Episode 220: Seeing TOTS with New Eyes with Olivia Edmondson, MS, OTR/L

Hi and welcome to episode 220 of the Untethered Podcast. Today we have Olivia Edmondson joining us. Olivia is a sole practitioner and owner of Tied Together Occupational Therapy. She's a wife, mom and pediatric occupational therapist specializing in infant and toddler feeding and development. She provides individualized help and guidance in areas such as breast and bottle feeding, tummy time and development, transitioning to solids, pre and post frenectomy therapy, oral motor therapy, self feeding, picky eating, and more. She believes in taking a full body approach to feeding and values working collaboratively with families and other local providers. 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 myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct coral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Foreign. Welcome to the podcast.

Hi. Thank you for having me.

I'm excited to chat and you know, I think it would be really great for our listeners to learn a little bit more about you, like who you are and you know, share a little with us about how you got into the feeding world.

Yes. So I've always wanted to work in pediatrics. I actually wanted to be an OT since I was 12 when most people probably don't know what they want to be. I had a cousin born with disabilities and so I kind of grew up watching her go through all her therapies and seeing the OT gym and as a 12 year old seeing the ball pit and all the fun stuff, just kind of deciding this is the best job ever and this is what I'm going to do and I never changed my mind. So I'd always wanted to do pediatrics and then it wasn't until grad school we had a guest lecture come in from the NICU and talk about feeding. It was like, I can't remember if it was a day. It probably was like 11 hour class and our whole of grad school and that's all we got on pediatric. Sounds right, But I just remember, like, oh, my gosh, I want to do feeding. I want to work with the babies, I want to be in the nicu. And that's kind of what I set my mind to. But obviously a lot of people want to be in the nicu, and that's a hard, hard place to get into, and you can't just start there. So kind of my whole journey leading up to finally working with babies was like working closer to get to that point. So I started off in a pediatric clinic right out of grad school doing feeding some younger babies, mostly toddlers, older kids, the picky eating crowd. I had some mentorship there, and within the first six months of being at that job, I took the SOS approach to feeding course. And that kind of further fueled the fire of wanting to do feeding and then kind of tangent, like, took a tangent for a while and was in the schools for four to five years. But the whole time being in the schools, I was like, I want to be with the little ones. Like, I just, how do I get to the little ones? How do I get back into feeding? And that's kind of when I jumped in and took feed the peds as kind of a bridging or starting off point, like getting closer to that goal.

That's awesome. I. I feel like, you know, we were talking before, but it's so common that when I ask someone, like, how did you get into Mayo or how did you get into feeding? It's like, either, you know, they're one of their kids, kind of threw them down that rabbit hole, or they are, you know, we. I said one of two paths is very common. It's either that or like a colleague shared something and they were like, oh, my gosh, why didn't anybody ever tell me this? I need to learn more. Yeah.

I mean, I had kids with feeding and my issues, but that came later. Right?

Exactly. Right.

But.

And that was like, similar for me. And that threw me down, like, the different rabbit hole of like, my tots and all that beyond the feeding stuff I was doing and work and then working with younger ones versus, like, toddlers on up. But, um. But yeah, no, you made up. You made a really good point that so many of us don't get this in grad school or if we get like anything, it's like a snippet like a one hour talk on pediatric feeding from like a guest speaker or just something that does not do it any justice. Right. But you know, I'm glad it was at least enough to pique your interest and for you to be like, oh my gosh, like, this is incredible. I need to know more.

This would be a cool job.

Yeah. And I, I think that's happening more and more both in like OT and slp, like grad programs, because we've had a lot of graduate now come to us and be like, hey, can I take the course? And we're like, sure. I'm like, as a grad student, I was like, don't give me any more work right now. So all of these students who are like, give me more. I want this course. I'm like, are you sure?

Come on.

Like, you're welcome. But that's a lot. It's a lot when you're in school and like treating patients for the first time and everything.

Cool. If they just taught it in school a little more.

Exactly. Right. I'm like, that is the end goal. Like, can we get this built into the curriculums inside a course. Right. Or inside, like the universities and, um, it's one of those things where, yeah. Like, we're doing such a disservice to these children because you would think pediatric feeding being a large part of like both your OT scope, my SLP scope. It's like, we kind of need to know about this before we graduate because we're probably going to have kids on our caseload who need this, even if that's not why they came to us in the first place. And, you know, and there's just so much more to even specialize in after the fact, so.

And that's been all of it, like everything I know, none of it, I learned in school.

Right.

It's all been the extra trainings and the courses and mentorship and having to seek that out on my own. Like, it's not just handed to you on a silver platter. It's a lot of work.

Yeah. So were you like, when you graduated? What kind of a. You were in a clinic setting you had mentioned?

Yeah, just like clinic.

Nice, nice. And you, were you doing like all kinds of ot, you know, intervention?

Yeah, it was a pretty good mix. It was probably half feeding, half, you know, just sensory, fine motor, gross motor, all the kind of more general OT things, self care, working on dressing. But I don't know, my memories are of the feeding because that's what I was into.

I love It. No, I love. But I think it's great, like, as a new therapist to have some experience in. In a, you know, a variety of areas. But then I also think it's really cool that, like, you knew that early on. Yeah, this is what I want to do.

Yeah. So district was a big tangent, but I also learned a lot in that setting and how to collaborate with different people. You do a lot of that in the school setting, so it definitely was helpful. But it was kind of like the whole time I was there, I liked it, I enjoyed it. I. My boss was amazing. I loved my coworkers, but I was like, is this what I want to keep doing? Like, what. What is my mindset too? And let's kind of get started and getting there and stop wasting time.

Yeah, no, I. I love it though. And I. It's so funny. You're like, I knew I wanted to be an OT when I was a kid. And I think when I was a kid, I was like, I know I want to work with children, but I had no idea what, like, what capacity. But that's as far as.

I only knew that OT was a thing because I had experience with it. Otherwise I probably would have gone the like, I want to be a teacher route.

Or my aunt was an slp. I had no idea. Yeah, no clue. Not doing feeding, doing other SLP stuff, but still no clue. But she always had like, you know, all the toys and all the fun games.

I should have 12. I just wanted to go to work where there was like a ball pit and swings and all the toys.

That does sound fun for a 12 year old. Yeah, that makes sense.

Yeah.

So, okay, so after that experience and after the schools and everything, you. You pivoted at some point, right? Because now you have a private practice. So at what point did you launch a private practice?

So I feel like it was a pretty quick pivot. I started doing regional center, so I contracted with Orange County Regional center to start doing more in home, kind of getting closer to that 0 to 3 age group. I simultaneously took Feed the Peds. It was during my kind of extended Covid maternity leave. A few friends and I did the course together. So that was fun. And that was kind of the launch into things. Right after taking Feed the Peds, I had the opportunity to switch to another clinic setting. It was actually an ABA company and they had originally taken a solely behavioral approach to feeding. And we're kind of finding out, like, this isn't really working. And it was actually their SLP reached out to me and Was like, will you come help us? So I went and started there. I kind of took over and headed up all the feeding related cases that were coming in and it was gosh. So a lot of mostly 2 year olds, but 2, almost 3 year olds, kid after kid coming in for feeding and they've been struggling their whole life. Like this is not a new thing. And doing the case histories and talking to the parents and going over like breast and bottle feeding history and a lot of the parents sharing like, oh no, like they couldn't breastfeed, even though that was the original goal. It was either they never latched or I just didn't make milk. Which we all kind of know is not, not as common as it seems when parent after parent is coming in. And that's the complaint, like what else was going on? And now we're two and a half and no one can kind of explain to you why we're not making progress or what is going on. So kind of taking a step back and realizing like no one's ever looked in these kids mouths, no one's ever asked the parents about sleeping breathing. Like half of these kids are snoring, they have ear tubes. Like there's a lot going on. And kind of realizing like, why was this not caught sooner and how can I be a part of catching this sooner? So in the background, like, I'm like, great, I have the toddlers now, but what about the babies? And if someone would have caught this when this child was a baby and not latching or when they were having trouble starting solids, how can I get to that place? So taking feed the peds was also kind of a big part. And all the little business modules you have at the beginning of like giving me that confidence boost, like, I can do this and I need to do this. So that's kind of how I fell into the more.

Yeah, you mean like in the free.

Airway rabbit hole that feed the peeds tends to send you down.

It does, and I'm here for it. So are you.

Like half these kids have tongue ties. And how can I connect you with the right resources. But also starting that process at two and a half is a lot more challenging than if someone just caught these issues when you were a baby and struggling.

Yeah.

So kind of trying to be a part of that solution.

I love that.

Being a part of the solution. That's amazing.

And so when you were saying like the business, you know, the business chats, the mentoring, were you talking about like in the beginning of the free five day challenge like that week when I would talk about, like, you know, identity and like, all that stuff. Yeah.

They're like, you can do it.

I'm like, it's like my most favorite thing. It's the most favorite thing to do, though, because I feel like it's in our industry, like SLPs, not like we have so many people telling us that we can't do it or we don't have enough experience or you can't call yourselves that or this or that. And I'm sitting here going, well, what does your license say you can do if you have enough practice? And, you know, what is your scope say for your national organization? If it's something that you, you know, tap into, you know, because obviously licensure is going to basically rule the roost on that front. But, you know, we still want to consider, like, if you're a member of, like, ASHA for me or AOTA or NBC ot. I mean, I know, like, they all have their own documentation of SCOPE and all that fun stuff, but, you know, it's one of those things I'm like.

But who said, like, who.

Who gets to be the name police and tell you you can't call yourself a feeding therapist? Like, it's under your scope of practice and it's covered by your L. I'm sure, you know, it's those kinds of things. And then also just, I think, like, it's a little bit scarier sometimes in some of the other areas that, you know, fall under our OT and SLP hats, if you will, because we're talking about feeding and that leads to swallowing. And this becomes very medical at times. And so, and obviously the kid's not eating, then there's a whole other host of things going on. And, you know, maybe it's more than just picky and it's a bigger problem, like you said. And so, yeah, I mean, I love that they brought you into that ADA company kind of realizing, like, hey, this like, 100% behavioral approach is, like, not working for these kids and they have.

Some oral motor things going on.

Yeah, yeah. I mean, look, like, obviously behaviors happen as a result of, you know, something else. Like, every behavior has some form of. Has an antecedent. Right. So if we're going to go back.

To, like, you know, I think you talking about that in the. Or whoever. I think it's Caitlyn who does the, like, sensory autism, picky eating module and just going over, like, there's a reason for these behaviors and what is that reason? And that's what I feel like I highlighted a lot with the other kind of members of the team that I was working with is like, they're not throwing their food off the table and pushing themselves away from the table and refusing to eat because they want to be bad.

Right?

Like, kids don't want to be bad. So what is going on that is causing them to react in this way and how can we work on that? I love that thing is hard.

Yeah, well, and it's like when you can just see something through a different lens and appreciate that the kid doesn't hate you, the kid doesn't want to make your life more difficult. Like, I mean, look, there are some children who may like, choose to do certain things at a certain age where, like, we're not going to say that every single child is, like, not doing this something on purpose. However, like you said, children are inherently, quote, unquote, good, right?

They.

They want to. They want to make the adults in their environment happy. They want to please. Usually they want to be able to do something. And so if they're struggling, we as adults, like you said, like, we kind of have to go, why? Like, why is this happening? And, you know, I think that whole behavioral approach to feeding, it, it's a band aid.

It.

It's treating the behaviors, not the actual root cause of the behaviors. And that's where it's like, if we can kind of figure out what's causing these behaviors and look in the mouth and figure out structurally what's going on. And is there something cognitive going on too? Is it oral motor? But I also love to always highlight, too, that sensory motor is so highly integrated that we're taught them in silos, but you can't tease them apart. You really can't tease the sensory system from the motor system. That's where I'm. The beautiful marriage of SLP and OT together. Being able to take our expertise and kind of bring it to the table and have conversations. I think it's so important because obviously you guys get a much deeper dive into, like, the sensory system and different approaches and treatments and everything, you know, assessments and treatments. Whereas, like, we are more focused most of the time more on, like, the motor, the oral motor, or the motor system. And it's almost like we get taught these as if they exist independently, but they don't. And it's like all OTs and SLPs need to have that same level of training when it comes to, like, oral motor and the sensory system, so we can all kind of have least an understanding of, like, what might be going On. So I love that you were able to do that for them. That's really super cool. And so then you are also able to do some mentoring over there. Is that right?

Yeah. So as I was kind of getting busier with the private practice, you know, it's typical clinic work. You have all these cancellations and you show up for your eight hour day and two kids show up. And that's kind of the life of it. And that was always my kind of reason for wanting to do more of like the in home and regional center. Because I always thought, oh well, at least if someone cancels, I'm not stuck in an office. Like I can run to Target, I can go home and throw in a load of laundry and kind of continue on with my life a little bit easier. So things were very up and down there when I started. It was very busy. Then it kind of slowed down. They ended up hiring a new grad OT to do all the general ot, but they had no feeding experience. So I continued to do the feeding and simultaneously, like she would sit in all my sessions and I would kind of answer, answer questions, mentor her. Then she left and another new grad came in. So there's a lot of turnover. So then I was showing her and she's the one who's actually there now and it's been great. I still help them out sometimes and I'll go, if she has like a tricky case or an eval she needs to do, we'll kind of go in and do it jointly. So supporting her in that she texts me her questions and then she's actually taking. I pointed her in the direction of your five day training.

Oh, good.

Right here, do this. And then she's taking, I think SOS this summer. So it's been fun to kind of be a part of someone else's journey into kind of finding a love for feeding.

Yeah, no, and it's, I think it's so nice when you can also kind of like open up the eyes of others and how have them realize like behaving is rarely, you know, behaving. Sorry, feeding is rarely behavioral. And I, and I took SOS too, like way back when. And I remember even they said like less than 5% of cases are actually behavioral. And you know, I was like, I don't think enough people in this room like clicked with that. Can we say that 10 more times? Like, I think that that needs to be like really, really highlighted like 10 times over. But it was one of the first places that I'd actually heard it Said in a course like that. And I was like, okay, like, I'm gonna grab. Like, I love that they shared that, but because it's exactly what I was feeling from my own experience was like, most of these kids are not. They're not doing this on purpose. They're doing this because that's what their body is basically, that they don't have the capacity and their body's just shutting down. And we have to figure out how do we work with them so that they can enjoy food and they can enjoy being in a cafeteria, or they can enjoy going out to a restaurant, or they can enjoy sitting with the rest of the family at dinner, or they can, you know, tolerate even having two foods on their plate or three foods where maybe one of them's not their favorite, but it's at least allowed to be on the plate now. You know, it's like without vomiting or gagging or running away from the table or having a meltdown or, you know, like all these quote unquote behaviors that are communicating something to us, but we're.

Not into the sensory system in that.

Exactly. It's like the sensory system because the motor system, because, you know, it's like, because, because, because. And like, when we look at it and we go like, okay, wow, like, this kid is living in fight or flight. Every single time they hear snack, dinner, breakfast, a certain type of food, whatever, it's like their bodies just go, nope. And they're already not available before we've even approached the conversation further. I love when conversations can be had around this topic, especially because I think it's also very helpful for parents to be aware of this. So I don't think most parents realize that because we get a lot of calls. My child's a lazy eater. My child really picky eater. My child this, my child's that. And it's not that the parents are, like, wanting to attach a negative label to their child. It's just that's how that's their perception because that's what they know right now. So I always feel, like, excited when we can provide education in this space. So the parent, like, oh, wow, there's something I can do to, like, change this or help or, like, my kid doesn't just hate me. Your kid doesn't hate you. Like, they're not doing it to make your life harder. Promise. Let's work on this together.

But then it's like you take. You take these courses and like you said with the whole myo airway tongue tie, you get that in your Head. And then you see these kids in fight or flight, and your brain immediately goes to like, are they just not sleeping? Are they not well because of this and that and the other thing? And that's part of why they're in this state of constant fight or flight. Yes.

Yeah. It's so, it's such a way back.

And address that we're multi layered onion.

Right. It's like there's so many, so many layers. But I also think that like, then comes down to just having a really good comprehensive evaluation and intake. Because sometimes we can gather so much information or at least figure out like, okay, I need to get more information in this area. Or, you know, the parent says they sleep okay, but the kid's sitting here with their mouth open in front of me. So I wanted to dig into this a little bit deeper beyond evaluation. And you know, I think that it is a rabbit hole, but it's also like, when I look at it, like, holistically, I'm like, it's also given me such a really cool, like, lens to see patients through that allows me to then, you know, kind of check the boxes and go like, okay, we think these areas are okay. Let's put our focus here. So I always tell parents, I'm like, it's not that I don't believe that other therapists have the ability to do a feeding eval. It's that I know people who have feeding myo and tots training are going to do a really holistic eval, typically on the front end, which is going to help kind of case manage and plan what needs to happen next and may save you a lot of time and energy and like running around to a whole bunch of different people when we kind of know like, okay, step one, two and three looks like this. So, you know, easier said than done, of course.

But, you know, where do we start? Who do I need to refer to? Starting off the plan of what usually end up being a long journey. Yeah.

So with your private practice then, are you solely focusing on like, feeding? Like, what, what are you doing in your private practice?

It's all feeding. Probably 80% are under one. And then I see some toddlers. So still I finally kind of got into that baby crowd. A lot of them ended up. My first few babies I saw were actually siblings of some of the older toddlers I'd been seeing. And you know, that two to three age range, that's when we're having more babies. And so the moms already know me and they're like, wait, if he has all these issues and now we're struggling with this. Can you come and help me with my baby? So that was kind of a great opportunity and segue into that. And it was through doing that that I was able to connect more with lactation consultants and dentists and different providers in the area. And then it kind of just all fell together after building that network and just starting to get more referrals. And I ended up renting an office space. So I originally started in home, transitioned to an office space probably like eight months in, and it's been the best thing ever. I'm in an office that's a shared space with a chiropractor. There's IBCLCs, there's a massage therapist, and then literally across the courtyard, there's a peds PT and another great ibclc. So having that community and referral network, like, close by and so tight knit for me has been so amazing because that's one of the things that's lacking. You go into private practice and you're by yourself. You don't have those relationships that you might have in a clinic setting where you can kind of go, hey, I have this tricky case. What do you think? And those conversations that tend to happen, I think by being in a space and having those connections and relationships with other providers, now that's built in and we have this conversation network. There's a whole network of feeding therapists up here down in San Diego, and we all talk and have text chains going on. And it's so helpful just to not be the only eyes on a case, or if something comes up, to have people that you can ask and weigh in, or if a child's not making progress, to be able to run that by other people and have that reassurance of like, okay, that's what I'm doing. Like, it doesn't seem like I'm missing anything. And that kind of encouragement of like, no, just keep on keeping on. And so you're not alone. As much as sometimes going into private practice you feel alone. I think that's why having that network is so important. And I feel so lucky to have found that. And then feed the peeds throws you into that too. And we have the Facebook group. And if my little network down here isn't enough to answer my question, I can go post it. And people all over, everywhere will weigh in with their own experiences and feedback and information on whatever it is you're looking for.

Yeah, no, I love that. And like, I mean, you, you've hung around long enough to know, like, I am so much about, like, the community and supporting each other and also. But yeah, I mean, being a private practice owner myself now, going on, my gosh, 2014, I'm like, nine years. I. I've totally been there where it's like, it feels very lonely. And then sometimes you also feel like it's competitive depending on where you live, and people don't always want to collaborate. And you're like, okay, I mean, this is really to benefit our patients, so why is it so hard, at least in the SLP world? So I love that. And that's one of the reasons why I was driven to even create the businesses that I did online, because I was like, this has got to stop. Enough gatekeeping, enough of the. With whole. You know, we need to share information and have conversations so that we can best support our patients. And obviously, we want to, like, continue. You know, kind of. There needs to be quality control around that too. Right. Which is kind of where the course came from. And now we know everybody, like, in the Feed the Pizza alumni group has at least gone through the course. But it's one of those things where. Yeah, I mean, when you have the community of referrals that, you know, that referral network that, like, you have immediately around you, like, that is so cool, because, yeah, you've got. First of all, it's very easy, obviously, for you to then, like you said, interact and, like, have conversations with others and, you know, right outside your door, here's the chiropractor. Here's this. Here's this person. But then I think for families, it's nice, too, because even if you guys are like your own individual business owners, but you're all kind of in one area that's, like, such a perfect thing for a family, like, for convenience, for also them feeling like, okay, you guys all talk to each other. Like, you guys are connected. And, you know, they kind of get that same feeling as if you all exist, like, under one business. And, you know.

It definitely helps with that. We stack appointments a lot. So if I know someone seeing the chiropractor at this time on this day, I'll try and schedule for right before, after, especially if they're traveling just to make it easier for them. It is. It's a lot of appointments. So being able to kind of leave the house just one day instead of two appointments on two separate days, I think just helps take a lot of the weight off the families, too. And, yeah, again, they know we're on the same page. We're talking to Each other. It's immensely helpful when babies are going through the release process because we can also then stagger those appointments. So I have one who just got released on Friday, but they're seeing the chiropractor today, and they're seeing lactation on Thursday. So then I'm able to confidently say, okay, if you're already seeing those two providers this week, let's push our visit to next week. Like, we don't need to do three appointments in one week. I trust that these people are, you know, looking at what needs to be looked at and getting you to the point you need to be at that. It just helps everything kind of flow nicely. And we're all in communication. I can check in with them easily. I just walk down the hallway and say, hey, how did so and so do today? Do they need to be seen sooner? Are they okay waiting until Tuesday? So we have that constant communication going on, and it just makes sense.

You guys have any, like. Did you have any, like, snafus, like, in trying to create this? Like, did it come to you easily? Was it sort of like, it.

I mean, it was pretty easy, I think, just so it's the chiropractor's office space. And it was kind of her original goal. Like, I want to have people rent these extra rooms and spaces that are kind of part of this village with that goal of making it an easy place for parents to come and everyone's kind of all together. It just so happened that we. I was taking my kids to see her before I even really started doing this, and so it kind of just fell into place. She was like, if you ever need an office space down the hall. Actually, I was like, I actually might. So it kind of fell into place. It's seven minutes from my house, so it's so nice. I will never leave unless they kick me out. But, yeah, it's been so nice. And just finding those people, and I think that's something that is not talked about enough, is that building of a network. And it's not always easy. And you kind of have to find those. Those right people, as you were kind of saying, like, there's a lot of opinions and a lot of just different personalities and things going on and different belief systems, and it can be very polarizing. And so kind of finding those people who have that same teamwork mentality and kind of latching onto those people and creating a group of people who wants to work together and wants to have that same level of communication surrounding patient care and just the people who support you and uplift you. And if they have a strategy or something they found that's working really well, like, I'm going to share it. I'm not going to keep it a secret if it can help these other families. So kind of having that open communication and if I learn something new, I'm going to teach it to you too, because we can all be better and when we're all better, it betters the families.

I love it. I love it. Well, and then you also now have been through this as a mom of your daughter. You said had your tots myo journey and all that. So if you're willing to share, you know, where, like, where is she now, like, or what have you learned things, I guess through that too? As a parent and practitioner.

Kind of taking feed the PEs, it was a little backwards for me. I feel like a lot of people took the course and were like, I'm taking this because my kids have all these issues and blah, blah, blah. So I took it and I was like, oh gosh, my kids have all these issues. And how did I miss that? But also, is it on me? Like, why? When I saw lactation when she was a baby, like, no one ever looked in her mouth. And I didn't know 6 years ago what I know now. And the people I saw apparently didn't either. So kind of getting. She was four and a half, I think, at the time. I took feed the peeds and that kind of started us off on her whole journey, which is still ongoing two years later. We started off in Mayo. So she's been through myofunctional therapy, a functional frenuloplasty, upper and lower palate expansion. Let's see, when she was still having her issues, we did the sleep study. She ended up having her adenoids out, her turbinates reduced, still in the expander. So we finally just got out her expander and she went into a permanent retainer. So it's been this on going journey and kind of throughout the whole thing having these frustrations of why is she still having the same functional issues that we went into this process with? We're still grinding our teeth, we're still bedwetting, we're still snoring. So kind of what is. And that was me as a professional and knowing things, trying to process and even being in this place with multiple providers who are the specialists in their field and no one kind of being able to figure, figure it out. And everyone kind of just saying, well, when she, when she gets her tongue tie release she'll stop doing that. Or when she gets her expander, then, then it'll get better and kind of. Why is it not getting better? So we're at the place now where, interestingly enough, she got her rapid palate expander out retainer put in. She has stopped wetting the bed. She has stopped snoring. So some may say it's a coincidence. I think she doesn't have a mouth of metal anymore and her tongue can rest up. Yeah, was kind of the missing piece is maybe we just need to wait and kind of let her body do what it naturally needs to do versus, like, oh, we need to spend another $2,000 and go into this other expansion device because she's still having these issues and always kind of there's one more thing to do. So that kind of relief of realizing like, maybe if we just.

Maybe you've done enough right now. Yeah.

All together. And so that's been very cool and also a huge relief to see finally some improvements happening. And I mean, the journey's not over. I have a younger one whose palette is much more high and much more narrow than her sister's ever was. And she's my chronic finger sucker at 4 years old. And so it's, it's a never ending journey. It's exhausting, it's frustrating, it's expensive. But I think that it's given me kind of that ability to truly empathize and connect with a lot of these families. You know, it doesn't matter if Your child is 2 weeks old and you're going through this, or if they're five and you're going through this. It's really hard either way. And so although I wouldn't wish it on anyone, it's definitely given me that ability to just relate to families as a mom. Like, hey, I've been there. I know it's a lot. But also on the other hand, like, this is why we're working on this now at two weeks, at four months. So you hopefully don't have a five year old that you're doing all this with years and years later down the road.

Yeah, no, I get it.

Sort of thing.

Right, exactly. Yeah. I mean, it's like, it's great that we can empathize. Right. With patients and families and you know, have conversations like from one parent to another in a sense. But yeah, I'm like, I wish it upon nobody. It is a. It's a journey. And like with Lily, she was 24 months when I figured out that her tongue was high. They Came back from my MYO course and I was like, oh, my gosh, same thing. IBCLC said nothing. There was the one in the hospital. There was one of my pediatrician's office. And, you know, so, yeah, it's like when we know better, we do better, as you mentioned. And I think it's, again, it's just one of those things that it is a journey. And when you were saying this, I was thinking, like, you know, oh, my gosh, she's still not, you know, she's still mouth breathing or snoring or, you know, sweating the bed. And you've gone through all these things. I was going to tell you, like, take a couple months off and see, like, if her body integrates. Because, you know, like, I've had cases like that. And what we found was exactly what you said, like the mouth of metal, when the tongue cannot physically reach up on the top of the mouth. Which is why there's a lot of people who will do mayo with an appliance. And you cannot, in my opinion, complete a MYO program with an expander in your mouth. Unless the. Unless it's one of these slower expanders or something that allows the entire palate to be open.

Suctioning her tongue, like, way back behind the extender.

Yeah.

Lower jaw back and.

Yeah, yeah. I mean, to do my. Early on before. So sometimes we'll do. People will do it like, before, you know, surrounding a tongue tie release before expansion. And then it's like, okay, does the body have the muscle memory to maybe get the tongue up where it needs to be after expansion has happened? Now the tongue has full range of motion. I have seen cases where that happens, even though they don't really have enough space for their tongue before expansion. You know, on the flip side, we have cases where it doesn't always happen, you know, just because they've had everything that you described. And so. But I always like to say, let's give the kid like a month and let them integrate and see, as long as there's no, like, major health issues going on, like, let's see what happens. Let's see if the tongue finds its way up there now that that space is available and there is enough space and the tongue has the range of motion. And we know the nose is patent because if it doesn't happen, but the child has now had some time to kind of reintegrate everything else. I think they'll be more ready for a mile program versus, like, okay, we got our appliance off yesterday. We're here for miles today. Like, whoa, like, let's all breathe for a second. Yeah.

And that's something I knew going into it. And when we were talking about, like, okay, does she need to go into a different type of expander? I was like, well, could it just be that it's been almost a year that she's not been. We've not been doing her myofunctional exercises because she can't do them well. So what would it look like if when she got out of this expander, we went back to that? So kind of going back to that, like, the effects that the myofunctional therapy alone can have. And, like, is that the missing piece, you know, where she just needed to get back on that and rebuild some of that tongue strength and tone and the patterning and relearning where her tongue needs to be. Because even though she learned it before her release, it's been how much time that she's not been kind of keeping up on that. And if you don't use it, you lose it.

Right, Right. Yeah.

Getting back on that train. Yeah.

No, it's. I actually recorded an episode with Mia yesterday. My. My five year old. And she. I was like, mia, and like, this is a kid now who is. She has got her permanent retainer in right now. It'll come out this summer.

And.

And she. I was like, so, Mia, where is your tongue supposed to be? And she's like, down on the floor of your mouth or something. I was like, what? I'm going to put this episode out there because I want everybody to hear. And by the time that, like, they hear this episode, they'll have just heard that one last week, you know, the week prior. I'm like, I want everyone to hear that. Even when your mom is a myofunctional therapist, even when you've gone through myo. Even though her tongue is resting in the top of her mouth and she is a nasal breather when she's sleeping, when she's awake, she still, like, when I asked her, I was like, are you sure? She was like, in the middle? I was like, no, she's like. I was like, she's like, on the top. I was like, yeah, it's going to be up on the top of your mouth. Or maybe I told her, I don't remember.

Oh.

I was like, oh, man, Mia, you're making me look bad. No, I was.

My poor child who, like, won't go to sleep at night because she's like, mom, I'm breathing through my mouth like, to this child. But she is, at six years old, worried about where her tongue is. And you know, it's more comfortable right now to breathe through my mouth. And sometimes I just have to tell her, like, that's okay. Sometimes my nose feels stuffy too, and I have to breathe through my mouth. It's okay. We can't worry about it all the time. So finding that balance of like, you're also six years old and that's like, I try to tell them constantly be worrying about where you're breathing from.

Yeah. If our body's going to do what it needs to do. Path of least resistance. I always tell my kids, I'm like, if you're stuffy, your mouth is going to be open. And that's just how we have you breathe. I'm like, and then we, when we're not stuffy anymore, we'll think about where it needs to be. And I was like, but clearly I need to kind of have another little follow up with Mia about tongue lives up. We used to like sing and dance for a little like song. We made up too. Like tongue up, lips, clothes, you know, this is how we breathe through our nose. Like little things like that. And I'm like, I guess when she started mayo, she was, she was definitely like four, just turned four and now she's like, you know, five and three months. So it's been a while, but still I'm like, all right, lesson learned here. Gotta, you know, gotta work on that a little bit. But yes, you're absolutely right in that. And I think that's so true of just like everything in life and in this area. Because it's so easy as a provider to like go gung ho, like down all the avenues, all the roads. I want to do everything and make sure I'm doing everything. And we've got patients like that. And like, at the end of the day, it is less healthy to be so like far one direction and so like obsessive over making sure that you're doing all the right things and your kid has all everything they need and, you know, forget about how much time it takes and money it takes to even do this. It's like we kind of have to figure out what is the best middle ground sometimes and what's realistic. And I always joked, I was like, I am the worst patient mom because we never did our mile homework. And she was working with one of my therapists and I was like, oh, gosh, guys, we got to. I'm not going to make you a.

Follow up right Now I know we haven't been compliant. Like, we need to get back on that and then we'll kind of see where we are. Like, do I want to start my younger one in mayo right now when I can't even remember to get her to do her myo munchy on a regular basis? Which, like, we have it. Don't ask me when the last time it was in her mouth. That's on me.

Yeah, yeah, we did the. We had the myobrace before they went into expansion, or at least for my younger one. I think she got it before and it was just too big for her mouth. And so it was uncomfortable and she did not like it. And her mouth was like small, but even like small for like a four year old's mouth. And so we ended up not using it then. But then afterwards they said, you know, keep using it because it'll help, like direct the growth going forward. But I noticed that like their lips were apart and they were. I don't know, I was like, I'm not understanding how this big old bulky thing in their mouth after expansion, Like, I get it. I highly respect the dentist and I totally get it from a functional standpoint in that sense. But I'm like seeing and practice my own kids, they hate it. So, like, it's not taking to them really easily. They all wear it because they're told to. So, like, we would have them set a timer. We did like 20 minutes and then 40 minutes and then 60 minutes while they were like reading or watching a show or just whatever. And then there was one night where Mia fell asleep with it in her mouth and I noticed like her lips were parted because it was just too big for her mouth when she was laying down. And this is the beat. Like, this is the little kid side.

I was in the office, I had never seen it in person. They were recommending it for my older one and she was showing me the smaller ones. I was like, there's no way that that's going to fit. And she's like, well, this is the baby one. I'm like, but this is her mouth. Like, yeah.

And I'm like, if it works for some people, like, awesome. But I'm like, for my family, I don't know, like, my kids didn't like it. I just feel like it caused more stress for them, like thinking that they had to have this in their mouth and even. And we gave it a good old try. And I posted something on Instagram. So I was like, you guys, like, look at me as Presentation. She's snoring and her lips are slightly parted with the myobrace. And like, would you take it out or would you leave it in? Like. And I actually took it out. I was like. And she actually ended up spitting it out one of the nights. And then I took it out the second night when she was snoring because then her mouth was closed, her lips were together. Right. And her tongue, I checked, her tongue was up and she's breathing through her nose.

And I'm like, she's perfect, right?

I'm like, oh gosh. Like she still has.

No way they're going to leave that in when they sleep. And they were like, oh, well, that's. You have to lip tape. And I was like, I don't. I'm not my child.

I am very against taping children personally. That's just my opinion.

But that's not going to work. That's not going to work for me. And so I'm going to put this giant bulky thing in her mouth and then I'm going to tape her mouth closed and just leave her alone in her room. Like, I don't. That doesn't work for my anxiety.

But you know what? I think it's also, it's not even an anxiety thing. Something your gut is telling you that that's not state or that that's not right for your family. Do you know what I mean? And then it's like you kind of.

Get those anxious feelings where you have to weigh that.

Like, like for me it's trusting your intuition.

But is it right for me? And not the same thing isn't going to work for every child and every family and that's okay. And kind of finding the providers and the people who are going to help find what is the best option for this one child.

Yeah, yeah. And that's why I always love when the providers have like more than one appliance available for a child because then they can really tailor it to that kid's needs and their nervous system or their, you know, it's like the parents too, because it's also falls on us as parents to have to also be compliant with. Especially if it's a removable appliance or it's an appliance where you have to turn a key or it's, you know, whatever the case may be, like, it's still requires a lot of compliance on our part. And I was talking to the kids dentist and she was like, wow, you guys are like so good. I was like, what do you mean? And she's like, well, like, you actually turn on the schedule you're supposed to. I'm like, yeah, I have reminders on my. My calendar, on my phone. It pops up every night before bedtime. So I know like, what night we're supposed to turn whose appliance. And like, or it wouldn't happen. She was like, no, no. Like, there's parents were like, we suggest that. Or they say, hey, have that too, but they just don't do it. And then it takes forever for the kid to.

She knew she was, hey, mom, it's key tonight. And I'm like, oh, yeah, okay, you're right, it's key tonight. I love that because it was every other. So it's easy to remember. But yeah, I appreciate when providers can kind of give that rationale. Yeah. The different things I remember when I first took her in, you know, you learn about the alf and that's kind of the only. A lot of times one of the only appliances you know about going in. So I went in having knowledge about that. And he very quickly pointed out, like, for her specifically, that's not the best option because she's holding X, Y and Z so much tension in her face, she's gonna override it. I was like that. We ended up doing a different provider anyways just because of cost and all of that. But hearing that rationale, like, was important because someone's actually thinking about her and what she's going to respond well to. And I kind of. That's what I try and do with my family is I think a lot of times when you just explain the reasoning why behind like, why am I giving you this exercise to do? You could say, like, okay, do this exercise three times a day. Let me know how it goes. Are they gonna do it? Maybe, maybe not. But I think when you explain the reasoning, like, we are doing this because it is working on this skill and it's going to build towards getting you to this point. They see the value in it and they're more likely to follow through with whatever those recommendations are because they know why they're doing it.

Yeah.

So that's a big part of things too, I think.

Yeah. No, I love that. It's, you know, it's like, we need to be able to explain what we're doing and why we're doing it 100 of the time. Otherwise, why are we doing it? If you can't explain it, then why are you doing it?

Right.

And then it's, you know. But then also, like you said, giving the family that information, I think it just kind of helps everybody take a deep breath and like lean in and it's just a more well rounded experience and, you know, for everybody. So I love that you offer that to your families because there's also that like, fine line between the art and the science. It's like I always say there's that dance between art and science of like, what are we doing and why are we doing it and why am I doing this? For your child specifically and like, what are your concerns? And we can like integrate what their concerns are into like what we're telling them because if you don't, you lose them. You know, it's like, you know, it's like you gotta tap into who that human is and who that family unit is, the support system sitting in front of you, like what their needs are. So I love that you do all that because it's one of those things that I feel like I'm hearing it discussed more and more, but I don't see it in practice very often. So it's really nice, like when a provider focuses on that because, yeah, I mean, at the end of the day, everybody benefits. You benefit, the family benefits, the kid benefits.

So yeah, I mean, I feel like if I want them to do what I'm asking them to do, how, how do we get to that point? And I think it's understanding. I could give them a whole list of exercises and they could print it out on a paper and I still do send like a written home program, but it's in there too. Like the rap, like this works on this, this is why we're doing this. And I think you just, half the time you just need that buy in of like, you could look this up, you could look exercises up on the Internet and do this whole protocol and. But is that one necessary? Are you doing extra things that you don't really need to do? Because that's not the issue that your baby is having. So really kind of understanding what, what you're focusing on and building off of.

That, well, they're, they're lucky to have you because you are a very well rounded practitioner. And I know you, you like also share that you had some training in the Gillespie approach and that you wanted to get certified in MYO and like all the fun things. So like it's so all the things, you know, it's like, it feels to.

Do all the things.

I know, I know it feels like a lot, but I also feel like it, you know, these things specifically, like these types of courses and These approaches, they all blend so well together to like really give you a really holistic approach to like working with a patient that I think it's so incredible like to hear that, you know, you're kind of looking at it through all these, these different lenses because again, I think the patients make faster progress too when we take this kind of an approach, when we are more like well rounded as practitioners and you know, holistically approaching like what's going on.

So that balance of like, I can't do it all, but I also doing more, you know, like, are there things that, especially for the older toddlers I'm seeing, are there things related to more of that myofunctional therapy component that are lacking in my treatments that I could by taking this training, add in and just further help these families or even making it more accessible so like they're not having to see all of these different people and, or picking and choosing because of finances, like, okay, I can afford to see one provider and who am I going to choose? And that's kind of the reality of it a lot of the time. And so I think just adding in and there's obviously still cases where I'm like, oh, I gotta refer out for that one. Like I don't have the MYO training yet, so for the older ones, but at the same time, like we have some great and amazing myofunctional therapists down here and a lot of them are about six months out, so there's definitely a need and I think just going back to that network too, and I've talked to some of these people and asked their opinions and nobody's like, oh, but if you start doing this, are you going to take clients away from me? Like, no, that's not how people are thinking of it. Because I'm also very clear, like I don't want to see anybody over the age of 4 or 5. Like I'm still sticking with my like 0, 1, 2, 3, 4 year olds max. And those are the ages they're not seeing anyways. So kind of bridging that gap area where a lot of the myofunctional therapists can't really start their formal programs till they're four or sometimes even older. And I have the baby thing down, but what about these two and three year olds? That yes, you're still taking that oral motor feeding approach, but there's got to.

Be more, right having that MYO lens and understanding kind of like the end goal you're working towards and, and that's a Nice thing too is, I think, like, SLPs and OTS, especially when you have that feeding background already and you work with this population, you can go to a MYO course and one, I think it's going to be easier for you to take in the info. Like it was for me, I think, because of my feeding background. And then. And I wasn't even working with, like, the little, little ones yet. I was doing more like toddlers. You know, toddlers in preschool. So they're still little, but, like, I wasn't doing infants, I should say, at the time prior to having Lily. But I kind of started going like, oh, okay, how do we adapt this? Like, how do I take these same types of things and do this with the little ones so that we can actually accomplish this early on? Because they shouldn't be waiting till they're older. Like, if I'm working with this child now and they have feeding struggles. Well, okay, let's put our MYO eyes on too and look at it through both lenses because truly, it all starts to overlap. And that's why I always say, like, MYO is really pediatric feeding, but you have to have that extra training in myo. It's not like you can just go get trained in feeding and be like, okay, I'm good. It's like, you need to have that, that MYO training too. And so then you can realize, like, oh, these are the overlaps. And okay, you know what, there's something else going on here. And now I know this information from having gone through this IO course. Like, I wonder if that could be going on here too, even though it's not typically what maybe I would have looked at, you know, from a peat feeding lens. So it's such a beautiful marriage. Like, I always. That's why I always, like, say, like, beat the peas was my whole, like, little, you know, feeding with a twist of tots in myo. Throw a little MYO and pick a.

Little tots in there.

But then, yeah, you definitely need to kind of further that MYO and potential education beyond. Because I'm only giving you, like, a couple hours of, you know, coursework and then a couple hours of case study. And yeah, it's the amount of time that we've ended up spending down these specialty rabbit holes is just unreal.

Yeah, it's definitely something I want to do. And just, you know, the families come to see you and they trust you, and I'm definitely that person where I'm like, they're spending their time, they're spending their money. I Want to be the best provider that I can be and really fully utilize all the tools that I have access to. And if that means spending more money and taking more courses myself so that I can be a better provider for these kids I'm seeing, then I'm going to do that. And it was the same with taking the CFT course is I've always kind of done the whole, like, full body approach to feeding, and I incorporate tummy time and looking at symmetry and looking at positioning and all these things. And I refer out to Cairo a lot. And so many of these babies are still so tight, and there's not a lot of body workers in the community. And I went back and forth like, oh, do I want to go do my CLC and learn more about the breastfeeding? Because I just. I love the babies and I love the breastfeeding, but I was like, if I'm gonna do what's needed, like, these babies need more body work. And there's not a lot of providers in our area. I think at the time we have a couple people who do craniosacral therapy on infants. But at the time I took Gillespie, there was no one providing that kind of therapy. And I had gone and researched, like, all the different types of body work and looking into the different options. And after reading a lot of the provider and the parent testimonials, I was like, okay, I think this could be a good option and something that would be relatively easy to incorporate into my practice and what I'm already doing. So I took the course. And so kind of the same thing with the two of those is I've always been the kind of person where I'm like, oh, like this. This specific baby or child I'm seeing needs this. And, oh, I don't have anyone I can send them to for this. So I guess I better go learn it.

Yeah, there's like a big movement right now.

I feel like, push me down more rabbit holes and trainings. And there's. I have, what, 30 years left in my career, and there's a million more trainings and things to learn. And that's exciting too, is thinking, like, I'm already getting all of this knowledge now and how much more is there to learn and experience when I have 30 years left of this? Like, who will I be in 10, 20 years?

I love that. I love the lifelong learning.

Always, like, more things to learn and train in and go do. And, yeah, it's fun and exciting to just kind of think about also the direction that all of this is going in, like, myofunctional therapy was not a big thing 10 years ago, and it's becoming more common and more people are getting help. And, you know, hopefully we'll see some changes in our practices with lactation and babies in the next few years. Eventually in my lifetime. It's starting to happen. So slowly but surely the future is hopeful. Yes.

Oh, well, this has been amazing. Is there anything else that we didn't cover that you want to chat about in the last moment?

I don't think so. It's been fun.

Yeah. Well, thank you so much for chatting with me and with sharing everything about your practice. Where can they find you if they're like, oh, Orange County. Like, where. Where are you?

So I'm in south Orange County, Laguna Hills, specifically, right off the freeway. So that's like the whole Laguna Hills, Mission Viejo area a little bit south of Irvine. So what is the practice name? Oh, my practice name is Tied together. So website is tied togetheroc.com there was already another Tied Together. They were going to charge me $5,000 for that domain. I said, don't you love that?

I know, I know.

Together. Oc. That's fine.

You're like, we'll find another one for 12 bucks. Thanks. Yeah, no, it's. Websites are such a fun.

Such a fun thing.

Well, we will make sure that all of this is located right under the episode with the notes and that way they can click through and find you. Thank you so much, Olivia, for joining me today. This was so much fun. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halliebalkin.com or pop over to hollybulcken on Instagram to get all the latest updates.