Episode 192: Common, Not Normal

Hey and welcome to episode 192 of the Untethered Podcast. It's your host, Hallie. You got me for a short episode again today and we are going to dive into the saying common but not normal. You hear me say it all the time. Probably for the last couple years. You've been listening since I launched this thing in, I don't know, July 2019, but here we are saying it again. So we're going to focus on some of the top areas of statements that may be common in children, but yet they're not normal. Let's get started.

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, 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. Welcome back to another short episode in our little, we'll call it the holiday series that we're doing. I don't know if you guys if this happens, if you own a private practice or if you work at one, but we tend to see an uptick in concerned parents and calls during the holidays, especially surrounding Thanksgiving and, you know, Hanukkah Christmas, when, when a lot of family members are getting together and parents are noticing sometimes that children, you know, young children, infants, toddlers, like, they may have some delays. Like, you know, parents sometimes get concerned and wonder after they've seen other children in the family if their child's skills are on par with where they should be. Right? And so we typically will see a bit of an uptick in calls following Thanksgiving, following the New Year. And so anyways, this might be really helpful to give you that little nudge to yes, make the phone call or you know what, no, I don't see these things in my kid. I think things might be okay, but I always say follow your gut if you're concerned, it can never hurt to have an eval done to at least give you peace of mind and or determine, oh wait, you know what, there is something more going on here. So anyhow, that's not the point of today's episode. The point of today's episode is common, not normal. And this is something that you've probably heard me say a bunch of times. It's something that I feel is used in place of actually doing research, collaborating with colleagues, making referrals. What do I mean by that? You'll go to a pediatrician or you'll go to a doctor or somebody, some type of specialist, and you'll say, well, hey, like, I'm concerned about my child's drooling, you know. And they'll say, oh, you know, like, drooling is so common. And you'll be like, well, my kids too. And they'll be like, yeah, it's fine. Just, you know, by the time they're three, like, it's so common. Like by the time they're three, they should stop or oh yeah, my kid still sucks their thumb or uses their pacifier. And you know, provider will say, it's fine. Like, you know, by the time they're four, they'll probably be done with that. Like, don't stress. If not, we'll, you know, we'll take away the pacifier then. Or you'll hear things like, oh, yeah, colic and babies. Like, that's so common. So common. What I want to tell you is, and I'm going to give you a whole list of things in about 30 seconds, but what I want to tell you is just because something is common does not mean it's normal. And what I mean by that is it's not something that should necessarily be ignored. So if you have a concern and somebody is writing you off that they're writing that concern off, they're downplaying it. Maybe you feel like you're being gaslit or whatever the case may be. Use this as a. And this is not an all inclusive list, but these are. A lot of these are just going to be off the top of my head, really. But a lot of things that we hear frequently that I want to share with you so you have a really good understanding on what is common these days, but not necessarily normal. So. And I do feel very passionately about this, like, in my mind course I have like three main parts. The first part is called, like, correct versus common because I want to really drill into the brains that go through the course, the providers that just because something commonly happens doesn't mean that it's functional or healthy. You know, I don't love calling things like typical, atypical, correct, not correct, normal, not normal per se. I don't love putting those kind of labels on it. But if that's what gets the attention so that we can focus on what's healthy, what's going to help a human thrive, especially if they're still in early growth phases like our infants and toddlers and young elementary school students, then you will hear me say these things because I know it captures the attention of people who need to hear this. So what are these things that are common, not normal? I mentioned colic. I mentioned drooling. Right. You know, if a baby's cutting a tooth and they're drooling a bit, fine, I'll give you that. If a baby has to wear a biblical, a toddler has to wear a bib, that you might see it happen. It's not. It's not normal. It's not. You should not have to wear a bib to catch drool. That tells us that there is mouth breathing going on during the day and that the child does not have control over swallowing back. Their saliva and. Or their mouth is open, so the saliva is escaping the mouth and dripping down the face, maybe onto that bib. We need to be looking at why this is happening. Right? Teeth clenching and or grinding, common, not normal. And this is across the lifespan. We see this in infants, toddlers, young children, older children, teens, adults, never normal. Clenching and grinding is typically a stress response. We do see in patients who have airway obstruction, like maybe you have enlarged tonsils or adenoids, or you have a small airway, or maybe even you have a large airway. But it, like, is very easy. You know, it collapses really easily, especially when you lay down. If we're seeing clenching and grinding and the teeth are. There's wear on the teeth and the dentist is pointing that out. That is, we need to be looking at airway that is concerning mouth breathing. Right. Kind of goes hand in hand with the drooling piece a little bit. Because if our mouth is open, we're mouth breathing and the drool can escape. That makes sense. But also it's important to mention things like audible breathing, whether you're awake or asleep. Like, we should not hear someone breathing. Let that sink in. We should not hear breathing. We've had parents and I've shared this on other episodes where they're really concerned after they. Their child either has a tongue tie release or they have tonsils or adenoids removed or all the above, or maybe they've had some intervention. The child's now nasal breathing, not mouth breathing anymore. Right. We've had some combination of interventions and They're. They kind of get freaked out because they're, like, used to hearing, like, a. Right. Which takes me into snoring. We'll get there in a minute. Also not normal. We should never hear breathing shouldn't be audible. We should not hear breathing whether a child is awake or asleep. And it can be quite scary if you're used to it. And all of a sudden there's silence when they're sleeping or sitting next to you, and you're like, are they awake? Are they alive? What's going on here? And that is actually a fear. Like, not a fear, but like a Maybe it's a fear of response that we've had many parents share with us. That, like, I. I kept. I just ended up sitting next to the crib all night, or I kept going and checking on them all night, or I kept checking the monitor because I could not hear them, and it scared me because I'm not used to that. And, hey, that's your child. Probably getting one of their first complete restorative nights of sleep ever. So something to really pay attention to. That's a big one. Mouth breathing, audible breathing, whether you're awake or asleep. But snoring. I mentioned snoring. I have a whole episode on that. It was like, way early on. In the podcast, episode 33, I actually talked about, like, sleep apnea, too. Sleep apnea in children. And how snoring is never normal. So go back and listen to that, because that plays into what we were just talking about. Unfortunately, we live in an era where mouth breathing, snoring, it's. It's like. What's the word I'm looking for? Like, if. If we're playing with a child and we're pretending like we're asleep, the first thing most people do is pretend to snore, right? We see it on TV shows, We see open mouths on T shirts. Like, it's a cool trend. Sexy actresses and actors and models are all, like, posing with their lips apart, right? So it's what is ingrained into our brain from the day that we're born, where we should really be, you know, prioritizing. Closed mouth, closed lips, nasal breathing, right? That. That should be made sexy. That should be the sexy thing that everybody's paying attention to. Not these, like, open mouths, like teeth partially hanging out and, you know. Anyways, I digress. Constipation, you see that in many young children. Not normal. Why? Well, constipation, it could be, again, due to a number of medical issues, but in a lot of the kids, that we see if they cannot properly chew their food, if they favor one side of their mouth and chew mostly right there and they fatigue quickly, right. If they're swallowing food that's not properly prepped or pieces that are still whole or not chewing it at all, we're going to have trouble digesting a the food that's not been properly prepped and broken down for our body. So that in turn leads to constipation, as does sometimes diets that are, you know, lacking foods that we need to remain regular, which a lot of our little kiddos who may have feeding issues, you know, that that could be a real challenge. So constipation is a sure sign that something is awry. Right. We need to be looking into what's going on. And I would definitely be ruling out any issues at the level of chewing and prepping that food for swallowing and then the initiating of the swallow, what that looks like. What else? Bedwetting just did a whole episode on bedwetting. You can go back to the prior episode. It's short and sweet. Listen to it. Bedwetting, pass. Like age four, arguably five, like preschool years. It's not typical. Not normal. Especially if daytime is under control. So go listen to that episode. I won't jump into all that because chances are you already listened to it or you're gonna go listen to it next. Malocclusion. Hi. Disclaimer. Not a dentist, not an ent, not an allergist, not. You know, I don't move teeth for a living. I don't remove tissue. I don't, you know, I'm not claiming to. I'm just sharing with you what we see frequently in patients, what I talk about frequently with colleagues, especially on the podcast. Maybe you've heard all this before, but expansion, needing expansion. Common, not normal. Malocclusion, right. Cross bite, open bite. Class one, class two, class three. Well, class one, ignore that. But, you know, different types of malocclusion, not normal, right? Crooked teeth, not normal. That's malocclusion, right? There's not enough room for the teeth. Delayed eruption of teeth, because there aren't. There isn't space. Not having enough space for your tongue. None of these things. Like, these things may be more and more common, especially because we've talked about how, like, you know, epigenetically we're seeing changes in the skull. We're seeing. Jaws are shrinking. We're seeing things happen as a result of the times that we live in. Right. It's both due to. Well, we won't go into. That's a whole. I could talk about it for an hour. So we'll go into another episode. But bottom line is it's happening, right? And it's common. But needing expansion, needing braces is not normal. Why are there people who don't need any of that? Well, because they have airways that are a healthy size. They have enough room for their tongue and their palate. Their tongue is not tethered to the floor of their mouth. They're chewing properly, they're swallowing properly. They are. Maybe we could go so far to say is maybe they're eating the right foods. Right. To maintain their healthy status. They're not drooling. They're not, you know, babies typically experienced colic. I'm not going to say it's about an older child or adult necessarily, but, you know, they're not grinding your teeth, they're not clenching their teeth or not. They're pretty regular with their bowel movements. They're not constipated. They're nasal breathing, like I mentioned. So we're not seeing that mouth breathing or any. We're not hearing them at night when they sleep. Their mouth is closed or breathing. Breathing through their nose. They're not wetting the bed or getting up frequently to go to the bathroom. Right. All of these things, when you start to think about them, should really give you pause if this is you or your child or a patient on your caseload. Even picky eating. Okay, picky eating is not necessarily a typical thing that we expect for. Not all kids go through that. We give. We should. We. We say, okay, it can be something kids go through, but it could be related to different stages of development. And arguably, maybe these kids are figuring out, like, what autonomy is like, hey, I get to make my own decisions. Oh, you know what? I really don't. That tastes change experiences happen. Right. So picky eating, fine. But beyond a few months, if it goes on for more than, like, two months, that's no longer picky eating. That is selective eating. And that needs to be addressed. Right. Excuse me. Might be common. Maybe coming more common these days. Not normal. Tongue ties. Common, not normal. Have plenty of episodes on tongue ties, so be sure to go and check that out. This one's going to ruffle a little bit of feathers. And I'm gonna. I'm gonna end on this one today. Maybe this one even deserves its own whole episode. I thought I've done an episode on this before. Maybe. Maybe that'll be our next episode. I'll do it next. It's. We're just gonna say it. Speech. Speech sound disorders and delays being in speech forever. Lisps might be common, but it's not normal. Okay? And look, again, I'm not saying any of these things to alienate or make somebody feel poorly. I'm saying them for you to put your ego aside. And I'm talking to you practitioners and go, you know what? Yeah. Like, why is it that some kids have this and some kids don't? Obviously, there's other root causes of some of these things that we've talked about, including speech sound disorders. Okay? And I'm not discounting that. Right. I'm not saying that these other diagnoses are not real. But if we haven't ruled out a feeding issue, an orofacial myofunctional disorder, tethered oral tissues, airway issues. Right. We haven't ruled these things out. How can you possibly make a differential diagnosis and know that these things are not at play? You can't. You just. You can't. Okay? And because I told you I was going to keep these short and sweet, I'm going to make next week's episode all about speech. We'll do speech, and then I'll talk about another topic that I mentioned. I would talk about one of the prior episodes in this series. All right, so let's continue the speech conversation, because I want to talk about lists and production of different speech sounds, you know, the impact of tongue ties, and ultimately beyond that, you know, beyond the fact that lisps are not normal. And I want to jump into some specific sounds and how maybe putting a band aid on some of these things and teaching compensations is unethical. And unless that's what the patient asks you for. Right. Keeping a child in therapy for a long time. Not. Okay, so we're going to wrap this up here, but I wanted to give you this list of things that are common but not normal so that you can arm yourself, whether you're a provider who's getting into this space, a provider who wants to share this with a patient, a patient who wants to ask more questions. And now you have, you know, this has helped you formulate some questions and. Or a parent of a child who's looking for help surrounding any of these issues. You are not crazy. These things are common. They are not normal. And I am not going to apologize for other people who have dismissed you, but I am going to encourage them to hopefully get some education in the airway health space, because that's really what all of this ties back into. So I hope this was helpful. If you are a provider and you're listening to this before December 7th, as you heard, we are doing a or I am giving a training go to what is the site that I have that I'm having you go to? Go to airwayfirstmyo.com and join us. I'm going to be talking about some of these things and individualized treatment planning, order of treatment based on the individual's needs. I'm going to use my own case as the example of what happened over a course of seven years and how I actually wish I did things in a different order because I think it would have changed turned out a lot differently. I'm technically not done. There's a little bit more for me to do, but I'll be talking about that in the December 7th training. So if you're a provider in the space, I welcome you to join us there. And if not, I will be back right here next week with another short episode talking all about tongue ties and speech sounds. Chat with you then. Bye.

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