Episode 277: TOTs and Feeding in Clinical Practice & Public Health Initiatives with Hallie Bulkin

Hi and welcome to episode 277 of the Untethered Podcast. This is your host, Hallie Balkan and we're going to talk today about a question that came through that honestly, it's not one of my most favorite things to talk about, but I think it's something that's important to talk about and that the question that came through was like, what gaps exist in our understanding of the relationship between tethered old tissues and food aversions and like where should future research focus? So I did a little research myself because again, not my most favorite topic like to talk about. I like to leave the research to everybody else like you guys do it, let me know what it says. I really like the clinical side of things, but I wanted to dive into this a little bit today and I welcome your feedback, your thoughts and everything once you've listened to this as well. Because I'm curious to know what you all think. And if anybody who is doing research or has interest in research wants to come and join me on the podcast and talk about that as it relates to these areas, I would love that. So always reach out to us. Supporteedthepedes.com but let's jump in. 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, female 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 oral rest.

Posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Foreign. Okay, so again, not my favorite topic, but let's talk about it for a few minutes. This will be short and quick, I promise. So what do we like? What are the gaps? Right, so when it comes to sensory processing and tethered oral tissues, I just last week put out an episode on like tetheral tissues, food aversions, the sensory System, nervous system, the nervous system, all that good stuff. So you know, if you're kind of like, well, I want a deeper conversation just on this topic, go back and listen to episode 276 because that's going to be that conversation. Right. What I do think is I feel like we need to investigate deeper into how tethered oral tissues impact sensory processing as it relates to like the senses. Right. As it relates to taste and texture and smell and the sound during eating. Because I think that there is more information for us to learn from, from the patients or whether they're little patients or older patients when it comes to these topics. And I think that we need to understand whether like there, there's an alteration in what is sensed, like in these sensations. Right. From those with tethered oral tissues versus like maybe those who don't have tethered oral tissues. And is that then tied to food aversions that we see? Because, you know, I know what I can see and I know that when the tongue is tied, I know that that is going to impair our ability to have that adult like, rot. I know that's going to change the sensory experience. But I would love to see some further research around that topic. I think that would be really fascinating. You know, when I, when I was doing some research, there were some suggestions on like the neurological mechanisms, like exploring the neural pathways that are involved in tethered oral tissues and their influence on feeding behavior. There were suggestions to study like the brain areas. Right. Associated with taste perception and oral motor control and like reward systems and that kind of stuff, which I thought was kind of fascinating from an early intervention standpoint. You know, I used to always say, everybody, every baby should get a tongue tie release and, or not tongue tie release. My goodness, listen to me. A tongue tie screening at birth. I actually feel like we need an initiative to have tongue tie screenings that are functional. Right. Like functional feeding evaluations at birth, breast and bottle or whatever that goal is for that feeding dyad. Right. And that's where a lot of people want to see these like evidence based interventions for infants with tethered oral tissues to prevent or, you know, mitigate food aversions. Like I've seen these suggestions. I think that it's hard to prevent these things from happening sometimes. Like we don't really have good indicators all the time, like at which children are going to develop a feeding aversion and which one's not. And I think there's just so many factors. I'm not sure how easy this would be. To study or how easy it would be to control some of those variables, if you will. But throwing that out there. Also assessing the effectiveness of, you know, early release, tongue tie release procedures and improving feeding experiences. I know that there is more of that being done, but I feel like it would be really cool to see, see, you know, have a comparison. I personally would love to see, you know, comparison and including information on like breastfed babies and on bottle fed babies, on babies who had pre op. You know, you're not going to see anybody withhold a intervention from a child because it's not ethical. Right? So you're not going to see like, well, let's have a pre op group and one that gets pre op and post op and when you gets just post op and see how the three groups and then our control group all, you know, yeah, no, they're not going to withhold therapy that they know can be helpful or an intervention that they know can be helpful. So I think this is again a very challenging thing to assess in infants and infancy. But I do think that we can look at the effectiveness of those who do go for a procedure. Right? It's not like, hey, some get a procedure and some don't. It's like, no. Of the children that have chosen to go forward with a procedure, you know, what was their protocol? Let's compare protocols and what did they get before and after and what were the outcomes and let's track them over time. Like I think that would be very cool to see. And then, you know, like I said, tracking them over time, those longer term outcomes, following children with tethered oral tissues over time to observe like how and if food aversions do evolve and investigating like whether the tethered oral tissue release then impacts their dietary preferences, which we know would impact their overall health if it is impacting their diet. So again, I'm not the research brain, but I did a little research on this because I get this so often. I told you this would be super quick. So maybe what we'll also do is talk about some. Well, I mentioned, I mentioned research, but let's also talk about some different like initiatives. So another question that came through was like how might awareness of tethered oral tissues and their impact on feeding and eating habits influence like clinical practice and like public health initiatives? And I kind of talked a little bit of some of the initiatives that I'd like to see especially with like you know, early identification in clinical practice of recognizing tevidural tissues early, allowing for more timely intervention, doing those functional feeding Evaluates, feeding evaluations like at birth or as soon after birth as possible. And I do still think that early identify identification factor is so critical. And then informed assessment, right? We talk a lot about informed consent, but during assessments, right, we can get parent, we can inform others of, hey, when we're doing this feeding assessment, we can also do a tethered oral tissue evaluation as part of the feeding assessment, because that's how it should be done. I think that's a really important thing. And I saw this term pop up that, like I said, said informed assessment. And I was like, interesting. We're gonna run with that collaboration, right? So I talk a lot about collaboration, team, you know, approach and everything. SLPs, pediatricians, dentists, LL, OTPT, lactation, you know, everybody who's involved in that infant, for example, case, you know, or older children and adults. And there's other providers who will be involved as well, like all coming to the table and collaborating to address the, the issues that are stemming from the tethered oral tissues and maybe some of the other symptoms and, you know, figuring out what's what and how best to move forward in a holistic way. Super, super important from a clinical practice standpoint. And then also as that team discussing, you know, frenectomy as a consideration and having the team approach in making that decision as well, based on all factors like kind of being laid out on the table and having this holistic conversation. So important. Okay, so from in clinical practice, that is how I think, you know, awareness of tether oral tissues, their impact on feeding and like eating habits and everything. I think that is how greater awareness and really, truly what I've tried to do with this podcast over the past so many years is try to bring that awareness and bring the education so that we can discuss things like tethered oral tissues and their impact on feeding and eating habits and, you know, you know, just the experience around food, right. And how we approach it in clinical practice. That is a big focus here on the podcast. So I kind of wanted to summarize that a little bit. But from a public health initiative, you know, look again, like, I am not in the phase of my life where I'm going to take this initiative and run with it, but I would love for someone else who's listening to this to do listening to this to do that. And if this can be a catalyst to getting some of that started, amazing. We need more educational campaigns, right? I do that here already on the podcast. I do that on my social media. We need to raise awareness amongst parents Caregivers, educators, medical professionals, like we, we in this industry, in this space that we're in, may feel like we hear it all the time, and we may be sick of it. The more the sicker you are of hearing about it, the better, because that means it's finally starting to be heard by others. Right? So you're not here to entertain yourself in the work you do. You are here to be bored out of mind over repeating yourself so much that your ears bleed. Not really, but that's just the saying. But so that this information is making it to other people who need to hear it, sometimes for the first time, sometimes for the tenth time, and maybe it's finally getting through. Right? Then we need more screening programs. I've talked in the past about how we do this in my private practice, but implementing tether oral tissue screening programs in pediatric health care settings, and that screening should be more than just, hey, can you stick your tongue out? We need to be doing a functional screening, right? Just like I say, functional assessment. There needs to be a structural and functional component to get that diagnosis. We are also not diagnosing from a screen. We're screening to see, do we think there's a problem? Should we refer for further evaluation? Okay, that is super critical. That should be part of what children have early on as infants, you know, following birth, and throughout infancy and toddlerhood, as they have their, their checkups at the pediatrician's office, as they go into other providers for other things that, you know, deal with the oral cavity, that deal with orofacial structures, that deal with digestion or gut health or, you know, anything connected to the mouth. And then, you know, research funding. We basically, you know, a lot of the funding right now is private funding from providers in the space, you know, or, you know, people who know how to write grants. And so if you're interested in seeing more of this research, then maybe get out there and figure out how to help fund the research or how, how to help write grants to, to get certain research funded so that we can get more support behind what we see clinically. Right. And have that actually published in the literature. I know that more of the stuff again is coming out there is some of this being done, but we need studies on that impact of tethered oral tissues on feeding and eating and then the effective interventions that we're all doing. But it would just be nice to have it documented too. So really, by integrating tethered oral tissue awareness, we can improve, improve feeding outcomes, we can improve the overall being of children. We can take them from surviving to thriving. That is something that is so, so important. But I do think that this all starts with you. This starts with us. You know, I feel like I've done a big part here with educating. I will continue to educate on this podcast. You know, we are 277 episodes in as of this episode, which is just mind blowing to me because I started this in the summer of 2019, and we are now in the summer of 2020. It's just wild. This has been going strong. I haven't missed a week. We've had a podcast every single week. But again, it's my passion behind this, is getting the information out there, sharing more about individuals working in this space, sharing more about individuals and professionals connected to this space, and truly just bringing information to the masses so that you all have the information at your fingertips, whether you're a parent or a professional, that can help you understand, like, where to go next with a patient, or what to look into, or how to get your patient help or get your child help, or how to just understand and know that there's more out there that can be done. And you're. You're not. Like, if you're throwing your hands up in the air, like, where do we go next? Like, there's always a solution. I. I don't take otherwise as an answer. Like, there is always a solution to every problem. There is always a way to put out a fire, right? There is always a way to. If something is not working or you are struggling with something, there is always a solution, a resolution. There is something that can be done, right? And if you can't find somebody to help you, maybe you just haven't found the right person yet. And so I encourage you to keep going, push forward, do your research, right? And those of you who can do the research, the actual, like, research is to be published, you know, and you can get involved in some of these public health initiatives. Maybe you have a private practice or you work for somebody, and you can encourage, you know, screenings. You can encourage, like, a program within the practice you work at. You can even, you know, encourage an educational campaign, whether that's providing information to your patients or online or wherever. And maybe even, like, the research funding side of things, figuring out learning how to write grants and finding individuals who want to do the research and then helping them, you know, maybe you donate your time by writing the grant to help them get the funding they need. There's so many ways that we can be moving forward. And everyone's always asking me, like, what do we do next? How do we push the needle forward? So these are some of the ways that we can do that. So I hope this helps. Super quick Quick episode today. Hope everyone is enjoying their summer and I'll talk to you next week. 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@halliebulcan.com or pop over to alliebulcan on Instagram to get all the latest updates.