Episode 281: Rushing To Release with Hallie Bulkin

Hello my friends and welcome to episode 281 of the Untethered podcast. It is your host, Hallie Balkan. And before we dive in today into answering one of our member. Well, someone who is a part of some of our member, our membership and some other things. But this, this question came through Instagram. Before we jump into answering that question, I do want to let you know real quick that that the free training screen the peds to feed the peds is returning. Yay for I think this is the 15th time we've done this since March of 2020. Holy cow. So it'll be coming back September 9th through 13th, 2024. So you're going to want to go to feedthepedes.com backslash training to join. That is a free five day training. You're going to learn how to use that free pediatric feeding screening packet that you probably have sitting at the bottom of your inbox somewhere. If you do, that's okay. No worries. Join me that week in September so that we can get together. You're going to see me screen my two year old. Then we're going to screen my four year old together. We're going to discover how to make sense of all the screening results, make next step recommendations. You're going to learn the fastest way to then launch yourself into treating pediatric feeding cases after that screening is completed. So go register for free. We have had over 23,000 SLPs and OTS go through this free training, which is wild to me. We've had over a hundred and I think it's 103. It might be 105,000 SLPs and OTs download the free screening packet which is even wilder. So join us because we are grabbing the bull's horns right by. What do you say? Grab the bull by the horns. That's saying. And we're taking things into our own hands. Children need to be screened so we know who needs to be assessed. Those critical sensory, oral, motor feeding skills are being missed. So way too frequently and we can address these things. Plus tethered oral tissues and early signs of myo, you know, orofacial myofunctional disorders, certain symptoms that may already be present even at birth. These are the kinds of things we're going to dive into. So join me again. That's feedthepedes.com backslash training and that's that. Let's jump to today's episode. 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, Holly 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. 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. Okay, so what are we talking about today? Well, I had this wonderful question come through and I know we've talked about it in the past, but I wanted to address it on today's call because I feel like it's something that comes up frequently and that is the topic of reattachment surrounding the conversation of appropriate timing for a tethered oral tissue release. Because as this person points out, there's a lot of variability amongst providers. So we could talk about this topic for hours, but we're not going to. This is going to be maybe a short episode. I want to say it's going to be short, but and that's because. Well, one. I talk about this in the free training that's coming up. 2. I talk about this inside the feed the beads course. 3. From a free restore standpoint, I know we've talked about it here on the podcast, but I also have a blog. If you haven't been to the blog before, go to Halibalkin.com and go click on Blog. It's in the top right and you'll see if you go back to like September of 2023, I have an article titled Rushing to Release. That's a really good one to read. And I have another one that followed on September 27th of 2023 on how long does it take to prepare for a tongue tie release? And so those two alone would be a really good time, a good way to jump in. There's also how long does it take to heal from a tongue, lip and or buckle tie release? That's October Thirds article from last year. And so those three articles are probably going to be some really, really great solid reads around these topics and they're really great to share with families who are also wondering about these same topics. Right. But all that said, right, let's say you're a provider or maybe you're a parent and you suspect something more is going on, right? You're kind of like, ah, there's something more going on here. I'm not sure if there's a tie at play, but what if there is? Okay, so you suspect, right? And let's just, let's just talk about tongue ties. And you know, that'll encompass everything from tongue lip buckles. When should you schedule the release? Well, it shouldn't be right away. And I know so many people are like, wait, but don't we want to deal with it sooner? Because the child's just going to keep developing and they're going to have the snowball of issues. It's going to continue to snowball and it's going to be harder to undo things. Pump the brakes. While a release provider is an important member of the team, they are not always the first person that we want to go see. It is important to see them and it's important to see them early on, but we want to have the primary feeding team intact first. What do I mean by that? If you're breastfeeding, you may be working with an IBCLC or other lactation, you know, credentialed provider. That person may also be an SLP or an ot. If you're also bottle feeding, then you're going to likely have a feeding therapist like SLP or OT on board. For example, if you are transitioned to solids already, then you're definitely going to have one of those feeding therapists involved because it's no longer just about breastfeeding at this point and or bottle feeding. Right now we've moved beyond it where you absolutely need a feeding therapist involved in that as an SLP or an OT by license. So that release provider is the person who's going to be extremely important on this team. But that should be a referral from the person who does the baseline evaluation and sees how things are going before releases ever happens. Why do I say this? I can't tell you how many times my own private practice has received calls in the past. Thankfully, this is not common anymore. But we've used to receive calls like years ago where we get a frantic parent calling and saying, my child was just released and the provider said to give you a call so that you can start working on post release exercises and, you know, function and all that. We're like, what like we don't know what your child looked like beforehand who prepped this baby for this procedure. And okay, now that your child is uncomfortable, we're going to start working in the mouth now. Like, there's just a lot that is not ideal about that scenario. Now if you lived through that and you had a child who was not prepped properly, that's life, right? That happened. Don't judge yourself. You did the best with the information that you had at the time, right? Or maybe you made that choice and you said, you know what, I don't want to do all this pre op and you have that information anyways and you made a decision to proceed forward. That's your decision. Own it. Right? But in a perfect textbook world, that child and yourself as the caregiver need to be properly prepared. And there's a lot that goes into that preparation. Okay? The timing of a tongue and lip tie release is critical because the magic behind it, right? The success that we see in tongue and or lip tie or, and or buccal tie releases is in timing it properly. And so one of the big things is the body needs to be properly prepped for the surgical release. Every child and family unit moves at their own pace. And so while we may have some patients who are ready for release quickly within days or a couple weeks, there may be others who take longer. And the same thing can be said for the healing process as well. We have to allow our body to heal while it's also working really hard to gain optimal function following a release procedure. And those who do best following the release procedure are those who are properly prepped going into it. How do I know? I've worked with dozens of children who were not properly prepped. And I can tell you that every single time, those who were have better outcomes, better results following release. And it's much easier. The child is more, is calmer. The child's nervous system is usually more in check or it's easier to bring it back in check. And when I say in check, I mean like rest and digest babies. Relax. Baby can more easily feed. A child who is not settled is going to have a really hard time feeding. Okay? And these are the kinds of things that we need to think about, but that are not commonly discussed when it comes to tongue tie releases and lip tie releases and buckle tie release. Okay? There's no magic bullet here. There's no magic pill you can take as a parent to make this, you know, go super easily. Hopefully it will go easily, but you're gonna have to put in the work. And it is work. And anyone who tells you otherwise is lying to you. I'm just gonna put that out there. So the success truly comes from the timing being properly addressed. Right. So that correct timing for the release and by working with the right team of professionals leading up to the release and following the release. Okay. When you skip this, when you don't follow these necessary steps, and I can't tell you the exact steps that are necessary for your child because that falls under a functional evaluation that needs to be done by the proper feeding therapist or lactation provider. And so. And, or Right. Sometimes you have both. But when we see poor outcomes, Right. With continued difficulty with breastfeeding, bottle feeding, reattachment symptoms that, you know, were present from that, that tie to begin with, that sticks around after the release, well, that's because either the timing wasn't right or the, you know, the baby or the family unit was not properly prepped, possibly. So we need to be consulting with the right team and that team needs to be specialized in tethered oral tissues, sensory, oral motor feeding therapy, lactation, if that's involved. If you're breastfeeding. Right. Your baby and or MYO for like an older child. Okay. And that person should have a network of professionals that they refer to and that they work collaborative. Collaboratively with on a regular basis. There is also something to be said about the age at which we are addressing these. These. You know, someone came to me the other day and said, I'm confused about who treats children under the age of 4 versus over the age of 4 for myo. And I said, we'll pump the brakes. Traditional myofunctional therapy. Since we're talking about releases and that that may be a therapy needed, let's just clarify this, you know, for the 5,000th time. Not really, but feels like it. Under the age of four cognitively, that means that you need to be functioning at the level of at least a 4 year old. If you're over the age of 4, Myo is great. And that can go all the way through adulthood. Traditional myo and those providers who can provide myofunctional therapy include SLPs, OTs, PTs, RDHs and dental providers. Okay. That's who can do Maya, who can work with these children even if they have myo symptoms under the age of 4 cognitively. And when I say cognitively, I'm sitting here pointing towards my brain on both sides of my head as I'm saying this. Not that you can see that unless you're watching this on YouTube. Cognitively, like your brain, right, needs to be functioning at the level of at least a four year old cognitively. And I say that like five more times. Who are those people? Well, those are infant toddler feeding therapists. Right? And so a feeding therapist by license is an SLP or an OT. Sometimes PTs who have specialized training, Lactation providers also can work with these children. But lactation providers are working on things related to lactation, like breastfeeding, for example. Right? So that's how you kind of figure out like, who do I need to go to? Very simple, very straightforward. It's based on licensure and if someone tells you otherwise, they're working out of scope and without a license. And that's actually illegal. So I do apologize because apparently this is a rampant issue. So please know who you're referring to. Please know who you're calling. Please find out what the credentials are of the individual that is offering to do therapy with you or your child so that you make sure you're paying somebody and going to somebody who can actually help you and is licensed to do so. Okay, so what do these professionals do? They're going to assess the function of the muscles. They're going to recommend an appropriate treatment plan to prepare for a release, if that's what the next step is. And they're going to help make referrals to other professionals that need to be on the team potentially. And so that preparation, right, that takes time. And again, there's no magic pill. We don't have a crystal ball. And nothing will tell us exactly how long it will take, despite how many times parents ask us. And because there are just so many factors, right? Age, involvement, compensatory patterns that are present, you know, the current anatomy and function of that anatomy and that individual, that human sitting in front of us, right? And so much more so, so much more. So the bottom line here is that without the preparation, we are going to see suboptimal, suboptimal outcomes. Okay? Tongue tie releases are kind of like a use it or lose it situation. If we release the tongue and it's not prepared to move in all new directions and work functionally, right, do the function that's intended to do. This alone can cause reattachment. And so if you think about that, right, we've got this newly free tongue, it gets released and it just continues to lay on the floor of the mouth, what do you think is going to happen? Like that's a perfect scenario for reattachment to occur. And that's the opposite of what we want. Right. We also see the body tension sometimes and strain and people with oral ties. And that is why you might get a referral to a body worker, whether that be a cft, cst, pt, Cairo osteopath. Right. And in no particular order, you know, just something to be aware of. We have to address that tension throughout the body as well. That is a critical step in preparing for the release of any oral tissues. So before rushing to a release, let's stop address the big picture. Because releasing tissue without proper care is. It's a waste of time, it's a waste of money, it's a waste of energy for everybody. And it can actually make things worse for your child or for the child. Right. For your patient, our goal is to gain and restore function and make sure that it's optimal so that the child and the family unit can thrive. So let's keep that in mind. Let's collaborate properly. Collaboration brings the best outcomes. There is no one protocol for, oh, we need three days or three months on this and that. No, it is so individualized. And I think that's why there's so much variation out there, because people see what works in their practice, but they also are working with humans and we're also different. Right. So you got to figure out like what is the best collaborative team for you and ultimately what are your outcomes that you desire? What are the goals? Because that, that's what we want to keep front of mind when we're working towards releasing tissue. Okay. So we just covered why we don't want to rush into release. We talked a bit about what it takes to in general. Right. Prepare for a tongue tie release here. I can't say it. Tongue tied. And so the idea, right, just to review, is that we, when it comes to preparing and figuring out how long it takes, we don't really know that information until we get working with you or your child. Because everyone responds differently and we need that thorough functional assessment to figure out what we need to do to help your child. Sometimes we may even be able to avoid a release that is possible. But we don't know that. We don't know that until we start working. We see if we can gain a function. Right. And then if we're unsure, that's when we may refer you to the release provider. We'll consult with them, we'll collaborate, and that's where we figure out everything else from there. So hopefully this helps give you a good idea about why we don't want to rush into release. And a little bit about what it takes to prepare for a tongue tie release. Join me on the next episode so that we can talk about how long it takes to heal from a tethered oral tissue release. All right everybody, this is Hallie signing off. 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 Podcast and share this episode on your social media platforms. You can access free resources and all I offer@halliebulcan.com or pop over to hollybulcan on Instagram to get all the latest updates.