Myo 101 for Feeding Therapists: Why You're Already Doing It (And How to Do It Better)

If you're working with feeding, you're already touching myofunctional stuff. You are. You're already looking at tongue position, oral motor patterns, postural relationships. You're halfway there. You might not be calling it myo yet, right? So today we're doing myo 101.

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 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.

Hello friends, and welcome back to the Untethered Podcast. We are diving into like myo 101 today. I want to talk about something that I think is genuinely misunderstood in the feeding therapy world. And that is myo, myofunctional therapy or orofacial myofunctional therapy. Okay. I hear this a lot from SLPs and feeding therapists. They're like, Hallie, I don't do myo. That's not my specialty. I'm a feeding person. And listen, I get it. You've got your lane, you've got your training, but here's the thing. And I think the last a solo episode, laid this out, like in the groundwork, laid some groundwork for this, I should say. And it's not for people who want to become full-time myotherapists necessarily, but for feeding therapists who want to understand what myo actually is, why it matters to your feeding cases, where it overlaps with what you're already doing, and how you can start to think about function and pattern differently. Okay. Because I promise you that once you start seeing the myo lens, you can't unsee it. Okay. Like once you got your myo eyes on, they're on, and your feeding cases are going to benefit. Okay. So I've been an SLP, I've been doing this for nearly 17 years, and I've shared across over almost 380+ episodes at this point. I've built programs like Feed the Peds and CPFT and the Myo Method and the CMT, right? Certified Myofunctional Therapist certification. And one of the things that I've learned is that feeding and myo really aren't separate disciplines. They're partners. They're one and the same. They're part of the same functional whole, if that makes sense. Okay. And so in clinicians who really understand that, who can see both, they're the ones that are moving the cases the fastest. Okay. All right. So let's start with what is myofunctional therapy. And I wanna start with a very straightforward definition because I think there's a lot of like mystification around it and just misinformation as well. So myofunctional therapy, myo meaning muscle, functional meaning like how it works, right, is the assessment and treatment of oral and orofacial muscle function and patterns. That's it. Like, that is the baseline. It's about how the muscles work, how they're positioned, how they're functioning to create patterns, patterns like how we swallow, right? Swallow patterns, breathing patterns, chewing patterns, our tongue position during rest and when we're functioning, like speaking or eating. And now that definition might seem a little academic, so I'm going to make it a little more concrete. When you look at the mouth, when you look at a child's oral system, you're looking at a bunch of muscles that are doing something, right? The tongue is positioned somewhere, the lips are doing something, the jaw is in this, in some position, the muscles have like some form of tone, they're either relaxed or they're holding tension, or they're weak or they're strong, right? The strength comes into play as well. All of that is myofunctional stuff. Okay, so here's an example. You see a kid who's got a tongue thrust. Let's use a tongue thrust because I feel like that's the very common. And I think it's also a really great way to also pull speech into the equation a little bit because a tongue thrust can impact speech, it can impact the chew and swallow pattern, right? But let's just focus on the swallow for all intents and purposes. So there's an anterior tongue, you know, projection happening during the swallow. And classically, we used to think this was a developmental thing. That's what I was taught, right? I've even been taught that it's a sensory processing thing. And so we would do exercises, But the myolens actually says, why is the tongue doing that? Is it because the airway's compromised and the tongue is trying to protect the airway? Is it because the tongue hasn't developed normal resting position? Is it because maybe there's a tongue tie or restriction, right? Restricting normal motion? Is it because the jaw is in a position that forces the tongue to be in a different position? When you start asking those questions, you understand the pattern, right?, and then your intervention can actually target the cause, like the root cause, not just the symptom. So many of us are taught to treat the symptoms, and that's not the goal here. Okay. Myofunctional thinking, right? Functional is systems-based. It's asking, what is the muscle doing? Why is it doing that? And what needs to change so it can function better? Okay. And here's where it gets really interesting for feeding therapists. And this was my experience. I'm speaking from experience here. I was a feeding therapist before I was a myofunctional therapist. And then an integrative therapist integrating the two. And feeding therapists are already doing a lot of this. When you work on tongue placement, you're doing myo. When you talk about jaw position during chewing, you're doing some myo. When you think about how posture affects swallowing, you're doing myo. You're just not necessarily calling it that, right? You're thinking of it as feeding mechanics or oral motor skills. And the difference, and it's important, right, is the depth and also the age of the patients and what we're asking them to do. And if— You know, so let me back up for a second because traditional myofunctional therapy is really for a child who can function at the cognitive level of a 4 or 5-year-old and all the way through the rest of the lifespan, right? Typically pediatric feeding covers the rest of the kiddos under the age of 4 or 5 cognitively. Now, why is that important? Because we're asking them to do things that we're not expecting a child to do until they're already 4 or 5 years of age, cognitively, meaning their brain can follow those directions. Can we still adapt this and do this in feeding below that age? Yes. It's just falls under feeding therapy, but you're technically doing some myo, right? And that requires the licensure of someone who can do feeding therapy, like an SLP, OT, or even sometimes highly trained PTs. Okay. So I just want to share that first, but let's talk about the depth. Okay. Because feeding therapy often focuses on the feeding outcome, get the kid to eat better, manage more textures, swallow safely. amazing, important, like we've got to do these things, right? Mayo just adds another layer and it asks like, what functional pattern, keyword functional, needs to exist so that feeding can be easy and efficient? What's the tongue supposed to be doing? What's the jaw supposed to be doing? What's the breathing supposed to be doing, right? And then how do we retrain the system so that those patterns become automatic? So it's really the difference between saying like, Let's work on chewing and like, let's establish a functional chewing pattern where the tongue and jaw are coordinated, where breathing is nasal and supports swallowing, where the muscles that stabilize are strong enough to do the job. Both approaches are trying to improve eating, but one is targeting the function. One is targeting the outcome. I wanna focus in on like why this should matter to you, like why you as a feeding therapist should care about Mayo. Okay. You've got a caseload of kids, right? Case load of kiddos, you're working on textures, on safety, intake, variety of foods, right? Why should you care about myofunctional patterns? Here's my argument. Just hear me out because I think it's a pretty strong one. Because myofunctional dysfunction is often the reason that feeding is not improving. And I saw this in my own patients. All right. So think about it this way. You've got a kid, they've got significant feeding selectivity. They're only eating soft, easy foods. You've been doing some slow texture progression, maybe even some desensitization, all the standard feeding stuff that a lot of the courses out there teach, right? You're like 6 months into therapy, the child's maybe eating 5 foods now instead of 3. You're like, okay, that's progress, but like, that's slow progress. It's not the junk that you would expect. So you add in myo thinking, you look at the resting tongue position, it's low, it's back, you know, back is great, but it's still low. Lip seal is weak. And I will tell you, oftentimes it's low and forward, which is not what we want. I'm just trying to give a little bit of an easier case here. Maybe the lip seal is weak. Maybe the jaw stability is questionable. You're kind of like, oh, I don't think that's where we— what we should be seeing. The child is mouth breathing. The mouth is open, right? What does that tell you? It tells you that the muscles that need to be active and strong to manage varied textures aren't organized to do that job. And so the system here isn't set up for efficient chewing and swallowing. So of course progression is going to be slow. You're asking the system to do something that it's not structured to do. It doesn't have the ability to function the way you're expecting it to. So when you add in myofunctional intervention and we work on tongue repositioning and the lip strengthening in this case, and jaw stabilization and breathing retraining, now we're setting up the foundation, right? It's sort of like when they say a house is being built, not sort of like, but when a house is being built and they lay the foundation first, otherwise the house that's built on top of it without the foundation will come crumbling down? Yeah, same thing. We have to set that foundation with our patients because then the system is organized to handle textures. Then feeding progression makes sense. And sometimes that alone, just organizing everything, organizing the myofunctional system, that creates a jump in feeding. I've seen it time after time after time once I started to add this in. You know, I see this in, you know, we see this with our cases, kids who hit a plateau in feeding therapy, with frustrated parents, right? Clinicians also frustrated. And then we go, hmm, we look at the myo piece and we go, all right, let's add this in. We add it in and suddenly feeding starts to move. Like, what? What is happening? Right? And another reason why myo also matters to feeding that I don't want to forget to touch base on is like for safety and efficiency. If a child has a poor tongue control, poor coordination, weak muscles, their swallowing is not efficient, right? The things we've been talking about, it might be safe. They may not be aspirating, but they're still working a lot harder than they need to. Every bite is effortful, and that child fatigues. We see it happen, right? They don't want to eat harder foods. This is why, right? And that's also why parents will say, well, like, eating seems hard, or they're lazy, or, you know, we hear all kinds of things from parents, right? And listen, they're— the parents are just sharing their experience and what they're observing, right? They're explaining the behavior of the child as they see it through their lens. So when you address the myofunctional dysfunction, eating becomes easier. It requires less work, and the kids naturally want to eat more when it's not effortful. Like, kids aim to please. They are not here to be like, oh, I just want to make everyone's life hard around me. I'm not gonna eat any of these foods. I'm, you know, they're not doing it intentionally. Okay. And here's the third thing. So if you understand myofunctional patterns, if you understand how breathing and posture and tongue position connect, you can catch problems easier and earlier, right? You can see that a kid with mouth breathing is going to develop feeding issues before those issues fully develop, or maybe before they get worse. Maybe they're already there and no one's really recognizing that this is connected. You can say to a parent, let's work on nasal breathing now, because when that's in place, feeding will be easier, right? You're kind of— you're swimming upstream here, and that's really powerful. And here's the thing that really gets me: myo-knowledge actually makes you a better feeding therapist because you understand the system. You understand why feeding mechanics matter. You understand the connection between function and between pattern, and you can see the whole connected system— airway, jaw, spine, nervous system— instead of just seeing the feeding piece in isolation. So I'm not saying you have to become a myotherapist. I'm saying like myo-literacy, like becoming literate in myo, makes you a better clinician in whatever your specialty is. Whether you're focused on speech sounds or you're focused on feeding, it's going to help you and your patients. Okay, so let's make this really concrete by walking through where feeding and myo overlap, because they do significantly, and I really want to highlight that for you. Let's start with the oral motor skills. Okay, we're going to go through like oral motor skills, tongue position, swallowing patterns, breathing coordination, lips, like the seal and function, postural support. We'll talk about tongue tie and structural considerations, right? So we're going to go over all of this because there's such an overlap. So starting with those oral motor skills, feeding therapists work on like tongue mobility, tongue strength, jaw strength, lip strength, right? These are all fundamental myo concepts. You're literally assessing and treating myofunctional competence. So that overlap is already there and it's huge. The frameworks and the approach might be slightly different, right? Feeding might call it oral motor skills for swallowing. Myo might call it functional tongue strength for various oral functions, but you're assessing the same thing. So that's the first thing. Next thing, tongue position. So feeding therapists understand that tongue position affects the swallow. Where the tongue is during the swallow affects pressure that's generated, right? Are we able to create that negative pressure required to swallow the bolus back in our mouth? It's also gonna impact bolus formation, pharyngeal timing, all those things related, right? Mayo takes that further and says, okay, where is that tongue at rest? Because where it rests affects where it's gonna go during other forms of function, right? Where is it when we are chewing? Where is it when we start to initiate the swallow? Is it able to seal off the palate, you know, the lingual-palatal seal? Are we able to accomplish that so we can push the bolus back and swallow? Right. So that myo eval is really looking at both resting position and they're looking at the swallowing patterns, which I kind of jumped ahead on a little bit. But with the resting tongue position, we're looking at like, is the tip resting at the palate? Is the tongue fully resting on the palate? Right. And where is that tip? Like, is it— sorry, I didn't mean it. Is it at the palate? But is the tip of the tongue at the front of the palate, like on the alveolar ridge? Or is the tongue sitting low and back? You know, is it symmetrically positioned or is it asymmetrical? That resting position is a really fundamental myomarker, but it also directly affects feeding, which I already started to talk about, right? So let's focus in again on the swallowing patterns themselves. So this might be the biggest overlap. A swallow is a motor pattern and how the tongue moves, how that jaw stabilizes, how breathing is coordinated with the swallow, that's all myofunctional. And so feeding therapists train swallowing patterns, myotherapists train swallowing patterns. You're doing the same thing, probably with slightly different language and frameworks. Okay. There is massive overlap here. And as I told you before, depending on the age of the patient, then it'll also look different. Are we doing for, are they doing for themselves? You know, what is their age? What level of instruction can they follow cognitively to know if it's traditional myo or if it's gonna fall under feed feeding and or both, right? So just all things to be aware of. All right, next up, breathing coordination. This one seems more subtle, but it is so super important. I'm kind of morbid. I always say like, oh, it's a little morbid, but if you can't breathe, you're dead. I mean, it's true, right? If you're not on breath support and you can't breathe on your own, hello. That's our number one goal biologically, is to breathe. And feeding then is our number two goal, right? And feeding relies on good airway management. The coordination of breathing, swallowing, and sometimes chewing is really critical. And I don't think people really think about this enough, but Mayo puts a lot of focus on nasal breathing and breathing coordination. Now, feeding therapists, right, you understand that aspiration risk is affected by swallow safety, but Mayo adds another layer. How is breathing supporting or undermining our swallow, right? Are we coordinating breathing and swallowing, like, optimally? That falls into the myofunctional territory, but it directly affects speech. feeding safety and efficiency. So do you start to see how there's like this integration between the two? Yeah. All right, next up is lip seal and lip function. So feeding therapists work on lip seal because it affects swallowing, eating, drinking, right? Myotherapists work on lip seal because it's a fundamental functional pattern that affects so much, like breathing, swallowing, orthodontic development, right? Same thing, complementary purposes. Let's move on. Postural support. This is where things get very interesting. Feeding happens in a body, right? We can all agree on that. That body has posture. Yeah. If the posture is compromised, like we have a forward head posture, like head, neck forward posture, we have poor core activation. Our spine is misaligned. Feeding is affected. Myotherapists think about like whole body postural support as part of oral functional patterns. Feeding therapists are starting to think about this more, but it's not always automatic. Now I will say like in our feeding program, in my course, Feed the Peeds, we do teach about proper positioning for feeding. And that is really critical. And OTs oftentimes, and sometimes PTs even, will talk about this because it is really important that you have proper posture for feeding. But I don't see it talked about all the time, right? So when you add myo thinking, postural support becomes an automatic part of your feeding intervention because you're not just working on the mouth in isolation. Hi, we don't work in silos here. You're supporting the body that mouth sits in. All right, let's talk about tongue tie. Love me some tongue tie conversations and structural considerations as well. This is also super relevant. Feeding therapists increasingly work with tongue-tied kiddos, right? Myotherapists do as well. So both of us, right, feeding or myotherapists, both of us are asking, how does this structural restriction affect function? What rehabilitation needs to happen? Does a child need a release? Do we need to prep them before and then follow up after? Like, right? So that overlap is real. And if you're doing feeding therapy with tongue-tied kids, myo knowledge helps you understand the functional implications better. Period. End of story.

Right?

So here's the thing. Feeding and myo aren't as separate as they're taught. They're deeply overlapping. And you're probably already doing myo work because as you know, I haven't put a label on it, but essentially we cover the oral prep and oral phase of the swallow inside of myo. So that's where we see this massive overlap, right? And you might just be calling it something else. The more explicit you are about that myo thinking, the more nuanced your feeding intervention can be. Let's move on to another topic. I want to address some stuff I hear clinicians say about myo that I just think is not accurate because misconceptions are what keep people from understanding something and from helping your patients. So let's clear a few things up. Number 1 misconception: myo is just exercises. And myo just is just exercises. I was about to go off on a tangent, like tongue thrust exercises, palatal exercises, that kind of thing. And so clinicians think Mayo's outdated, or it's not evidence-based, because they're thinking about exercises from when it evolved in 1908. Yes, it's over 118 years old, and maybe they weren't that effective yet, or maybe we just didn't have enough, you know, evidence to back up their effectiveness at that point. But here's the reality. Yeah, Mayo uses exercise, but so does pediatric feeding. But here's the thing. Modern Mayo is way more than that. It's pattern retraining. It's postural education. It's breathing retraining. It's Sometimes we also involve like a myofascial release component. Now that's not your tip, that's separate, but people will start to integrate other modalities in, right? It really all comes down to understanding function and systematically reshaping how the system operates. The exercises are a tool, they're not the whole thing, okay? Misconception number 2, myo is cosmetic or aesthetic driven. Now listen, I know you've seen mewing probably, and you've seen people trying to get these sharp jawlines and all that fun stuff. Some people are like, I just want my tongue position to look better, I wanna prevent orthodontic relapse, which are also great side effects and sometimes a goal, you know, but I see feeding therapists who tell me like, ugh, that's not my world. I care about function, but not how things look. Here's the truth. Mayo is about function first and foremost, and functional patterns show up aesthetically. If the tongue is in the right position, the palate develops better, the jaw develops better, the face actually develops a certain way, which helps support the airway and overall function, right? But that's a consequence of function, not the goal. We're after functional patterns that support breathing and swallowing and feeding and speech, like the whole system. Okay. The appearance and all those benefits, those are secondary. All right. Misconception number 3, you need a special certification to do myo or like a myo credential. Clinicians often will say, well, I'm not certified in myo, so I shouldn't be doing any of the work. But here's the reality. Scope of practice matters. Absolutely. If you're a feeding therapist, you're an SLP, OT, or I said, like, like before I said a highly trained PT, You're trained in oral motor function, swallowing, feeding mechanics. Okay. That training is relevant to my work. Could you benefit from specialized myo training? Absolutely. And should you be doing it if you're going to add myo into the work that you do? Absolutely. Like you should do a course, but you don't need to have a certification in myo to start integrating myo thinking into your feeding practice. Many of my best myotherapists come from arguably SLP backgrounds. That's where I'm seeing a majority of them come from. Do we have some really great OTs out there too? Yes. Maybe a couple PTs, or they're few and far between in the myo world, but they all got additional training, right? They also didn't throw out their SLP knowledge or their OT knowledge or the PT knowledge. They added to it. All right. So you don't have to be certified. Certification is really geared towards people who want a deeper dive into that specialty and they wanna like have credentials after their name related to that specialty. So it's not a bad thing to get certified, but you don't have to be certified if you have the license to provide pediatric feeding therapy already. Misconception number 4. 4, myo takes forever. It doesn't. People are like, oh, like you need like 3 years of sessions or 2 years of sessions. Not necessarily, but you also can't just prescribe a 12-week cookie-cutter preconceived program. That's not myo. And how many of those kids do we get into our practice who parents have paid thousands of dollars and wasted 3 months in therapy where they really haven't made any progress because somebody told them they were doing myo and it really wasn't myo. It was just a bunch of exercises that weren't relevant to their needs. Anyways, let's not stay there. It's not super slow. Families don't have to commit to a super long-term program. But I will say, if there's other things going on and you're integrating MYO in, might the kid be in therapy for a longer period of time? Yes. Could it be 12 months or more?

Yes.

But it really depends on what's going on. Your traditional MYO kid, right, that comes in 12 to 16 sessions, maybe 16 to 20 on average, over 3 to 4— what is that, 3 to 4 months? But we never promise that because some kids will take longer, some kids will take less. Some adults have come in and they've done it in 6 sessions spread over 5 months, right?

Right?

It's really tailored to the child or even the adult for adult myo patients. It's really tailored to your needs and how involved you are and if you're doing your homework between sessions, right? All that fun stuff. Right? So a lot of busy clinicians have said, oh, I don't have time for that. But yeah, some, like, as I mentioned, some families might need more sessions to really establish new patterns, some kiddos. But that duration again really depends on the complexity, the age, the involvement. All those things, all those variables. It's not inherently slower than feeding therapy. Arguably it's faster, but it does depend on the case. Misconception number 5. So myo is pseudoscience or doesn't have evidence. All right. This one makes me crazy because there is actually decent research on myofunctional therapy for sleep apnea, for swallowing, for palatal changes in combination with like palatal changes using palatal expanders and different approaches. It's not, maybe not as robust as some areas of speech pathology, but it does exist. And clinically the functional outcomes speak for themselves. When you retrain oral myofunctional patterns, function improves. Period. Families see it. Kids see it. Integrated therapists working in different domains of medicine see it. And it's now appearing in more and more research articles, which is exciting. But I want you to release all of these misconceptions because myo is functional. It's evidence-informed. It's within your scope, at least the screening and basic integration piece, right? And then you can get trained further to be able to do full-on myotherapy. And it's time efficient if it's done well. All right. So if you were to add some myo thinking to your, your feeding eval, I wanna talk about like what that looks like, what that would actually look like. So let's walk through a basic assessment and that way you have an idea of, like I said, what a basic myo eval could look like or really how you add it to what you're already doing. So first you're gonna do your standard feeding eval, right? That doesn't change. You're looking at feeding history, oral motor skills, swallowing, sensory processing, safety, all the things, right? You got a baseline. Then you add in myo-specific observation and assessment. And so let's break that down by category a bit so that you can have a better understanding of how this could actually integrate into what you're already doing. So let's talk about resting posture and positions. So if you're observing the child and they're sitting comfortably, they're not eating, they're just at rest, maybe they're playing. I like to look at like, where is their head? Is it forward, neutral, back? Where are the shoulders sitting? Are they elevated, neutral, or relaxed? Like, what's the overall spinal alignment? This takes about 30 seconds, right? You're not measuring, you're observing. Then you look specifically at oral rest position. Is the mouth open or closed, right? When they're not eating or speaking, they're just— maybe they're just playing. Maybe you're playing on the floor with them in the beginning of the eval, and you're just observing when they're coming back to your therapy room or you're walking into their house. What do they look like? How do they present? If their lips When they close, do you see lip tension or ease? What is the tongue doing? Is the ti— is the tongue tip up on the palate? Can you tell? Is it sitting low and forward in the mouth? Is it sitting centered? Is it more asymmetrical? Is there a visible tongue thrust at rest or when swallowing saliva? You know, again, you're just looking, you're observing, you're noting. Okay. Let's move on to breathing. So breathing, I kind of already talked about mouth breathing, but what about if you're looking at nasal breathing. And I guess arguably we could say nasal or mouth breathing here. Which one are they doing? Is it quiet or audible? Like, do we hear it? Does a child snore? And that might be a question for the parent, especially if you're not seeing them during a nap time, which hopefully you're not because you're assessing them otherwise. What's the breathing pattern? Is it steady? Does it seem effortful? Can the child breathe through the nose when cued if they're breathing through their mouth when you're, you know, with them? You might even say, ask them to close their lips and just breathe through their nose and time, how long they can do that for before their mouth pops back open, right? That'll tell you if the child has a structural barrier potentially at play. And so that breathing part, that's really important. And it's so easy to observe that resting posture and position of the head, neck, tongue, right? Lips, all that fun stuff. And then the breathing patterns, like all these things are things you can just kind of observe in the very beginning. Then oral motor function. At rest and with movement, right? You're probably already doing this for your feeding evals. You're going to assess like the tongue range of motion. Can the tongue reach the hard palate, move side to side? What does strength look like? What does tone look like? You know, and then same things with— same thing with the lips and jaw. Like you're assessing mobility, strength, tone, coordination, right? So if you move on to the lips, the lip seal and function, like can the child maintain lip seal at rest? Does it require effort? Does it appear easy? Can the child pucker their lips? Do they smile symmetrically? What's the overall lip strength and tone, right? And then moving into jaw stability and movement, can they move their jaw side to side? Can they open and close their jaw smoothly? Is there any clicking or deviation that you hear or observe? What does their overall jaw posture look like? Is the child able to stabilize the jaw during function, or is it look— does it look like it's, you know, moving around a lot and unstable? Then we can look at like a tongue thrust assessment. That's where I probably would go next. Next, if it's applicable, you can assess whether there's a tongue thrust pattern, not just during swallow but at rest, during speech, you know, and then of course during the swallow. Does the tongue project forward during any of these functions? Okay, that's very easy to see because we oftentimes see it come up against the teeth or between the teeth or between the lips, right? Then we have the swallowing pattern. And so again, probably part of your eval already, but from a myo lens, you're really looking at tongue position during the swallow. And jaw stability and breathing coordination, whether there are any like compensatory patterns at play. And so if you're not looking at that through that same lens with your feeding eval, this is just kind of a little tweak. Palate shape and oral space. So you're already looking at the palate for feeding, or maybe you're not. I don't know. I feel like I've met some therapists that don't really look in the mouth, but they do feeding therapy, which is very confusing to me. Mayo is going to add in specificity. Is the palate high? Is it narrow? Is it V-shaped? Is it wide? Flat, U-shaped, right? Does this match the breathing pattern that you observe? Because palate shape and breathing are related, right? The floor of our nose is the roof of our mouth. They're basically sitting together. So one's gonna impact the other, right? Especially our palate impacting our ability to breathe through our nose. So we really look at these functional patterns. Okay? This is this integrative piece. You ask a child to do something that combines multiple motor patterns. It's complex, right? Chew a pretend apple, blow a kiss, make a raspberry sound, suck on a straw. What do you see, right? Are the patterns coordinated? Are they compensating? Does the child hold their breath during any oral functions? Does breathing appear coordinated, right? That's basically it. Like, I know that sounded like a lot, but you're already doing a lot of it in your assessments. You're not doing anything crazy. You're adding observation and specificity to what you might be already assessing. The framework is just a little different. Okay. You're seeing the patterns, you're understanding the functional relationships. You're building a picture, not just of can this kid feed, but how is this kid's oral system organized? And then you document it all, right? Maybe we write something like resting tongue position is low and back. Like I gave the example before, maybe it's low and forward. Mouth breathing pattern observed: lip seal requires effort, jaw stability good during function. That's very concrete and observable, and that helps direct intervention as well, because we know the tongue position, right? At rest is something we want to address. We know that mouth breathing, right, we want to address that so we can work towards nasal breathing. We know the lip seal requires effort. We know that the dossibility appeared to be good, so maybe that's not something we target immediately, but that can really benefit us in working some of these other things. So it's really important to be looking for this and documenting it as part of your evaluation. Hopefully by now you're convinced and you see the overlap and you understand it matters, right? So how do you actually start to integrate myo thinking into what you're already doing? Okay, I'm gonna give you— let's see, I made some notes here for this one. I'm gonna give you about 7 steps. Okay, or no, 5 steps. I'm gonna give you 5 steps. Let's keep this simple. So step 1, I want you to add myo observation to your evals. I want you to get really comfortable seeing resting position, breathing pattern, postural alignment, tongue position at rest, right? And again, you might be doing some of this already, and some of it might not be new, and you may just be like, oh, this is myo, like this is putting a myo lens onto my feeding evals. Yes, yes, it is. Just observe. Okay? And add it to your standard report. Doesn't change your session time. It just changes what you're looking for. Right? That's step 1. Step 2, when you're planning feeding intervention, add one myo component. So if you're working on texture progression in feeding, I want you to ask, like, is the position of the tongue positioned where it needs to be to manage this varied texture that I'm trying to introduce? Right? Or maybe ask, like, is the jaw stable? Is breathing coordinated with swallowing? And if not, you can work on those things initially or concurrently with trying to expand the diet, right? You're not replacing feeding work, you're supporting it with a myofunctional foundation. All right, so that's step 2. Step 3, start doing some basic pattern training that feeds into both, right? So maybe some nasal breathing cues, maybe tongue positioning for rest posture, activating the lips seal, maybe some jaw stability exercises. I know in this kid, we didn't, we said that the jaw appears stable, but these are things you can teach families to do at home that support both feeding and oral function. Okay. Now step 4 is to notice what changes. When you address the myofunctional piece, feeding usually gets easier faster. Families will say things to me like, oh, he's eating more. Kids will be like, I can chew, or it's easier. You know, older kids will tell me like, it's easier to chew, or I'm not getting tired. Like I used to. It's very interesting. Or you're just going to notice that they're more willing to try new foods and to expand the foods they eat. That feedback is powerful. I had a kiddo who had been in feeding therapy for a very long time. He also had a very severe tongue-tie, but he started in— he started adding in 5 new foods per week. We just, for him, we just kept it— he was, I think, 8 at the time. We kept them in the same color family. So every week he would add in 5 new— like, it was 5 new red foods this week, 5 new orange foods the next week, 5 new green foods the next week. And it was like a game. And it was really powerful because he— we use a Myo slash feeding approach and an integrated approach. And let me tell you, this kid flew through therapy and added in so many foods. I think he'd added in like 50 foods within several months. It was so exciting. And that is how you're on the right. That's how you know you're on the right track. Okay. And then step 5 is get trained. So I obviously recommend my programs like the Myo Method. We have our Myo membership, we have CPFT and the CMT. There's other good Myo trainings out there. So get some deeper knowledge, understand the assessment more, you know, fully build your skills. That is going to deepen your feeding practice too. I was a feeding therapist first and I learned Myo second, and it was so easy for me to learn Myo because I already had the feeding background. And then when I started to integrate the two together, I was like, I like— the lines are so blurred. Right. And here's the thing I wanna emphasize. You don't have to become a full-time myotherapist to integrate myo thinking. You don't have to be, you don't have to completely like pivot your practice. The thing is clinicians who can see both feed it through the feeding lens and the myo lens, they're the ones who have the most complete picture. They're the ones moving cases the fastest, as I shared earlier today. And they're the ones whose families will say to you like, oh yeah, you get my kid. Like you really understand my kid. Yeah, I do. Because we're taking an integrated approach. That is the goal, that integrated understanding. Okay. All right. So I wanna tie this back to what we talked about in that last solo episode that I did, because this is the bigger picture. You have a child, that child breathes, they eat, they have posture, tone, nervous system, you know, state, all the things, right? It's all interconnected. The airway piece that we talked about in the first solo episode, that affects the feeding piece, that affects the myo piece, the myo organization, like that supports feeding, that supports breathing, that supports postural development. It is all one system working together. Remember I said we're not working in silos, so we can't treat in silos. It's— when I say working, I mean like the body doesn't work in silos. It works as one system. So we have to approach it that way in treatment. When you understand feeding as a feeding therapist, you're getting part of the picture. When you understand myo as a myotherapist, you're getting another part. But when you understand how they interact, how they're part of a connected whole, that is when you move from competent to really powerful. And I think of it like this: breathing is the foundation. If breathing is compromised, everything else is harder. Myofunctional organization supports breathing, it supports proper tongue position, nasal breathing, coordination, all the things, right? That organized myosystem makes feeding easier, safer, more efficient, and good feeding supports growth and development and caloric intake and all those things, right? they feed each other, literally. Yes, that was intended. So the SLP or feeding therapist who understands the whole system, like, who can see this whole system, who can see the airway piece and understand the myo piece, understand how it all connects to feeding, that's a clinician who's seeing the whole child. That's who I want to be, and that's who I think you should want to be too. All right, let's do a quick takeaway because we covered a whole lot today. A whole lot. This has been longer than some of my past solo episodes. Number 1, myofunctional therapy is the assessment and treatment of oral and orofacial muscle function and patterns, right? It's functional, it's systems-based, and it's more comprehensive than just exercises. Now that we've cleared that up, let's move on to number 2. Myo matters to feeding therapists because myodysfunction often underlies feeding plateaus, and so addressing the function is gonna create faster feeding progress, right? We talked about that. Number 3, feeding and myo overlap significantly. You're probably already doing the myo work. As a feeding therapist, you might just not be calling it that. Four, there are misconceptions about myo, that it's just exercises, that it's only cosmetic, that you need special certification, that it's slow, and we already debunked all that and we know those are not accurate. Modern myo is functional, evidence-informed, and efficient, my friends. A basic myo assessment looks at resting posture, breathing, oral motor function, tongue position, jaw stability, functional patterns. It looks at a whole lot more than that, but this is what you can add now to your existing eval. Okay. 6, you start integrating myo by observing, adding one myo component to your feeding plan, doing basic pattern training, and start to notice what changes, right? That's how you're gonna integrate it in initially. And last but not least, feeding and myo are part of a connected system. Hopefully you heard me say that 5 million times over today. No, not that many, but a number of times over where it's so interconnected and integrated with like breathing and postural development, right? And so understanding the whole system. system makes you a more powerful clinician. So let's tie this up with a pretty bow. Here's what I want you to do: take your next 3 feeding evals, add one Mayo observation piece to each. Look at resting tongue position, notice the breathing pattern, see what you see, and then come back to thinking about how that piece affects the feeding work. If you want to go deeper, and I really think you should, I want you to check out the Mayo membership, which by the way is— we have something really exciting coming down the pike. We're making a big shift. And it's built exactly for this and the integrated, you know, the integration between myo, feeding, and even speech. But as myo membership stands today, it's myo education streamlined for busy clinicians. It's got, you know, the new part that we are launching in a couple of weeks, actually internally to our members, has a feeding connection built in. We do have the waitlist open and I want you on it. So if you go to themymembership.com, you can definitely get on the waitlist right now or just DM us if you want more information, DM @HallieBulkin or email support@feedthepeds.com. But in the next episode, the next solo episode, we're going to go deeper. We're going to talk about like screening versus assessment versus treatment in myo and why that distinction matters, when to do each, scope of practice. That's— that is the clinical depth episode beyond what we already started here. So I will catch you guys on that episode. Until then, this is Hallie signing off. Quick disclaimer: all information, content, and material of this podcast are the opinions of the speakers and serves as informational purposes only and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these myotats, 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 at halliebulkin.com or pop over to @halliebulkin on Instagram to get all the latest updates.