Episode 112: When Sleep Training, TOTs & Airway Meet with Natasha Duffin

Hi and welcome to episode 112 of the Untethered Podcast. Today we have Natasha Duffin joining us. Tasha's an occupational therapist working in infant and early childhood sleep and feeding, mom of three little kids and the founder of Sound Asleep Baby. She's passionate about education and dispelling the commonly held belief that sleep problems in infancy and early childhood are all behavioral. She's worked with countless families who have traveled the behavioral sleep training path via many mode multiple sleep hospital stays, sleep consultants, books, advice from friends and family, all unsuccessfully without the physiological aspects of correct breathing during sleep being considered. Two of her three children have had sleep disorder, breathing and tongue tie that was dismissed and she is living the journey and has lived the journey and knows firsthand how amazing improving sleep quality in our kids is. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist 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, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. So let's get started. Hi Natasha, thank you so much for joining me today. I'm really excited to have you here and to talk about all things sleep training, so thanks for having me. Will you start and tell us a little bit about your background because you're actually, you're an occupational therapist first and I know you're still an occupational therapist, but how did you get from that to sleep training?

So background in occupational therapy and I didn't even work in paediatrics before I had kids and basically, you know, when you have your own children and you come up against these little hurdles and I thought my first baby was not a good sleeper and I think it was just, you know, adjusting to actually having to get up in the middle of the night and taking all that time to settle and things like that. And I guess I started by reading a thousand books because I always wanted to know why or what to do and different aspects of it and how I could get my baby to sleep through the night. I had literally like 15, 20 books and surprise, surprise, none of them were the magic trick. Then by the time I had my second baby, I kind of discovered that actually there's actually some science behind infancy. And so then I went on to learn to study that because what didn't sit well with me with all these books that I read First Baby was that you're telling me to do all these things, but why? And coming from that health science background, that really, really annoyed me. And all these people said different things and no one would tell me why, just because it worked for the baby that they were doing it with. So when I discovered sleep science, then I was like, wow, okay, there is sleep hormones, there's circadian rhythms, there's homeostatic sleep drives, all these sort of things. And so I actually started out on my sleep consultant journey in inverted commas with a behavioral perspective, because that's what's out there. And then funnily enough, when I had my third baby, I then discovered, oh, hang on a sec, this doesn't seem to fit. Like I'm noticing all these things that surely affect her sleep. And so then found yourself. I found Dr. David McIntosh and various other health professionals which were like talking all about tots and airways. And then I've just amalgamated all that knowledge to I guess come up with a. Not come up with, but to consolidate all those things together to provide a different approach to sleep support or sleep guidance rather than behavioural sleep training. Considering the child holistically and taking into account all those things rather than just like, okay, you need a two hour nap here, two hour nap, two hour nap there and you got to just let your baby cry because we've got to consider them as a whole. Yeah, that's how I ended up here.

I love that. And this is something that I also, between children, dove into a little bit, as I was just mentioning to you off, off recording a moment ago, because my first one always slept and, but only really slept if she was like on me, next to me, like we were bed sharing, which everybody in the US says is like, you know, a. No, no. And then if she was in the stroller or car seat when she was like under the age of one, like she would for sure fall asleep. And I think for her a lot of it was related to her tots and her digestive upset just from, you know, swallowing too much air. And I think she was always most comfortable if she was either attached to me or she was like in that, you know, that changes your, your positioning when you're in a car seat. It just feels better on the belly so that compression on the belly and that different positioning versus, like, laying flat for her, that was why I was convinced she slept better that way. I mean, I would put her. We'd go for a car ride and we would go, like to the mall or something, and she would just sleep for three hours straight. And I was like, why can't I get her to sleep in a crib like this? She also would never sleep in her crib. She was in my room for, like, a really long time. And so we ended up doing traditional sleep training with her more behavioral approach, because that's what people say you do here. And I didn't know any better, you know, and it killed me as a mom, but it seemed to work. But now I go back and I look at like. But did it really, like, did it really work? And she was, yeah, we can talk more about this. But like, she was also the kiddo who slept with her tush up in the air and that tripod sleeping. And for her, I think she was also trying to keep her airway open so that, you know, she never wanted to sleep on her back. And she would always flip herself right on over to her belly, like as early as three months. And then she went up into that tripod position and I was like, okay, well, she's sleeping, so she's fine. And now that I know what I know, I'm like, holy cow. She was probably keeping her airway open. And that's kind of frightening to even think about. So, anyways, we'll get there. But it's just so interesting because I totally took a different approach with my second. So I'm really excited to just learn from you today about the differences between some of these approaches. And for people, you know, especially those of us in the US who maybe are not as familiar with different approaches, can you tell us a little bit about, like, the difference between a behavioral approach to sleep training in infancy and what you consider a more holistic approach?

Sure. So I guess a behavioural approach is that basically the concept that the problem is the behavior and the sleep is the problem. So therefore, the intervention is targeted at those problems. So with that perspective, the concept that the problem that the reason your baby won't sleep is because you rock them to sleep or because you co sleep, it doesn't see that as the symptom and it sees that the disturbed sleep is the problem. But when you look more holistically, my perspective is that, okay, we rock or we feed or we co sleep when there's underlying issues with sleep. Because that's the only way the baby will get to sleep because of essentially a fight flight response triggered with the brain that's flagging that sleep as a risk. The child will create a set of safe circumstances around sleep. And often that can be really involved because they activating that fight flight response. So there might be lots of rocking, lots of, you know, it's not an easy process to get them to sleep. And that actually alongside that perspective, my perspective is that the sleep is not the problem, the sleep is the symptom. That's the thing that you're seeing, but what's going on underneath the surface there that is presenting like that. And those things that you touched on there with the, you know, the car seat, the tripod sleeping, the sleeping on, the co sleeping, they're all huge flags for me because like you touched on as well airway patency lying on your back. Not great for if you've got tots or other airway issues going on, it's going to be a hell of a lot harder to breathe. And I do often find that with bubs that do roll quickly or as soon as they start to roll, they figure it out and so I can breathe better like this, over I go. And a lot of. And you know, if you're lucky and your baby learns to roll at three months like you and like my first baby, then good. And then they seem to sleep a bit better. But those babies that I know you talk lots about the whole body effects of tots in terms of delaying some gross motor things like that. So how that, you know, sometimes those, those roles take a long time to get to. So even though the baby could potentially sleep better on the tummy, you obviously can't sleep them there until they can get the roll there themselves and roll back out themselves. So you don't. Yeah, I guess I'm saying that in terms of like if you think, oh yeah, I think my baby would sleep better on their tummy. You can't put them there unless they can get in and out of that position themselves.

Right. Yeah. No, that's such a great point because. And Lily, my first, she was the kid who rolled early. She was climbing up the stairs at six months, climbing back down the stairs at seven months. Like she was that kid who I kind of blame like her overall tightness and her body.

Yeah.

Like as the reason why I actually was doing a presentation and I used her last Friday and I was just thinking back to like her birth and when you look at all of the, the images from in the hospital, she was already holding her neck up and had a preferred side that she would look to and, you know, fed better on one side than the other. And, you know, all the classic symptoms of a baby who's got, you know, maybe some torticollis. And she doesn't present as a kid who has it now, but we've done some interventions, and she, you know, she was super mobile early on. She walked normal. Like, that was a normal, you know, stage and everything. But she was pretty early in her other gross motor milestones. And, you know, I knew she could get in and out of the role, and she was putting herself into it. So thankful for that. But, oh, my goodness, if I'm almost glad that I didn't know then what I know now to some degree, because I think I would have been a completely, like, neurotic mother. Total mess being like, why is my baby sleeping on her stomach? Should I be concerned? I mean, yes, I should have been concerned, but, yeah, yeah, yeah. And it's so interesting because you mentioned these. These symptoms or these red flags that, you know, okay, when a mom says baby's tripod sleeping, they sleep better in the car seat. Baby, you know, sleeps better on the parent. Like, she would do tummy time on me, but tummy time on the floor was like, it didn't last very long, and she was not happy in it, you know, because of how tight she was. And even though she would sleep, you know, in that tripod position on her belly, but that was a different positioning and she would, yeah. Head more to the preferred side. And, you know, it's so interesting because the program that I used, they called them sleep props. Right? And like you said, it makes it the sleep props. The problem, it's like, well, you, mom are holding baby too long, and you're rocking her to sleep, and you're giving her, you know, something that is basically helping her to sleep instead of her teaching herself how to go to sleep. And it gives me chills to think about because it's sort of.

It's.

I'm over here going like, wow. Like, that was completely behavioral. I am an slp. Like, I understand behavioral approaches to treatment, you know, and here I am as a mom just doing what I thought I should do purely out of survival and because that's what people told me to do, and that's what people were using, you know, and now I look at it and I go, oh, my gosh. Like, wow, these were all major red flags for her airway issues and her tots issues and it's all so interconnected.

Well and yeah, like that, that's, that's the story that's out there and that's like my big passion thing to like help parents learn that it's not your fault, it's not something you've created this hole, you've created a rod for your own back. It's just not a thing. Like if your baby is functioning optimally and they're given the chance, they will learn to do that themselves. Like, and yes, there's, you know, you're upfeeding, you're doing all that stuff like early on. But if they, if everything's going well, it's not going to be like this huge, you know, two to four to six week fight trying to teach them to self settle. Yeah, and I'm not saying that there's no need for any behavioural intervention because some, yes, those behaviours do become habit, but the behaviour is not the problem. And so when you address holistically what's going on, you then have biology working with you instead of against you when you want to do these behavioural interventions. The other big thing I think about with that is that if I recognise that there is something going on underlying, I also understand that, you know, like we were saying before, like if you've got to go back to work and your child's up six times a night, you probably got to do something about it here and now rather than waiting till when they're two and they can have their tonsils out kind of thing. And so I guess it's about identifying what's going on and going, okay, they've got stuff going on, we can do these things to support them through it. And look, I'm not going to say, and I wouldn't anyway, but I'm not going to say let's do a cried out method because I know this brain is flagging that as a risk and it's just not fair to be like, okay, you've got, you can't breathe properly, but I'm just going to shut the door and check on you at 2 minutes, 4 minutes, 6 minutes. Like you can support children through it. And it's about respecting that underlying issue to me and you can do, you can support them through it. And that's the other thing with any behavioural intervention, I guess the big, the thing that's out there is that it's all cried out and leaving your baby's to cry and all that sort of stuff. It's really not, that's one old, I think it's further thing that, you know, that's what's out there. And people think, well, that's my only option. It's not, it's 100% not like you can do behavioural intervention supporting your child. But it's from my perspective you want to look at what the bigger picture first and foremost. Like I have, it's really sad. I have families that come to me that have done these multiple inpatient stays at various different services, like you know, three or four, five day stays or a day stay here and you know, all this stuff and they're just doing the same behavioural thing over and over and over and over again. And then as part of my intake assessment I do obviously a really holistic questionnaire, but I look at feeding and get them to send through videos and photos if I'm not seeing them in person. And I can tell straight away from the look of their face, okay, that's an airways kid. And the reason that that 15 days of hard slog behavioral sleep training hasn't worked because the problem is not behavioural. So it's never going to work. That's heartbreaking when you get those families.

It is, it is. But also it's amazing that they even have the ability to connect with you and that there are providers out there who can advise on this and help through. I don't think parents realize that. And I was so excited to have you on the podcast because, you know, I was one of those parents who didn't even realize that there was something other than cry it out. And I didn't realize that my child was going into fight or flight. And I didn't realize that, you know, I just thought this was a baby resisting wanting to sleep. She'd rather sleep on me. That's what she knows. I need to remove these sleep props. And you know, so I think it's a really critical conversation that we're having because if we can flag these things early on in infancy, then we really are changing these children's lives. And you know, I know that you have, you know, you wrote down David McIntosh's book and you know, you've, you're familiar with him and I know he's also in Australia and I wish he was here. He actually just presented for us recently and I was like, can we clone you to the US because the US things operate so differently and you know, it's tough to find an ENT like I can count on maybe two hands the number of ENTs in the entire United States of America who recognize Some of these issues in infants and toddlers and will do something about.

Really, it's.

It's awful. So my, so my first daughter, when I took her at 24 months to the ENT, the first ENT turned me away and said, well, I'm not going to release her ties because she's not breastfeed feeding anymore. And I was like, okay, what? And then the second one turned me away and said, she's fine. And I actually took her to him specifically, look at the tonsils. Because he was supposed to be like the airway centric guy. And her tonsils were almost touching. They were so inflamed, they looked sickly. And he was like, they look unimpressive to me. And I was like, I'm not an ent, but they look very impressive to me. It's just like in a bad way. Yeah. And her mouth was closed at rest and she was nasal breathing. So he wasn't concerned. And I was like, but what about sleep? Like, what about. It was just, it was very interesting. And so she's. Since she's now 5 and she's had some expansion work done and her tonsils did go down quite a bit when we expanded her palate, which was either coincidental or totally related. Who knows? But. And she also went to an oral surgeon and had her, her tongue tie release when she was 24 months old. Around that same time I was taking her to these other appointments. And it totally, I mean, it totally changed her life. And like, we're still working through some things, but, you know, she had gone from. She's now, she's a great sleeper. She's not a bedwetter. She's not, you know, she doesn't have all these issues that I hear about other children her age struggling with. And so I'm like, okay, like, we've worked through that, but. But in the know, I know David talks about, well, if those tonsils are enlarged and they're causing sleep disordered breathing, like, we need to get them out. And here in the US it's like, well, if they don't have obstructive sleep apnea, I think they're okay. Let's try, let's try some antibiotics. If the antibiotics don't work, we'll try another round of antibiotics or we'll send you to the allergist. And it's just such a runaround for these parents. It's really, really tough. And these kids, for the most part, have been dealing with this since birth. It's been there all along. It's not a new problem. It just got it snowballed into such a big issue that they finally realized something was going on and took their child to the doctor. But here everything has to go through insurance. So even with an emergency tonsillectomy, like you still have to go for an emergency sleep study first to get insurance to cover it. It's just. Yeah, welcome to the U.S. so there's that. But yeah, you know, we kind of touched on this whole topic of sleep disordered breathing. So let's go there for a minute because you've mentioned it kind of briefly but that you know, if there is an airway issue, if they truly have disordered sleep because of the airway, we know these cried out methods are just cruel. We're sending them into fight or flight. So is there anything else you add on that topic?

Yeah, and I guess, yeah, they're already in fight or flight and do. And with all that hormonal cascade of things that happens with that and the elevated cortisol and all that kind of stuff and then you do a cried out cortisol and you will see behavioural change when you do that. I just don't think it's a fair way to do it. But you will see behavioural change but you won't see an improvement in sleep quality. So the child is still not going to get deep restorative sleep. They will stop calling out for help. But it hasn't actually done anything to improve their sleep quality. And invariably what happens is that you do a really hard slog for a couple of weeks and everybody's in tears and then they be sleeping. Then you go on holiday or maybe get sick or it's daylight savings or you have a family member come and stay and if you just get that set of conditions and circumstances off center, back we go again. And. Yeah, and then you're back at square one. Yeah, you're nodding like that's happened.

Me. Yeah, no, and that's, you know, and it's interesting too because I feel like even the program that I used spoke to that and was like you're going to, you know, it's the high, it's high likelihood that if you change the sleep environment that your child may have a backslide. If you're still within like your first year of sleep training and you know, they almost make you think like, okay, expect this so that when it does happen, not wrong, but then again it's. And that's fine except it's hiding the issue. Right. It's basically covering up.

It's a band aid.

Right. And it's a band aid for a very serious health issue. And that's where we have to be so careful who we listen to. And, you know, there's so much information out there these days that it's tricky because it's like, well, who do I trust and what's helpful?

And, you know, Absolutely.

You know, and I know what you're. What you're sharing with us. Tasha is Natasha. It's very informative, and I think people need to listen to this because, you know, as somebody in the tots space and having been the mom of the patient who's lived through, you know, trying to sleep train a tied baby, who had, you know, torticollis and who. Who clearly was fighting to keep her own airway open, versus my second child, who slept on her back. No problem. We released her ties day one. We did every. Things just went different with the second one because we were able to intervene a lot earlier. I never really had to sleep train her, per se. I think we did try it for a couple of nights just to get her used to her crib, but it was not the same experience as it was with my first one, by any means.

And that's what it comes back to. Yeah, you had biology working with you this time, and it's just like a little bit of an adjustment. And.

Yeah, so it was much easier and less breaking for all of us for the second one. But I also didn't. I, you know, I made up my own rules. The second time. I was like, I am not going to have a screaming baby for an hour and a half first night. Like I did the first night, and with my. My other child, and I'm not going to, you know, and it went. I can. I can tell you, even, like, she's five and a half, and I can tell you, like, the first night, she cried for like an hour and a half. It was like 90 minutes. The next night it was 75 minutes. The next night it was like 60 minutes. And then it went down to 30. And I'm, like, sitting here horrified that I put my child through that. And it's now five years later, like, it's. You know, because when you know better.

We only do what we know.

Yeah, Right. You know, it's like, I was like, I have to go start treating again. I want to go back to work, so I need my baby to sleep so I can sleep. And.

Yeah.

And it's. I feel for the mamas out there, because I know also in the US we don't get more than three months and some moms are back to work even faster than that.

And yeah, which is tough. And you're going to do the quick fix, right? Because you're going to survive. Yeah, yeah. And I guess and to touch on, I guess that whole journey of finding who you ask for. So I have three kids and two of them incidentally are both airway and top kids as well. And like I have also lived that where how many times can you ask somebody? I don't think is that normal? Yes, they're fine. They don't have a tongue tie. They don't have this. They're fine, they're fine. They'll grow out of it. And then I now thankfully have a great little network in Perth and some providers around Australia where yeah like that I have, I've actually, you know, the Perth one specifically I have taken my own children to. So I know how amazing they are that are really in this space and are willing to treat it because you know like yeah, you can wait till they're five but all that brain development that's been going on in these formative years. I personally want my baby to be breathing as best they can all those five years and not just waiting to see what happens. And yes, my middle child, he had his and this is how I often will explain to people like this is what happens when sleep quality improves. Like he, I think we had his tonsils and adenoids out at and tongue tie release at about three and a half and he used to wake up like he always slept 12 hours at night but he would wake up so, so grumpy, so grumpy. And he would have two and a half, three hour nap at three, three and a half years old if you'd let him, you'd take him in the car at 11 o' clock in the morning and he would be out. You'd transfer him like I mean great. It was great for me having a kid that slept so long but sleep quality is not there. When we had those tonsils and adenoids and tongue tie done like literally within weeks you could tell when he woke up in the morning and he never snored, he never snored, he never had apnea. He never. It was this end of the sleep disorder breathing scale, not this apnoea end but he, you can just tell like he is a different person. He could get through the day before that if he was refusing to nap because napping wasn't cool anymore because he was three and a half and then he Got to day three, it was like his behavior was horrible in the afternoon to be like, right, tomorrow we're getting in that car and we're taking you. Um, and literally weeks after he had all the ENT stuff done, never napped since, and makes it through the day and wakes up like he's had 12 hours sleep, not four and a half.

That's amazing. I mean, my. So Lily stopped napping at 18 months. I think she stopped napping at 18 months, never took a nap again. And I have to wonder if she was just like, I'm not fighting this like twice a day, like, you already put me down. And she was so exhausted at night, she would sleep through the night. And I've had it. I had a patient who is one of my favorite examples. I actually walked into a preschool classroom and heard this two year old, I think she was two at the time, snoring. And so. And I love how you brought that up. And we'll talk about that more in a minute. How there's this whole, this whole scale, right? It's to. From the kids who are. Mouth appears to be closed. They don't snore, but they have all these behaviors and their quality. You know, basically their quality is not there. They're getting quantity, but quantity doesn't mean quality. And that, you know, then we see all these other behaviors during the day. They. This child in particular was snoring. She did have obstructive sleep. Sleep apnea as a toddler. And I just heard her in the classroom. She wasn't a patient of mine. I was treating another child. I took them back to their classroom. It was nap time. And I asked the teachers, I said, she always sound like that? And they were like, oh, yeah, yeah, since day one. And it was like five months into the school year. And I was like, okay. So I went to. I was, I went to the director and I said, okay, might be overstepping here, but I think she could contact this child's parents and find out if that's how she sleeps at home too. I was like, because I have some big health concerns. Like, this is very dangerous what she's doing, what's going on right now? And they were like, well, if you're flagging something you think is dangerous, I feel like I'm like. They were like, absolutely, we'll reach out to the parents. And I was like, okay, here's my information. They can call me. I'm not going to charge them. Just have them call me. I just want to talk to them. Turns Out Mom. Mom worked in a hospital. She's a medical professional. You know, it was just all these things that I was going, how do they not recognize this about their own child? And mom was like, I work with adults. I didn't know that snoring wasn't normal. I mean, this is a medical professional, right? So I say this because I want parents to realize that even medical professionals know that snoring is common, but they don't realize that it's not normal and that we should, you know, be paying attention. But also, on that same, you know, regard as you were mentioning, your child wasn't even snoring and still had an airway issue. So we need to be looking at more than just, is their mouth open? Are they snoring at night? Do they have audible breathing? Well, all three of those are big issues that we need to deal with. But they could also have a slightly open mouth or a closed mouth and still have airway issues. So we really need to be looking at all the red flags, all the symptoms surrounding it for this kiddo. You know, she did go for an emergency sleep study, which turned into an emergency tonsillectomy. And afterwards, the parents were like, she used to sleep through the night. She never woke us up. But she was also the child who was turned around at circle time, who didn't respond to her name, who seemed kind of, you know, out there and just in her own little world because her quality was shit. Excuse my French.

Absolutely.

And to see the complete 180, you know, we had some catching up to do, even at once. By the time she was three, we were working on speech and language skills at that point because she had missed out on so much. And this is, like you said, these are the formative years and the impact that it has on these children's ability to learn and to exist with their peers and to, you know, engage in social communication and just exist and learn how to be in a classroom or how to just play in a playground. I mean, it's. Everything is impacted, even to the point of feeding. You know, I know I've got. I've had a lot of kiddos. I worked on her with feeding as well, because she was also tongue tied. And my kids, too. It's like between the tongue tie and huge tonsils, she couldn't keep food in her mouth. And so she learned these awful habits of, you know, putting. Using her fingers to keep food in her mouth and push things over because her tongue couldn't do it to her molars to chew. And very Messy. And, you know, thankfully, I can say she's doing fabulous now and she is really thriving because we were able to intervene early. But there's such a spectrum of how these children present that it's not always this case. This is a more severe, obvious case that actually got missed for quite time. Some. Some time, because nobody was really looking into why this child was snoring so loudly until I flagged it and it was a child I didn't even know, you know, and it's just. For me, it's scary that those children are slipping between the cracks, because if those children with all of the major symptoms that are overt, that we can see and hear are slipping through the cracks, we know there's a major epidemic of children who are going undiagnosed to have these silent. More silent issues. And, and I'll let you speak to more about this, but we know that the brain is restoring itself during sleep. And so is there anything that you want to add on that topic? Just in terms of what's happening in the brain and our airway when we are sleeping?

I will just quickly go back to the normal and common thing. And that's something that I really try and half on about, that normal and common are not the same thing. And so just if your kid snores, it's still. Because if you snore and Granny snores, that means it's common in your family, it's still not normal. And. Yeah, and look, I really wish that there was literally a question with, you know, when families touched base with child health nurses or, you know, the immunisations and things like that about, do you hear your baby snoring? Can you hear your child breathing? Do they wake refreshed? Like, just a few simple questions to get those. Get that ball rolling or bring it into. Bring it into the sphere of, hang on, let's watch this. And yeah, like you said, it affects everything. It's not just they wake up grumpy and they're a bit annoying and at the end of the day, like, you know, like when you're an adult with a fully formed brain and you've had a crappy night's sleep, everybody around you annoys you and you know how to have relationships with your friends. Whereas if kids are learning to have, you know, interpersonal relationships, they're learning reading, writing, maths, all that kind of stuff, if you've had the equivalent, you know, this is just a total random number, but, like, you've been in bed for 12 hours, but you've had the equivalent of a good three hours sleep. You're not going to be equipped for that. So. Yeah, and I guess so coming back to the, I guess what, what's going on in the brain is that, that you're not getting that memory. You're not transferring short term memory to long term memory memory, you're not consolidating memories, you're not, you know, all those synaptic things aren't happening where all those new learned skills are getting consolidated and that whole, I don't know if there's any research about it in kids, but certainly with adults that glymphatic system that opens up in the brain only during sleep, which takes away waste in the brain, you know. And look, I don't actually know what the research is with kids and the glymphatics, but certainly with adults there is a link to that buildup of that protein and you know, cognitive consequences because of that. So all those, there's just so much restorative stuff that happens during sleep and good quality sleep and then yeah, those, those play on effects of the rest of the day.

Sorry, Absolutely. No, and I think that that's so important because one of the things you mentioned earlier, you used the word formative, that these are the formative years. And I, I constantly say that even about my own children to my husband. I'm like, the formative years are really important between like birth and seven. Like everything that happens to them in these seven years is going to form them for the rest of their lives. So we can either really screw them up now or we can really help them through. I laugh because like that's been my, you know, my whole thing. I'm like, well, we have to feed them organic food and we have to make sure that, you know, they get enough sleep. I don't care what time they go to bed, as long as they're getting enough sleep and they're waking up, you know, at a certain point after that. And you know, it's just, everything has been very much so around that conversation, but also just because if you know basic psychology, they teach you this, that these are the four formative. And it just, it impacts so much. And I know that sleep disorders are connected to airway issues, are connected to major health issues and major health events throughout your life. And so if we can create these healthier habits now and get our children on track, you know, it's that toss up between like, how do we get them sleeping and making, also making sure also that they can breathe properly while they are sleeping another airway adequately open. And so maybe we can, maybe we can shift over to talking a bit about tongue tie again. Because I think that one of the things that I've seen is with like my MYO patients and even with my infants, my, my infant feeding, you know, babies who have had tots, it's just, it all goes back to airway. Can this baby breathe properly? Can, you know, the suck, swallow, breathe in? An infant is often disturbed because they have an airway issue and they can't seem to get in that rhythm because their airway's not patent. And if their airway is not patent, we have big problems because this baby needs to feed. And that's, you know, and it's just so, it's fascinating to me because why isn't anybody looking at that? Why are doctors turning away? Why are they saying, oh, just go see the feeding therapist, which is great, send them to lactation, send them to feeding, but then we need to be screening for this. And I will add that Richard Baxter, who's actually my first ever podcast guest, he just recently sent out a updated email article with his tongue tied, his Tongue Restriction Questionnaire. And it's a screening tool to identify tongue tied patients. And on it he does ask about, let's see, restlessly kicking, moving while asleep, grinding teeth at night, sleeping with mouth open, so snoring quiet or loud mouth breathing during the day, large tonsils or adenoids, amongst other issues, hyperactivity, inattention, you know, so I'm really excited to see that this was actually published and that it has, it asks about these things because like you were saying, we need to have these early intervention providers, whether it's a pediatrician, whether it's a lactation consultant, an SLP here in OT who may be doing feeding with the infant. We don't have the nurses that come to our house after we come home from the hospital. I think I just spoke to somebody recently and I can't remember if that was Australia or I think it was Canada, but they had like some nurse practitioners who will come into their home, I guess throughout the three months after you come home from the hospital. There's nothing like that here unless you hire them private, pay out of pocket. And usually, usually they're just night nurses to take care of the baby at night so that you can sleep. So if you're not breastfeeding or they bring you like they bring you the baby to breastfeed and then take baby back to like put baby back to sleep, what people do in the U.S. and look, I'm not knocking it. If you can afford that, great. I never did it because I didn't. For me to have some stranger in my house at night while I was sleeping with my infant, to me, like I just couldn't. Like I had too many.

Relax, you'd be in light sleep.

Yeah, my children were in my room with me. But anyways, I'm like, I don't judge you either way. You do what you want to do. But anyways, the whole point being that we don't have that support even to as a, you know, as a new mom with a new baby, with somebody coming into the house and checking on us. It's just really those pediatrician appointments and then we don't even go to our own gynecologist until six weeks post op or, you know, post delivery, which is absurd compared to what I know happens in other countries. And so there really isn't. There aren't many people checking on mom and there aren't even that many people checking on baby. And so now mom is home with a newborn and it's like feeding is not going well. Nobody told me this might happen. What do I do? And then sometimes you reach out to the person. You get vulnerable, you reach out, they come, they help, things seem okay, they leave, it all falls apart again. Or like me, I took my daughter to, to the pediatrician, to their ibclc and I was told I was just positioning her wrong, position her in the football hole, do this. It worked beautifully in her chair in the office. I took her home, it all fell apart. And I was like, well, okay. And they said she didn't have any restrictions or anything. So here I was, back at square one. So I just pushed forward and suffered. Both of us suffered for 13 months. And it's insane to me that we do not have more support as new moms. And especially when it comes to two of the biggest things, airway and feeding. Like we need to be able to eat and breathe to live. So, you know, you would think that we'd get more support around that. And I just the fact that such a little restriction under the tongue can cause such a big impact and that it's not being looked at as that much. Or people are now arguing. The newest thing I've seen is people are arguing that tongue tie releases are not necessary and they're over diagnosed and dentists are. Or just dentists in the US or release happy. And look, maybe that's true in some areas. I don't know. I'm not living in all those spaces. But what I do know is that here in my area I know who the providers are that I trust, that I refer to. And they're never going to release a baby who doesn't have functional issues. And by function we mean sleep issues and airway issues and feeding issues. And that's why they're coming to us in the first place. So I think it's very important that we start having more of these discussions so that mamas can, can access the information they need but also realize, yeah, that little tight piece of tissue or fascia under the tongue or the upper lip keeping the mouth open, causing mouth. You know, I've seen the tongues fall back into the airway. So sometimes the tongue is so tethered that when the baby's laying on their back, the tongue is falling back into the airway and they can't clear the airway. And if the nose is congested, well now they're really going to struggle to breathe because they can't breathe through their nose. Now they can't breathe through their mouth that well. And that's why they also want to throw themselves onto their bellies because it forces gravity will then pull the tongue, you know, forward out of the airway. So that's, I'm guessing that's exactly what happened with my child. But you know, I never, I'll never truly know, but that's, that's my guess and that is what I've seen with quite a few of my infants. And you can even see with your own child, lay them on their back and open their mouth up and see where is their tongue? Is it up on their palate? Yeah, falling back in their mouth, you know, is it laying down and forward, is it between their lips when they're sleeping? You know, where is their tongue? Because that gives you so much good information. But anyways, I'll turn it back over to you. But I get very passionate tongue ties.

And I guess I always with the, along with the tongue tie talk about obviously how it's a muscle, as it as is all the musculature around the throat. So when we're asleep those things relax. So if your baby is resting with a visibly low lying tongue during the day when they're upright, can you imagine what's happening to that tongue and throat at night when they're lying on their back? How we are told how we have to position them, particularly when they're little. And certainly here we get, I get a lot of clients that will say, oh, but the ped checks them. So it's like at birth, lift up the tongue. No anterior tie. Yep. Cool. And I was like, okay, but tongue tie is not based solely on the anatomy of the tissue. Unless a whole bunch of symptoms have been asked about and feeding has been assessed, then that's not a. And the actual movement of the tongue, not just a little flip. Look, look, what's going on then that's not a accurate diagnosis. But I think that's really hard for parents to grasp because it's like, yeah, but they're a pediatrician. Like, surely they would pick that up. Also my GP said and like this and that. And yeah, someone said that these dentists are just trying to make money. Like, trust me, they're busy enough. They don't need.

There are other things that make them a lot more money than a tongue tie release.

Yeah. So. And it can be, yeah. Hard to get people sometimes on board because they'll be like, well, no, but my GP said was fine or my paid or, you know, my ibclc. But you know. Yeah. Are they tongue tie trained?

So we have that issue here too. It's, you know, why has nobody ever told me this? Why are you the first person that I'm hearing this from? I've been to all, you know, 13 other practitioners between my, this specialist and my pediatrician and this IBCLC and that feeding therapist. And, you know, you're our third opinion. And I'm going, look, you know, not. And that's the thing. I wasn't trained in this in grad school. And most SLPs and OTs at least in the US don't even get pediatric feeding training. I think I can count on one hand how many total programs do courses on pediatric features feeding. So they're not even talking about peed feeding. You know, why are they going to talk about tongue tie? They're not. They're not going to talk about ankle glassia when they're barely talking about pediatric feeding and they're not teaching on myo. I think now in the US I know at least the SLP programs are going to be at the asha position statement is now includes, you know, there's one for myofunctional therapy, orofacial myology. So now I think that they say, and I don't know how true this is, but I've heard through the grapevine that they're supposed to be adding like myofunctional therapy and orofacial myology into the graduate coursework. I think in the next couple of years, I Don't know that if that's definitely happening, but I would love to see that and pediatric feeding equally introduced into the coursework. Because for me, I knew I always wanted to work with pediatrics, but they only taught us adult dysphagia. And adults are completely different than infants and toddlers. The anatomy is different, the physiology, everything is different because they're growing. And when we talk about formative years, we know as feeding therapists that children develop their feeding skills between birth and about 36 months of age. And there's so much change going on during that time, just throughout all of development. They're such critical years that we can't just apply what we know about adults to peas. It doesn't work that way.

Just make it smaller.

Yeah, it's like they're just mini adults. No, they're actually not. Not until they're maybe about four or five. Then I can.

You can.

I can argue that maybe some of the anatomy applies the same. But, like, while they're still developing and things are dropping and shifting and changing and growing and. Yeah, no, that doesn't work. So it's definitely one of those things where I think we need to be looking at these little ones and recognizing that the people who unfortunately spend a lot of the time medical professionals who spend the most time with these kids are not trained in tetheral tissues. They're not trained in orofacial myology, they're not all trained in sleep disorders. Most of them are not trained in sleep disorders and airway issues beyond some of maybe the more medical complexities that are, you know, taught in their medical programs. And so we need to recognize that a lot of this is post doc or post grad type of learning. And some of us have really gone down the rabbit hole with that and taken whatever courses we can get our hands on, read the books, listen to the podcast, you know, just. And worked with the patients. You know, when you start working with these patients and you start seeing one after the next, it becomes pretty obvious pretty quickly, like, what the underlying root cause of these are. And, you know, and then when you start to treat the root cause and you can see that, wow, like you said, look how fast sleep improved after the absorption was removed in your child. I've heard, oh, their tonsils came out and holy cow, I've never seen them. They slept like a rock and they seem rested the next morning. And some behaviors have improved. And I'm like, oh, look at that. What do you know? When our body gets what it needs to thrive, like, you mentioned we're really going for optimal health, not just survival, not sick and compensate. We want to thrive and work from a place of optimal health. And that was the other thing that I also saw. There was a recent post in one of these groups that I'm in, and there are some older generations who work for, for minimal competency. And the thing that really bothers me about minimal competency, meaning, like, what do we just need to give them so that they are, they're. They're surviving and they're okay. They can function. Like, there's a difference between are they able to function to a certain degree and are they optimally functioning? Right. And you know, you that word optimal in there earlier, and that's one that I love, because if we're teaching them enough that they can compensate to get through their day, well, they're not. They're not thriving. They're not functioning optimally. So for me, I don't settle for like, minimal competencies. I go for like full, optimal, holistic health. Like, I want people to thrive. And I say this because I've worked with enough adults as well now in the myo world who had tetheral tissues, who have come to me because one, one realtor came to me because she was like, I've had one phone call, a cup of coffee. I'm sitting in front of you. It's 10:00am and I'm exhausted. I'm done. I can't talk anymore today. Like, my mouth is physically exhausted and I'm out of energy. And I was like, okay, well, let's dive into this. And all she wanted to do was recite her wedding vows without being tired. And I was like, wow. And having a tongue tie release and myofunctional therapy did that for her. And she was like, I didn't know what I was missing. And that is a common theme I hear from adults. They've been sent to so many professionals, so many specialists, nobody can help them. They to the point where I've had a couple adults where they actually thought they had, like, PTSD or they thought they had mental health issues. Because people are like, you are making this up. And then I see them, I'm like, you're not making this up. You have a myofunctional disorder. Like, you've got tight tissue, tight tethered tissue under your tongue. And we treat them and what do you know? All of a sudden they're now no longer mentally ill or crazy. And I'm not downplaying mental illness, but it's sad. To me that doctors are so quick to. To write off adults when they're telling you these are my symptoms. Like, sometimes these people are actually, you know, they do know more about their body than the doctor does. And that's. Yeah.

And I guess. Yeah, sorry, you go, no.

And that's where I think we really need to start listening to our parents and these patients because they're telling us something that we can't always see with our own eyes. And it tells us we need to help them figure out the root cause of the issue. And I will never settle for minimal competency because I think we're doing a major disservice to our patients, whether they're pediatrics or adults. We need to make sure they're thriving, not compensating, because compensations, they just continue to snowball into larger compensations over the course of your life. I've seen it with the adult patients. So anyways, that's my little rampage or rant on that one.

And come to on that kind of thing. Like, it comes down to your definition of health and that as an ot. My, my definition of health is not the absence of illness or sickness. It's when you are functioning optimally, you're thriving, not surviving. And you have cohesiveness across that whole biopsychosocial model of, of health. And yeah, look, it comes back to that thriving again. Like, I want my kids to thrive. Everybody wants their kids to thrive. And good sleep quality is literally a pillar of health. And for everybody, sleep, nutrition, exercise are your three pillars of health. And, you know, and that also goes for the parents of children that are. Have these ongoing sleep issues. They're not healthy and optimally functioning whilst they are not sleeping well. So there's this whole interplay with that whole system, the family unit, you know, all of it. So, yeah, I mean, sleep affects everything.

Oh, yes, 100%. I mean, and I always say this to parents. I'm like, think about what happens when you've had, like, you know, three great nights of sleep, and all of a sudden you just. You get like four hours of sleep one night. How do you feel the next day? Now, let's pretend like that happens every single day of your life. Let's pretend like you're only getting three to four hours of good restful sleep night after night after night. And they're like, no, no, I don't want to think about that. That's how your child is surviving right now. Your child is basically on, you know, three to four hours of, okay, sleep a night. Despite the fact that they were in bed for 12 hours. And I think when we start to explain things like that to parents, they start to recognize like, oh, okay, well, that sounds horrible. So what do we do? You know, And I don't do it to scare a parent, but I also will, you know, because I ask about sleep in everything that I do. So I was so excited to have you on here because I'm like, I don't think we've had anybody on who's really talked about sleep in this regard before. And it's such an important topic that we've talked lots about sleep disordered breathing, but not necessarily as it applies to sleep training. And I just love your whole holistic view on sleep because I'm a very holistic person myself. And I think we need to be looking at the whole body. What is going on with this child? What is the root cause of the behaviors that we're seeing, seeing. And so thank you. Thank you for all this. It's been so amazing. Is there anything, anything that we didn't talk about that you want to touch.

On, I guess just briefly about the feeding sleep interplay. So, which is actually. So I've done the feed the peeds course with you guys and yeah. So look, feeding assessment forms a really formative part of my whole holistic assessment because, you know, you can pick up airway issues, you can pick up top issues that you can also pick up. Yeah. If they've got gas, if they're snack feeding, you know, all those types of things. But so that is a really important thing to look at when you're going to provide any kind of sleep intervention because not only because it can pick up those issues, but because a hungry, gassy baby that's exhausted from trying to draw milk out is never going to sleep well. Yeah. So I think that the whole. That's why I think feeding and sleep are so, so linked and why I did your course.

Yeah, no, absolutely. And thank you. It's really, you know, and it's such an interesting, like just me working with other professionals in this space because, you know, it's not just me teaching the course, but we find that just across the board that, like you said, if these infants have feeding issues, sleep is probably going to be disrupted. Not always, but we really need to look at it because it is so interconnected. And like I was saying before, you know, a suck, swallow, breathe is going to be impacted if the baby doesn't have patent airway. And that could be one of the major causes of why they're not feeding well. And so we have to be looking at these things. And I find so often that we're not. And even to the point where I've. I've seen heard of cases where. And I've had cases myself where they were sent to the ent, and the ENT said, baby's fine. And so baby is cleared to work with, you know, a pediatric feeding therapist and ibclc. And we're both, you know, babies breastfeeding and bottle feeding. We're all trying to work together. And then, you know, it just. Things are not improving, and we're going. Something is. Something is off here. Like, I'm not convinced there's not an airway issue. So we send it back to another professional who then also refers to the ent. And all of a sudden, the ENT now starts paying attention, because now babies come back a second time. Now there's more professionals involved, and we're like, why did you not take this seriously the first time? And we have this big issue in the US where parents are just written off, even when they come with a report or referral from a provider, another provider. And it's scary, it's sad that they're not looking for some of these larger medical issues that could be causing very serious airway issues. And, you know, there's things, obviously, beyond tonsils and adenoids. We could be dealing with a laryngeal cleft. We could be dealing with all kinds of things, but those are less frequent. More frequently, these children just have some inflamed airway, you know, tissues that may be blocking the airways. And that's not a little issue. It's kind of a big deal. But we need to know about it so that we can address it, because if we can get baby breathing properly, then it's much easier to get them to sleep, get them to feed, get them to just, you know, then they're functional little mini infant humans during the day. And so, you know, it's so important that we talk about sleep more and more and that we consider what that means in terms of airway. Right? So, yeah. Yeah.

100%. Yeah. And that you need to look at it holistically. And there are different. There are other options besides cry out, Please. There are other options.

I wish I knew that there were other options besides cry it out with Lily, because I still have, like, that mama guilt, even though I'm like, I didn't know better, but still, like, it just. It breaks my heart. Like, I told you. I can tell you, like, how many minutes she cried to sleep every single night for the first five nights before she finally, like, went to sleep after just a teeny bit of fussing. And, you know, and to know that I did that to a child who had, like, airway issues, I think that's what really kills me the most. Like, I just, you know, I can't. So anyways, we're beyond that. We're dealing with her health issues. She's thriving. She's doing great now, you know, not. This is not meant to shame anybody, but if you are in that boat, you know, where can they find you? I know you're in Australia, but if some, if a mom is listening and they're. Or even another professional and says, okay, we need to work with, we need to work with Tosh, how do they find you?

Yeah, so my Instagram, so sound asleepbabyau and that's got links to all my websites and things or otherwise. Www.soundasleepbaby.com and thankfully, through the power of technology, yeah, I can connect with people, people all over the planet. Amazing.

Yeah. Yeah. That's so awesome. Well, we will make sure that this is also in the show notes so they can contact you in case they're driving. Don't. Don't try to write while you're driving. And thank you. Thank you so much, Natasha, for joining me today. This has been amazing.

Thanks for having me. Holly.

Thanks for listening to this podcast. If you want to hear more of these Myo Tots, Airway and Feeding related episodes, be sure to leave a review on Apple podcasts or pledge a small amount on patreon.com the Untethered podcast. If you found value, others you know in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook. On my Facebook page at halliebulcan, biz, on Instagram @alliebulcan. And you can head over to theuntetheredpodcast.com to grab a copy of the show notes where you can also subscribe to be kept up to date on the latest podcast episodes.