Mouth Breathing vs. Nasal Breathing: Changing Lives Through Early Airway Intervention

We've seen parents like fall in love with their kids again. Not that they don't love their kids, but their heart, they get stressed because of the behavior issue and all that mellows out. And now the families are bonding, they're closer, they have better relationships with their children. They want to be around their children and do things with their children. And everybody's sleeping better, not just the kid, but the parents too. And I think that is just that ripple effect that just keeps going and going and going. That sometimes, honestly, when I started my away centers for kids, I didn't anticipate that.

Welcome to the Untethered Podcast.

I am your host, Hallie Bulkin. 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, temporal 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.

Hi, and welcome back to the Untethered Podcast. Today we have Dr. Leslie Pascoe joining us. Dr. Leslie is the founder and president of MyoWay Centers for Kids. She spent nearly 3 decades in dentistry digging into how airway and muscle function shape a child's growth. Growth, sleep, learning, and overall health. Instead of chasing symptoms, she focuses on early screening, functional assessment, and bringing other providers to the table so kids actually get the full picture of care. Her mission is simple: help kids grow right, breathe right, and live better. What I want to do before we jump in with her is have you think for a second about what if the kids being evaluated for ADHD— I was one of those— are actually kids who cannot breathe at night, because our guest today has been quietly making that case for almost 30 years and the science is finally catching up.

Yay!

So Dr. Leslie, welcome to the podcast.

Well, thank you. Thank you for having me. I really appreciate it. I always love sharing this information, especially with like-minded people like you and the audiences that you send your message to. Yeah.

Thank you for joining us. I'm excited. I love when I can have these conversations with others who understand, and I know that our listeners are going to greatly appreciate this conversation today. So will you share with us, to kick things off, you've spent almost, what, 30 years in dentistry. What was the moment that you realized airway and muscle function were that missing piece in pediatric care?

Yeah, I would say it probably wasn't until maybe about 5 to 10 years ago, probably closer to 5 years ago, putting it all together. But I can say that over my career, the thing that prompted me to look further into it was that as a dentist, when I first got out of dental school, which was a while ago, you know, it took me just a few minutes to take a look at my patient's medical history. Going through that, it was very easy, straightforward. But as my career went on and towards the end of my career before I retired and got into what I'm doing now, sometimes it would take me, Hallie, about 15 minutes to get through someone's medical history. Sometimes I'd have to look at it even before the patient came in because it was so extensive. And in my mind, I'm thinking, good medicine, shouldn't people be getting better? And less sick, and shouldn't their medical histories either at least be where they were nearly 30 years ago or better, not getting worse and taking me this long to go through. And as I started to do a deep dive into the information and looking at the research, what it really comes down to is how we breathe. And this dysfunctional breathing happens mostly in early childhood. And if we could get in there and we can change the child's jaw and airway development and improve their breathing habits, habits, they have a better chance at being healthy for the long haul. And that's really what motivated me to do what I'm doing.

I love that. I love that. You have— I know you talked about the facial recession. Will you explain to our listeners what you mean by that? Like, why? And you just mentioned we're seeing smaller jaws, right? That's obviously leading to more crowded teeth in kids compared to two generations ago. So can you speak to that a bit?

Yeah, I would love to. Sometimes you might have to stop me because I tend to get off on a tangent on this, because I have to tell you, this anthropology, the study of and our bodies and how they're formed and what makes them do what they do and shape the way they shape. It's so interesting. And I'm addicted to reading this information. In fact, before we hopped on here, I had just finished the book by Daniel Lieberman, The Human Body, The Story of the Human Body. And I have pages and pages of notes and all kinds of thoughts and ideas going through my head. Now, based off of that information, the anthropology and all of the science, I wrote this book, it's called The Great Contraction, and it really is a cry for all of us to come together and collaborate to help these children's jaws and airways grow properly at an early age. Really what it's coming down to, Hallie, is our bodies are genetically the same as they were 10,000 years ago, but our environment is different. And as you see with what you do as well, our bodies are really mal-adapting to our current environment. So we have Stone Age genes living in a modern society, and it's just the body's way of trying to survive and trying to get through because we're not exercising our jaws, eating the foods that we should be eating the way that we should be eating them. There's chemicals in our air, chemicals in our food, chemicals in our home. Our houses are being sealed more and more to be more airtight. So less airflow, less healthy breathing. There's so many contributing factors. And when those muscles aren't working properly, the bone suffers. As we know in medicine, the bone submits to muscle, and if those muscles are weak, the bones are weak. They're not gonna grow to their full potential. And the science shows that it happens as early as childhood and even before that in utero, depending on a mother's diet. So there's a lot of things that we need to know and understand to be able to grow and raise good, healthy children into aware and healthy, productive, contributing adults in society.

Absolutely. And you mentioned in utero, and we know on the pediatric feeding side of things, we look at the fact that the swallow the child will be born with is already in place by 12 and a half weeks in utero, and it's highly dictated by where that tongue is sitting in the palate or not already at the end of the first trimester. And people don't really realize like how impactful that is because this is not just happening once the baby is born.

This is—

we're already two trimesters into to this pattern that's been developed. And now the orofacial complex is shaping around that. It's already been shaping around that.

So yeah, that's right. That's, it's a habit, right? It's, it's an improper swallowing habit that came from whatever message it told it to operate that way. And that habit has to be broken. It has to be retrained. And it's a muscular retraining, a neuromuscular retraining. There's so much involved in it. So I think sometimes we forget just how amazing the human body really is and how much effort and thought and design goes into all of this. Good to take a step back and take a look at it from time to time.

Absolutely. And that kind of leads into mouth breathing, right? Like, you're just— you were talking about these habits that we develop. And so these babies that we see, sometimes they come out of the womb— yes, babies have to clear their airway, but babies should— we are nasal breathers, we are not mouth breathers. And I think people really go, wait, babies should have their lips closed? Yes, As they should, as should children and adults. And so I think people feel like it's very harmless, have been almost taught that this is okay for them to breathe that way, and many providers believe that too. So talk to us about— I know everyone here hears me preach about open mouth breathing versus nasal breathing all the time, but it's like a physiological alarm bell going off. And so can you share a little bit about that with our listeners? Because chronic mouth breathing does do something to a child's development.

Oh, it certainly does. From a dental standpoint, mouth breathing dries out the mouth and it creates havoc, increases the chance of inflammation and gum disease and decay. And I have to be honest with you, early on in my career, when I would see a young kid that had decay, a rampant decay in their mouth or decay in the front teeth, our first instinct is to blame the mother. Oh, you must be giving them sugar. You must be giving them a bottle before bed. No one taught us in dental school that it's mouth breathing that could be contributing to that, or most likely is, because I've had parents say, we brush their teeth, we floss, we don't give them any sugar. Why are they getting all these cavities? And when, as dentists, we're kind of trained to go, oh yeah, sure, sure. Brush them off to the side and say, use more fluoride or do this or do that. But the truth really is, Hallie, is that it's the dehydration of the mouth that's proliferating the bad bacteria that's causing the acidic environment that's creating the decay and the oral disease. Disease process. So we look at that, but to me, and I know this is hard to believe, but as a dentist, that's the least important thing. What's really important is to understand the chemistry behind the mouth breathing habit, and that chemistry can completely change the proper growth direction of that child, both mentally and physically. And I'm sure you've had other people on this show that have talked about these things before, but the thing that I wanna really stress to your audience is it's not dangerous. It, to me, is one of the most dangerous situations for a child's growth and development because you have to think like the human body thinks. You have to think like the brain would think, and the brain is just a computer that operates off of the information that you give it. And that information that comes to the brain when a child is mouth breathing is that the child is in danger because mouth breathing is reserved for dangerous situations for short term use, maybe 30 to 60 seconds until you get out of that dangerous situation. Mouth breathing is to bring in more air, but to supply more oxygen quickly, say to your extremities, like your limbs and your arms so that you can get away. So what does that mean? That means that it's taking all of the energy away from what a child needs to grow and develop because mouth breathing turns on the sympathetic nervous system, which turns off the parasympathetic nervous system, which is what's needed for growth and rest and digest. And kids so desperately need that. Adults do too, but kids really need it because that prefrontal cortex is developing at these young ages, 3, 4, 5 years old, all the way through into their teenage years. That's why as parents, we don't wanna let our kids do anything until they're fully developed, if that ever happens. That prefrontal cortex is so important for that cooperative behavior, that linear thinking, the analytical response over the reactionary animalistic type of response. So when children are mouth breathing, that's one problem, their dental issues. The second problem is their brain development. But then the third problem is the chemistry behind what's going on with the carbon dioxide process, because mouth breathing then also makes us intolerant. We're blowing off too much of that carbon dioxide and we can't release the oxygen that our blood cells are holding onto. So people will tell you, oh, to get more air, to get more oxygen, you have to breathe through your mouth. That's completely false. And actually it's inefficient and ineffective during exercise, during sleep, and during everyday function. You're actually preventing your body from utilizing the fuel that you're giving it because your red blood cells, the hemoglobin, is holding on too much to that oxygen without the carbon dioxide. Tolerance, the CO2 tolerance. So it's dangerous. It's very dangerous.

Yeah. No, that's such a helpful lens to look through. And I know we're gonna talk about Buteyko and everything as well in a little bit because we'll, but before we get there, I wanna talk about like how the danger I see too is even beyond that. It's into talk, talk to me about the kids who land in your office that have ADHD as a diagnosis, but they actually have sleep disordered breathing because I know this was me as a child. I didn't know this until I was an adult. I was diagnosed with upper airway resistance syndrome as an adult. I've had dental expansion. I had my tongue tie released. On myo myself, worked on breathing, worked with PRI-trained PTs. I'm now working with a pelvic floor PT who's PRI-trained in a whole host of other things, Herman Wallace, all the things. So as an adult, I've been there as the patient. I was also the child. I now also have children who have gone through, and honestly, I think one of my kids would've looked very ADHD had we not expanded early. Had we not done myo, had we not focused on her breathing and her nutrition and all the things. And she's still that kid who bounces around a lot, but she's in that rest and digest. She's not in fight fight or flight, right? Because we've done all of this work and that's just who she is as a kid, but she can focus when she needs to. She's not getting that diagnosis. However, there are so many kids— we've had 5-year-olds come to my practice on uppers and downers, stimulants and all, 5 medications at 5, at age 5. And I'm going, did anybody do a sleep study on this kid maybe before putting them on all these prescriptions? Because forget even asking about a sleep questionnaire, or did we even do a study? No, no one ever even talked to us about that. So anyways, I want to turn it over to you, but I'm just curious to know, do you see this in your office?

How frequently?

Well, we see it all the time. And in fact, a lot of parents are coming to us because of that reason. They're at their wit's end. They don't know how to handle their child. They've heard that changing their breathing patterns can help their behavioral patterns. And so they're coming to us and they're asking us for screening and asking us for the information. And some of it is because they're not getting the information that they want to hear from their pediatrician. The pediatrician is just brushing them aside and saying, oh, they'll grow out of it. Don't worry about it. Oh, it's just snoring. It's not a big deal. And parents Parents are becoming more and more educated, thank goodness, and they're looking for answers themselves. And I have to say, the medical profession, we all have to be on board and understand what these parents are reading and understanding, because if we can't have these discussions with them, they're going to go find another provider, and that provider might not help them with what they need. But we have parents bringing their children in also too, because they're trying to get into sleep studies, but they can't because there's only so many of those available. Some of them are waiting 6 and 12 months before they can get in for something like that. One of the things, and you can see this on our website too, the science and the research actually shows in some of these younger kids, especially 3, 4, 5, 7 years old, sleep studies are actually considered inconclusive and that's why insurance companies won't pay for it. And so if you take a look at oxygen saturation versus oxygen use, it doesn't give you any of that information. So the sleep questionnaire is actually very valuable for these small children. And when we go through that sleep questionnaire at the beginning, of their therapy and then we go through it at the end and we don't have any more checks on the yeses, it's such a good feeling and parents are really happy with it. Their behavior improves because they're breathing better, because their brain is developing the way that it should, and they're breathing better because we're telling the muscles what to do. We're reprogramming them with the therapy that's being provided, and parents are just ecstatic about that because they're not getting those answers anymore. Somewhere else.

Absolutely. Yeah. And I'm completely in agreement with you. We tend to actually, in our assessments, we're screening for certain— using certain screen screens for pediatric sleep and then referring onward. But most of our patients don't go for a sleep study, right? But it's— and it is, I think, for reasons that you shared. Yes, there are waitlists, but also inconclusive. And I've always said to parents, if you— if that's what you really want to do, go for it. But putting a child into a very unnatural environment with all these things hooked up to them, your child's not going to sleep like they normally do. It's not a very accurate picture regardless of the information we can grab from this or not. I always ask parents when we do assessments to take videos of the kids and send them to us, different clips at certain parts of the night after they've gone to sleep. And that is— that alone, also in addition to like you mentioned, the sleep questionnaires can be such helpful and valuable information. Is there anything else that you would recommend that like feeding therapist or myofunctional therapist or SLP, if that's the person referring, whoever's referring to you, that screened for either before assuming behavior is the issue, which I don't, but, or even referring to you all and the work that you're doing?

As far as their sleep goes, is that what you mean? What you could be looking at?

There's like other things, obviously, like the PSQ. I don't know if that's what you're using or other questionnaires, but are there things that if someone was to refer to you, whether maybe it's not somebody in this space, but they're going, I think they need to see you, is there something helpful that can be done by another therapist before referring onward to you?

I think one of the things that often gets overlooked that is telling us that the jaws and the airways are suffering is the position of the bite and the teeth. That tells me a story, and that's what makes what we're doing unique as well, is we have these viewpoints from a dentist, the Buteyko viewpoint, the occupational therapy viewpoints, the myofunctional therapy viewpoint. We have so many different viewpoints to put together. Most people think that crowded teeth are genetic, and really, up until I looked for the truth, I did too. That's what I was taught in dental school. Dad has crooked teeth, kid has crooked teeth. But the science shows that it's not that. That is not genetic. The size and shape of the teeth and the color and your gums and that stuff is genetic. But our bodies are perfectly engineered to— and designed to grow to the full potential so that all the teeth can come in straight like they did 10,000 years ago. They didn't have impacted third molars or crooked teeth or need braces. In fact, they had movie star smiles before the movies were ever thought of. I think when an S— and we work with SLPs a lot. I think when an SLP or any other type of therapist looking at this, these children shouldn't discredit the fact that their bite is bad, or that they don't have spacing between their teeth. A lot of parents get really nervous about that spacing between the teeth. Oh my gosh, there's too much spacing. It's not— is that how it's supposed to— it's supposed to have— the primary teeth are supposed to be spaced. Spaced. That's showing good growth patterns. But if those primary teeth or even the mixed dentition, if those things are not spaced or they're coming in crooked or teeth behind other teeth, that's muscle dysfunction. And muscle dysfunction is breathing dysfunction, and those things need to be corrected. So that's one thing that I would say. There's the sleep questionnaire, and that's really important in screening, but also visually looking at the face. For the indicators, but also looking at the mouth. Most people know to look for that high vaulted cathedral-like palate. That's the big talk of everything right now. Palatal expansion, it's really good, but that, and I'm gonna say it and just be truthful, you have to do myofunctional therapy if you're doing palatal expansion because it forces the tongue in the low position and it develops that low tongue posture habit. And the science and the research shows, and all these science articles and research articles I didn't do the research, but I studied them. They are on our website, that myofunctional therapy, when it's paired with rapid palatal expansion, increases the nasal airway volume. But when you take myofunctional therapy out of the palatal expansion equation, they'll get some increase for sure, but not as much as if they pair them both together. So yeah, I think people know to look for that, but sometimes I think they just misunderstand that crooked teeth are genetic, and they're not. It's lack of and muscle dysfunction.

Yeah, no, and I think that's very helpful because I know none of us were taught this in graduate school. We weren't even taught pediatric feeding. We've all, for the most part, learned that post-grad. And so myo definitely wasn't taught either. And that's one of the things we don't diagnose or move teeth for a living, right? We deal more with the muscles. But I try to educate everybody on we still need to understand what malocclusion looks like. We need to understand when there isn't enough spacing because that right away, it's a visual. You get this window into the mouth because most of these kids have mouth breathing habits, immediately you can see when something is off, right? And I had a kiddo, not a kiddo, my own child had like shark teeth, right? She had that second row of her lower central incisors growing in behind the other two. And I'm going, this kid has already had some expansion. What is happening? And she went through two more rounds after that. But, you know, the dentist who I love, but he was like, oh, it's fine. They'll grow in, they'll push the other two out, and then her tongue will just push them forward. And I was like, I was like, well, you're not wrong in the current state of affairs. However, when we move into the myofunctional therapy and get that tongue up, when she has more space in her palate, that's not the answer that we want to be telling parents. Can we not? I was like, let's not do that. And he's absolutely right, because that within a matter of months, that's what happened. We weren't working yet on her, on getting her tongue up because she just didn't have the space yet, was about to go through more expansion. But I was like, oh my gosh, he was right. And I hate that he was right. And that's Unfortunately, what we see so frequently, right? So, but yeah, it's— I can tell you from my pre-MYO days to my now post-MYO days, and I've been in the myofunctional therapy space since 2017, night and day, absolutely night and day. And I was also an orthodontic relapse case. You know, I had permanent retainers placed behind my lower and upper, you know, arches. And I was told at age maybe 12, oh, they'll fall out by the time— maybe was 13— they'll fall out by the time you're 20. 20 rolled around. 30 rolled around, the dentist is always saying, you're having a hard time cleaning behind your teeth. Yeah, there's glue and there's something in the way. So I finally was like, just take it out. And immediately my teeth started to shift. And I went back to the dentist who was a family friend and I said, hey, my teeth are shifting. He's like, no, my teeth are shifting. And sure enough, they just continued to turn because my tongue was pushing them into that position. It was not where it was supposed to be. Right. So that's when I say I've lived this as the mom. The patient, the clinician that, you know, the wife even as well, but that's a whole nother story for another day. It's, you see it everywhere and it's such night and day when you, because I've now lived going through myo more expansion and I've done it with my children and I've done it with my patients, right? Everything that we see in the research is what we see in practice.

Very true. Very true. And I think you made a really good point earlier on, you know, our education is our foundation, but it's not everything. We have to continue to grow and enhance our knowledge because it's very limited information that we're given in the educational environments. It shouldn't be that way, but it is. So coming out of school, you have to be willing to dive in and look at what is really out there and what the truth is, because they're not always telling you the truth in dental school or in, you know, in our part of the world, in graduate school. So like I know in dental school, they had to, what I was taught was, oh, teeth grinding is they're growing, you know? And so I walked around with that false false data for years and years because if someone was grinding their teeth as a child, they were growing. It wasn't an airway issue or muscle dysfunction or, you know, the lateral pterygoid not balancing out with the mass, you know, the medial pterygoid not balancing out with the masseter, you know, oh, it's not that, oh, it must be stress, it must be stress. No, it's muscle dysfunction. I have seen stressed out 3-year-olds, believe it or not. It's sad, to see, but that's because of their breathing dysfunction. You have to be willing to look for the truth is what I'm trying to get at here. I think practitioners like you and I, and there's plenty of us out there, they want more answers and these parents want these answers too. And I believe it's our responsibility. Our education never ends. Once we graduate, as hard as it is to study more, because you kind of get sick of it after all those years, but you gotta still do it. So those young practitioners out there, I'd say, you know, you got to continue to expand your, your horizons and your— if you really want to help your, your patients.

Absolutely. I always say the best medical professionals are the ones that are lifelong learners, right? You're consuming more information, research is constantly changing, your clinical experience is kind of keeping you afloat in the meantime. But yeah, I mean, it's— you had mentioned earlier, and I want to dive back into this a little bit, how we can use myofunctional therapy to stabilize the airway, because you mentioned in combination with expansion, that's where we see like the nasal airway, actually, you know, nasopharyngeal airway actually expanding. It's not just like retraining the tongue, right? So it's not just myo. For people who are wondering, you know, and I think most of our listeners know, but in case anybody's new here, can you talk a little bit about like the nasal airway and what that is? And because I know, you know, we also as feeding therapists on the other side of this learn sometimes about like the lower airway and the dangers of of things going into our lungs, and we're really focused here more on like that upper airway. So will you just share a little bit about the upper airway and anything you think would be informational or helpful for our listeners?

Yeah, sure. You know, in my world, in dentistry, the upper airway is it. I mean, that's where our primary focus is. When you see a kid with a long face or the dark circles under their eyes or the buck teeth, right away it's like, focus on the upper airway. Get that palatal expander in there, widen it up, you know, flatten out the roof of the mouth and the floor of the nasal cavity so that the air can flow through better and hunky-dory, you know, that should be it. And that's how I practiced dentistry for years. In fact, there was one orthodontist in my area that I always knew when children saw him because I could tell by the smile that they saw this orthodontist because they weren't shy to expand. And that's a good thing. And actually, that was sort of my introduction to what I'm doing now, believe it or not, is the importance of not just straightening out the teeth, but the airway. And then that's when I started connecting the dots and going, wait a second, you know, and that's when I kind of came up with and what led me to where I am now. It is very important. It's important to increase the volume there, but it's also important to decrease the resistance by making sure that good breathing function is occurring. So there's— changing that is really changing the form, you know, and then you have to include the function. Then you also have to think about the fuel, the air, and how that individual is using that. Where I tend to focus now more is not just that upper nasopharynx, but the oropharynx and the air tube. And the way I explain it to parents is, is if we get that genioglossus muscle to function the way it's supposed to, It actually can strengthen the air tube because of the way it's attached to the hyoid bone and to the air tube. And, you know, and good breathing on top of that and being able to tolerate CO2 buildup in your system, you know, gives you more strength in your soft tissue, you know, in the smooth muscle. And, uh, that keeps your airway firm and open rather than collapsible and resistant. Uh, so it's kind of a combination of that. So I'm all for that, uh, that upper airway. I, I did some research on where palatal expansion came from, it didn't come from an orthodontist, it came from a ear, nose, and throat specialist, you know, they were, they did it in an effort, you know, to actually open up the airway, it wasn't to make a nice smile. And if you go back and you look at the history of even orthodontics, orthodontics started as muscle function, not as braces. So, so it's really interesting to go back in time. And I'm the type of person that likes to think about the future. And I think I think it has to be a good balance of the present, the past, and the future. You have to be able to plan the future for these little kids that you're seeing and your patients that you're seeing, but you have to be able to use data from the past and learn from it and be able to explain that in the present time so that, you know, your patients can get the best treatment that they can get. So it's really a combination. And then, you know, you can get into like the lower part of the airway, you know, where the pulmonologist is or the, uh, breathing specialists, you know, are located. And there's so much, if you think about it, the nose is first, then it's the nasopharynx, then it's the, you know, your lungs and all those tubes associated with that. So there's two precursors before the air actually gets used. And so what we're doing and what you're doing, it's very important.

Absolutely. Absolutely. Thank you. I think it's always helpful for everyone to get a little refresher or sometimes hear for the first time, like what specifically we mean with the airway, because I think that a differential between the upper and lower, obviously it all works together. However, we are talking about different things. So do you also get a number of patients coming to you because they think they have a tongue tie or a lip tie or those, those tethered oral tissues? And is that, I'm assuming that's a part of your functional assessment?

It is. It is. We don't treat them. We refer them. Could I treat them? Sure. But my facility isn't set up as a dental office. Strictly a myofunctional and breathing facility. So I don't have any dental instruments, mirrors, explorers. I mean, we barely even use gloves, you know, like it's, it's, uh, it's, it's very different. So we, we work with specialists in that area to provide those releases, but we do them. Uh, we do do the screening. We know exactly what to look for, especially with my background. And we make the referral from there. We can do that as early as birth. I think the youngest person we had come in was 17 days old. And then, you know, we can do it into adulthood. I just recently finished treating a 40-something-year-old that had sleep issues. So we can do the screening process. I have to, you know, be truthful and fair and honest with this. Back in the day, I was a little more resistant to jumping into releases. But after doing the research and seeing the dramatic changes that occur, With children and adults, when a release is done, both from a feeding standpoint, which I don't understand it as much, that's not my specialty and we don't focus on that, but also from, you know, a sleep and breathing standpoint, I'm, I'm definitely less shy to talk about it and to tell parents that it's something that they should consider. If we feel that the therapy is kind of stalled or slowing down, or of course if it's very obvious, with a grade 3 restriction or a grade 4 obvious. You know, most pediatricians will catch the grade 4. That's pretty obvious. Anybody could catch that. But when they're looking at restrictions in the grades 2 and 3, they're just not equipped to understand that, observe the measurements and the function. They're just not equipped for that. So we do, we do work with that.

Yeah.

And I know you, because I've done a little research on you as well, because that's what I do. I love to understand things. I really do. You know, I know that, um, you're a big proponent— I believe I got this right— of doing the therapy before and after, and I feel the exact same way. I've seen so many failures because nothing was done, and I think most practitioners think it's, oh, you know, you do the release and then you do the therapy. You got to get everything ready, get it ready you know, to go before you do that release. And I can't stress how critical that is.

Yeah. Well, and you made the point that, you know, when you get to the point of therapy where we're not making progress anymore, we've stalled, we've hit a wall in therapy, that's usually a pretty good indicator for cases that are more borderline where we go, well, I see it, but like, what's the functional impact? We're not just going to release tissue to release tissue because it looks tight. You know, maybe they're compensating well, but maybe if it's a baby, they're not going to compensate so well if we release it, right?

There's always so many considerations.

Nobody has magical crystal ball to know how it's going to go. And so I feel very strongly about making sure that, like, if we are referring onward— and obviously we're not making the decision about release or not release— but if we're referring, I, I want it to be because we know the child is close to being ready for this release, and we've hit a wall, and there's a functional impact, and feel really good about that referral. Because, you know, on the other side of things, if parents come back and the release happens and they weren't prepared and and, you know, it's just, it's a mess, and nobody wants that. It's already a stressful enough, you know, experience for a lot of parents. As much as we try to keep them in rest and digest and help their nervous systems along this journey, we really try to make sure that everybody feels really good about going through that process because we know it's going to be a little angsty regardless of how prepared everybody is.

Yeah, yeah, yeah. It's— if you look up the history on tongue-tie releases too, you'll see that it's been going on for hundreds of years. In fact, when a baby was born born, especially into royalty, that was the first thing they do, the midwives, they specifically, you probably learned this, I'm sure they grew their nail so that they could cut that tongue tie with their fingernail. Oh my gosh, how barbaric, you know, but in those days, you know, if you didn't eat, you didn't survive. And there were a lot of infants that couldn't feed and died. And so while it sounds barbaric, it was a necessary measure in some cases, I'm sure. And Yeah, it's just interesting. It makes you feel good. We've come a long way. So far.

My— it was funny, I took my Mayo course, my first one back in 2017. I came home, I flipped my child over. She was 24 months old. And I was like, there it is. That's why we had painful breastfeeding for 13 months. And you are a very tense child, like tension throughout the whole body, tip of the tongue to the tip of the toes. Could hold her, you know, head up and her neck up at birth and And anyways, she ended up going, we prepped her, she went for a release. And then I had a second child who at day 5 was released because I knew right the second I latched her at birth, I was like, and I even was like, a little silly, but I was like, I'm not going to look for the first 24 hours. I'm just going to live in bliss of having a child that came through delivery naturally and they didn't have to be induced. And we're just going to enjoy this moment. And the second I latched her, I was like, oh, here it is again. It's just like, I knew. So we prepped her. Took her on day 5 to the oral surgeon who released her. And I mean, it was night and day, night and day, you know. But I also had the education and I had the tools and I, I knew the provider and they were waiting for the phone. They were checking in with me after, you know, I delivered the baby. How's it going? How's feeding? Do we need to do anything? I'm like, give me a few days. Let me get her ready. Let's get her nervous system in check. Because I tell parents, it's usually not emergent, right? It's very rare that you have an emergent tongue-tie situation and there is time to prep that body, that baby, that family are the caregivers, so we can go into this with a rest and digest nervous system ready to have an easy release. And then we're going to heal. We're here to heal together afterwards. So it's, yeah, I'm very much so a proponent of, like you said, of that pre-op, that post-op, and just really making sure the families— I was talking to somebody the other day— making sure the families feel really confident about what they're going to do post-op, like how they're going to— because we don't guide the active wound care, the, you know, release provider does. But once it's been, you know, prescribed, we can then work with the families to say, okay, they told you this in, in the consult, we can now help you make sure that you know how to do this. They showed you in office, let's practice together. Make sure they know how much pressure to apply, make sure they do it on us, on themselves, on their child beforehand, on their own hand, you know, whatever we need to do. Because if they don't feel good about it, they're not going to do it afterwards.

Fruits.

And that's half the battle.

It's a big part of it, that's for sure. Yeah, yeah, it's interesting. I'm kind of in the research phase now where I'm trying to figure out why it happens, because I always try to think back to like our ideal design and our ideal lifestyle, you know, 10,000 years ago. If a mother— we didn't have bottles, so if a mother couldn't feed the baby, then what happened? Because of the— I'm into that research now, and I won't share what I found yet because I don't know everything, but it does— it comes back to our environment. Some of it's genetic. There is some genetic component to that, just like there's some genetic component to like the fast-twitch muscle fiber component and things like that, and in the grinders and the clenchers as well. But most of it is environmental, and it's the genetic response to the environment, sort of that epigenetics, you know, that, that creates the resistance to that tissue resorption. Because that's what it is. It's just, it's usually the tissue, and it's just like our fingers would have had webs early on, but it resorbs it's the same, the same thing. Yeah. So it's an interesting— it's an interesting study. Maybe next time we'll talk about that.

Yeah.

I'm like, you're going to have to update us on that because I'm always over here going, guys, it's like the apoptosis. It's not happening. Yeah, it's not resorbing. We don't know why, but we kind of know that we go from like bottom up and then things, you know, resorb top down. And if it's not— that's why I always say it's very common that you, if you see an upper lip tie, there may also be a tongue tie because of the process in which these things happen. Now, obviously, That's not perfect. It's not going to always hold true that there's always a lip tie or tongue tie. There's lip tie. It's a bit commonly we'll see tight tissue in both locations and maybe even the lower lip, less common.

Yeah, sometimes that— yeah, that, that's a really good point. And again, you know, it's what, what's creating that. Some of the research shows that potentially it's, you know, you had mentioned like diet, nutrition. Some of it might be the chemicals in our food from the pesticides they're saying is slowing that that resorption process down. There's some, there's some information out there that goes over like how our bodies have changed and how our pel— you said some pelvic floor, we're talking about that, you know, how our hips have changed. And so the child birthing process is different, which actually changes how the head is coming through the birth canal, which can contribute to some of these situations with the vaulted palates and so on and so forth. So I think there's just so much information out there that types of— these types of conversations, you know, need to be had, and they need to be had amongst the group of individuals who want to have them and who want to look and who want to have answers for themselves, but also for their patients. So yeah, yeah, very well.

And I know you've already shared with us a little bit about like what you look at, you know, beyond the teeth and everything, as far as like your initial assessments go. Is there anything else you're doing in an assessment that you think is worth sharing at my way, you know, that maybe people aren't thinking about or you're not commonly seeing done in assessments elsewhere?

Yeah, you've brought up, and I, I've heard you mention before too, like the, the importance of the child being able to breathe through their nose, right? So one of our first assessments is breathing function tests. So we look to see if they can nasal breathe. Depending on their age, we want to shoot for 3 minutes at least. Now if they can nasal breathe, then you know it probably is okay to move forward with some sort of therapy and not send them to the ENT. We have had many parents come in that the ENT is like, yep, let's just take them out, take out the tonsils. We don't look at the adenoids, but we, you know, obviously through our breathing test, we can screen enough. And there's some markers there when those adenoids, like around, you know, 10 to 12, they're inflamed, you know, around 7 is the maximum for the adenoids. But these, you know, these ENTs, Goddess, you know, they, they want to get in there and they want to do what they know how to do, which is, you know, take these things out. But we've had a lot of children avoid those surgeries because we measure, we do our measurements and they can breathe. So there's no emergency here to get those out right away. So a lot of parents want to try first to avoid those surgeries. So the breathing function tests are really important, um, and there's 3 different tests that, that we do for that. Uh, we do full myofunctional orthodontic evaluation, visual. So we're dealing with little kids that are 3, 5, 7 years old. We're not— we don't have— we're not going to take a Ceph or a CT scan or, you know, a panoramic or any of that kind of stuff. Again, we're going by observation, and I can tell you if there's crowded teeth and their mouth is hanging open and they got dark circles under their eyes, there's a problem. You know, I don't need an x-ray to tell me that. I can walk through the grocery store and tell you who has the problem and who doesn't, and I don't need an x-ray machine for eval. So that myofunctional evaluation, we're looking at the shape of their dental arch, we're looking at the positioning of their teeth and their bites, you know, we're looking at the shape of their face for any asymmetry. I'm sure these are all things that you're looking at as well. Then we're looking intraorally at the soft tissues, we're looking at the soft tissue function, how the tongue functions, how they swallow, how they speak. We don't deal with speech, but But we have seen, as you know, just some simple, you know, myofunctional treatment can improve their speech dramatically, you know, and then we're going through like a series of questions too about any head or neck pain, any earaches, ear infections, ear tubes, chronic throat infections, you know, the usual. And then of course our sleep questionnaire too. I mean, that's our screening process. By the end of the evaluation, I'm usually evaluating, ticking off on a checklist, the Ferris 6, you know, and what their risk level is. And most of the kids that are coming into our center, they're moderate to severe risk and parents don't know until they get the screening process. So, you know, those frequent nighttime wakings, the nightmares, sleep talking, sleep walking, bedwetting, you know, they just think that's part of being a kid, but it's not, you know, it's dysfunction. It needs, you know, it needs to be evaluated and they need to know that there's an option for correction.

Yeah, absolutely. This is amazing. Give us your best clinical pearls, because I know you work with those 3 and 4-year-olds. So how are you getting the littlest ones? I mean, the older ones we can negotiate with a little bit. How are you getting them to do exercises consistently? Like, do you find that there's something that works best with these little ones and their families?

Yes. So I have a dental background, but I don't have a therapist background. So my therapist who also is trained in myofunctional therapy, but is an occupational therapist, that's my secret weapon. And, you know, moving forward and as we continue to go and expand, I mean, that's the avenue I'm going to go down for future prospects because her ability to think with therapy and to think with results is much different than anybody from, say, the dental profession. So it gives us, you know, a step up. You know, a lot of the times what we find, and maybe you find this too, it's not so much the kids. The kids are very willing. You know, especially at that age, 3, 4, 5 years old. I mean, they're pleasers, they want to please. Some of them have behavioral problems, there's no doubt, but once we start with those Buteyko breathing exercises, and we can do that as early as 3, okay, their breathing function changes, their ability to tolerate CO2 changes, their brain function changes, and it increases compliance. It's one of our secret weapons. Parents are just amazed by how, how quickly a child child's behavior and cooperation. Again, we're working on that prefrontal cortex, which is cooperation and behavior. So it very quickly improves. And so, so that assists, you know, as well. Very organized, systematic routines, you know, we use those and we do use, and I know, you know, I've seen and heard some of your thoughts on this. We do use the oral appliances, the oral appliances. When they're— and I agree with you, oral appliances aren't the only answer, but when they're in the right hands of someone who knows how to use them and knows how to use them well and understands them and has studied them as deeply as I have and has had that training and pairs it with my dental and myofunctional and breathing education, they're extremely helpful in helping those children. So yeah, so I would say, you know, that's how we get kids. And then stickers, you know, we bribe them with stickers.

Never above bribery. Love it. Love it. Okay, let's also talk about Buteyko. We had like— I don't want to forget about it because I know I like alluded to it earlier in the episode. And so for listeners who haven't heard any of our episodes on that, or they haven't heard of this ever before, share with us like what it is, how it fits into the work that you're doing, because not every myofunctional therapist, feeding therapist, SLP, OT, dentist, RDH, you know, doing myo actually focuses on the breathing side of things. And sometimes they'll focus more on like diaphragmatic breathing, but they're not actually trained in or aware of Buteyko. So I would love for you to share a bit about that.

I would love to. I'd start off first by saying that I went to a CE course and Patrick McKeown was speaking at that, and I was just fascinated by him and his ability and his story. And I said, I, I want whatever he's got. And, um, very quickly after that, I registered myself to go through his full training program, which honestly is very intense. It's very intense. I kind of thought, I'm like, oh, this will be like my CE courses. I'll just kind of, you know, meander through them and it'll be easy. It wasn't, it was hard. It's very difficult training, but it's so important and so informative and so critical to understand how we use oxygen because, you know, orthodontists and dentists, they're thinking of the form. Myofunctional therapy is thinking of the function. But from a Buteyko standpoint, we're, we're looking at the fuel to the body. So it's form, function, and fuel. And you could have the form, you could have the function, but if you don't know how to use the fuel or you put the wrong fuel in the tank, it's not going to work. And I think that's where our successes truly come from, is really getting these kids, not just the young kids, but we have older kids and adults that are understanding how to breathe right, how to utilize oxygen, how to build up their tolerance to CO2 so they can release that oxygen to their brain and their muscles and their organs. And they're getting healthier, they're getting smarter, they have better athletic performance. Kids that were always kicked out of the game are now the ones that are winning the game. Their coaches, you know, and parents are always proud of that, of course. You know, it changes everything. And, you know, even if you don't go through the training to— again, it's, it's pretty intense. I highly recommend it, but it's intense. If you don't go through the training, you gotta at least read those books and understand the chemistry and, and behind it. Uh, it's so critical. So I think that's where, you know, we really come in from a different angle and where we can really help, because we have exact systems and processes for those Buteyko methods that we apply with the form and the function that we, that we handle. And, uh, it's, it's extremely helpful. We're getting quick results Results, sometimes within 2 weeks, kids are sleeping through the night where they weren't before. Kids will go from waking up every morning with headaches to no headaches. They go from stress and anxiety to no anxiety. Sad story I have to tell you, Hallie, because I think you'll appreciate it. I had a 4-year-old come in and the first thing he showed me, he drew on his little erase board 4 sections. He had graphed out or quadranted out into 4 sections and each section had something that he was afraid of drawn into it. Snake, shark, you know, something like that. It was— it honestly, that made me want to cry. Yeah. I don't know how a 4-year-old— that's what they're thinking about when you have the world is your oyster, right? But they're thinking about the things that they're afraid— because his brain, he was not sleeping. He was exhausted.

Yeah, fight or flight 100% of the time.

Yeah, yeah. So now, you know, maybe we get the tongue in the right place and it's stimulating the vagus nerve and they're a little calmed down and things are getting better, you know, but what if, what if, you know, you kind of started off this way. What if, what if we actually got them utilizing the fuel the way they're meant to, you know, they could have a 99% oxygen saturation, but if they're not using it, what's the point, right? So getting them to understand how to release that oxygen into their brain and their body, you know, is critical. So I can't, I can't stress it enough. It's an important thing to understand.

Yeah, amazing. And thank you for sharing that because I think people forget until they start to see these kids, right? And they see the impact it has. I had a kid who was 3. She already had a long, narrow face. She was turned around at circle time. She was sent for— this is the only case this has ever happened with, so this is a very rare case— but she was sent for an emergency tonsillectomy as they said that her sleep— I mean, she was snoring worse than a middle-aged overweight male. At 3 years of age. Turn around at circle time, didn't respond to her name. I mean, completely out to lunch. Okay, gets her tonsils taken out, starts work— we're working together, and she— oh, completely different kid. Within months, it was a completely different kid. On track, responding to her name at circle time, completely keyed in, having conversations. No longer looked like— no, kids still— people would describe her as like a space cadet. No longer appeared that way. Completely different child because she could Breathe.

Yeah.

And so to see what being able to breathe and then being able to sleep, get restorative sleep— and the parent said she sleeps all night, 12 hours straight. She was so exhausted that her body was just collapsing at the end of the day. It wasn't restorative, it wasn't actually benefiting her. It was because she was in an emergent state the entire time. And so you go and you see kids like this, and again, a more specialized situation because most kids are not being raced to the ENT and having, you know, being raced into surgery because they were afraid she wasn't going to wake up. They were afraid that she would actually die in her sleep. But so many of our kids are still in an airway crisis. It may not be that extreme, and we may have more time to expand with it. And we get a lot of families too who are like, we want to go through expansion. We don't want to take these tissues out. You know, the ENT won't even do it anyways. Okay, great. Let's see what we can do through the myofunctional therapy in combination with appliance therapy and get these kids breathing. And it works beautifully.

Yeah. And you know, Hallie, to take it one step further too, not only how it affects the child, but we've seen familial changes. We've seen parents like fall in love with their kids again. Not that they don't love their kids, but their heart, they get stressed because of the behavior issue and all that mellows out and now the families are bonding, they're closer, they have better relationships with their children, they want to be around their children and do things with their children and everybody's sleeping better, not just the kid but the parents too. And I think that is just that ripple effect that just keeps going and going and going. That sometimes, honestly, when I started my away centers for kids, I didn't anticipate that. I didn't think that far out. But it's such a rewarding thought and thing to see happen. It's kind of like what you said. We have one parent, you know, sit here and look me and my therapist right in the face and says, I don't know who she is, she's not my kid.

Which is—

was a good thing. She's like, in a good way, in a good way. She goes out, she's quiet, she listens. She pays attention, she's thoughtful, she's respectful. It's because she's using her prefrontal cortex and her brain and body is functioning the way that it should, and she's cooperative and, you know, and has good behavior, you know. So yeah, it's, it's, it's— I can tell you this, Hallie, it's more rewarding than a filling or a crown prep.

I can't relate, but I would imagine so. Yeah, I mean, and honestly, that's why I started doing traditional speech and language stuff early on. I quickly fell into feeding, and then I fell into Mayo, and I was like, my love for the work is in feeding and MYO because of everything that we're talking about here, because there's such an overlap, right? I mean, you're basically dealing with the oral face, the oral phase of chewing and, you know, prepping the swallow when you're doing MYO. So there's such an overlap, and the impact that it has on these kids and the impact it has on these families, it's dramatic. It's drastic, right? This, the changes that you see. So I thank you for sharing that, because I think so often we focus so much on on the science and not the art side of it, right? Like, it's such a dance between the two. And it's like, you're dealing with humans, and we have to remember these are humans, and these are little kids, and these are their parents. And, you know, we get a lot of parents who are almost embarrassed to say, like, I, I don't want— like you said, I don't want to be around my kid. I don't know how to manage them. I'm exhausted. Nothing's working. I've tried everything everyone's recommended. And we just look at them and go, oh my gosh, they're in an airway crisis. Like, we can help you. We got you. We got this. And it's almost, you know, we've had moms in tears, dads in tears because they just thought their kid was so far gone. And so it's— yeah, it's just—

it's hard not to get emotional about that. Um, and sometimes it's okay to, but you know, as the practitioner, you want to cry with them, but you got to be the strong one, right? So then it's for the hardest part. Yeah, so you go cry later.

Exactly.

And you have a bigger mission. I think that's very aligned with my, you know, aligned with my bigger mission. Um, you've got your book and everything, and I want to give you a moment to talk about that before wrap up, because I know you talk about like the silo approach fails kids so badly, and I talk so often about how the medical system treats in silos. We assess and treat in silos, and we can't because we're dealing with humans and nothing actually operates in a silo, and how really holistically we need to be working together, looking at the full body. It's like such an important topic, so I'm gonna let you speak about it, um, and tell us about your book and what you're hoping that it shifts and how maybe providers writers think about early intervention and collaboration and all those things.

I would love to, and I'd like to just play off of for a second how you combine the art and the science together. And, you know, that's the way I look at it. The body is the most creative and artistic masterpiece on the planet, and then we combine that with what we know from science, and those two things should complement each other, not work against each other. They should be working together, and that's how I feel that practitioners should be looking at the, especially these little children. It's, it's not the orthodontist's airway or the myofunctional therapist's airway or the SLP's airway or the ENT's airway. It's that child's airway, and it belongs to them. We're just all there to assist them to get the most out of it so that child can grow to their full potential, and as I mentioned earlier, develop both mentally and physically into a good quality human being that can be contributory and productive in society and in life. And unfortunately, the direction we're going now, which is what I point out in The Great Contraction, is our society is more sick and more stressed than ever, more detached and distant and disassociated than ever. And when you go back and you look at our ancestors and you look at the science and you put all this stuff together, what you realize is we're kind of doing it to ourselves. And I think that these children who don't know any better, just like you didn't know and I didn't know when I was a kid, because I have a small jaw and airway too, you know, we have to help these children and these families come to the conclusion that there is something that can be done. And it's not just one person who's going to help me do this. It's a group of professionals with different aspects of knowledge that can come up with the best solution. And so in The Great Contraction, I consider it a new frontier to pediatric airway health. It's a cry, true cry for help from all of us. And I start at the very beginning, even in the in utero, and I bring it all the way through childhood into adulthood and what happens even in the workplace. Workplace when adults are sleepy, or even when we're driving. The statistics behind the number of crashes and accidents that happen because people are too tired because they're not sleeping. So it's kind of the full spectrum. And to give you a visual of it, you know, this is the book. This is how thick it is. It takes about an hour to read, but it's all based off of all of these scientific articles that I've read through and studied. And I often will sometimes say to other practitioners, or sometimes even some parents who are very engineering-oriented, so, you know, like, well, you can read all this. I'll let you— it's all on my website. You go ahead, go through the articles and read it all. And most people are definitely not going to read that.

I haven't found—

and no one's taken me up on it.

We always ask for the research, but they're never willing to actually read it and digest it, you know.

Yeah. And it's a lot to do that, and it's a lot of long nights. I mean, this has hundreds of hours you know, of my study, whereas this has 1 hour of reading. So I try to do a good job to summarize all that and put it into the most compact, efficient message possible to reach, you know, healthcare practitioners. But I've had mothers and families read it too, and they start connecting the dots. I had one friend tell me, I think my father suffered from this. I think this is why my father has dementia, just from reading that book. Book and, uh, you know, and then become proponents in the public of good airway health, which I think is critical as well.

Absolutely. Absolutely. Well, this has been absolutely amazing. I know they can, they can get the book at myowaycenters.com or—

Yeah, there's a link. Yeah, there's a link there, um, which will take you to Amazon. Yeah, that's where, that's where, uh, it is. It's on Amazon and you can purchase either the, the digital copy or, you know, the paper copy right Amazon.

Amazing. Well, we'll be sure to link everything. We've got your websites, Instagram, some of the research papers you flagged and everything. And we know that you have a lot of the research on your website as well if anybody's looking. So thank you so much for sharing this with us and for all of the amazing knowledge you shared today. Everybody go get that book because it sounds incredible and like a really great resource to one, read as a clinician, but then two, have available to share with your patients as well. Like have them go buy the book and read it. So we do get sometimes those parents who are like, you know, completely bought in and they don't need to know anything else. They're like, I am with I'm with you, you just guide me. And then you get families who are very cautious and they've heard 10 different opinions and yours is very different than the other 9. And so, you know, sometimes they just need to see the science, right? Whether they read it or not, if the book exists and the articles are there, they're a little bit more bought in to, okay, let's try this because nothing else has worked yet. Okay, great, let's try this, right? So we always like to meet our families where they're at. But I love, I love when resources this exist because it just helps the cause.

Thank you. Yeah, thank you. Yeah, that's what it's there for. It's for clinician support, but also to help educate the public. You know, if anybody's willing to read it, it's pretty sciency, but it's not so sciency that a mom or dad or even a grandfather, grandmother, you know, or teenager couldn't understand. There's references to where all the information comes from, plus a full glossary. So I try to make it as simple as possible.

That's amazing. Well, thank you so much for for sharing this and sharing your wealth of knowledge and joining us today.

Well, thank you. Thank you for doing what you do and increasing awareness. You've been doing it longer than I have, and I really appreciate you, and I appreciate what you're doing.

Oh, the feeling is mutual.

We need more of us.

Yeah, that's right.

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