Oral Motor and Airway Red Flags in the First Two Years with Mackenzie Shiba

How do I not know about this when I am a speech-language pathologist? I went to grad school. Nobody told me about this. Nobody told me when you have your baby, it might be hard to feed them. We're not looking for perfect children. Nobody is perfect. We're not going to get perfection. I've got my own nasal stuff. I think a lot of us myofunctional therapists are like, oh yeah, we're working on that too. We're not looking for perfection, but we want to give our kids the best outcome possible. I feel like what we do sometimes here in some of our practices, they are weird, but they're only weird because nobody else is doing them and nobody else is talking about them. So they feel weird for people.

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, 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. Hi, and welcome back to the Untethered Podcast. I am so excited for you to hear from Mackenzie Shiba today. Mackenzie is a pediatric speech-language pathologist Certified myofunctional therapist and the founder of Communication Bloom Speech Therapy in Lodi, California. She works in the earliest years, babies and toddlers, across feeding, oral motor development, airway health, and early speech and language. This work gets personal because her own son struggled with feeding and growth, and she realized that even with all her training, nobody had handed her a roadmap. So she built one. She is the creator of the Bloom's Blueprint, a guide that walks parents through their baby's first 2 years, and she's on a mission to replace the wait-and-see approach with watch and support. She's also a mom, which she'll tell you is her most important credential. Mackenzie, welcome to the podcast.

Thank you. I'm excited to be here today.

I'm excited to have you here. So I know they just heard all about you, but I would love for them to learn a little bit about like how you got into the work that you're doing. So take me back to the night that you became a 2:00 AM Googler.

Yes, absolutely. So I am an SLP by trade. Did not specialize in supporting infants or anybody in regards to airway feeding. I was like, I don't touch that. However, once I had my son, it— from the beginning, it was a super difficult feeding journey. He had all of the things, the open mouth posture, the recessed chin, the tongue tie that we tried to address, but I didn't know enough. So I took it upon myself and I dove headfirst into the airway information space, tongue-tie, trying to research everything that I could. But in the area we live, there really aren't a lot of resources and nobody's talking about this. It's just you go to the hospital, they'll just release with scissors. That's the end of it. And I feel like it's probably pretty common in a lot of areas, but ours especially. So we were driving an hour to 2 hours for all these different specialists, and I really felt How do I not know about this when I'm a speech-language pathologist? I went to grad school. Nobody told me about this. Nobody told me when you have your baby, it might be hard to feed them. The little snorty breathing at night, all of that. I'm like, is he okay? He also had difficulty gaining weight. So just the constant, is he meeting his miles or his percentiles? What is going on? And pediatricians were only looking at One part of it. They were just looking at, is he gaining weight? And no, he wasn't. So I was even set up at one point on the triple feed system. And if anybody's had to do that, it's awful. And everything is blamed on the mom. When could we actually look at all these different systems working together? I actually saw 4 different lactation consultants and none of them were able to support me in the way that I needed. And finally, I found a myofunctional therapist who I was able to see via Zoom. She did an assessment over Zoom when he was like 2 months old after we had already done a tongue-tie release and a revision, and still nobody had told me, hey, you probably should have done bodywork. Hey, why does he have so much tension in his hands? All of these things that were not just separate or in isolation were not being looked at in an integrated way, and that was super frustrating. So I was the only one trying to put all the pieces together and understand. What was happening for him. So that, that is how I got here. And at 6 months old, went back to work, or when he was 6 months old, I went back to work and I was like, you know what, maybe I'll go back to school, become a lactation consultant. And I was like, no. And it just didn't feel like the right time. And then last year I just had this wild hair and was like, it is time. Maybe not lactation consultant yet, but I took your course and got certified and I was like, We're going to change this area and we are going to help parents look at their babies as a whole. Obviously, we also see in my practice kiddos who are older as well, who are experiencing airway issues, persistent tongue thrust. But I really want to find all of these families who have their babies or before they even have their babies, when they're researching the car seats, when they're decorating their nurseries. Let's also be prepared for any airway issues that come up, any feeding issues that come up. Tension in their body, all of these things that go together. So that is the long version of how I got into this.

I love that. I love that because we all have a story. You know mine, my own children threw me into this as well, like this own specialty within my SLP world. And I tell people I was also working with feeding, but more like 2+, hadn't taken any myo courses, was not, definitely was not doing any infant feeding or transition to solids type of feeding really. And then I had my own kids and same thing, first percentile on the weight charts, not gaining any weight, but they were like not concerned because she was on her own growth curve, staying at first percentile, not falling off the chart. And I was like, still seems concerning. Also couldn't find lactation consultants to help me. I did work with a couple, but really went nowhere. Was triple feeding, but nobody— I didn't even know it was called triple feeding at the time. I just realized this is what I have to do to help my child feed and get enough ounces in. So yeah, it was a wild ride, if you will. And I guess I'm forever grateful for that very, you know, emotional roller coaster of an experience, because it's now what has allowed me to step into this space and help so many other families. And I was just Recording some other things this morning for therapists, but as I was like recording and talking about the integration of the work that we do and so much of what it takes in this space, I was like reminding everybody, parents are not educated on this. They rely on us to connect the dots. So when a family comes to you and you're asking about sleep, even though they came to you for a feeding or a speech concern, and they're like, wait, wait, why are you asking me about that? I came because I'm concerned about X. You're like, yes, but it's all connected. And you start educating them, right? And then they start going— Oh my gosh, I would've never known. Well, of course you've never known. No one's ever taught you that. We can't expect you to know that. And I think it's, you brought that up and it's such a good reminder that parents don't know what they don't know. They don't know what they haven't. It's not readily available information. It should be part of the hospital required course or whatever courses and information that's being taught. I know our hospital required that we take so many hours of birthing classes or information in that.

Yes.

With some information about like breastfeeding. It was very minimal. It was not enough to help me actually when I needed it. Right. We need to beef that stuff up a bit more and the airway stuff. Right. And the feeding and the airway and the sleep, like that should all be in there because I think we all walk in with this like blissful expectation of what life's gonna be like once you have that newborn. And not only are you tired in your fourth trimester, but now if you're dealing with issues, you're like, you've entered a whole entire new universe.

Yes. Yes. Then we just slap a colic label on it and call it good. And that's just how your baby is. I feel like if we can access parents before and give them the information of like what to look for, what are some signals that might be connected?

Yeah.

I feel like whenever I'm doing like a myofunctional evaluation, especially for the infants, I'm the first one to put all the things on a report, like all the things your babies are experiencing together in one place. And No, some of them might not be connected, but usually there's a constellation of symptoms we're seeing. Or I meet an older child and I'm like, oh yeah, okay, heard that before. That all goes together. One of the things that with our new kind of approach, or that I'm trying to encourage our community to do, is take action early. Even if something's not super big, have it documented. Have it somewhere. So that's why I'm trying to work on this different kind of blueprint approach where we're starting early and then you have a plan if something is going to happen.

You call that the Bloom's Blueprint, right?

Yes, the Bloom's Blueprint.

Tell us a little bit more about that. I know that you mentioned there's 6 age windows, like birth to 2. So why, like, maybe share with us why you built it around like these windows instead of a milestone checklist or something.

Yes, absolutely. Milestone checklists. can be a little bit vague. As we all know, you can find everything on Dr. Google when you've had no sleep and you're just up triple feeding your child. But what I wanted to do is break it down into small digestible sections where, so for instance, the first section we have 0 to 3 months. There is a whole little spot on what we'll call developmental milestones for feeding, for communication. For social kind of cues, and we can document, yes, are they meeting those? No, they're not, or they're emerging. And then we also have a section called the signals. So signals instead of red flags, because they may not be red flags yet, but they are things that need to be paid attention to. And if there are a lot of them going on, we should probably pay really close attention. If they're demonstrating signals, And they're not meeting milestones, that deserves a lot of attention. We should probably make a referral. Within each of the sections, there's just some general strategies that I've used with my own clients that I used with both of my children that were super beneficial for all of the different domains. Because again, everything is working together. All these developments from the ages of 0 to 2 are listed in there just because I can't gatekeep those. Think about including as kind of like a little pathway. So if you're seeing XYZ, This is who you should take that to. If you're seeing this, you should take this to this professional, you know, whether it's a physical therapist, feeding therapist, speech therapist, or sometimes the pediatrician too. There is also a special little section of implementation of strategies that make such a big difference. Using those teethers, strengthening the jaw, making sure we are working on lip seal, tongue up when they are babies. And then obviously whenever they're getting a little bit older, are there obstructions? Is there inflammation in their nose? All of these different things. I know some, so many babies, they struggle with like dairy as well. It can be super inflammatory for babies. I know both of mine struggled with that and it was something that we had to cut out. Even as they're a little bit older, we have to address that. One of the things that I've been trying to, and I don't know why it's so hard, I think for me, because I practice every day, let's use our XClear every day for everyone. We all need it.

Yeah.

And it's such a simple thing that we can implement. And if your baby's used to having that stuff squirted up their nose, From infancy, then when they are 2 years old and they're a wild alligator and you're trying to do it, they're already used to it. No, it's not fun, but it's something that is super important where we live too. Like there's, it's farming community and so there's dust, pollen, all the things. And so it's just something that I'm trying to get everybody to do. XClear, sponsor me.

You're like, let's do a thing together. It's, that's so funny because like when I, I remember when I had my nasal surgery back in April 2018. My kids saw me using the NeilMed and they were using the Clear already, but they saw me using NeilMed and they were like, can we do that? And I was like, sure. And so I bought them their own little like NeilMed nasal rinse bottles and they started doing it. And I was just, it was because they saw me doing it, right? So if we as parents can normalize these things, they see us doing it, they often will ask or wanna try too. So us focusing on them. Now I know for some parents that's gonna take a little work for them to also start doing this for themselves. But I think it's such an important thing because one of my, one of my thoughts was like, I have people say, how do you bring this up with families without scaring them? This whole airway conversation, because some people hear it and it sounds— not that feeding's not medical, but people hear it and they're like, what do you mean there's a breathing problem? I think it could be frightening for some parents. So do you have a strategy for how you bring that up?

I do actually. So especially because a lot of times I have a lot of referrals for families, I do let them know that nothing right now is an emergency, right? If it was an emergency, they would not be in my office. They would be in the hospital. So letting them know that these are all different things we want to consider and we want to look into for the child. ENTs in our area notoriously writing people off. And so that's not usual. That's usually somewhere where I'm sending families, but I know that it may not have the best outcome. But yeah, just letting them know that it's not an emergency, but I want to look at all of the things. I would not feel, I would not feel good about them leaving my office and me not educating them on everything that I know.

Yeah.

And that is my hope for this blueprint too. Here is everything that I know. Obviously there are probably more details that are in my brain that I would like to impart on people, but here's the quick and dirty. You can have access to my brain, access to everything that I know, and you have this plan because that's what I want families to know is you can have a plan. There are so many things that we can do so early on. In the blueprint, it also includes stuff on communication because I just feel like so many things get missed. Obviously for me it comes very naturally, right? I'm an SLP and sometimes you've just got it, right? You know what to do. You know about the wait time for your child. You know how to model all of these things, but parents don't. And it's much easier to do all these things super early on versus reacting later. And yes, we would love to see families in our private practice. We want to treat kiddos, but also I would rather not see you and I would rather you be able to do stuff earlier on. I think one of the big things though that I don't want to be like misconceived with this is that it's preventative in that it's going to prevent a diagnosis. It's not. It's preventative in that we are preventing time from passing before something is being addressed. It's preventative in not letting this problem get too big. Doesn't mean that things aren't gonna happen. Like for my own son too, we did a lot of like all of the airway stuff for him. We worked on so many things and we are Still working on the airway journey and he's 5 and a half. Doesn't mean we're out of the woods, but I know that there's a plan and I know that he's going to be supported. I think the other thing to keep in mind for families too is we're not looking for perfect children. Nobody is perfect. We're not going to get perfection. I've got my own nasal stuff. I think a lot of us myofunctional therapists are like, oh yeah, we're working on that too.

Yes.

We're not looking for perfection, but we want to give our kids the best outcome possible. And get rid of that survivorship bias that we didn't breathe through our nose and we're fine. Are you? Yeah.

Yeah, that was me, right? I had my, the left side of my nasal cavity was pretty much blocked. I didn't even realize it. And I'm in this space, right? And I was in this space educating. And when I saw the imaging and my septum was like completely blocking the left side of my nasal cavity, I was like, oh, that explains a lot. But also I didn't realize because your body starts to compensate in ways that you're not even aware of. Second nature. It's biological. It's what your body has to do, right? And so it's like whether the other side was overworking or I was mouth breathing while sleeping, all the things that it had to do to help me function. That's always interesting because I've had older kids and adults come back to me afterwards and be like, I didn't realize what I was missing out on. This is how it's actually supposed to be. Yeah. And then like you also mentioned— now I'm totally blanking on what I was gonna say. But anyways, going back to just the whole like prevention is an important part, but that it's not a diagnosis. I love that you highlighted that. Conversation that did come up was like, how do you know when to watch versus when to take action? When do you monitor versus going like, oh, we need to intervene now?

So I feel like if we're seeing like maybe one thing, we're gonna watch it, right? If we're seeing 2, 3, 4, we need to intervene. Even if it's not something like you have a mole on your back and you're like, I don't know if this is cancerous, but I better go check it, right? We need to just be comfortable and okay with Going in a preventative way. I know that it's easier said than done because obviously like us as adults, we're like, oh, I should probably go get this checked out, but I don't, I put it off. But for our precious little kids, yeah, it requires some moving around of your schedule. Sometimes you might have to take off of work to take them to a doctor's appointment or take them to a specialist. But it's super important. We have to prioritize our kids. And I know a lot of these additional supports, like our services right now, we are private pay. I know everything costs money. Everything costs money. And I do notice some of the holdup for a lot of families accessing the support that their child needs. So one of the things that I do help guide parents through in my practice is what is the priority, right? Especially when they're a little older and we're considering ortho, we're considering bodywork, we're considering a release, all these different things. And, you know, they probably need myofunctional therapy. What is priority? Right. What is the family willing to do? That's why I'm trying to give something that is more accessible from infancy and it's not crazy expensive. Here is all this information, just like your little Bible for the whole 0 to 2. And you have this plan and you have the knowledge and it's not gonna solve all of the problems. Certainly there's definitely plugs in there. Hey, come see me. I think you need to see me now. Right? Because that does happen. I do wanna bring it back to, you had, I had a thought after you were mentioning like the xClear and the NealMed talking about like, you have to do it and your kids are going to notice that you're doing it and they're going to want to do it with you. I want to bring that back to feeding because whenever I hear, oh yeah, my kiddo doesn't want to eat, I'm like, well, do you eat with them? Do you sit next to them? Do you eat with them? Do you show them how to chew? Are you exaggerating your chew? We have to show them. They are fresh. They've never seen this before. They don't just come out knowing how to eat.

Yeah.

Especially for our kiddos who are experiencing tongue tie, airway issues, jaw discrepancies, all that stuff. They do not come out knowing how to eat, so we have to teach them. And we see in our practice, I'm sure you do too, like 3 or 4-year-olds who don't chew food. And so we have to show them, we have to teach them, and also not stop offering when they decide that they don't want it. So there is a bunch of information in there too on just feeding as they get older too, and food preparation things. But I'm sure you got that in your practice too, just like parents just don't know. But you actually have to show your child how to eat. We have to model it.

100%. And I think it also ties back into that whole integrated conversation, right? Because yes, we've got our mouth and it does all these different things, right?

We—

there's feeding, there is oral motor for different purposes, there is the whole airway stuff we've been talking about, there's the early speech development, right? Language, all the things. But these aren't like separate topics, right? This is all so interconnected. So unpack this a little bit because The mouth that eats is also the mouth that talks, right? But what does that look like in a real kid, right? And what are we catching sometimes during a, like maybe we're doing a feeding eval, but we're catching other things that will show up later in their speech. And I know people say, oh, but we use the mouth differently and different muscles for feeding versus speech. And I'm like, we're using muscles. These are still muscles that need to be used. Maybe we're using things, maybe the mouth opens a little bit wider to take a bite versus chewing. Maybe it doesn't open as wide for certain speech sounds as others or for the chewing, whatever.

Mm-hmm.

They're still muscles. We're still using oral motor movements, right? And there's this neuromuscular feedback loop pattern and things that are happening that are required in order for this to be successful. And so I think it's just such a deeper conversation that yes, we have one mouth, but these are not separate entities. These are not siloed things. This is all interconnected. So I would just love to unpack this a bit.

Yeah, absolutely.

Okay.

And forgive me, I don't know if this was in your course or where I heard it in my myo education, But the tongue works where the tongue lives.

Yeah.

And there you can't unsee that and you can't unknow that once you've worked with these kiddos. One of the things that more recently I have been noticing and like, all right, we're going to work on that ASAP. I don't care how young you are, is that persistent tongue thrust. If I'm seeing that at 2 or 18 months, we are working on it now. Because I know that either that is a symptom of a tongue tie or just persistent habits with that tongue. And so I'm gonna nip that right away because we talk, we eat, and our tongue hangs out for those, or our tongue thrusts for those actions. It's going to just live there.

Yeah.

So that's something that I've been working on very early on, and I've been encouraging my therapist, even though it's, we're not gonna work on the S yet. Like, oh yeah, we are. We are working on that right away. Or if we're seeing any dentalization of like the T or the D, like we are observing these patterns earlier on. And maybe that child's not here for airway. And I know that some families too, when they come just for speech, I do try and have conversations like, I think there might be more going on, but it's much easier when we understand these things when your child is a, an infant or a toddler. If you're understanding that all of these things are going together now, Then later on down the road, we already have that knowledge. So we know, okay, we're working on this, whether it's tonsils or adenoids need to be removed because their tongue is down low because they can't breathe and they have to breathe through their mouth. But we have, yeah, we have those conversations with families a lot.

I love that. I love that. And I think it ties back into why even in like my own business, right, with therapists, we decided to shut down our myo membership and our pediatric meeting. of and combine them into the integrative therapist and make it like this year-long— because we're like, no matter how much we preach it, we still feel like it's being taught in so many other places as in individual silos. And so there needs to be like one place where people go where they can learn that. Yeah, we're saying one mouth, but like not different topics, right? Like, yeah, you're one whole child. There is— this is an integrated system. We need to start teaching and treating and assessing in an integrated way. And I feel like we've taught that in our programs naturally, but it doesn't always translate because of the other education that's out there or the lack of mentorship or other things going on. And so anyways, I think that when I took— I was already a feeding therapist, as I shared, with infants, doing toddler on up. Then I took my Mayo course and it's through that Mayo lens that I realized, oh my gosh, we need to be doing this with our infant toddlers. And I wasn't even an infant feeding therapist yet, right? I was like, oh, but now I am because I'm going to figure this out so that I can go and help these kids. And then I was like, oh my gosh, we need to teach this to everybody else because This is what's lacking, the integration, the integrated approach. And I think what's tricky is like, I'm also the person who you'll hear say, MYO is really not for under the age of 4 or 5. And what I mean by that is like cognitively, right? They need to be able to follow those directions. But if you're taking a traditional MYO program and trying to apply it to those little ones, that doesn't work. But as feeding therapists, as SLPs, OTs, even highly trained PTs who specialize in this population, We can take that myo information, adapt it, and we should be doing that. That's why I teach that in Feed the Peds, because I'm like, like you're saying, these kids shouldn't wait. We need to address it now. And I will tell you, for every single case that I have ever worked with, when we address some of these things early on, that list goes away. Why? We weren't necessarily targeting the S directly in my practice per se, but in the back of our mind, we're like, like you're saying, that tongue is living forward in the mouth or interdentally between the teeth or up against the teeth or sitting low on the floor of the mouth. If we don't address that now, we're not going to make progress on anything else. We're just teaching compensations. We're not helping the child thrive, right? We got to get that tongue up where it's supposed to be, in the right position, full mobility, able to lateralize and elevate and protrude and create that, work towards that rotary chew and work. And honestly, let me tell you, and I know you know this, but like when you work like this and take this approach, speech sound production therapy becomes So much easier. And you even— I don't know about you, but I was like, I don't know that phonological processes are a real thing.

I was like, I just—

I was like, I'm not seeing those patterns anymore. What I'm seeing is a tongue that can't function that's causing what appears to be a language pattern. But I really think for most of these kids, it's actually a motor pattern that we need to change. And I know I'm gonna get a lot of hate for that, but there's other people out there that are doing the research that actually are proving my hypothesis is true now. So I'm like, yeah. Yes, it's out in the open. But no, truly, it's really cool to see the progress they make when you— what's driving the boat? What is the root behind all of this? You address that.

Why did the problem start in the first place?

Yeah, and it's not like everything magically just improves on its own. No, sometimes you still have to address it because they've got these patterns built in that you have to break, and you have to teach the new patterns. But it's so much easier.

These kiddos who are a little bit older, and it's like, oh, okay, you're here for speech sounds. And you're a very picky eater and you're snoring at night. All these things, yes, that they're all together. And yes, you're just coming for speech sounds, but hey, I would like you to be able to breathe so that you can be regulated during your sessions, that you can feel good. I would like you to be able to try more foods because you are able to manage them, chew them, lateralize your tongue. And we can work on all those things from infancy.

Wow.

We can work on the jaw grading, we can work on the tongue lateralization, we can work on that. Labial seal and the tongue up on the roof of the mouth with our thumb, our fingers, our hands, and maybe one tool. That's all that those babies need. And then successful feeding, obviously, right? But parents are just— one of the things that I see so often, and I don't know if you've seen this in your practice too, for some of my little older kids who come in for a myo evaluation and mom had zero feeding issues Or breastfeeding issues. And then I ask about, how was your supply? Oh, I was oversupplier. Okay, your baby's being waterboarded. They didn't actually have to work for it. Coming from me being a mom who had barely enough supply and a child with a tongue tie and feeding issues. So those are usually the ones that we are seeing earlier on whenever mom's supply is tanking too. But for the moms who have more of an oversupply, that baby is wanting for nothing. And then these other signals are being missed, right? Yes, they were eating fine. They're 95th percentile, but their tongue is hanging forward in their mouth and their mouth is open all the time and they have this recessed chin. And I'm like, okay, yes, you fed well, but that's one piece of the puzzle. That is one piece. I had another, I had a little one come in for an eval the other day and yes, 95th percentile, feeding well, maybe some initial pinching during breastfeeding. But he can't soothe himself. Can't sleep without mom.

All right.

His tongue is lying low in his mouth. So let's work on getting that tongue up. Let's work on some of that jaw grinding, cuz that little chin is so recessed. That is not looking good for ortho later down the road.

Yeah. Yeah.

It's all connected. Oh yeah.

100%. And we've seen the same kind of cases. And I always tell people too, I'm like, if some, if a baby comes to me between 3 to 5 months, at times there was like a window whenever they came at that age, but they were coasting, right? They were doing well. Well, also the swallow and reflux integrates and it always happens right around the time that mom has to go back to work. And so there's higher stress levels. So we've got some dysregulation in mom, which is carrying— it's like the perfect storm, right? So it's like the reflux integrates, they were coasting, maybe mom had the oversupply, whatever it was, like everything was working. And then it wasn't. And they're like, why now? I have to go back to work. And the baby also won't take a bottle.

Well, we didn't— Yep. All the time.

No bottle. Exactly. Exactly. And I think it's one of those things again, and I feel badly for these families because I feel like the system is failing them. They were not properly educated on it. And I don't wanna be like, woe is me and doomsday, and here's all the horrible things that can happen when you feed your baby.

For sure.

But I do think there needs to be a certain level of education so that parents are not set up for failure. Because if we're waiting to introduce a bottle a week or two before a parent goes back to work because they didn't want a bottle before that, well, what if it doesn't work? We have no window to help you before you go back to work, and that's a whole nother problem. And so anyways, and I pass no judgment on anybody's choices or timeline or what they choose to do or not to do. do when it comes to feeding their baby. But again, I think it's a system problem. We— the system, family, these parents. So I love that you have something for them, hopefully help educate ahead of time and as they go through this journey in the first couple years, because it's a lot. And there's a lot of development and changes that happen when it comes to feeding and speech and even gross motor movements, right? There's so much change that's happening in the first couple years of life, just developmentally, that It's overwhelming, I think, even for some therapists when we sit down and we go, whoa, okay, where is this child right now? Are they at least on the right trajectory, or do we have these splinter skills and they're all over the place? But it's a really— it's always interesting, and honestly, it's why I loved it, because working with these kids keeps me on my toes. And no 2 babies that enter the practice are the same, and/or if they had similar symptoms, the route wasn't always the same, or the approach wasn't always the same. And do we have a little exercise set that we might use on our kiddos repeatedly that are just some really good things that we should be doing with all kids? Yes. But also, it's still a very personalized, individualized approach. And so anyways, I love this conversation because I just feel like it's so important for both clinicians and parents to hear, be reminded of. And I think it just all goes back to like—

Mm-hmm.

Integrated we are as human beings and how we are not silos and we can't treat humans in silos. Unfortunately, that's what the medical system traditionally does.

100%. Yeah. And I like what you said about no 2 children are the same, and it is so true. And I will get first-time moms, obviously. I will get first-time moms that are having difficulty feeding their child, but I will also get— I've had moms in here who have had 3 kids before, and then they have this 4th child and they're like, whoa, I have not had these issues yet. I don't know what to do with this child. I thought I knew everything I needed to know. I've had all these kids. Yeah, but you didn't know what to do if something happened or if something came up, especially in regards to feeding, airway, because those 2 things for sure get written off. Communication, for sure. We also see the can get kicked down the road way too often. Even in our area, like the early intervention, parents are being told, no, my child doesn't qualify. I'm like, what?

I started, and it was like they had to have a 25% delay. Based on this particular assessment.

Yes.

Which was crazy. Yes. And so, and I honestly, so I was always the one who was like, I think this kid should qualify anyway. So we're going to qualify them and put them on my— we're going to work with them. And I lasted there a whole year.

So I think that you guys made our own practice.

Exactly. And I think that ties into that whole wait and see approach. And I know you were saying wait and see is basically advice that we need to retire. It needs to 100% be retired. And I think when a parent is sent home with that kind of advice, either your child doesn't qualify, so they think it's not bad enough, or they are like, let's just wait and see because they're at the pediatrician, or maybe it's a therapist, whatever. I think it's really dangerous advice because if a parent, especially if a parent comes to you with a concern, parents know their babies the best. And if they're concerned about something, that is worth exploring further and not just saying, let's just wait and see what happens. They're still young. They'll develop that because half the time If we could have worked on that and caught something earlier and started addressing and supporting earlier, it's so much easier. It takes less time, it takes less money.

And I think the mental tax on moms— yeah, you get told, okay, wait and see, but then you internalize that, you sweep it under the rug a little bit, but then you are up at 2 AM Googling every single night, like, am I sure that this is not right? Am I sure that this is something that is to be expected? And you'll get 15,000 different answers. And you know in your gut that this is not right and that you don't want to let it linger and you don't want to let it grow. And so trying to figure out— and sometimes we're just trapped, right? You have this pediatrician that you have to go to for whatever reason, whether it's your insurance or not, and you have nowhere to go. And we're trusting the medical system, and it for sure fails moms and babies big time. And it Makes me like, ugh, mad and tear up at the same time. It's frustrating because I've been there too. I'm like, what do you mean he's supposed to be that small? I don't think he's supposed to be that small. Look at me and Dad. I don't think he's supposed to be that small. And so I just want parents to know that they do have options. It might not be the— they may not be able to go and do the private therapy, but there are things you can do. And if they have these terms that they know, like If they're able to identify these particular signals that are going on, even the little YouTube tutorial, but knowing that you don't have to accept that no, this is just the way it is. No, your baby should not be snoring. They should not be snoring.

Yeah.

Period.

Coaching these parents if they are continuously getting dismissed by their pediatrician or even if they've just been dismissed once, right? Without putting them into let's say a fight with their provider because like you said, sometimes this is the provider that you go to because that's. Who takes your insurance, you don't have many options where you live.

Yes. Yeah. So I do try and give them obviously some alternatives, but then I also try and help them finagle the system a little bit, especially if their child's a little bit older. Okay. I think you did do the Flonase for 3 months, right? You did. You told me that last session, right? Okay, go. You already did the Flonase. Okay. And just trying to give them all the information that I know, obviously anecdotal from what I've tried with my child. Hey, let's make sure we are washing their sheets all the time. Let's make sure we are using the saline so that they know. And that's the other thing with this blueprint is I want parents to know I did everything in my power to give my baby the best outcome for feeding, for airway, for communication, right? You have all the strategies, you have all the information, and then yes, it might be a little bit of a fight, but you can safely say when you go to that professional you're trying to get a referral from, hey, I have done all of these things and it's not working, they need more support. And then they have all the terminology already to be able to say, I've done this, now help me. And then at least making sure you can tell the doctor, I would like you to write this in the note, right? So that you have the documentation.

Yeah. Oh, I love that. I love that. And I think that was part of like when I went into private practice, a lot of it was like I worked in the schools. I was like in the preschool program for 2 years and then the infants and toddler program for 1 year. And I was like, now I can help advocate on the private practice side and help these parents get what their children deserve. And that was honestly, it was such a passion project of mine. And they did every time. It was so great. I was like, I'll come to your IEP meeting with you because I know exactly how this is going to run because I used to run them. So bring me along and we will make sure you get what you need.

I think parents think even in schools and in doctors' offices and stuff, like Well, I don't want to take resources from other kids who may need it more. Just because your child's signal issue challenge is not a huge one doesn't mean it doesn't deserve attention and doesn't mean that you shouldn't advocate for your child still, no matter how small the thing. If your child needs stitches, like, you're going to advocate for them to get support. We have to advocate for our kids because nobody else is going to do it.

100%.

100%. I love that.

I know some of them will say to me, okay, I feel really confident with what to do with a 4-year-old, right? But I feel really lost with what I should do with a 4-month-old. Yeah. What changed for you? Because I feel like I had my whole experience, but like, what changed for you when you finally got trained in those like earlier years?

Oh my gosh, what changed was that I looked back at my son and I was like, I'm so sorry, I didn't know enough. And realizing that, hey, every diaper change we want to be Working on their lateralization skills. We wanna be doing those gum sweeps, using their little teethers, encouraging them to do tummy time and teethers. Like all of those simple little things that are helping support their speech, their feeding, and their airway.

Yeah.

Like all at the same time. You get so much bang for your buck when you are really thinking about their body working together. That's one of the biggest things more recently I've been trying to encourage parents is, all right, tummy time and this. And they're like, oh, they don't like tummy time. I'm like, oh, shocker.

I will.

Let me unpack that for you. I think we still need to work on it, and we might need a PT referral, and we might need to figure out how much air they're ingesting when they're feeding, right? All of those things being together. So I think one of the biggest things is just letting them know, again, like you've mentioned today too, like nothing is in a silo. Look at everything together. How can we help? And also giving the recommendations to parents that are going to be Parents are busy. Parents have other kids. Reminding them it can be 1 minute during diaper change, can be 5 minutes of intentional time a few times a day. I think one of the biggest challenges that parents run into is whenever other people are caring for their kids. I know for certain when my kids were at the daycare, walked in, I'm like, oh, you're propping the bottle up on a towel. Oh my gosh, I'm gonna pretend I didn't see that, right? But then you think about, all right, what can I do at home to counteract that? We're gonna chew on some resistant foods. Okay? We're not just doing the passive waterboarding. And so sometimes that, those are our circumstances, right? You have to go to work and you have to put your child in the hands of somebody else, but could you be confident in coaching them to, hey, can you give them the teether during XYZ time? Or can you make sure that they have this amount of tummy time during the day? I want parents to feel confident telling other people to do that for their children too, cuz it can be a lot. Or if it's just mom doing all of the things and dad's not participating, which doesn't happen all the time, but happens enough to know that a lot of it falls on mom and mom's trying to figure out what's going on with her child, being Dr. Google mom, being physical therapist mom, being speech therapist mom, being the ENT mom, right? We're trying to figure out all of these things for our kiddos.

Yeah.

Because we love them so much and we want them to thrive and we don't want them to not sleep because when they don't sleep, we don't sleep either. Yeah.

Yeah. Also for like more for the clinicians, like how do you take that parent's gut reaction to what's going on more seriously without overpathologizing a baby who maybe doesn't have as much going on? You're not seeing as much going on as maybe what the parent thinks is going on.

Yeah. So I do think if you have a parent who thinks there's So you're saying if the parent doesn't think there's a lot or parent does—

No, like they almost think like there's more going on than what we're seeing even. Yes, there's still some stuff going on cuz sometimes you get it on the, uh, the opposite end, right? Mm-hmm. Oh, for sure. Parents all the time who are like, oh, I wasn't expecting that. And they're like hesitating cuz they, it's like there's more going on than what we realize. And I feel like we often focus on that conversation as clinicians. Yeah. Like how do you tell parents when there's more going on? What about the flip side when it's like, for sure, the parent maybe is, we want parents to trust their gut and we want them to come to us with their concerns, but then what if they're over-pathologizing? And we're like not seeing as much as they are, which I don't think happens as often, but it does happen. It does happen.

Yeah, no, I've had parents come into my office and that's the situation. So in those cases, what I would recommend for therapists is you want to give the parent a plan, right? It could be as simple as, hey, if you're continuing to see these things, or if these things are not happening, and maybe you give them a specific number. If you see 3 signals in the next 2 months, Contact me. Let's make a plan, right? If they're not meeting these milestones, contact me. Let's make a plan. So giving them a solid plan when they leave, that can be super helpful because then you're not dismissing them again like other providers and saying, we'll see you if something really bad happens. I think about myself with my own doctor's appointments recently. They're like, oh, you're not that bad, so we can't really help you. Oh, good. Thank you so much.

Oh, your blood work is normal, so you're fine.

And you're like, I'm telling you, I'm not fine.

Yes, exactly.

So we don't want parents to leave feeling like they have been dismissed, even if it's something very small. Because yeah, I'm telling parents, hey, if something small is happening, go check it out. Doesn't mean that you shouldn't come and get it checked out, but also doesn't mean that you're going to leave with somebody telling you, yeah, there's something really bad happening and you need all these referrals. But I still give parents a plan. And I tell whether they're an infant or they're an older child, I still give them a plan of if this persists, Or if you see more of these types of things, then come back, or basically a flowchart. We try and make it very visually appealing so that the parent can visualize it, see it. Yeah, I'm telling all these parents to go and get these small problems addressed, so I don't want to dismiss them when they do come in if it's something small.

Yeah, but I think it's so important too because even the smallest thing could actually— there could be a lot more going on.

Right.

And I think it's more— it's less common that parents come and there's like nothing going on. And there can— I have had a couple situations where that happened, and I actually did make referrals for mom because I feel like mom needed more support. And I think there can definitely— that can happen too. And it's— I don't want to say it's not as common. I think a lot of times mom needs support and there are things going on with the baby, right? And it's a whole— it's a whole big picture. It's a whole host of things that need to be addressed. So supporting our moms, I think our parents, our fathers too, it's just such an important piece of the puzzle that a lot of people don't talk about enough, especially in non-artsy families.

Yeah, we could argue that the mental health piece is also integrated in there for moms.

100%, because if you think about it, like, what does that influence? Their nervous system. 100% influences the baby's nervous systems. All interconnected. Yeah, absolutely, absolutely. Okay, so another like more like Personal question for you, but to share with our listeners. So you went and got myo trained, obviously you're a certified myofunctional therapist on top of your SLP degree. So for therapists who are like wondering if that's worth it, like what did it change about how you actually practice?

Oh my gosh. This makes me look at kiddos so differently. Why are they not sleeping well? Could it be that they are not regulated? Are they not regulated because they're not sleeping well? I am looking at kiddos from a bigger lens now, not just why they're coming to me. Even some of my main— the way that I started was working with autistic children for AAC and consult language processing.

Yeah.

And my own specialty, I do still have a couple of kids on my caseload where I am supporting in that way too. And I am giving parents advice and information on airway, on feeding, and making sure that they also deserve to breathe. I have a couple of kiddos with Down syndrome on my caseload as well, and parents are pursuing palatal expansion because yes, they still deserve to breathe. And so I think for families who have never even considered addressing their child's airway dysfunction or low tongue posture or anything like that, I am providing education. Again, it is still up to families to pursue that because I know they have so many other things that they are focusing on, so many other things that they are addressing, so many other therapies they're pursuing. But it is my responsibility to educate.

Yeah.

And so we have made it as a practice, we are including airway on all of our evaluations because it's very important to us. Yes. Yeah. And we, yeah, we are, we have another therapist who's doing feeding therapy right now too. And we make sure airway is part of the discussion because yeah, you're not gonna wanna eat if you can't breathe. Right. You're gonna want something quick. You don't have to chew because you can't close your lips when you're trying to eat. So making sure that my therapists also know that all these things are connected. But yeah, for me, I can't unsee it. I'll see a kiddo come through and I'm like, did you take a picture? Did you check in their mouth? Did you get— how are they sleeping? Because I want to know. I don't want anybody to leave. I'm like, why is your child not sleeping? That means you're not sleeping and that sucks. Yeah.

And that means that their nervous system is a hot mess when they wake up the next day and then everybody else is a hot mess as a result. So it's a whole snowball of things.

Yeah. So trying to figure out how can we interrupt those cycles. Obviously I'm not a doctor. I don't have all the answers, right? But I know enough from working with so many kids over the years, having my own kids, doing so much research and doing all these certifications and training to understand more. I also did the Feed the Peeds training. Yeah. Um, but being able to understand everything, my brain is so full. I don't think I could take another training right now. But that's what my other therapists are for. We're gonna get them the other training so then I can share the information with them and vice versa. But yeah, I think all of my therapists now too, I got the bug in their ear and they're like, wait till you see this picture. And I'm like, oh, yep. You knew it. You knew it was there. So that feels really cool to me to be able to impart that knowledge on them as well. Because I cannot be the only person in our area doing this. It's 100%. It's a lot of pressure. And that's why I'm trying to create this product too. So like, I'm gonna, hey everybody, you need this. Can you tell your friends about this? Because I went. I want everybody in our area to have this knowledge, and I want the pediatricians to be inundated and be like, why are all these parents talking about airway and low tongue posture? Because they know. McKenzie told them. Yeah, exactly.

I love it. And this really comes back to what we've started to do as well, because obviously you're a graduate of Feed the Peds and the Myo Method, and you're a CMT and everything. And we got to a point where we were like, yes, our programs are integrated and everything, but it still requires the mentorship It still requires you taking that information, right? And actually going back and putting it into practice and then looking at your cases. That's a lot of the work you do on your own where you have to start connect— we help you connect the dots. Until you're working with those patients, that's where it all starts to click and you're like, oh my gosh, I see it. I see it in every single child that I'm working with. There's so much integration here. And not just integration and progress happening, but integration of the systems that are not working properly together and things that we need to approach better, the better questions we need to ask, like you're talking about with the the airway and all this. And so I get so excited when I hear this because one of the things that we had realized was, okay, we're helping to educate.

Yes.

But what so many of you need to do is go back and do exactly what you're doing. You need to be that leader in your community where maybe there's not enough information available in this space for parents because yes, we can train you as the clinician, but then really we want this movement to start. Where clinicians are really leading the way and paving the way in their communities to help get those parents and children the information they need. And I'm like, you're already doing it, right? And so now it's just a matter of lighting that match and making a bigger fire. And it's horrible analogy, but really, how do we go and have it take off, right? So that every single person has this knowledge. And so you're obviously already doing that in your community, which is so—

Oh, I'm trying. I still feel like it's hidden and people still don't know about it. People still don't know about What we're doing here. And I feel like one of the consistent things in my career, and I know that you are as well, if I may use this word, we are disruptors.

Yeah.

We're disrupting the status quo and we're not going to accept that we're not gonna address these things. These things deserve to be looked at so we don't become adults who are struggling with things that we don't need to struggle with, or having to get jaw surgeries or having to get nasal surgery. Right.

Like I did.

Exactly.

Yes.

Yes. So all these things that like, why would we not do these things earlier? And I've just, yeah, consistently in my career through all of the different specialties I've navigated, I'm okay being the one that does things differently because I'm not gonna accept that we're just gonna follow a standard.

Yeah.

I don't really like the rule books.

100%. I am always a rule breaker and like new rule creator. And it's part of it is also trusting your intuition. If you're someone who's so in tune with your intuition, because not everybody is, you just know you have that knowing within you and you see the progress being made, people's health like improving benefits from the work you're doing. And you're like, hold up, wait, okay, I was taught this, but actually that's not working. This is. And I'm connecting the dots and I'm seeing patterns and this is all making sense. And I've got the education to back what I'm seeing and what I know to be true, right? And then you're kind of like, okay, all right, I'm onto something here. And at the end of the day, if my patients are improving and they're graduating from therapy, that's enough that I know we are headed in the right direction and I don't need to follow the status quo, right? I'm okay being that disruptor. I'm okay being the one who's different. I'm okay being hated by certain people online who think they know better than everybody else and only wanna follow published research, which can't always research what we're actually doing in therapy. But that's a whole nother conversation for another day, right? You get it.

No idea who you're talking about.

Yeah, I have no idea. I don't know who that could possibly be. Anyways, it's amazing.

It's amazing.

Anyways, I just, I want to say thank you because you obviously took a big risk yourself going and taking some of these courses and implementing the things and trusting yourself and trusting your gut and using your own experiences to better the experience for other parents and children, right? You and I are like on parallel, parallel, leading parallel lives here with a lot of what you were saying. I started working with children who are autistic early as well. And it was actually those children where I started to see these eating patterns and the foods they were eating. And that made me so curious. I was learning about how the gut and the brain were connected. I just, it made me so curious. That's what really pushed me to dive into feeding. To begin with, and then from there I dove into Mayo and airway and tots, and then infant feeding beyond what I was already doing. And it just—it was an evolution over a number of years, right? So the cool part is we are all now here in this place where everything is finally being recognized as integrated. Whether some people want to accept that or not—that's a whole other conversation. But I think your community will be better for it, and it does take time, right? It takes time, and that's part of part of our mission and our movement now is. Helping you all take this information and bring it to your communities because we can't do that, and that's not necessarily we could, but that's a whole other business, right? You all are already educated; you're already doing the work in your community. You're the leader in your community, so it doesn't need to be us; it should be you. And so we want to better help you all continue to build that leadership position. So if someone's like my child struggling to feed, they're like oh go see Mackenzie and her team because I don't know what they're doing over there, but it works. You need to talk to them. Your baby's not sleeping well? Go talk to Mackenzie. Oh, your baby's throwing up feeds a lot? Go talk to Mackenzie. Oh, my child needs. Braces, go talk to Mackenzie. It's whatever is happening. They need— your name should be the name that's said in a room full of people when you're not present, right? And so that, at the end of the day, is our goal for you all now, is because you guys have stepped into this, you're doing the thing, you're helping the patients. And like, kids are not meant to be in therapy for their entire lives.

Yes.

I know there's some children who may have global delays, and that's a very different situation, but for a lot of these kids coming through with some feeding challenges, myotots, airway, whatever, our Therapy is to get you in, get you out. Maybe you come back in the future as things— if things pop up again, but you should not be lifelong therapy kids. And sadly, so many of these kids get to my office— get to— I don't have an office, we travel— but they come to our practice is the right word, and they've been through 7 SLPs and they've been in and out of therapy for 10+ years, and we're like, what is happening? This is not okay. We've got to change this. So we're right there, right to you, figuring out how do we get this information in front of the right people and position you all as the leaders in your community so you're the go-to expert because you are.

So we have a herd of unicorns floating around in the United States like, oh, there's unicorn. Oh, yep. All right, we're on the same page. Yes. Yeah. We're very proud of being different here.

I love it.

There's a book I just recently read I think it was like raising a business and raising babies. And one of the acronyms that she threw out was GROW, and it was grit, resilience, outlook, and weird. And I was like, I resonate with the weird one. Like, I feel like what we do sometimes here in some of our practices, they are weird, but they're only weird because nobody else is doing them and nobody else is talking about them. So they feel weird for people.

Yeah.

And that's okay. I'm okay being weird.

Yeah. But honestly, to be so confident in your weirdness, like you've gotta have the grit. You've gotta have that outlook, your bigger vision for what you're gonna do. Right. And then what was the other resilience? Like you gotta be resilient because at the end of the day, you are going against the grain and you know, that's not for everybody. Not everybody can tolerate or stomach that. So, you know, but the way I look at it too, for anybody listening who's like, how do you guys do that? If you can just think of one patient, one patient who will benefit from this work that you're doing, cuz you're going against the grain. That's just keep that one patient in mind because if you can help just one more person every day, every week, every year, whatever, then you're living your life calling. You're doing what you were put here to do. And so sometimes it's actually having to put that child in your mind or put that adult or child in your mind to help you overcome your own mental block or whatever may be holding you back. Because I just see so many therapists struggle with this. They're like, oh, but that's so different than— oh, they're going to think it's so weird, or nobody else is doing this. I know, and that's okay. And we want, we want to invite you into this weirdness circle, if that's what you want to call it, because it's the circle where everybody's actually helping patients, and patients are already— they're improving and graduating. So comfortable.

I've always been comfortable thinking outside of the box, like, oh, I have this weird idea. I've been telling my therapist, let's make this book, this book of Communication Bloom stuff, like, where we're like, that is not something you would ever learn anywhere, but you know what, it worked for that one kid, and I'm gonna try it with another kid because It was weird. It came outta my brain. I don't know how I thought of it, but we're gonna keep trying it. And kids like weird, kids like novelty, and they're gonna do it.

100%. Oh my gosh, I love this. I know we could talk all day. So tell us, where can people find you, work with you? Like where do they find your blueprint? All the things. And we'll make sure this is linked below the show notes as well. But tell us so everyone can see.

Yeah, so our main practice page is on Instagram @communicationblooms. We do have a website too. Just look at communicationblooms.org. That is our main therapy page. We are able to see clients and people virtually if needed in California. And then the Blooms Blueprint is my newer Instagram with my new product where we're sharing and educating on there more for that 0 to 2. I just felt like on my main page, we are serving a lot of older kiddos too. So sometimes we do share stuff over there as well, but I felt I needed a dedicated baby page where we are focusing on more of that preventative, again, not preventing diagnoses or anything like that, but preventing that time from passing before we're addressing problems and before they grow into something else. And we really focus on everything being integrated.

I love it. I love it. McKenzie, thank you so much for joining today. This was—

Of course. Thanks for having me.

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 myotots, airway, and feeding-related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer at halliebulkin.com, or pop over to @halliebulkin on Instagram to get all the latest updates.