Episode 148: Comparing 2 TOTs Case Studies: Early Intervention & Even Earlier Intervention

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 148 of the Untethered Podcast. Today it's me, your host, Hallie and we're going to be talking about some tots case studies or tethered oral tissue case studies. Now before we jump in real quick, if you're listening to this on January 31, Monday, January 31, 2020, 2022 when it airs, still hard to say that we are launching today a free training, a free five hour training to help you screen your first pediatric feeding patient. So if you are somebody new to this space or who just wants to participate, wants five free hours on a certificate, join us because you're going to be able to observe me complete a pediatric screening on a typically developing child and then as far as, as far as like feeding and other milestones go and then you're going to screen my other daughter with me who does not have such typical feeding or oral motor skills. So it's going to be a fun week. Come and join us. Go to feedthepedes.com training if you want to get all the details and get you can jump right on into the free group with us. Okay, so let's talk about these two little ones. First of all, full disclosure, these are my daughters. So if you've been listening since the beginning of this podcast, like all the way back to episode one, you know that I am on this journey thanks to my own child. Right? Again, I'm a speech language pathologist. I am a certified orofacial myologist. I am of feeding specialists and prior to having my own kids, I was working mostly with children who had, you know, what some people would describe as like sent more sensory or pickier based eating challenges. And I looked at things, you know, both from a sensory and a motor, an oral motor perspective. But there were kids who had a lot of patterns Maybe they weren't always our most medically complex children, but they definitely had certain behavior, certain patterns that appeared to be behavioral until I really dove deeper and realized they're not. These behaviors are present because of other things going on. Right. We learn from our environment, we learn from what's going on internally. So all that to say, here I am working with toddlers and young elementary age kiddos with feeding struggles. And then I have my own children. And the first one, Ms. Lily, who is now six and a half, she really threw me down a major rabbit hole. She was definitely a struggling feeder. Right. So what do I mean by that? We struggled from day one. I had issues getting her to latch in the hospital. We had lactation consultants come and work with us in the hospital and, you know, work together to latch and positioning and all that fun stuff. But she had lost so much weight in the hospital. Right. She's going to be our first case that we're talking about. I'm going to give you guys an update and like kind of where she was then, where she is now. And then we're going to talk about my second daughter Mia, who's pretty much typically developing at this point. But we did have some early struggles. So back to Lily. So here we are, right? We leave the hospital, she's lost more than, I believe it was the 10% weight that she was allowed to lose. And they basically said, you got to go to the pediatrician tomorrow, right? We need to wait, check. So I go to the pediatrician. My first day home from the hospital, that was so much fun. And we find out that, you know, she's just not. Maybe my milk hasn't come in. She's not transferring enough. And she's a newborn. Like she doesn't need that much, but she needs something, right? She needs to eat. So they give me formula. And finally that night I gave her, I think it was like the middle of the night, 1am I gave her one of the premixed bottles of formula, right? So here we are with, I think it was like Similac, one of the Similac formulas. And she within it what felt like just seconds, but minutes. She was like screaming, so miserable. I was, she's crying, I'm crying. My mom was there. I was like, I don't know what to do with you guys. My poor mom. And what's even crazier to me is that ended up. So I called the pediatrician, right? I called them in the morning and I'm like, look, here's what happened. They're like oh well some, some babies bellies are just not, you know, so well. They don't respond well to this many milk proteins. There's three milk proteins in this formula. Come by the office, pick up Gerber. Good start samples. That only has one milk protein. It should be easier on the belly. Well at that point I was like nah, nah, we're not doing that. I am not listening to my child scream at the top of her lungs for hours again out of discomfort. She hasn't been like that at all since I know she's only at this point, I don't know, four days old. But she hadn't been like that with other, with breastfeeding or whatever. So we get a pump, a hand pump because I also was not told that you need to order your pump in advance of going into labor. So I'm waiting for my pump to arrive, right? My, my pump you can plug into the wall and I'm using a hand pump. And nobody had taught me about like hand expressing or any of that. It was a lot of work. But we got the baby fed. It wasn't super easy, but we did it. And long, long, long story short, for 13 months we endured very painful breastfeeding that I was basically, I thought that was normal. I at some point kind of realized it's not. But nobody would help me. Nobody seemed to know how to help me. So I think I just kind of was like, well for me and for her it's important that I, I breastfeed her. That's what I want to do. So I'm just going to make this work. Right. Fortunately, I also have my own business at the time and was able to accommodate like basically create a schedule to work around when I needed to feed her. And I was only gone two days for like a six hour stretch where she was with a nanny. And I left a pumped bottle or a couple pumped bottles which she really like barely ever would would take but I was able to quote unquote, make it work. Right. So what I want to do is I want to talk about some of the symptoms that she experienced, right, the infant tongue and lip tie symptoms because she had both tongue and lip. And then we're going to talk about the nursing mom tongue and lip tie symptoms and then we'll go on to talk about where she is today. And also I want to discuss my other daughter's case as well. I know they say don't, don't compare your kids but really it's interesting when we compare like early ish intervention like 24 months of age. And I'll tell you what I mean by that in a minute versus like five days old. Okay, so here we are. So Lily's got aerophagia, right? She's swallowing too much air. She cannot create a good lip seal and she's swallowing too much air whether it's from breast or bottle. She was spitting up a. She was. Which I just thought was normal. She was gassy. She had, you know, colic, which everybody just kind of dismisses. Fussy hiccups. She even had. She had hiccups in utero a lot. And I love to see like the connection like you know, both inside and outside the belly and with these tongue tied babies because, yeah, Lily was tongue tied. Latch issues, as I mentioned. Very shallow latch. You would pop off the breast a lot. It was very, and the bottle very uncomfortable for me. She didn't have anterior milk loss or anything. No penetration or aspiration that we're aware of. But she did have a tendency to gum or chew on like both bottle nipples and me. She had poor weight gain. That was something that we struggled with. She was always on the first percentile, right? And they said, well, she's on her own growth curve and she hasn't fallen off, so she's fine. And that was kind of like what we based everything on. Like, she's fine, she's growing, she's fine. She hasn't fallen below the first percentile. I think it was around her first birthday or so that she finally jumped to the fifth percentile. I'm not sure she's ever been over the tenth percentile though, for her age, height and all that fun stuff. She was not an excessive drooler, but she did have an open mouth posture, right. And she would make sometimes like those clicking or smacking noises while eating that you could hear that while she was eating. She sometimes will cough. She didn't truly choke or anything, but sometimes we'll cough on things. She wasn't an averse baby. We didn't have any issues with like feeding aversion per se. She would push like the bottle away. She never pushed the breast away, but she always wanted to be on the breast. Like, like that was basically like I was a human pacifier beyond feeding. So like always wanted to be on. So I'm already uncomfortable. And then now we've got a baby who just wants to like comfort n. And that was, you know, tricky. She had lip and sucking blisters. She fatigued very quickly. So she would fall asleep while feeding and then would wake Frequently to feed as well. So she was literally feeding, breastfeeding, probably for like 45 minutes straight. And then we get like an hour break and then we were back at it. I couldn't leave my house without knowing that there was like somewhere to sit and nurse her, unless otherwise we'd be like stuff stuck in the car. And at that point I was not like nursing out in public outside of like a nursing room or somewhere that had like a comfortable place I could sit because I was sitting. It wasn't so much about what I cared about other people, but I wanted to be comfortable because we would sit for like 45 minutes at minimum. This wasn't like a quick 15, 20 minute nurse get up and go. Not that 15 to 20 minutes is super quick either, but this was like 45 minutes. It was around the clock. I was uncomfortable in pain and you know, to the point where I would turn my head away if I had a grimace because I knew it was going to hurt to lash her. And it just like, that's not something I felt like I wanted to do in public, right. So I wanted some privacy and I wanted, you know, most of the time we were home for feeds. Unless again, like I said, we went to certain stores where I could nurse her or I'd sit in the Target parking lot in my car in the backseat nursing her. So that was another big, big, big thing for her, that fatigue factor. And then, you know, airway wise, you know, we didn't have any like noisy breathing or congestion or anything like that early on, thankfully. But like I mentioned, she was a mouth breather. And from a sleeping position standpoint, she slept in that tripod sleep position with her butt, you know, her tush up in the air, her arms down below her head. And you know, she was generally, her neck was turned to one side or the other. She didn't appear to have like neck tightness or torticollis even for that matter. That was very obvious. But she definitely was working to open her airway, right? This told me that it probably wasn't super safe for her to sleep on her back because she would throw herself in onto her belly and up into that position way before she should have. This was happening like six, seven weeks of life. She was tight, so she didn't have what appeared to be like the common torticollis, where her, her, you know, she's shorter on one side compared to the other, but, but her whole neck was tight and she could hold her head up. And she definitely did have a little bit of A side preference. So there probably was, you know, a little bit of tension. I'd have to go back and look at videos and pictures, but off the top of my my mind, you know, there probably there was definitely a little bit more tension on one side than the other. It just wasn't very obvious looking at her even when she was like laying down. It wasn't as overtly obvious as some other infants that I've work, but it became obvious when I brought her to breast because she definitely would empty one side more than the other and seemed more comfortable and relaxed feeding on one side than the other and so often would feed her on one side and pump on the other side. So those are some common infant tongue and lip tie symptoms. Now the other thing I want to talk about are nursing moms because a lot of nursing moms experience symptoms from their baby's tongue and lip ties. Like I mentioned before, extended feeds. Baby prefers one breast over the other. The nipples may change shape. We may have lipstick shaped, cracked, blistered or bleeding nipples. There can be incomplete breast drainage which can lead to plugged ducts, engorgement and other issues. There could be discomfort while nursing. Maybe a nipple shield is recommended. I will say, and I'm not a breastfeeding expert, but nipple shields are meant to be short term use solutions, not long term like use it your entire breastfeeding journey solution. Unfortunately, I see it recommended a lot as just sort of like the end all be all. And these moms are not getting help beyond the nipple shield or nobody's looking into the baby's mouth. So just a little disclaimer, if you're somebody who's been there, you have patients that are dealing with this, you know, mother infant dyads, just something to be aware of. They're wonderful things, but they're not supposed to be a long term use solution per se. Like we need to get down to the bottom of why the nipple shield is needed in the first place. Sleep deprivation. So yes, new moms and babies are going to be sleep deprived. That's the nature of being a new mom or a new parent. Right? And having a baby. Especially if you're nursing. But of tongue tied babies, right? Parents probably, but I'm thinking nursing here, which is why I keep going back to moms. Nursing parents are fatigued and sleep deprived beyond. Because here we are maybe with other babies getting a two hour stretch of sleep or a three hour stretch of sleep or a four hour stretch of sleep. These babies are not able to nurse efficiently. So they compensate by Nursing more often, including at night. This is a pretty much round the clock kind of thing, right? So instead of getting those, those longer stretches you typically, you'll start to get these baby wakes every hour. And it's like by the time mom lays down and closes her eyes, oh gosh, baby's awake now we have to feed again, right? And so it can be extremely, extremely challenging. And so I always, you know, recommend checking in with your breastfeeding mamas, especially if you know that their baby is struggling to feed. And this can be true not just of tongue and lip tie babies, but babies who are struggling to feed in. It's going to be a much tougher go than babies who are feeding well, even for a newborn parent. And I say that because I've experienced both. Okay? I had one experience with Lily and I had one experience, completely opposite experience with Mia. Now when things get beyond just like plug ducks engorgement, you might run into issues with mastitis. There's also thrush that can be a problem, right? And that's something that you'd need to speak to the pediatrician or the OB about. And then compromised milk supply because supply and demand, right? Demand and supply. If baby's only demanding so much, then your supply is going to match that. It's going to match what the baby's trying to tell your body the baby requires. And that's where pumping comes into play. We're not going to go into a whole pumping conversation, but that's a whole nother rabbit hole to go down. But these are big considerations that we need be thinking about and talking about with, with nursing moms with these babies who are struggling to feed. Obviously as kids get older, we see other symptoms. We're not going to go into that right now. We can talk about things with like Lily when we talk, we talk about her in a few minutes, just in terms of what she personally has been through and where she's at. And then we'll switch over to Mia. But with Lily, right, we finally got to 13 months and I was like, I'm done. I mean, my goal was to breastfeed longer, but that was all I could take at that point. I was like, I can't do this any more. Like this is no longer sustainable, especially because teeth and distractions and I just, I think I'd hit my breaking point. I was like, nope, done. So fast forward to Lilly being close to almost 2 years old. I go and I take a mile course and my intro to my course, my first one, my first like big four Day course, I should say. And I'm like, wow, this is really eye opening, right? And I've. I start to dive into that tether oral tissue rabbit hole. I, you know, now I've got TOD's training and Myo training and all these different trainings. I remember going home after my MYO training specifically, and flipping Lily over. Like, we were sitting in the nursing chair, and I flip her over and we were no longer nursing, but we always sat there to read books. And I was like, oh, my gosh, she has a lip tie. She has a tongue tie. Why has nobody ever looked in her mouth? We struggled for so long, and I was vocal about my struggle. We met with an ibclc. We, you know, who basically told me I was handling her wrong. I needed to hold her a different way. I needed to strip her naked. I needed to blow in her face, spritz water at her to wake her up and keep her alert and awake while feeding so she doesn't fatigue. And I was like, this, this is not. This not my style. Like, you want to tell me I'm holding her wrong? Fine. I'm happy to have other positions and ways to try and feed her. You want to tell me maybe to strip her down a little bit? Okay, I'm not loving that. But, like, I'll try it. When you start telling me to, like, blow in the baby's face and spritz water at the baby, like, now you've lost me. Okay? This is just. And I pass no judgment, if it's something you want to do for your child, by all means, go for it for me. I was like, yeah, I shouldn't have to do any of this. Like, I should not have to. So what's really going on, right? What is the root cause of all this? Why are we having to work so hard at this? So again, Fast forward to 24 months, come home, discover she's got a lip and a tongue tie. And I'm like, huh, interesting. She also is a kid who could hold her neck up at birth. She was very tight. She could climb up, like kid rock walls, flip herself around, and slide down the other side on her bottom like at little gym. And everyone was like, how old is she? And I was like, nine months. She climbed upstairs by six months of age and downstairs by seven months of age. So when I say she was tight, what I think it did was give her some stability to get a little bit more advanced on some of these gross motor skills as a young infant, thankfully, we didn't have other issues that I was aware of at the time. But very interesting to go back and look at it all now. She walked around the average age, I think she was about. I want to say. Well, I'd have to go back and look, I don't want to make up a number, but it was definitely after 12 months. It could have been closer to 13 months or so anyways. Other than that, our biggest struggle was really the feeding. And she transitioned, well, to solids. She was eating all kinds of Foods. Around 15 months of age. She had a reaction to, I think just too many vaccines in one day. She had five in one day. Which I now realize is interesting because we have no idea what it was she reacted to. But she vomited in her crib that night. And thankfully she was a tummy sleeper because it was all over the place, like, gross. I'm not going to spare you the details, but I remember my husband going in together and he's like, halle, come quick. Oh my gosh. And I was like, what? Like I thought somebody was injured. Like it was. It was disgusting and horrifying and I felt horrible as a mother to know that my child slept like that for hours because it was like dried on the wall. Okay, we're gonna. That's details I'm going to give you. But this was like full blown. Like, not baby vomit. This was full blown. Like, yeah, no, not good. And she had had chicken and fish that day. And since that day, like she went from eating all of these things to basically not eating very many things at all. And I thought that was also kind of interesting. Like she would eat carbs, like dairy and some vegetables, but like protein could barely get her to eat any proteins. But all of these things that she had been eating just fine, like literally the day prior. And then we continued to introd produce them and have them available. And yeah, no, took a while and we've been through quite an interesting feeding journey with her since then. But I discovered her tongue in her lips. High. Right. She's 24 months old. And so I'm like, you know what, let me take her to have this address. Right, let's have this assessed. I. She also had enlarged tonsils. Let's see what the ENT has to say about that. So I go to one ENT and that ENT is like, well, she's not breastfeeding so we're not going to do anything about the adenoid. The. Not the adenoids, sorry, the. The lip and tongue tie. She agreed that there was a lip and a tongue tie, but said no reason to treat it now. And I was like, well, she's kind of having trouble, like chewing food and moving food in her mouth and she can't drink from an open cup very well. She kind of can't seem to figure that out. She can drink from a straw. But like, yeah, we also need to, like, keep developing these oral motor skills. She's already 24 months old. So that was the first appointment. The next one I did didn't go specifically for the tongue and the lip tie, but I went to another ENT to have her airway checked and looked into. And, you know, I was told that her three plus tonsils were, that were very veiny and unhealthy looking, were very unimpressive. And I was a little frustrated by that. I was like, look, I don't want surgery for my child. That's not why I'm here. But do we need a monitor? What do we need to do? Do we need to do something else? Like, does she need medication to shrink them? You know what? And just nothing. Nothing was done because she's not a chronically ill child who's always on an antibiotic or something. They were like, nope, she's fine for now. I was like, okay. And so then I went to a colleague, an oral surgeon, who agreed and looked basically at the functional impact of these tethered oral tissues and said, yeah, we should absolutely address this. And so we did have her tongue, her tongue tie treated at the time. He said he didn't think that the lip tie was really impacting things. And like, let's basically do the tongue and we can always come back to the lip later. And so that's what we did at that time. And she, gosh, within 24 hours, her constipation was gone, which I thought was very interesting. And I think speaks to like, the fascia, the tension in her fascia throughout her body. Because you always hear me say, like, we are connected from the tip of our tongue down the tip of our toes. Right? Yeah, that was pretty cool. And then we ended up at like age 4 putting her into an ALF appliance. She had early expansion. She's had myo before, during, after, and is basically, you know, not a child that I would consider having a full blown orofacial myofunctional disorder. At this point. However, we are working on like that tongue that still comes forward a little bit, mostly for like the, the S this sound. She appears to be swallowing better, but we did have to work on like, placement of her tongue. So even though we had gone through myo. She did well pre expansion. When we changed the shape of her palate, it changed where her tongue was basically resting in her mouth. And it changed. We had to go back and, like, reteach certain skills. So anyhow, so that's Lily. And we continue to introduce her to new foods. We continue to make things available. She. Somewhere around her sixth birthday, I mean, she'd become a little bit more, like, willing to try different variations of, like, foods she likes. So for a while, she would not eat pizza with sauce, right? But then also she wouldn't eat white pizza, right? Just from, like, any restaurant. It had to be specific places. It couldn't have anything. Little green things sprinkled on it. It had to be very specific, very particular. Now we're at the point where we can basically get her a pizza almost anywhere. Almost anywhere. And she'll eat like a cheese pizza with sauce pretty much from almost anywhere. And most recently now at the age of six and a half, which is really exciting. And keep in mind, her younger sister, since she could get her hands on food, has eaten everything under the sun. So that has had nominal influence Lily, up until. Up until recently. And it was so cool because last week we ordered out and they were getting. Lilly wanted pizza, and he was going to get, like, a kid's, like, hamburger from True Food. And she was. Lily was like, oh, well, I want to try. Like, I want to try the burger. And she did this a couple weeks prior and didn't love it, but it was very cool because she wanted to do it again. And so I said, well, do you guys want to split? You know, you can. We can get one of each, and you guys can split the pizza and the burger. Because I was more curious to see, like, what's Lily going to do? And so both times she's taken one bite, and then she's like, okay, I'm done, right? She didn't say, I hate it. It's disgusting. We always joke and say, you know, don't be rude to the food. Or what do we say? Don't yuck my yum. And she goes, don't yum my yuck. She flips it. So what's been kind of cool is being able to see that she's now interested in experimenting, right? And she. We're not having to ask, and we're just making it available. And then she's trying it, and she's not completely hating it, but she's just kind of like, okay, yeah. Nope, that's it. I don't want any more right now, which is great because now she's had it on two different occasions. And I know they can take up to like seven different occasions. Not like seven bites in one day, but like over seven different days. Right. Sometimes I've seen it take some of these kiddos I work with to really fully come into liking a food and then desire more of it and want to take additional bites of it at times. It's a slow process, but it works, right? So she. We'll see what happens. And I can always report back on that later. But she's definitely becoming more experimental. She has a closed mouth posture. She's nasal breathing. The tongue is generally, you know, up when I'm checking. So we're moving in the right direction. And it's very exciting to see that the one thing we do need to do is. I'm still seeking a orthodontist. That's my. That's been. I've been calling around in Boca that can help just like, do a lip bumper to bring her mandible forward a little bit. That's kind of like the last piece of her puzzle. Puzzle, which I think will also probably help with her, you know, oral. Her oral rest posture, because I think her tongue is just resting a little too far back based on the placement of her mandible and where her tongue sits in her mouth. So. So that's Ms. Lily. So she's definitely a longer story than Mia, right? A longer case study than Mia. As far as Mia goes, I knew day one, right? Like, I knew that this pot. This was a possibility. We may have some issues with tongue tie because genetics, epigenetics, right? And as soon as she latched, I jokingly was like, well, yeah, I'm not going to look under her tongue or her lip or in her cheeks until, you know, she's at least 24 hours old. Let's just give it some time. Live in bliss Pretend like all is good. And as soon as she latched, I was like, no, no, no, here we go again. It was like, I knew it right away. But at this point point, I basically texted my oral surgeon, said, hey, we got another tongue tied. Tongue tied, lip tied baby. It's impacting nursing. And he was like, come see me, right? So she was released. We were in the hospital for a couple of days. She was released a couple of days after we got out of the hospital. Like day five of life. And it was a completely different experience. Completely different. She was able to nurse, right? She was. It was comfortable. It didn't hurt me. She could nurse in much shorter windows of time. Her weight gain was much easier. I know we say weight gain is not the only factor, but it's one of the factors, right? No anterior milk loss or latch issues after the release. She's one of those cases where she didn't require a ton of therapy because we released her pretty quickly. Because as a mom in this space at that point, working with infants now who are tongue and liptide, following Lily, I was like, all right, I know what to do, right? So I started just kind of working on her face and her mouth a little bit. We had a release. We did the post op active wound care to make sure she healed properly. And, you know, other than that, she really did well. She transitioned to solids well. And she's been like the best eater ever to the point where she just wants to try everything. We're eating and we're like, okay, that's enough. No, it's great. It's great. But she'll have had a meal, and then, you know, an adult will be snacking and she'll just say, can I try? Can I try? And I'm like, you're gonna get constip for a different reason. Too much food. So, you know, so it's been really interesting to see it night and day, but to have seen and felt like the lip sucking blisters were already starting to develop. Like a couple days after birth, she was fatiguing, falling asleep. You know, she definitely was starting to follow in her sister's footsteps, if you will. And I was like, we are just. We're just not having that. We're not. We're not going down that rabbit hole again. The one interesting thing about Mia was that she. She was always a hot baby. She was always very warm, very sweaty, and she was kind of like teetering on, not falling behind on the gross motor skills. But because I knew about the tongue tie and I knew that some body work could help, I did take her to an early intervention PT practice that was like, highly recommended. And we did a lot of, like, more traditional pt. She, Mia, never seemed to take to it. Like we would kind of. It kept her from falling behind on her gross motor milestones, or I should say, maybe it just. It kept her on track, but she may have been kind of there. Anyways, what I learned later from some PT colleagues in. In this airway space who have been trained through partial restoration institute pri and who have, you know, who do modern counter strain technique and some other methodologies is when you have this kind of strain, like for her, she did have a little bit more of like a torticollis presentation. And we had a tendency. It was interesting though because they said, well, she doesn't really have Torticollis. But then the handout they gave me said, like exercises for torticollis. I was like, wait, I'm confused. But anyways, she definitely had a neck preference aside. Preference, she was tighter on one side of her neck than the other. It wasn't severe torticollis, right? It was probably more mild. But they were always stretching against the tension instead of kind of going with the tension to then release it. And when I, what I say by that is, what I mean by that is a PT told me, right, if you're, if you're tense on your left side, that the thought process is, well, if you just kind of stretch that left side a bit by tilting your head to the right, you're going to help, you know, stretch it out, right? So that tension is going to stretch out. And what I learned, at least one school thought is that that's the opposite of what we should be doing. If you want to release the tension on the left side, then you bend towards the left side to release the tension and then come back to like midline with your head and your neck. And so when I started working, you know, with Mia and trying to do this, I saw what they were talking about. It made so much sense. And at that point I was like, you know what, we need to go see an osteopathic and a cranial sacral therapist. And I had been like seeking different people. It was kind of either hard to get in or I couldn't find somebody in my area who I felt like I, who I felt like knew how to do this for tongue tied babies. And at this point she was already a little bit of an older infant. And I even had like one craniosacral therapist say to me, well, she's a little bit older now that she's mobile, you know, Because I had started looking into this when she was probably about like 7 to 8 months of age, maybe even a little bit older. And she was like, so that's not really the population I typically work with. And I was like, okay, so if the baby can't lay flat on the table, like, you can't work with them all right? I was like, but what if my baby can? I was just very kind of turned off by that because I'm like, we won't even try to like evaluate her or see her like, okay, cool. I mean, if it's not your area of expertise for this age group, that's fine. But then she was, like, trying to get me to schedule an appointment anyways, and I was just kind of confused. I was like, yeah, no, I just. Something about my gut tells me, like, they go a different direction. So I did find a cranial sacral therapist and osteopath who actually happened to be in the same building. We saw the cranial sacral therapists one week, and this was, I think, Mia. By the time we went and did this, she was already about, like, 13 months of age or about to turn 13 months. It was just past her first birthday. And I remember that the craniosacral therapist did some Chinese, like, did a Chinese medicine technique on Mia to, like, help remove heat from her body. And I'm telling you, like, her sweatiness disappeared. Like, that day it was gone. And I was like, what? Okay, well, you have my attention now. Like, this is pretty cool. Talk to me. What did you do? How'd you do that? Like, this is really, really awesome. And then beyond that, I took her to the osteopath for an evaluation the following week. They said she's very healthy. They kind of worked on her a little bit. It was a husband, wife, team. He has. He's also a pt, and so. So, you know, he has that kind of really cool background that plays into this. And they both. They kind of evaluated her for systems, and I don't know what magic they did because, you know, osteopathic work is very gentle. And, you know, oftentimes craniosacral is pretty gentle as well. But it's. It's pretty cool to see because, like, within the week, she was walking. And then that same week, or like, within a week of her walking, she basically. Within a week, I think of. No, I take that back. I think she got up, like, pulled herself up to stand and, like, took her first steps, like, right after that osteopathic appointment. But the week after, she crawled across the couch, which is, like, an unstable surface, right? It's not hard like the wood floor and the carpet on the wood floor. It's more of an unstable surface. She crawled across it for the first time correctly because that was one of the biggest reasons I had taken her to pt. She had a tendency to crawl, and she was fast. She was efficient. She could get from one side of the room to the other. Initially, she would just roll, and then that turned into crawling, but she would drag her right. Her back right her back, right leg. Like, she's got a front leg, you know, and babies are down on all fours. She would use her front left and right hand and her back left leg properly. And basically to compensate for what her right leg was not doing, her right leg was, like, bent behind her, and she was just scooting and, like, dragging that leg behind her. And it didn't matter what we did, we could not get her to get that leg, you know, that knee down, right? We tried to do it crawling. We tried. We bought her different soft stair things to practice on. We tried going up the hard stairs. We tried doing different things up against the wall, you know, different exercises, all kinds of stretches, all kinds of things. And it wasn't for, you know, it wasn't for not trying. It just. It wasn't working. And in my brain, I was like, well, I know she needs therapy. I just. I can't seem to find the right person to work with her. Until I finally discovered this cranial sa. Sacral therapist in this osteo. In the osteopathic couple. And, you know, the rest. I'm like, all bets are off now. Like, this is it. I'm just referring people right here, they need to go straight to. To this osteopath. They want a cranial sacral therapist. The cranial sacral therapist was also excellent. So it was really eye opening for me as a mother to see what happened, to see my own child having gone through all those struggles, you know, one with the feeding, one with the feeding for the initial first. First couple days of life, and then that turned into some gross motor struggles. But this was all because of the impact of tethered oral tissues and tight fascia throughout the body. Right? We know it's just in the mouth. We know feeding is sometimes the most overt struggle. And some, for some kids, older kids, it might be like, speech appears to be the most overt issue going on. But when we look deeper, we figure out there's a lot more than meets the eye, right? And those were my kids. So I wanted to share this with you so you can kind of come to understand and appreciate why, one, I'm so passionate about this space, but also, too, why I really try to connect families with providers, because I don't want anybody else to struggle. And I know it's still a struggle to find the providers who get it, whether it be an slp, an ot, a cranial sacral therapist, an osteopath, ent, a pediatrician, a pt. I'm sure I'm forgetting An ibclc, the list goes on. Right. So that's where we all need to continue on our journey, our learning journeys and our learning paths and learn more about different cases and presentations and you know, Mia is going to go into an expansion appliance. I am coming to terms with the fact that we might be having to drive over an hour to go get her alf appliance in South Florida. Because that's just the reality. And I think that that would be, that's the appliance, appliance route that I think I want to go with. But you know, that's, that's her next step on her journey. She's doing pretty well overall. Her mouth is generally closed, but she's also my kiddo who has a history of asthma. It seems to be semi seasonal, but it's always been during the past couple summers, which has been really interesting. And they put her on like flow vent and she's on for like eight weeks and then it seems to be gone again and we haven't quite. We're now living in a new area so we'll see what happens this coming summer. But you know, initially they said it was viral induced, then they said it was allergy, allergy induced, then they said it was viral induced and she should grow out of it because it's not like year round. So who knows? All I know is that asthma can also be connected to all of these issues and her way she's breathing and so getting her into an appliance now, she's about to turn four in a month. But getting her into an appliance now is critical. It's really important to grow that airway, to grow her palate, to make sure the tongue is where it needs to be and then to also work on, you know, breathing with her and her breathing skills so that we can make sure that we are not headed towards like chronic asthma because we don't have that now. And I'd love to address every little thing we have, you know, present now so that we can hopefully prevent. And I'm not making, you know, major disclaimer. I'm not saying this cures, prevents, whatever, I'm not here to say that. But from what I've seen with patients, from what I've seen through experiences, obviously the earlier we do certain things the better. And you know, my goal for her is obviously just to give her the best, best opportunity at living a healthy life and experiencing ease throughout the process and not having to, you know, struggle with asthma. If that's something that we can prevent down the road from her from becoming a chronic issue. So anyways, that's that with those two little love bugs. You're going to see me. So if you join me, if you go to feedthepedes.com training you are going to see that Mia is that typical baby, that feeder that is having a meal in the training that you see me screen. I do a full screen on her and then your going to see Lily have a snack and we're going to screen her together and we're going to use my free pediatric feeding screening packet to go through day by day, page by page how I would do the screening, like what's on the milestone chart and why you need to know that information and how you can use that even with families. Right. And then you know the checklist that has the 50 most common symptoms and then we have the page that just helps to summarize everything, pull it all together and determine if we need further assessment or other referrals. And we even threw in a referral chart. So our referral form. So that packet we're going to go through day by day, you get five hours of continuing ed for free on a certificate of completion at the end of the week. It'll be recorded in the group and up for a week only feed the peds the course, a 12 week paid course that you pay for, right? Not free. That opens February 7th. The cart opens February 7th at feedthepedes.com so you can get on the waitlist there if you want to learn more about that. That but it's only open for five days, February 7th through 11th. And if you do join the course, then you do get lifetime access to the free training that I'm doing next week. But either way, even if you're planning to, you know, join us in the course, come join us for the free training. We have a ton of fun and everybody walks away with a whole new skill set and a whole lot of confidence in looking at a lot of these kiddos that are already on your caseload that need to be screened for feeding. So, so that's that FeedThePedes.com training go there. Join me next week in our Facebook group. I am looking forward to seeing everyone there and we have some awesome episodes coming up with some guests in the upcoming weeks. So I'll chat with you guys soon. 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 @HALLIEBLCAN BIZ on Instagram at Alibulcan. 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.