Episode 132: Feeding With A Twist of Myo

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. Let's get started. Hi and welcome to episode 132 of the Untethered Podcast. Today we're going to be talking about a few things. So the first thing that we want to talk about is where this all begins. And you've heard me talk about this a bit lately. This came up on the episode with Jen Kirkham and Dr. Michael Gelb and we've talked about this previously as well. But I think that it's really important for us to re highlight the topic of are we intervening with a infant who's having feeding struggles due to tethered oral tissues? Or could something else be going on? Or could it be all of the above? Right? And so we get a ton of these cases and yes, it is true that many infants who have feeding issues get referred to my team, my practice in particular to rule out tethered oral tissue. Maybe we see a higher incidence of those cases. That's where our expertise really comes in to determine we are seeing these tethered oral tissues because we know there is a functional impairment. If you know me, if you've heard me teach, if you've heard me speak on here, you know, we say there's no such thing as a mild tongue tie. It's either there or it's not right, it's present or it's not present, number one. Number two, when we have these infants that get referred to us, typically they're coming in with a functional impact. Otherwise they wouldn't be appearing in our office. They're usually appearing or we travel to their homes a lot. Most of my team travels to the home. We also do virtual, we also have some home based offices they can travel to. So bottom line is when we are working with these infants, we need to figure out is the functional impairment that the parent is reporting, right? Because keep in mind, if they're breastfeeding dyads. There could be, and there generally is a set of symptoms for baby and another set of symptoms for mom, for that breastfeeding mother. Now if they're bottle feeding right, then we're primarily looking at baby symptoms. But if there's a functional impact, meaning is feeding impaired? Is this goes beyond feeding? Is airway, is the airway impaired? Do we have concerns about the airway? We're going to go into that because this is coming up a lot and this is why I'm saying we're going to get into a few things today and then yes, you know, tether, oral tissues and what does myo look like in babies? Hot Topic. Now again, you know me. True myofunctional therapy is it requires the cognitive ability of at least a four year old. And so when we're dealing with infants and toddlers, we can apply the principles and general goals of myofunctional therapy to infants and toddlers. But the way in which we do it is different than a traditional myofunctional therapy program that we might do with a four year old on up. So we get calls requesting myofunctional therapy for infants and toddlers and we know enough to ask to figure out before we schedule an evaluation to determine like is, is there a potential functional impact here that we need to assess for? Because we don't want a parent just coming from MYO because they think that a six month old should have a traditional myofunctional therapy program, right? No, we don't want that. And, or we need to advise them on what their child might need if it's not traditional myo because they're too young for that. On the flip side, we don't wait, we don't wait until they're four to start this therapy. I think that's an important discussion to be had because a lot of people ask me, well, what do we do in the meantime? Well, we look at the symptoms and we try to figure out what are the root of these symptoms, where are these symptoms coming from, where are they stemming from, what is the etiology, what is causing this? Because if we can figure that out and we can treat that, then these symptoms will disappear. They will, you know, so if we have a baby with reflux, for example, and they're put on reflux medication, it might help. But we have a lot of cases where it doesn't help. And why? Because it's a band aid. In many cases, a lot of babies don't actually have reflux. I'm not Saying that they all don't. There are some babies with true reflux. There are some babies who with true gerd, right? Beyond just regular reflux. I'm not talking about those, that subset of infants. I am talking about the infants who just get put on reflux meds because they seem to spit up or vomit up their entire feed every time they eat. Right. Or these babies who are screaming in pain, arching their backs. You know all the reflux symptoms, right? We know that this, that these medications also, some of them are not healthy and are not tested on infants and they cause a higher incidence of broken bones in the toddler years. And that is why a lot of doctors may trial reflux meds, but they don't want to keep babies on them long term unless absolutely necessary. And it's where you start to weigh your pros and cons. I am not a doctor who can decide for or against this. I am just a practitioner sharing my observations with you in this space. And what we see with a lot of these babies, what we also see is sometimes when we treat the dysfunction that is going on in the mouth and that dysfunction that connects to throughout their body, we take this full body holistic approach. Guess what resolves the reflux. We see it happen quite a bit. And again, we're not treating the reflux with a medication directly. A lot of these babies are not on meds when this is happening. We are looking for the root cause. Now, I can't tell you that any one single holistic treatment or any five different holistic providers working together is going to be an absolute cure for fixing an infant's reflux. I'm not going to do that because that's one out of scope for me to do two, just not a proven thing. So there's no data to back saying something like that. But I can tell you that clinically what we see is we do see it significantly improve and sometimes resolve when the right approach is taken for that patient. So what I want to share with you is a case study today, an infant case study who came to me for a feeding evaluation and our feeding evaluations. Obviously, one single part of an infant feeding or toddler feeding evaluation is that we're going to look at tethered oral tissues, right? When we talk about evaluations of tots of tether dural tissues, we need to understand that that's not a standalone thing. We can never just look for tether dural tissues and go, oh, yep, there they are. Yep, I see it. There it is. The same reason why we can't diagnose in a picture. We can't, you know, if somebody sends videos and whole history and there's conversation, there's consultation over what's going on, what are the symptoms, you know, we have a good understanding of patient history, current, you know, and that includes medical history, birth history. Right. Especially for these infants. We want to know about anything happening in utero. We want to know about what happened at birth, how things have been going since birth. We need to know all of this information. Right. And then we're going to do our feeding evaluation. And again, that feeding evaluation encompasses a tethered oral tissue evaluation, and we suspect tethered oral tissues based on visualizing them. But also from our findings in a feeding eval, I really want to highlight that because I know as of late, I feel like I've been talking quite a bit about the difference between feeding with a twist of myo, feeding with a twist of tots and myo and true myofunctional therapy. That's why I like to draw the hard line. At around four years of age, some kids actually need to be a little bit older. And so they, even at 4, might still require an SLP or an OT. Who does more of a feeding approach with a twist myo? If the child's not truly ready for traditional orofacial myofunctional therapy, can this be just as effective? Absolutely. That is why we don't wait. But we need to have this early intervention discussion because I have a vision. I don't know how I'm going to make this happen, or, you know, hey, if you're interested in, you know, making this happen, reach out to me. I'd love to discuss it further. I have this vision and this conversation came up with Dr. Michael Gelb recently. I'm not just screening these babies at birth, right. And a quick tots screen would be great, a quick feeding screen would be great, but an airway screen, and I want to see that being done in preschools as well. And I share this with him because it came up that I used to go into preschool programs in Maryland and D.C. and my team still does. And sometimes I would take a kiddo from the classroom, we would go to the therapy room, we would do their session, I would take them back and we would enter and it would be rest time or nap time. And we're talking like 2 year olds, 3 year olds. Most 4 year olds were not napping at that point, but they might rest on a mat or have quiet book time. There were different Rooms sometimes for kiddos who were napping and kiddos who no longer napped. A whole variety of opportunities to see children, one, sleeping and two, playing quietly to look at what their mouth was doing. What is so fascinating about this was I didn't even need a screening tool. I just went in and I was the screening tool. I was like, holy cow, these three kids have their mouths open while they're sleeping. Are they congested? Are they always like this? And the teacher was like, oh, their mouth is always open while they're sleeping. And that one that you hear. Yeah, that one always sounds like that. I was like, oh, okay, that's concerning. I mean, d snoring for a 2 year old or a 3 year old, highly concerning. And thankfully we were able to get somebody within the school program to kind of intervene, connect the families to me. And I did some consults with them and sent them on their way. It didn't even turn into treatment for a couple of these kiddos with me. They just needed the proper referrals to other resources and I was able to help with that, which was fantastic because otherwise these kiddos would have gone, you know, completely unnoticed. Nobody would have known it was an issue. For how long, how long do these kids need to go before somebody trained in this starts paying attention? And so I am all for these school screenings. I want them in the hospital when babies are born, I want them in preschools, I want them in elementary schools. We need to be screening our youth. When we do those vision and hearing screens, throw in a five minute airway screening, Throw in a five minute. You know, we need to be looking at how our children are presenting because it so highly correlates to their ability to pay attention in class, succeed in school. And hi, if you have obstructive sleep apnea as a child, your IQ is proven to be lower than your same aged peers. And I've seen articles where it's anywhere from 10 points lower to sometimes I think I saw 15 or 16 points lower. Lower on average than your same age PR. If you have obstructive sleep apnea, that is. That's telling you something. That's telling you that your brain is definitely impacted by the inability to sleep well, but it's also starving the brain of oxygen every time you have an apnea moment. And if that's occurring throughout the night, because, yes, this happens in infants and toddlers too, we need to be paying attention. All right, so I got a little off topic here, but let's go to our case study. Clearly a Topic I'm passionate about and a conversation that I want to continue with anybody who's interested in figuring out how we can come together and make something like this. A universal screening process for all infants, toddlers. I've been talking about it for a couple of years. We've done it with my team. Every speech language screening that we do, even our OT screens, if we're not doing speech screens, we look at these things. We screen for myo airway tots, feeding concerns with our traditional speech, language and occupational therapy screenings that we do in schools. So this is definitely something that we're already doing. It's a matter of how do we get everybody else to do it too, how do we integrate it into these daycares, these schools, so on and so forth. So anyhow, again, I digress. So, all right, so let's talk about this little kiddo. So I had this case that came to me and this kiddo was a triplet. Actually, one of the triplets seemed totally fine. Like, no concerns of feeding airway, tetheredral tissues, none of that. The second one appeared to have a tongue tie, per the referring provider, but absolutely no functional impact. Like feeding was going great, airway was great, oral rest, posture was great. We had absolutely no concerns with overall development in that child. So we decided to, let's just monitor, make sure that as things transition as we go from bottle to solids and that introduction of solids to weaning off of milk at the 12 month mark, let's just make sure that things continue to progress as we would expect. And then there was the third sibling who really was struggling to feed and gain weight, had a whole bunch of symptoms going on. Okay. So basically they, you know, the goal was that we want to get this child well nourished. We want to make sure this child is getting the nutrition that they need. And you know, and basically how, how can we do that? How can we help this child gain weight and help this child eat properly? Now, I'm just going to pretend this is a boy because it could have been a boy, it might not have been a boy, but I don't want to give out actual information on the patient. We're using this as a model case. But this infant was 8 months old and was born at about 36 weeks gestation in Maryland. Born early. Just keep that in mind. This infant weighed around, I think it was about four and a half pounds or so at birth. So tiny and, you know, had some. I've had a number of babies that had iugr intrauterine growth restrictions. And so you know, sometimes that's obviously a concern with multiples and also with these earlier, you know, and also multiple sometimes leads to earlier inductions and whatnot. So anywho, the infant otherwise was pretty healthy. The parent was pretty healthy in terms of gestational. There were no concerns with the infants in utero outside of the IUGR and outside of obviously having to induce prior to 40 weeks. But aside from that, no issues with mom, no issues with the infant immediately following birth. Baby was breathing well, but because of low birth weight these triplets went to the NICU and there were, I believe I want to say this infant also had a little bit of trouble with body temperature regulation but this can be common in some of our infants. So it was one of those things where that might have happened. I don't remember if that was this infant, if it was him or his, his brother, one of his brothers. But anyways this parent was a bottle feeding parent and did not have any interest in breastfeeding but did attempt to breastfeed initially just for the first couple of weeks. And then mom was like, you know, I really wasn't interested in doing this, I want a bottle feed. And that was her goal and that's totally fine. So this infant also later we found out about, I think it was around, I think it was while the baby was still in the nicu. They found out that the baby with the IUGR there were some other concerns with gastrointestinal intestinal issues that the baby was being monitored for. And yeah, that was the biggest thing per the history. Nothing else really stood out. Again, the baby was only in the nicu for about 10 days and then was able to go home. This parent was using the Dr. Brown's bottle feeding system because she had learned that that was supposed to be the best. And so she was using Dr. Brown's and she was trying to use the Philips Avent pacifiers. The Susie Pacif baby wouldn't take the pacifier which is also very common with a lot of our tight infants. And keep in mind that this, this infant, right is what did I say? He's eight months old. Okay. The parent called me because the infant was not yet eating anything by mouth other than milk, right? No purees, nothing. Nothing other than just milk. And again we see this sometimes with some of our kiddos that they have these really heightened gag or vomiting responses to any food presented. You know a lot of these infants, which I find is interesting, will sometimes mouth like an empty spoon or plenty of Other like non edible objects. But as soon as you dip that spoon in some puree or you preload it, they are just like, they bring it to the lips and they gag or they vomit. And this oftentimes leads to just a disinterest in food. It's not enjoyable. It's a lot of work. Why would I do that when I can get my nutrition from my milk? But again, remember this was a child who was struggling to keep weight on and to gain weight. So we need to explore this a bit further because, you know, I've had an episode where we talked about sleep before. One is not just for fun. It's, you know, while we may not rely on the calories per se, it's still extremely important for the orof the sensory oral motor system to. Sensory system. The motor system, sensory motor system, right. It's all intertwined. It's really important for us to have those early experiences and to use those orofacial muscles and to enjoy the process while we do it. Otherwise we start to learn this is not an enjoyable process. And then kids refuse to eat. They refuse food because it's a lot of work. It's not enjoyable. In fact, it's complete. It's the opposite. It's unenjoyable. So it makes sense why we get these toddlers who are like, nope, don't bring that anywhere near my face. I have learned that is not a fun thing for me. Not interested. Take it away. Right. So this little one was able to drink from an open cup. They had taught him that. And, but like I said before, the majority of liquid intake and nutrition in general was coming through the Dr. Brown bottles. And oftentimes what we also see in a lot of these babies very frequently is that they need to. They may also need dream feeds. So parents might report, well, they feed well enough, but we get the most in when they're sleeping, right. And that tells me, huh, this baby, if they're not feeding well when they're awake, they're dysregulated. There's probably something going on. Like I need to observe them, feed to see what's going on because my antennas go up and I go, they're probably feeling pretty dysregulated internally, externally. Like we probably need to bring somebody else in here, like maybe a cranial sacral therapist or an osteopath or somebody who can do some light, gentle touch type of work with them to help reset their system or help things flow properly or help just help things work a bit better. Because we know that if they're struggling to feed, if they can feed while they're asleep, okay, that means things work, right? But what's happening when they are awake that they're refusing this? Why is it so unenjoyable for them? Why is it so hard for them? So we really need to kind of pull that apart a little. Now. I'm trying to remember, too, because I've had a number of these babies over the past year or so where they just. They just. They only really feed well when there is, like, solid feed, not solid feeds, but like, good feeds. Meaning, like, they'll take the amount of ounces that they should versus a quarter of that amount during these dream feeds. And sometimes these dream feeds then stop working, which also happened in this case because there were gastrointestinal issues occurring. And the child will wake up and not feel well and need to be put back to sleep to then continue feeding once the gas or stomach cramping passed. So this is something that a GI doctor was following this infant for. And, you know, it's. It's very fascinating because I don't think that people who are outside of the space really understand how much goes into just keeping these little ones alive, getting nutrition into them. I mean, I've had parents who have to lay their children on a bed in a certain position, propped up a certain way, like on the left side with the head slightly propped in a certain direction in a certain way and certain slightly elevated. What am I trying to say? And in order to help them take the feed and not have the feed just immediately come back up or have the child wake up, you know, completely dysregulated and screaming. So this is something that I think just I wanted to open everyone's eyes up to because I've had again. And sometimes these babies have some significant diagnoses. Sometimes they have gastrointestinal issues. Sometimes they have laryngo Malaysia. You know, sometimes they. They are just very challenging little ones to feed. And this is so super stressful for these families. And by the time I, like, like I've told you before, by the time they get to me and my team, you know, they might be coming to us just for feeding without any knowledge of tethered oral tissues. But we do get a lot of babies who have been seen by other feeding therapists or other professionals, and things are just not improving. And now they're just wondering, are there ties at play? Are there tethered oral tissues? Can you help us rule that in or rule that out? So, all right, so let's see what else I can tell you about this little guy. This was a kiddo who would wake up frequently throughout the night. Now, keep in mind, eight months old, so that's still relatively. For an infant who's getting their primary and actually all of their nutrition via bottle feeds and who's not feeding well during bottle feeds, we should expect that. We should expect that they may be waking up frequently because of Hung. Also, interestingly, or maybe not so interestingly to some of you, this baby always had an open mouth posture. Okay. A tighter upper lip. And that was both when they were sleeping and when he was awake and didn't go to sleep very easily. Really hard to put this baby to sleep. Infant upon evaluation, had aerophagia. Chronic constipation was shared. Despite home remedies and things discussed with the doctor, things just weren't working, basically without some holistic, without some homeopathy that they were using given to them by a provider. They felt that this child was just pretty miserable all the time, just uncomfortable from a gastrointestinal standpoint, but also felt like these holistic things were kind of wearing off and not working the same as they had used to. And so now they were kind of back to step one and they were like, okay, what do we do? This is not working anymore. This poor child is screaming all the time, not happy. It seems like she's. He is in pain, like, what is going on? Right. And again, a lot of these infants, in this case included, had a history of reflux, but was not actually on any reflux medication, which was great, but definitely had that airophagia. And for those of you who are not familiar, that is where we are swallowing air. All right? So I told you before, he would not take a pacifier. And this is something that we tried to introduce as a therapeutic tool to see if he would tolerate and just absolutely send him over the edge. So it's not something we ended up using, but he would put his hands and his fingers in his mouth, which was great because we want children to explore. Right? But usually babies are not doing this around eight months, 10 months or so. They're doing this around two months, three months, right? And then in go the objects, they start to explore and mouth things when they're playing. And this little one could put things in their mouth and mouth them, but usually it was their hands. So that also adds an additional challenge when you're trying to feed a child who's already not, you know, the easiest to feed. So let's see what else I Can share with you. He had a. He didn't have great head control. His posture was not great. Not sitting up on his own yet again. Remember, he's eight months old. You could, you know, a lot of times you can prop these little ones up in like a tripod. Tripod sitting where they're like, legs are out and their hands are supporting them in front of them kind of in that tripod shape. But then as soon as, like, you release all or any support you might have been giving, even if just a little bit, it's like within a couple seconds, they kind of like topple to the side or fall forward. And so, you know, he was not yet pushing himself back up. He wasn't crawling. He wasn't even really scooting across the room. Did not like tummy time, also very common with our TOTS babies, and would flip himself out of tummy time, also common with some of our TOTS babies. So that was an interesting conversation, too, because we need to look at what these babies are doing, not just from the standpoint of, okay, what are they eating, how are they sleeping? Is their mouth open or closed? We need to look at full body. Sometimes these babies are so tight that they can hold their head up early and they can sit up early and they can do some of these other things because they are hypertonic. Like, they've got this hypertonicity to them. And other times they're much more low tone and they just flop right on over. Right. So we need to be looking at that and we need to be working closely with other providers who work with infants and help with things like I talked about with, like, my cranial sacral therapy, you know, osteopathic manipulation. Some of those types of providers who can work with these babies and do some gentle treatments with them to help regulate their systems, because there's a lot of cranial nerve interaction and a lot of things that I'm not going to go into on here, but that I did talk about with Mariah Woody recently on one of the earlier episodes. You should go back and listen to that. We need to not forget about when working with these little ones. So really important to collaborate with those types of providers. Now, from a speech standpoint, no big concerns. Infant was 8 months old and babbling. Appeared to understand everything. Very interactive, smiley kid, genuinely happy even when unhappy. Like a kind of kiddo who will smile at you and then, like, scream a second later because they're honestly in pain. Like, he was in pain. But there were no, like, other developmental concerns as far as speech and language go, we were really concerned more about gross motor and oral motor and you know, reflex integration and sensory system. You know, we wanted to really, that was really the direction we were looking to take this case. So upon palpating the oral structures and reviewing the sucks swallow breathe pattern and all, this infant was really struggling. This infant had some tight cheeks, definitely did not have a lot of control over the tongue. The tongue was laying flat on the floor of the mouth and did not elevate, did not cup around the finger. It was really challenging to develop that sucks follow breathe pattern for this infant. And we did develop it, we did work on that, but it was a challenge over time. And what else was really interesting about him was he could get us up going eventually. And I do see this, so it's not that interesting. I guess I do see this in a lot of infants we could get us up going but we really had to give that that leeway. We had to give some time for the child to get regulated and to coordinate everything. And then within, you know, 10 to 15 seconds we could start to get a suck going. And it wasn't quite the sex follow breathe pattern that we wanted, but within about 10 seconds or so he did start to engage in that pattern, but then he would fatigue pretty quickly. Right. So this was something that we had to build up over time. Now this little one did eventually transition to eating solids. It was, we're not going to go through his whole treatment plan, but I wanted to share his case because I know a lot of parents listen to this and I know that a lot of therapists listen to this podcast and I think that when we have these infants that present with what we call oropharyngeal dysphagia and feeding difficulties, pediatric feeding disorders, we need to be looking at this holistically. We need to look beyond just the mouth, we need to look beyond just the tray and what foods the child is or isn't eating. We need to look beyond baby LED weaning or a modified baby LED weaning or you know, presenting purees on spoons or giving a child a spoon to feed themselves because that is usually not enough. For infants who truly have feeding difficulties, they generally need some form of intervention that is going to be oral motor based. We're working intraorally with these little ones because they're oral motor abilities are delayed or non existent. Sometimes we got a tongue laying on the floor of the mouth that can't cup around a finger, is not able to draw milk out of a bottle. Or from mom's nipple. What do we have? We have a baby who can't feed, and then we're at risk of heading towards possibly a feeding tube at some point if we can't get this baby going. Right. Sometimes these babies have parents who are breastfeeding with strong letdowns and it really carries the baby for a while and then things start to fall apart later on, you know, that maybe they made it through breastfeeding for six months, but now they're not transitioning to solids. Well, you know, we see so many different variations of these types of cases. And it's just really important that we stop and we look at these babies holistically. We look beyond, we look in the mouth. Because let's, let's remember a lot of providers don't ever look in the mouth. They don't ever look beyond sticking the tongue straight out. That is not sufficient way to evaluate these infants. We need to be looking under the tongue. We need to be feeling the oral structures. We need to palpate. We need to see if we can get a sex wall of breath going. We need to evaluate, you know, the gag and the palate and so on and so forth. I mean, I could keep going, but we need to be looking at much more than just, oh, hey, baby can stick their tongue out. They're not tied, they're fine. Because no, that, that's not, that's unacceptable this, this day and age. And I'm sorry to hear there are still providers out there who diagnosed this way or don't rule out diagnoses this way. But that needs to be done away with because we're failing these infants if that's how we look at them. We have to look like this little infant, for example. We had to work with his orofacial structures. He had an inability. He couldn't close his lips when feeding because he had a restricted upper lip frenulum. He had a restricted lingual frenulum. He actually had very tight cheeks. And his buccal frenula needed to be released as well. I think, I think two of the four were released. I think both the uppers on either side were released. So his maxillary frenulum. So I want everybody to start to really get their hands in these babies mouth on their faces, if you work with these populations, because otherwise we can't truly. And we need to get a list of symptoms. We need to be talking to the parents. We need to understand the medical history, the feeding history. We need to know what happened in utero. If we have that information, we need to have our eyes on the child and watch them feed. However they are currently expected to feed, we need to be watching for that. And then we need to also trial things in our ongoing therapy sessions as well. So. So again, I share all of this because I think we are so quick to write these infants off. And now if you have an infant, the last thing I'm going to say before we wrap this one up is if you have an infant who is not struggling to feed, but who's been referred for a tether, oral tissue evaluation, or, you know, because, okay, they said, well, feeding is not a problem. We should be looking at airway. We have a responsibility as SLPs, OTs who do feeding therapy. We have a responsibility to be assessing that upper airway. We need to look at their. What are they able to do, what are they not able to do, and what requires a referral out to a specialist who can further evaluate this in case there may be a diagnosis that needs to be made, some type of plan of care that needs to be put into place so that we can do our jobs properly. We cannot expect an infant to breathe through their nose if they can't physically breathe through their nose, right? If they have inflamed tissues throughout the nasopharynx, maybe that could be the tonsils, maybe it's their adenoids, maybe they have very narrow nasal passages. There could be other things at play here too. Maybe there's an allergy that's causing systemic inflammation. There could be all kinds of things going on. It is our job when we are doing these evals, to look at what is their mouth doing, where is their tongue is. And this is that, that twist of myo. Because we can work with these infants and toddlers on breathing through their nose if we know it's safe and if we know they're 100% cleared to work on that and getting that tongue resting up on the palate. And if we can do that and we can help them feed, you know, that will also benefit their ability to feed. That will benefit their ability. It will give them the ability to sleep better, right? And so we're impacting, we're taking that airway, we're addressing it, and we're giving them improved feeding, improved sleep. They're going to be different children. A lot of these kiddos come out of this completely different children. And really, you know, a lot of the toddlers, I think, are sometimes where you see this like the most I've had parents say to me, like, after we We've gone through treatment and we've addressed these things like, holy moly. Like, my child is a totally different kid than they were just six months ago. Like, I was at my wit's end. And this, this kid is so. He just. He seems rested and he's chill and he's like, you know, plays by himself now. He's not always screaming. He's always, you know, angry. He's not turned around at circle time at school. I mean, I just. It's a laundry list of changes that we see in these children, and we owe it to them to be looking at their airway. And the reason why I harp on this is because of the epidemic that we live in where our jaws are getting smaller. And I saw a post today that it threw me for a second. It was on Instagram. Threw me for a second because I was like, what? 90% of kids don't have sleep disorder breathing. But that's not what it actually said. What it actually said was that 9 out of 10 children exhibit outward symptoms of sleep disorder breathing, 92.6% of which will not self correct. And then 30% of those will worsen with age. Okay. And what they were really discussing here was this epidemic that I'm referring to that, you know, if we have smaller jaws or we have a jaw, a lower jaw, that sits back, it's retruded, that pinches the airway, that gives you a smaller airway, that impacts your ability to breathe. And yes, our infants have this in utero. This develops in utero, and it can worsen over time. So we need to be looking at sleep and breathing and airway issues and overall health and wellness. Right? So that if there are symptoms that are presenting, and I'll give you a list of symptoms that they. This was through Healthy Start that they shared on their post. This is what I'm talking about. We need to be looking at these things beyond just feeding. Right. And I share this again because I get a lot of DMS about, oh, my. I'm concerned that my child is tethered oral tissues. Feeding is going well, though. Should we do anything? Yada, yada, yada. And bottom line is we, you know, a lot of people say, well, no, feeding is going well. You don't need to do anything. My question always, I always say, I'm so happy to hear, because I'm so genuinely happy to hear. Like, I'm so happy to hear feeding is going well, but I wonder what your child's mouth looks like when they're sleeping. I wonder what your child's mouth looks like when they're playing, but like not talking and they're not eating anything. Like nothing's in their mouth. Because I'm trying to find out, is that mouth open? Are they mouth breathing? Because that leads to a whole other conversation. Right? Well, maybe it is worth going in for an evaluation to see who do you need to see to make sure that we can optimize your child's ability to nasal breathe, Close their mouth, rest their tongue on their palate, which is ultimately the goals of myofunctional therapy, but again addressed very differently in our pediatric kiddos. And I do teach this in my Feed the peds course for SLPs and OTs. But here are some symptoms that we see as a result of sleep, breathing and airway issues. ADD and adhd academic challenges, arrested growth, they wrote underdeveloped job, bedwetting, chronic allergies, crowded teeth, teeth grinding, aggressive behaviors, depression, mouth breathing, sleep apnea, snoring, nightmare snoring was there twice and inability to focus. And this is not an exhaustive list. Okay, so I don't share all this to scare you, especially if you're a parent of an infant or a toddler. I share this so you can be aware, so you can have the information so that you understand the importance of nasal breathing and why I promote that so strongly and work. I've worked on it with my own family. I've worked on it for myself, for my children and I absolutely. It's an absolute part of treatment plan for all of our patients as well. So we're going to wrap it up here today. But I hope that you enjoyed this little chat and this little infant case study and some of the things that you should be looking for when assessing infants and or if your child is an infant that you have concerns about. As always, if you're looking to connect with a provider in your area, please reach out and I will gladly, you know, see who I know in your area. You can always contact me. Elliebolkin on Instagram is where a lot of people reach out to me and ask for connection to a provider and I'm happy to connect you with the right provider based on your child's age and presentation or their needs. So hope everybody has a great day and we'll chat next week. 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. If you found value. Others you know in this space will too. 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