways, it was— and she was struggling. She had all the symptoms. So, you know, didn't realize until 24 months when I was able to advocate. And at that point, I was working with feeding, but more from like the 12-month-plus standpoint. Was not in the Mayo or Todd space yet, and having her really threw me into it. But it wasn't until I took the Mayo course and my tongue-tie courses that I— she was about 18, 24 months old— that I was like, okay, it's time. I know, I now know what nobody else could identify. When I took her to lactation and I took her to the pediatrician and, you know, it takes one person, like, to—

like, they see 15 different providers and one of them's like, maybe it's a tongue-tie. You know, it just takes that one person that this happened to their kid is typically what it is. They give a personal experience with it. And so I tell all the parents like, hey mom, tell your provider, your speech therapist, your pediatrician, you know, whoever it is, lactation, like, hey, let them know this helped. So it can help other people. We're not trying to drum up more business. Like there's a bunch of people that are struggling. Like we check all the moms with the EPDS-10. So the like postnatal depression scale and a lot of them score 15, 20, 25. It's like above 10 puts you at a higher risk for postpartum depression. Above 13 means you have it. So a lot of people are really on the struggle bus when they come see us. What's encouraging is very often a week later after the release, this is in conjunction with bodywork and lactation consult, that kind of stuff, we see that number go down below 10 even. It's like 7. It's like they're still struggling, but we took like a bunch of rocks out of their backpack essentially. They can make it. And they check, you know, the check mark afterward a week later says like feeling more confident and a better emotional state. And it affects the whole family. It affects grandma, affects dad, other siblings. So it's no, it's not just like a cosmetic, a laundry issue. Again, they're gaining weight, but they they are colicky and spitting up and gassy and it hurts for mom. Again, they don't have to have all those things. It could be any combination of those, but that's like the typical clinical presentation that we see.

Yeah. So, okay. So for therapists who may be listening who, tongue-tie, right? Or any type of tie, but their referring provider either won't release or disagrees. Any, any advice?

Come see us. We're in Alabama. I'm just kidding. I mean, we have people drive from like Wisconsin or wherever, like, you know, far away. But seriously. There's, there's someone in your area that you can get a second opinion from. So that's why we don't require referrals. We happily take referrals, but we don't require it because a lot of times people are Googling at 3 AM or ChatGPT. If you type all those symptoms in ChatGPT, it'll be like, this is like very likely a tongue tie. Like it will tell you that. Even like Gemini or Grok or the other AIs, they will, they will tell you like, this is very like, but the problem is it's not even on the differential diagnosis for most primary care providers, pediatricians, family medicine docs. It's not even on their radar. That this could be a tongue or lip tie. Unless they've seen like 10 of our patients that are like, this helped, this helped, this helped. Then maybe they're like, all right, maybe this colicky baby has some kind of an oral dysfunction, you know, like a tongue or lip tie. So yeah, get educated, help educate your friends. Tongue Tied is, it's on sale on Amazon. It's $9. Amazon has like pretty, I think it's 40% off or something. It's literally $9 for a copy of the book. That's cheaper than like we can sell them in bulk for. Our bulk price is $10. That's a good way you can hit someone over the head with it. We have it translated in 12 different languages now for that reason because people are asking like, how, what do I do? My provider's never heard of this. It's like, well, here's, you know, here's a book essentially. The neonatologist in Houston, she found us and I just gave her a link. There's a YouTube lecture I gave last year. It's like 3 hours on our YouTube channel. And she watched like the whole thing. It's like, we need to get you in to talk to our other neonatologists. They don't care about this. Let me know. I'll be happy to do a Zoom or something. So I think just reaching out, if you're a therapist listening to this, reach out to your community, your tribe, other providers nearby. Often, you know, chiropractors would be interested. Often other therapists would be interested. Dentists are often pretty open-minded about this because we see a problem, we want to fix it, like right then. The primary care providers, ENTs, it's a little bit harder, just like with their training, to be open-minded about this because it's kind of, they think it's like woo-woo, like the chiropractor. It's like out there. You know, it's like, no, no, like this is like, they've physically can't move their tongue. So when we had a pediatrician just last week to our office, he was there for his daughter. I showed him the Tongue-Tie Center. I just pulled up a random patient from the day before. I said, look at this, this is a 3-year-old that came to us from Florida. It's all the way to the tip. He said, that should have been seen, that should have been identified as a baby. I said, you're right, it should have. So if they like see it, they're like, okay, there's something wrong there, like this needs to be fixed. But I don't know, the obvious ones, that's like, we'll start there with the to the tip ones and then we'll work our way back towards the rest. Yeah, do 50%, and then like we'll get them to the 10%. Like even this child, you know, with 10% restriction for this individual child, not everyone with 10% restriction, but just Johnny because he had all the symptoms, it's also helpful for him. And last thing I'll say about that, we had a pediatric ENT and a pediatric pulmonologist from Houston, from Texas Medical Center or Texas Children's, come see us in December. I met him at a conference and he's like, he's really on board with this and interested and wants me to come speak at their conference. Parents. I'm still open if you're out there, let me know. But all this, they came to see us and he said, you know what this is like? He said, it's a therapeutic trial. He said, basically that's what you're doing. So they'll put kids on, you know, like Pepsid as a therapeutic trial just to see if it helps. So give them medicine, see if it works. Or they'll do a surgery sometimes. They'll do like a minimally invasive surgery to see if it helps with something. And so basically, and then if it helped, well, that was the problem. So that's essentially what we're doing. For the medical people listening, it's essentially, it's a therapeutic trial for these kids with 10% tongue There's minimal risk. We're not putting him to sleep. It takes 5 or 10 seconds with just jelly, not even an injection of lidocaine, like no shots. And then the stretches are the hard part. And if it gets better, well, it was the tongue. If it doesn't get better, it wasn't the tongue. And so essentially looking at it from that perspective, like, okay, it's a therapeutic trial. In some kids it causes problems, sometimes it doesn't. There's also an issue they call— it's called laryngeal cleft, where it's like you can have these issues. You've heard of that before. In some kids it causes problems, sometimes it doesn't. It depends how big it is, so they can inject it or do surgery on it. And it often helps, but there's they were saying like, this is basically their version of like a laryngeal cleft that like people think it doesn't exist. Some people say it does exist and you treat it, it gets better. So essentially that's like tongue tie is in their space.

So yeah, it's interesting to hear that perspective. I was having a conversation with an ENT here in South Florida and he was talking about, I was like, you know, what are the qualifications even to consider tonsillectomy or adenoidectomy or, you know, both. And just having him share like as an ENT, this is what we are basically going by was just very helpful for I think parents and other providers to hear. This is the lens through which we can either do this or not do this. It's very cut, black and white, very cut and dry.

Yeah. What are you saying? What was sleeping, snoring, sleep apnea?

Yeah. I mean, it was basically, there were certain symptoms that they're looking for in a certain percentage as well sometimes. So they said, put a kid through this. Obviously, the adenoids are an easier procedure than the tonsils as far as recovery goes. But then I've also had ENTs say to me, It's really not a big deal still. I guess it hurts like anything for the child and it's a longer recovery for the tonsils versus the adenoids.

The tonsils is rough though. I mean, there's a lot of morbidity and then there's even mortality with tonsils out. Yeah. And so, you know, it, it's hard. Yeah. But like, again, like why are they big in the first place? Right. Breathing causes irritation, microtrauma to the tonsils. They get big. Why were they mouth breathing? The tongue was in a lower position. Why was the tongue in a lower position? Because it was held down by a tongue tie.

Yeah, I mean, expanding my own child, her tonsils and adenoids shrunk, her sinuses all of a sudden weren't filled anymore. They were nice and clear. And, you know, I'm like, we have other options now and other conversations we can have for children who maybe aren't in an emergent situation, which I feel like is more rare than it is common. You know, most kids are not at risk of dying in their sleep, but they should not be snoring. They should not be presenting as if they have, you know, obstructive sleep apnea or any form of sleep disorder breathing. So anyways, it was a very interesting conversation, very eye-opening as well, because most parents don't go in wanting a surgery, right? So we usually refer to the ENT and say, listen, they're gonna look and they're gonna tell you whether or not the child qualifies for that, or if there's another intervention, and maybe, you know, we should try first. But at the end of the day, if that's not what you want, like, let's just rule out that it's something that's— let's make sure it's not emergent, and then we can have other conversations. And there's other interventions like figuring out how to get them nasal breathing, getting that tongue up to the roof of their mouth. Do we need to send you to an expansion provider? You know, there's so many other pieces to this puzzle, but it's just also interconnected.

Yeah. Now, if I say like, you know, tongue-tie is not going to kill you almost all cases. I'll tell you about Noah in a second. But, you know, basically it's like typically the bar is like down here. It's like, are they going to survive to the next well visit? Yeah. Like for babies especially, like they're gaining weight, they'll be fine. It's like, no, we want the bar up here. I want them to thrive. We want them to be happy. We want dad happy, grandma happy, mom of course happy, you know, the child happy. Like, we do all kinds of interventions just to help them, you know, like with quality of life improvement. And so, and then for our friend Noah, so he came from East Coast to Florida. It was about an 11-hour drive. And from Viera, Florida, I'm not sure if that's close to you or not, but they came up to see us and he was choking so bad on his food. They had to do the Heimlich maneuver. They said like 12 to 15 times on him. Like, how do you like a true Heimlich on him? Like 911 on the way, I think at least 5 of those times, like really bad. I mean, he almost died multiple times. And he got to see us, but he also had speech issues, eating issues, sleeping issues, dark circles under his eyes, just tired. And then no one picked it up. It was to the tip. It was obvious, like to the tip. I'm like, this should have been picked up. And so there's a lot of kids like that running around. They have a to the tip tongue tie and they have all these struggles and we fixed it. And then magically he's not eating, you know, poorly. He's not choking anymore. Stop choking, stop snoring. He's getting high quality sleep. His speech was improved already. Even in like a 1-week follow-up. And often it's not that dramatic, you know, it takes a few weeks or months, you know, in conjunction with therapy to get better. But his was pretty dramatic because it was tooth to tip. And so I was like, well, Noah almost died. But most of the time it's not going to kill you, but we want everyone to thrive. And then in the rare case, also survive.

Yeah, yeah. I mean, there's always interesting cases. I had one where this kid was— he was basically being sent home every day from lunch because he would vomit in And it wasn't even that he tried to eat. It was just the sensory input from everything around him. He couldn't handle it because he had such an oral aversion from how severe his tie was and all these, you know, his whole nervous system was such a wreck. This kid, and anytime that he would put food in his mouth, that happened too. So mom was like, he's been in school a total of 8 days where he has been able to stay past lunch. And we were about towards the end of the school year. I was like, this is, I mean, you just hear these things. It's not normal. It's not normal. It's a problem. Tongue tie released and guess who never vomited again?

I know.

I mean, why?

But you know, I bet that was a coincidence.

Of course.

I bet that was just a coincidence that that happened.

Yeah. Uh-huh.

So it's like, ma, it's like you put a turkey in the oven and it turns brown. Like, we need a randomized control trial on this. Like, I don't see why Asha and all the people are still like, oh, I don't know if it makes a difference. Like, at this point, like, yeah, I mean, we would have all 1-star reviews if I was just lying to everyone.

100%.

100%.

You know, like thousands of releases in, like, what would you say separates, because, and I think I know your answer, but separates those kids who really thrive life post-release from the ones who maybe don't?

Yes, I mean, part of it's like parent buy-in. So like doing like high-quality stretches is critical. Working with like the team approach, so the ones that have like been referred to us— if they just find us on Google and they've like never seen like a chiropractor or PT, they've never like have a speech therapist, feeding therapist, we often won't even do those if they're younger like that. If they're older, we require myo after a certain age. But so working with therapists is key. Parent buy-in, high-quality stretches. You have to do the release obviously the right way. Case selection. We don't just laser everyone that comes to see us. So that's, that's real key. If they're going on vacation next week, maybe wait, don't do it right away. If they're going out of the country or something, you know, you want to make sure they can get back to see you for follow-up. So there's all these like little things like that. And everyone that comes to see us, like to train with us or do a live course, because I'm not actually watching them. So I'm saying I get trained, trained. So I'm not saying go more, go less, that kind of stuff. But if they're coming to observe with us for our live course, you know, they'll, they just want to focus just on the procedure. It's like, it's all the other stuff. It's like what I say, like, you know, what happens when it doesn't work? Like, how do you encourage the parent? Like, how do you do the stretch? If you just go in there and stretch the tongue afterward and it stretches and it bleeds some, but you didn't like warn the parents beforehand, like they'll be really mad. So a lot of it's like really good communication, playing like therapist or like psychologist or psychiatrist, whichever one, depending on the situation, that's super important. So yeah, like holistic care and making sure it's done the right way, respectful to the baby and to the parents or the child, however the age is. But 2-year-olds, they're going to cry. Just get in there and get it done. Doing it quickly, as painlessly as possible. So all those kinds of things. We treat a lot of kids in no man's land, I call it. It's like the 6-month-old.

I was going to ask you about no man's land.

6-month-old to like the 4-year-old age, people are like, oh, just wait till they're 5 or 6 and they can cooperate for it. But, but that by that time they have so many of their eating habits, their sleeping habits, their brain development. By the time they're age 3, the brain is 80% the size of an adult brain. By the time they're age 5, it's 90% the size of an adult brain. How did that tremendous amount of brain growth happen those first, you know, through preschool years? Their speech habits, obviously, you know, way more than I do. So all those things, like we want to get them as early as possible if there is a restriction. So yeah, if it's an 18-month-old, you realize they only have 3 words, like that's a problem. And they can't like take solids, they're only doing pouches, like that's a problem. And if they have a tongue tie, like fix it at 18 months. Don't wait till they're 5. Yeah. Earlier the better, more team members the better. A full release, really good stretches. That's the key.

And if you can't find somebody who will work with that toddler on, you know, through preschool, there's no man, no man land.

Yeah.

Come see Dr. Hallie Bulkin.

Yeah. No, that's why they came to see us. It was a physician from, yeah, Green Bay that came to see us with his kid. 'Cause no one would do their 2-year-old. They do the baby up there, but they wouldn't do the 2-year-old. Old. And so we've had a lot of that, uh, you know, 1, 2-year-old, 3-year-olds. It's like, it takes 10 seconds if you know how to do it right. And then like for the stretches for the parents, we give them a mouth prop, like a MOLT mouth prop. They can actually use it to get in there. And that was just serendipitous. One of the dads was like, if I had that thing, I can do it, the stretches. I'm like, all right, here, take it. And so we get them, uh, you know, like $5 a piece now. We just give them out to the parents because if they can't get in there, do the stretches, like they're not going to be able to obviously do them if they get bit. I don't want them to come back, you know, like missing a finger part of a finger, you know. So we try to give the parents like all the tools, all the training they need to be successful with it because we really truly do want it to work for everyone.

Yeah. Amazing. Well, this has been amazing. Is there anything else you want to share with us before we wrap up?

I think we hit on all of it. I mean, if you want to learn more, we have obviously the book Tongue Tied, our YouTube channel. I don't post on there a lot. I'm not like— I don't care if you like and subscribe, but there's like a 3-hour lecture on there you can share with people. Our courses, obviously. And then we donate all the money from the courses to charities, like lots of like water projects in Africa, Asia, stuff locally like anti-human trafficking projects, orphan care. So I'm not trying to drum up course sales. I think it's a good course. We had lots of people take it, like you've had, we've had thousands of people take it now, which is super encouraging. We have a light version for therapists if you're not going to do the procedure, and we have the full version, Tongue-Tied Academy. So everything can be found on just tonguetied.com, so it's easy. That was not a cheap URL.

I can only imagine.

Yeah, yeah, tonguetied.com. It came down in price. I negotiated them down, but the original offer was way too high.

It's amazing how these things work.

Yeah, Tongkat.com, and then like the professionals tab has all the stuff on it. So yeah, hope that's helpful.

Thank you so much for rejoining me on the podcast. I know you've been on a couple times, but yeah, and having you had been like that first true guest that I had on the podcast and it being like the most downloaded episode, I was like, we have to bring you back.

And like, yeah, it's always fun, there's always something interesting.

Yeah, well, thank you so much, I appreciate it.

Yeah, for sure. Thanks, Hallie.

Good to Quick disclaimer: all information, content, and material of this podcast are the opinions of the speakers and serves as informational purposes only and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these myotats airway and feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer at halliebulkin.com, or pop over to @halliebulkin on Instagram to get all the latest updates.