1 00:00:00,000 --> 00:00:21,680 Hi everyone, and welcome back to another episode of Airway First, the podcast from the Children's 2 00:00:21,680 --> 00:00:29,600 Airway First Foundation. I'm your host, Rebecca St. James. My guest today is Anne Marie DeMarco. 3 00:00:30,640 --> 00:00:36,400 Anne Marie is a pediatric occupational therapist providing in-home visits with a focus on child 4 00:00:36,400 --> 00:00:43,440 development in Fairfield and New Haven County, Connecticut. She specializes in sensory processing, 5 00:00:43,440 --> 00:00:50,000 developmental delays, primitive reflex integration, as well as children with autism and ADHD. 6 00:00:50,000 --> 00:00:55,920 She currently works in the birth to three setting and takes a holistic approach to treatment. 7 00:00:57,200 --> 00:01:03,120 She is passionate about educating both caregivers and parents regarding a child's sensory processing 8 00:01:03,120 --> 00:01:09,280 needs while promoting overall growth and fine motor development. Anne Marie's goal 9 00:01:09,280 --> 00:01:13,680 is to ultimately improve a child's independence with their activities of daily life. 10 00:01:13,680 --> 00:01:20,960 You can find out more about Anne Marie at annmariot.com. 11 00:01:22,560 --> 00:01:27,760 And now let's jump into my conversation with today's guest, Anne Marie DeMarco. 12 00:01:28,400 --> 00:01:32,960 Okay, great. Thank you for joining us today, Anne Marie. I truly appreciate it. 13 00:01:32,960 --> 00:01:39,040 Oh, of course. Thanks for having me. Absolutely. Absolutely. All right. So before we jump in for 14 00:01:39,040 --> 00:01:45,600 parents that might not know the difference, what is the difference between an occupational therapist 15 00:01:45,600 --> 00:01:49,840 and a physical therapist? And when would their children need to come to you? 16 00:01:51,520 --> 00:02:00,080 Yeah. So physical therapists are wonderful. They focus mainly on mobility, restoring function, 17 00:02:00,800 --> 00:02:08,720 maybe reducing pain and preventing further injury. So occupational therapy is a little 18 00:02:08,720 --> 00:02:14,480 bit different because we help people be able to do the things that they want and need to do 19 00:02:15,200 --> 00:02:21,040 as independently as possible through meaningful occupations. I always say if you think of an 20 00:02:21,040 --> 00:02:26,080 occupation as an activity, it becomes a little bit more clear. I think we hear the word occupation, 21 00:02:26,080 --> 00:02:30,720 we think of a job. We think a job. Yeah. Right. So occupations can be 22 00:02:30,720 --> 00:02:40,720 feeding, sleeping, toileting, showering, play, leisure. There's a whole host of occupations 23 00:02:40,720 --> 00:02:51,360 that we partake in on a daily, weekly basis. So if occupational therapy, we really want to focus 24 00:02:51,360 --> 00:02:56,640 on like, for instance, I'm a pediatric therapist. So a lot of what I do looks like play. And a lot 25 00:02:56,640 --> 00:03:04,160 of what I'll do is taking certain toys or activities and that the child already prefers. 26 00:03:04,160 --> 00:03:08,960 And we find a way to make it a little bit more therapeutic to work on some of the goals that 27 00:03:08,960 --> 00:03:15,360 the child might have. Okay. So kind of building on that. So you're looking at 28 00:03:16,480 --> 00:03:20,880 tracking to skill sets and benchmarks based on their ages as you're going through this. So 29 00:03:20,880 --> 00:03:29,200 what is a session going to look like with you? Yeah. So it really depends. I have, 30 00:03:29,200 --> 00:03:37,360 you know, I work with infants and even up through kindergarten, grade school. I have some older, 31 00:03:38,080 --> 00:03:44,720 older, I'd say teenagers maybe that I'm working with. And now I'm even getting some adults that 32 00:03:44,720 --> 00:03:49,040 have some disabilities too, just because these day programs and I live in Connecticut, 33 00:03:49,040 --> 00:03:55,920 the day programs just are not, there's no availability for spot, you know, for spots for 34 00:03:55,920 --> 00:04:01,760 these people. So it really just depends on the age. So, you know, with infants, a lot of what I do is, 35 00:04:01,760 --> 00:04:06,880 you know, just making sure that families understand tummy time, floor time is really important. 36 00:04:07,920 --> 00:04:12,000 Working on like visual tracking, you know, everyone says to me, you know, what do you do with like, 37 00:04:12,000 --> 00:04:15,440 a one month old and a two month old? And it's like, Oh my gosh, you can do so much with them, 38 00:04:15,440 --> 00:04:20,880 you know, you can do tummy time and they can do visual tracking. And, you know, there's, 39 00:04:20,880 --> 00:04:26,160 there's a whole host of, you know, different things that you can do. A lot of the toddlers, 40 00:04:27,200 --> 00:04:31,280 even like some of the kiddos that are like kindergarten, I'd say first, second grade, 41 00:04:32,480 --> 00:04:38,800 a lot of those kiddos that I work with are autistic. So what I focus on is like socializing, 42 00:04:38,800 --> 00:04:45,840 play attention, just, you know, those foundational skills so that when they're in school, they can 43 00:04:45,840 --> 00:04:50,400 sit and attend and learn in a group setting, because that's usually very difficult for them. 44 00:04:52,160 --> 00:04:57,040 So I incorporate tons of movement into my sessions. I mean, I'm never sitting down. 45 00:04:57,840 --> 00:05:01,440 A lot of the kids, especially, you know, after a school day, the last thing they want to do is sit 46 00:05:01,440 --> 00:05:07,600 down and show them, you know, a board game or read a book, which those are all great things. But 47 00:05:07,600 --> 00:05:12,960 a lot of the kids that I work with crave a lot of that vestibular input, which is like movement 48 00:05:12,960 --> 00:05:19,440 and their balance and that different, you know, that sense. So, so they crave a lot of movement. 49 00:05:19,440 --> 00:05:25,440 So we'll do things like obstacle courses, you know, I, there's like things that you can, 50 00:05:25,440 --> 00:05:29,920 I have a swing that I'll bring with me, you know, just sort of visits and hanging up on the, 51 00:05:29,920 --> 00:05:34,320 on the swing set outside and the kids will go in the swings for core strengthening, 52 00:05:34,320 --> 00:05:41,440 visual tracking, bilateral coordination. So it's very much tailored to, you know, 53 00:05:41,440 --> 00:05:47,280 what is meaningful to the child, like what they enjoy doing. And then we can kind of go from there 54 00:05:47,280 --> 00:05:53,120 and, you know, try to work on, work on some of their goals. But it definitely varies. 55 00:05:54,080 --> 00:05:58,320 I think from, you know, from person to person, like OT is very individualized. So 56 00:05:58,320 --> 00:06:05,760 it really just depends. And what is, you know, we hear this phrase tummy time a lot. 57 00:06:07,520 --> 00:06:12,240 And, and first to admit as a mom, I don't know that I did it right. I know we had to do tummy 58 00:06:12,240 --> 00:06:18,080 time. Not sure I did it right, but I tried. What, what are some basics, you know, as parents, 59 00:06:18,080 --> 00:06:24,320 we could be doing as tummy time that actually helps strengthen our, our little ones, their cores, 60 00:06:24,320 --> 00:06:30,240 their skills. What, what are some things we could do? Yeah. So, you know, floorplay is really good 61 00:06:30,240 --> 00:06:34,960 when infants are, you know, when they're within the first like few months of life, they can see 62 00:06:36,560 --> 00:06:41,120 black, white and red the best. So like you see a lot of people have like contrasts to them. 63 00:06:41,120 --> 00:06:45,680 There's a ton of, you know, very colorful toys for us. We're like, Oh my gosh, that's, you know, 64 00:06:45,680 --> 00:06:51,280 beautiful and colorful. Well, for infants that black, white and red. So now there's more and more 65 00:06:51,280 --> 00:06:56,400 like books. And I think, you know, like cards, like different, just different tummy time mats that 66 00:06:56,400 --> 00:07:01,600 incorporate those colors that can help infant be engaged. And I always say, you know, if, if you, 67 00:07:01,600 --> 00:07:06,080 as the parent can get on the floor with them, just your, you know, you're probably the most engaging, 68 00:07:06,080 --> 00:07:12,880 you know, engaging toy, right, right. That, that really that they have. So, you know, tummy time 69 00:07:12,880 --> 00:07:17,440 is definitely important. Some of the little ones that I work with will even do like some 70 00:07:17,440 --> 00:07:22,800 side lying. So, you know, just helps like shape the rib cage, especially my little ones that have 71 00:07:22,800 --> 00:07:30,560 reflux. I work with a lot of pre knees that are just out of the NICU. So, you know, they might be 72 00:07:30,560 --> 00:07:35,760 experiencing maybe they've had like, you know, a G tube or there's something that sort of inhibits them 73 00:07:35,760 --> 00:07:42,160 from really being on their tummy. So we'll try to do, you know, some side lying, even just having 74 00:07:42,160 --> 00:07:46,960 the infant like up on your chest, we'll use sometimes like a therapy ball and just kind of rock them 75 00:07:46,960 --> 00:07:54,240 slowly back and forth, you know, side to side, you know, and some, some infants are okay with it, 76 00:07:54,240 --> 00:07:59,440 and they love tummy time. And then others, you know, depending on, you know, if they have reflux 77 00:07:59,440 --> 00:08:05,600 or tortoise, like they might not take to it so easily. So those are all kind of factors we have 78 00:08:05,600 --> 00:08:12,960 to bring in and sort of, you know, work on. But I would say, you know, it does sort of again, 79 00:08:12,960 --> 00:08:19,600 like depend on the infant, but usually if we make tummy time a little bit more fun and engaging for 80 00:08:19,600 --> 00:08:23,920 them, you know, like we can't really like put them on the floor and walk away won't work for a 81 00:08:23,920 --> 00:08:28,160 couple of minutes. But, you know, getting down on the floor with them and really helping them engage 82 00:08:28,160 --> 00:08:32,640 is a great way to kind of extend out how long they'll they'll engage in tummy time. 83 00:08:33,280 --> 00:08:39,520 And should we be working with them on things like, you know, pushing up on their arms or rolling or 84 00:08:39,520 --> 00:08:46,400 absolutely. Yeah. So, you know, just things like reaching out in front of them or yeah, 85 00:08:46,400 --> 00:08:51,360 pushing, pushing up, you know, you can have them like setting up like toys, kind of like in a 86 00:08:51,360 --> 00:08:56,240 circle around them, have them like pivot, that's a good, you know, kind of like those milestones 87 00:08:56,240 --> 00:09:00,320 that we don't, you know, we hear about the, you know, the setting up and the rolling over and the 88 00:09:00,320 --> 00:09:05,200 crawling, but like in between those, there's some pretty awesome like mini milestones. So 89 00:09:05,200 --> 00:09:09,760 like pivoting is a really great one or even like just rocking on their hands and knees learning to 90 00:09:09,760 --> 00:09:16,080 reach just to develop that I hand coordination. You know, I use bubbles with, oh my gosh, everyone, 91 00:09:16,080 --> 00:09:20,640 I mean, everyone loves bubbles, but that's a really great activity, you know, as they get a 92 00:09:20,640 --> 00:09:27,760 little bit older to start to really visually track and work on I hand coordination, reaching all of 93 00:09:27,760 --> 00:09:33,920 those things, all those skills too. Okay, I like that. Who doesn't love bubbles though, right? 94 00:09:33,920 --> 00:09:42,000 I know bubbles are great. So in a previous podcast, which I'll include a link for those that didn't 95 00:09:42,000 --> 00:09:47,760 hear it with Brittany Murphy, she talked a little bit, a little bit, pardon my voice, 96 00:09:48,800 --> 00:09:55,920 about primitive reflux integration. And I've heard you also talk about that as well as sensory 97 00:09:55,920 --> 00:10:01,920 processing. Yeah. So if you would just take a minute to kind of explain what both of those are and 98 00:10:01,920 --> 00:10:06,480 how they relate to the work that you're doing with children and their development. 99 00:10:07,280 --> 00:10:14,880 Right. Yeah. So primitive reflexes, they develop in utero, and they're really present for survival. 100 00:10:15,920 --> 00:10:22,960 They facilitate development, and they also help with the birthing process. So, you know, for instance, 101 00:10:24,800 --> 00:10:30,240 we all have, you know, there's tons of these reflexes, but we have, you know, one that comes 102 00:10:30,240 --> 00:10:34,720 to mind is like the palmar reflex. So when there's an infant and they're small and you put your 103 00:10:34,720 --> 00:10:41,520 finger in their palm, they automatically close their hand around your finger. Right. So that 104 00:10:41,520 --> 00:10:47,840 reflex is supposed to go away between, you know, six to 12 months. When it doesn't go away and it 105 00:10:47,840 --> 00:10:53,520 lingers and say like a, you know, a five year old or a six year old, seven year old, that's trying to 106 00:10:53,520 --> 00:11:01,280 write or use a spoon or a fork to feed themselves. They really don't have good control over, over 107 00:11:01,280 --> 00:11:07,200 their, their motor movements because each time something, a stimuli touches, they still try to 108 00:11:07,200 --> 00:11:12,240 your hand. Yes, they're going to grasp it. And so, you know, you look, you know, you want to see 109 00:11:12,240 --> 00:11:16,880 like that, you know, this tripod grasp with the, you know, an eight year old that's writing and 110 00:11:16,880 --> 00:11:24,320 printing and even, you know, I'll hear some older, older kids that I work with say like, you know, 111 00:11:24,320 --> 00:11:29,040 my hands like, I just get so tired so quickly that they can't do the monkey bars or they can't 112 00:11:29,040 --> 00:11:33,840 hold on to like one of those like a trapeze and, you know, swing and pick up their back. They just 113 00:11:33,840 --> 00:11:41,600 can't really do a lot of those things. So with the retained reflexes, they can impact, you know, 114 00:11:41,600 --> 00:11:48,640 reading and writing, they can impact toilet, toileting, toilet training, a lot of emotional. 115 00:11:48,640 --> 00:11:55,280 Yeah. So the one, you know, this, this one is the spinal gulant and that helps with the birthing 116 00:11:55,280 --> 00:12:00,320 process. So like when the infant is coming down the birthing canal and a stimuli touches one side 117 00:12:00,320 --> 00:12:06,400 of their back, they flex towards that, that feeling towards the stimuli helps them kind of make their 118 00:12:06,400 --> 00:12:14,160 way down. A lot of infants are born via C-section. You know, it's like, so they don't get that. 119 00:12:14,160 --> 00:12:20,400 They don't have the ability for that reflex to emerge and then the reflexes is then retained. 120 00:12:21,520 --> 00:12:27,520 So that has a lot to do with bowel and bladder control. It's closely linked to auditory or 121 00:12:27,520 --> 00:12:34,640 auditory sense or sense of hearing. So, and, you know, kind of going on, you know, off of that 122 00:12:34,640 --> 00:12:39,840 with retained reflexes, when those are present, you always have like some kind of confusion 123 00:12:39,840 --> 00:12:44,800 within the sensory system. So with sensory processing, you know, I have a lot of kids 124 00:12:44,800 --> 00:12:52,800 that I work with maybe will, you know, they might not want to touch, you know, the sand 125 00:12:52,800 --> 00:12:57,280 that the kids are playing with in the sandbox outside at school or they might, you know, be 126 00:12:57,840 --> 00:13:02,480 kind of engaging in some unsafe behavior, like jumping off something that's too high or climbing 127 00:13:02,480 --> 00:13:07,840 up the furniture in the house because they're seeking a lot of input and trying to regulate 128 00:13:07,840 --> 00:13:12,960 themselves. But they don't really know, you know, the right way to do that. Obviously, 129 00:13:12,960 --> 00:13:18,800 a lot of them are young, but with retained reflexes, when you start to see the confusion 130 00:13:18,800 --> 00:13:25,520 in the sensory systems, because reflexes help the sensory systems to mature. So if like our 131 00:13:25,520 --> 00:13:30,560 foundation is kind of off a little bit and those reflexes aren't integrated, 132 00:13:30,560 --> 00:13:38,560 it affects their sensory processing as well. Okay. Wow, that's fascinating. Yeah. Yeah, 133 00:13:38,560 --> 00:13:43,840 I would never have put those together. That's wild. Yeah. And I think like, you know, we don't 134 00:13:43,840 --> 00:13:49,840 talk about like sort of a singular sense that, you know, we just I just mentioned that has a lot 135 00:13:49,840 --> 00:13:54,720 to do with movement and balance that's located in the inner ear and then proprioception, which is 136 00:13:54,720 --> 00:14:02,000 it basically is so, you know, if you see kids that, you know, someone comes home with the 137 00:14:02,000 --> 00:14:05,680 groceries and they run over and they want to like lift up something really heavy and like put it 138 00:14:05,680 --> 00:14:10,560 in the fridge or, you know, pushing a heavy box across the floor, that has a lot to do with 139 00:14:10,560 --> 00:14:15,840 signaling to their joints and muscles, it signals to their brain where their body is. So heavy work 140 00:14:16,560 --> 00:14:22,560 is something that is usually very regulated to these kids. And sometimes they don't get it as 141 00:14:22,560 --> 00:14:28,320 often as they as they need it. So that proprioceptive sense, something like, you know, we'll do like 142 00:14:28,320 --> 00:14:33,040 animal walks, like, okay, walk like a bear or walk like a crab. So you're getting more input 143 00:14:33,040 --> 00:14:38,160 to your muscles and joints that signals to your brain. Okay, this is where my body is. I'm doing 144 00:14:38,160 --> 00:14:44,000 it. And I, you know, I feel, I feel a little bit more regulated. Sometimes like weighted equipment 145 00:14:44,000 --> 00:14:48,640 will come in or like even when we chew, like, you know, crunchy snacks or things that are more 146 00:14:48,640 --> 00:14:54,080 difficult, that take a little bit more effort to manage. You know, there's a whole host of ways 147 00:14:54,080 --> 00:14:59,280 that you can provide like that proprioceptive input. And even the vestibular input, like, you 148 00:14:59,280 --> 00:15:04,320 know, swings are balancing on a, you know, along a curb on a walk outside, you know, and a lot of 149 00:15:04,320 --> 00:15:09,760 kids gravitate towards these things. And we're like, Oh, yeah, hi for you. Or, you know, it's 150 00:15:09,760 --> 00:15:14,880 right, we have to kind of, you know, calculate that risk. But sometimes we want to encourage 151 00:15:14,880 --> 00:15:20,720 some of that because it really does help the sensory systems and usually will help to regulate the 152 00:15:20,720 --> 00:15:27,360 child if we can sort of, again, like, help to make some of these activities a little bit more 153 00:15:27,360 --> 00:15:33,360 therapeutic for them that they're already engaging in. Right. So just support it in a safer way, 154 00:15:33,360 --> 00:15:40,080 maybe. Right. Yeah. Yeah. I like that. And you kind of touched on this, but as far as things like 155 00:15:40,080 --> 00:15:46,560 tongue tie releases and chronic sleep, how can occupational therapy assist these children? 156 00:15:47,520 --> 00:15:52,400 Yeah. So I don't, I don't specialize in like, I would say, you know, a lot, there are some 157 00:15:52,400 --> 00:15:56,800 amazing OTs that specialize in like the pre-op and the post-op for the tongue tie, like the release 158 00:15:56,800 --> 00:16:01,600 and everything. I'm kind of in the realm right now where I screen, thankfully I met Brittany and 159 00:16:01,600 --> 00:16:05,840 I'm able to refer to her for the time being. I hope to learn a little bit more about that. 160 00:16:05,840 --> 00:16:11,520 But I'm able to sort of screen for it and see, okay, there is a restriction, let me refer out, 161 00:16:11,520 --> 00:16:18,000 but there are plenty of OTs that have amazing experience, you know, with that. But as far as 162 00:16:18,000 --> 00:16:25,600 sleep, I mean, going back to occupation, sleep is a main occupation. So if we are not sleeping well 163 00:16:26,160 --> 00:16:33,120 and we are not breathing well, which I, you know, I just recently looked at my case load, again, 164 00:16:33,120 --> 00:16:42,240 85% of my case load has some type of airway disorder. Whether or not it is, you know, 165 00:16:42,240 --> 00:16:47,760 it is being treated or it's formally diagnosed, there is something there. I've, you know, I've 166 00:16:47,760 --> 00:16:52,960 referred to, I'll refer to Brittany, there's an ENT that's in town that I refer to as well. 167 00:16:55,200 --> 00:17:02,720 But sleep issues, you know, it's, again, like every other occupation is impacted when we're 168 00:17:02,720 --> 00:17:08,480 not sleeping and when we're not breathing well. So, you know, in sleep issues can arise from 169 00:17:08,480 --> 00:17:13,840 retained reflexes. So the spinal gulat, as I mentioned before, that can impact bedwetting. 170 00:17:13,840 --> 00:17:18,400 So if a child has a retained reflex, so they're already not sleeping well and breathing well, 171 00:17:18,400 --> 00:17:23,520 which we know also breathing can be affected or bedwetting can be affected by not breathing well 172 00:17:23,520 --> 00:17:30,480 too. But, you know, the spinal gulat, so if they're waking frequently during the night anyway, 173 00:17:30,480 --> 00:17:35,280 and then on top of that, they're wetting the bed, you know, four or five times a night, 174 00:17:35,280 --> 00:17:41,280 which also can disrupt their sleep. You know, children that are in a fight or flight, so our 175 00:17:42,720 --> 00:17:46,960 moral reflex that there's another one called fear paralysis has a lot to do with our fight, 176 00:17:46,960 --> 00:17:50,960 flight, freeze cycle. So when they're not breathing and they're startling and they're 177 00:17:50,960 --> 00:17:55,200 waking up, it's like, you know, those, those hormone, the adrenaline and the cortisol are 178 00:17:55,200 --> 00:17:59,200 pumping through them because they're not breathing, it's survival for them at that point. So, 179 00:17:59,200 --> 00:18:06,160 right. A lot of different issues are arising because of the reflexes, but also because these 180 00:18:06,160 --> 00:18:11,360 kids aren't breathing well at night. I mean, the number of children, you know, in my intake form, 181 00:18:11,360 --> 00:18:17,440 I have a little portion about like, you know, just asking about snoring and the, you know, 182 00:18:17,440 --> 00:18:22,560 the restrictions or all restrictions and that they have reflex majority, like I was saying, 183 00:18:22,560 --> 00:18:29,680 of these children have, you know, do, do have some type of issue with their, with their airway. 184 00:18:30,640 --> 00:18:35,520 Even, you know, add their adenoids are enlarged or their tonsils and it's visible to me, you know, 185 00:18:35,520 --> 00:18:40,960 their palate is narrow. I know there's a, I always forget the name of the scale, but it's, 186 00:18:41,680 --> 00:18:45,440 you know, when they open their mouth and you can't even see the uvula in the back, I always 187 00:18:45,440 --> 00:18:51,840 forget the name of the scale. But anyway, I mean, it's, it's clear to me almost immediately when I 188 00:18:51,840 --> 00:18:57,600 look at, when I do an evaluation that there's some type of breathing issue going on. That's 189 00:18:57,600 --> 00:19:04,320 definitely, definitely impacting their sleep. So, you know, as an OT, there's, there's so much that 190 00:19:04,320 --> 00:19:08,720 we can do to help with sleep. And again, like a lot of it has to do with the sensory processing 191 00:19:08,720 --> 00:19:14,240 piece. So maybe, you know, for instance, bath time. So maybe bath time is more alerting for some of 192 00:19:14,240 --> 00:19:20,400 our kids as opposed to calming. So like instead of doing a bath like right before bedtime, we can 193 00:19:20,400 --> 00:19:25,680 move it to the afternoon and maybe, you know, that linear swinging is more calming for them. So we 194 00:19:25,680 --> 00:19:33,680 can do that. So there's ways, you know, even like weighted equipment that we can use. So there's 195 00:19:33,680 --> 00:19:39,680 like weighted lap pads, vibration. I have like a pillow that like vibrates a lot of the kids 196 00:19:39,680 --> 00:19:45,680 really like that. So there's certain ways to get a child to sort of like regulate before bedtime. 197 00:19:45,680 --> 00:19:51,600 Even, you know, I talk about sleep hygiene too. So a dark room, maybe, you know, environmental 198 00:19:51,600 --> 00:19:57,280 sounds, if they like the rain or, you know, whatever the case may be, you know, we talk about 199 00:19:58,240 --> 00:20:03,440 no screens before bedtime, you know, not using the iPad or the TV. So there's a lot to do with 200 00:20:03,440 --> 00:20:10,720 the sleep hygiene. But I'm really, I think as I'm entering a little more into your world, I'm 201 00:20:10,720 --> 00:20:15,920 standing and I'm telling, I'm very straightforward now with families. And I'm telling them like, 202 00:20:15,920 --> 00:20:21,680 if your child isn't breathing well, there's not much that I can really do. I mean, we can try 203 00:20:22,320 --> 00:20:28,480 and we can see, you know, how it goes. But, you know, so many of these kids, as soon as I see them, 204 00:20:28,480 --> 00:20:32,720 they have an open mouth posture. And they're not breathing through their nose and they can't breathe 205 00:20:32,720 --> 00:20:38,400 through their nose, you know, whether their adenotes are enlarged or it's a motor planning issue where 206 00:20:38,400 --> 00:20:44,720 they just have not been breathing through their nose for however many years they're congested and 207 00:20:44,720 --> 00:20:50,640 large adenoids, whatever the case may be. And again, like I will work on those things, but if they 208 00:20:50,640 --> 00:20:57,760 can't breathe through their nose because there's so much, yeah, right. So I'm definitely still 209 00:20:57,760 --> 00:21:04,160 learning, but I feel as though, you know, like I was saying before with sleep, if we're not breathing, 210 00:21:04,160 --> 00:21:10,240 we're just not getting adequate sleep. So right. Right. And I think the malanpati scale, 211 00:21:10,240 --> 00:21:14,720 is that what you're thinking? Yes, that's it. I can never ever stick to my brain. The malata, 212 00:21:14,720 --> 00:21:20,640 I'm going to write it down right now. Yes, that's it. That's it. Yeah. It's like, it's a, it's a crazy 213 00:21:21,440 --> 00:21:27,680 word. Malanpati. Yes. And I'll put it for parents that haven't seen that, I'll put a link 214 00:21:27,680 --> 00:21:31,920 to that as well in the show notes so they can see it because it's, you know, once you see it and then 215 00:21:31,920 --> 00:21:38,800 you look at your child, it's very eye-opening. Yes. I guess, yeah. It's just, yeah. And that's the 216 00:21:38,800 --> 00:21:44,000 thing. When parents have this knowledge, they can then advocate. I feel like, you know, you don't 217 00:21:44,000 --> 00:21:49,120 know what to look for. And actually it's like, you know, you don't know what you don't know. I'm 218 00:21:49,120 --> 00:21:54,400 still, you know, I'm still learning about certain, you know, areas too. But right. Like if they can 219 00:21:54,400 --> 00:22:00,400 see, okay, this is, this is typical and this is maybe atypical and needs some internal. 220 00:22:10,320 --> 00:22:16,560 You're listening to Airway First with today's guest, Ann Marie DeMarco. You can find out more 221 00:22:16,560 --> 00:22:22,000 about the Children's Airway First Foundation and our mission to fix before six on our website 222 00:22:22,000 --> 00:22:28,560 at childrensairwayfirst.org. The CAF website offers tons of great resources for parents 223 00:22:28,560 --> 00:22:34,720 and medical professionals, including videos, blogs, a recommended reading list, comprehensive medical 224 00:22:34,720 --> 00:22:41,280 research, podcasts, and so much more. Parents are also encouraged to join the Airway Huddle, 225 00:22:41,280 --> 00:22:46,240 our Facebook support group, which was created for parents of children with Airway and sleep-related 226 00:22:46,240 --> 00:22:54,000 issues. You can access the Airway Huddle support group at facebook.com backslash groups backslash 227 00:22:54,000 --> 00:22:59,360 airway huddle. Are you a medical professional or parent that is interested in being a guest on the 228 00:22:59,360 --> 00:23:04,480 show? Or do you have an idea for an upcoming episode? If so, then shoot us a note via our 229 00:23:04,480 --> 00:23:12,160 contacts page on our website, or send us an email directly at info at childrensairwayfirst.org. 230 00:23:12,160 --> 00:23:18,160 As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. 231 00:23:18,160 --> 00:23:23,600 If you suspect your child might have an airway issue, contact your pediatric airway dentist or 232 00:23:23,600 --> 00:23:43,120 pediatrician. And now let's jump back into my interview with today's guest, Anne-Marie DiMarco. 233 00:23:48,000 --> 00:23:51,280 Definitely. Yep. And I really think we should rename this podcast, 234 00:23:51,280 --> 00:23:55,680 you don't know what you don't know, because I swear we say it at least once an episode. 235 00:23:58,800 --> 00:24:03,520 Yeah. And I feel, you know, even, you know, I was talking to Brittany recently, I did 236 00:24:04,480 --> 00:24:09,680 her podcast a few months ago, and, you know, we were talking about that. And I, you know, 237 00:24:09,680 --> 00:24:14,160 I feel like too, we're talking about torticollis and its relationship with oral restrictions. 238 00:24:14,160 --> 00:24:20,080 I didn't know about that three years ago, you know, I didn't know to look in a child's mouth if 239 00:24:20,080 --> 00:24:27,440 there was something muscular happening, you know, and obviously, of course, like I do feel terrible 240 00:24:27,440 --> 00:24:31,920 about it, but I, you know, I also feel for these parents that are like, oh man, like if I knew this 241 00:24:31,920 --> 00:24:37,760 sooner. So I think it's, it's, it's, it's wonderful because you do help to bring, you know, some of 242 00:24:37,760 --> 00:24:44,160 this information into families homes because it's not something that is really talked about that often. 243 00:24:44,720 --> 00:24:49,360 It's not. And another important thing is it's not just with parents. I mean, we don't know, 244 00:24:49,360 --> 00:24:54,560 but there's so many providers that, you know, at least I'll say it or they'll say it every 245 00:24:54,560 --> 00:24:59,040 episode, you don't know what you don't know or we didn't learn this in med school. I didn't know it. 246 00:24:59,040 --> 00:25:04,640 Right. Yeah. We're all just kind of figuring this out together, which is really, and I know we 247 00:25:04,640 --> 00:25:11,520 touched on this a little bit, but, you know, more specifically, how does occupational therapy help to 248 00:25:11,520 --> 00:25:18,800 rebuild a child's synaptic connections? Yeah. So when you look at like, you know, that concept 249 00:25:18,800 --> 00:25:26,000 of neuroplasticity, especially with refluxes, like retained reflexes, you basically can 250 00:25:26,000 --> 00:25:32,160 rewire the brain and you can, you know, it's, it's kind of that, you know, you know, use it or lose 251 00:25:32,160 --> 00:25:39,440 it concept, but a lot of kids that have these retained reflexes, like you'll see them compensating. 252 00:25:39,440 --> 00:25:46,720 So by that, I mean, you know, they sort of have, they know, like, and some of the, I should also 253 00:25:46,720 --> 00:25:51,760 say too, some of the children that I work with just have retained reflexes and sensory processing. 254 00:25:51,760 --> 00:25:59,280 They don't have like a formal diagnosis, so they might not get in school. So cognitively, you know, 255 00:25:59,280 --> 00:26:04,080 they really understand like, I'm not doing that the same way as my friend is doing that, but I'm 256 00:26:04,080 --> 00:26:11,440 able to get it done, you know. So for instance, a child that has an STNR reflex, which has to do 257 00:26:11,440 --> 00:26:16,320 with the upper and the lower body, you'll, you'll see them a lot of times they kind of like anchor 258 00:26:16,320 --> 00:26:22,720 their feet around the chair. So like, put their feet behind. I know exactly what you're talking 259 00:26:22,720 --> 00:26:30,640 about. Yes, because when their lower body is, is like flexing, it affects the upper body. So for 260 00:26:30,640 --> 00:26:37,360 them to sit in a chair and write something, it's like their upper body wants to do the opposite 261 00:26:37,360 --> 00:26:45,840 of what the lower body is doing. So for them to kind of flex their body, it's not, it's not like 262 00:26:45,840 --> 00:26:49,600 a normal movement for them. Like I get to sit here and I could write and it's perfectly fine, 263 00:26:49,600 --> 00:26:54,880 but I have all of that going through my head if I have this retained reflex and it's very difficult, 264 00:26:54,880 --> 00:26:59,040 but they're, they're getting it done, you know, their handwriting might be a little bit sloppy, 265 00:26:59,040 --> 00:27:04,000 or they might rush through it, or, you know, but they're, they're getting it done. So with that 266 00:27:04,000 --> 00:27:12,560 concept of, you know, neuroplasticity, as we kind of work on the exercises and activities to help 267 00:27:12,560 --> 00:27:18,240 integrate these reflexes, you're sort of creating new connections in the brain. So that you don't 268 00:27:18,240 --> 00:27:22,960 have to compensate quite as much. They can kind of sit with their feet flat on the floor, and 269 00:27:22,960 --> 00:27:28,800 they're able to kind of maintain that postural control and engage like in a, you know, a handwriting 270 00:27:28,800 --> 00:27:35,040 activity or a worksheet or something in school. So that's why a lot of, you know, I can come in and, 271 00:27:35,040 --> 00:27:40,640 you know, when I come into the, into the home, I'll do a lot of these exercises and the activities, 272 00:27:40,640 --> 00:27:44,640 but the parent really has to make sure that they're carrying over, otherwise it won't, 273 00:27:44,640 --> 00:27:48,800 it won't have the same effect. Right. Right. Which makes sense. Yeah. 274 00:27:48,800 --> 00:27:54,000 It only makes sense. So one of the things as parents that if you have a child that's 275 00:27:55,200 --> 00:28:01,200 socially behind or underdeveloped, we hear a lot of is play groups, play groups are the answer. 276 00:28:01,760 --> 00:28:07,040 So is that, I don't want to say always because you're not supposed to say always and never, but 277 00:28:07,040 --> 00:28:14,000 more often, is that the right approach or is there another avenue that we should be looking at as 278 00:28:14,000 --> 00:28:20,960 parents? Yeah. I mean, I think that, so birth to three is a wonderful resource. I still work in 279 00:28:20,960 --> 00:28:28,160 like early intervention a couple hours a month. So it's ages zero through three. And every state has 280 00:28:28,160 --> 00:28:35,200 a variation of it. They're called, you know, different titles and different. Okay. But that 281 00:28:35,200 --> 00:28:40,800 would always be like the first, the very first thing I recommend is calling birth. 282 00:28:42,560 --> 00:28:47,040 I'll have something that will even call me and they'll have like a two year old or, you know, 283 00:28:47,040 --> 00:28:51,840 one and a half year old. And I always ask them, did you contact birth to three first? Because 284 00:28:51,840 --> 00:28:58,720 you can get like a team of people. So it could look like a social worker, behavior therapist, 285 00:28:58,720 --> 00:29:05,200 an OT, speech therapist, physical therapy, it's a team of people that are kind of with you and, 286 00:29:05,200 --> 00:29:10,400 you know, they're able to sort of, you know, your child has to be eligible for the service, 287 00:29:10,400 --> 00:29:16,560 which they can have a valuation. But even if they're not eligible, they'll still provide you with 288 00:29:16,560 --> 00:29:22,880 resources like play groups or, you know, there's a, there's a lot out there that they can provide 289 00:29:22,880 --> 00:29:29,040 to you even if your child isn't eligible for it. Yeah. I mean, as far as play groups, a lot of 290 00:29:29,040 --> 00:29:35,120 children that I work with do, do attend them, but sometimes it takes a little while, you know, 291 00:29:35,120 --> 00:29:41,520 just because, and I think especially during, during COVID too, the, that social piece was 292 00:29:41,520 --> 00:29:46,720 sort of taken away from the sick noise. Yeah, all of us. Yeah. Very, very difficult for a lot of 293 00:29:46,720 --> 00:29:51,440 these infants that were born during COVID to then attend a play group with so much, 294 00:29:51,440 --> 00:29:58,880 they were over simulated pretty much immediately. Sure. Yeah. So, you know, I think again, like 295 00:29:58,880 --> 00:30:05,120 sensory wise, it really depends on the child, but play groups can be a wonderful, a wonderful thing. 296 00:30:06,080 --> 00:30:12,880 I feel as though if your child is kind of over simulated easily or quickly, it's always okay 297 00:30:12,880 --> 00:30:18,480 to just even talk to the whoever's running the play group before beforehand and just say, 298 00:30:18,480 --> 00:30:22,960 listen, we're going to come and maybe only for three minutes and then we're going to leave, 299 00:30:22,960 --> 00:30:27,120 you know, so they don't have to be there. I always like to find, you know, play groups or 300 00:30:27,120 --> 00:30:34,160 music groups where they can move or they don't have to just sit down because they're probably, 301 00:30:34,160 --> 00:30:39,600 yeah, they're probably not going to. So, I mean, parents can always reach out to them beforehand 302 00:30:39,600 --> 00:30:45,280 and ask these questions. Are they able to move? Can we come for five minutes and can we, you know, 303 00:30:45,280 --> 00:30:50,880 ask these questions before and even bringing some of those maybe regulating toys for them. So, 304 00:30:52,000 --> 00:30:58,080 you know, something like a little like fidget popper or they can eat a snack during, you know, 305 00:30:58,080 --> 00:31:02,400 while they're kind of just watching. I'll have some kids that, you know, even my little toddlers 306 00:31:02,400 --> 00:31:06,960 that I work with that I'll sit with like on the outside, the outside sort of of the, you know, 307 00:31:06,960 --> 00:31:11,360 the play group while everyone's in the middle there. And they seem to watch, like they've seen 308 00:31:11,360 --> 00:31:17,360 to sort of observe for one, two, maybe three, you know, three sessions and they feel a little bit 309 00:31:17,360 --> 00:31:23,520 more confident. And I think, you know, but the beauty of births of three, two is, you know, if 310 00:31:23,520 --> 00:31:28,640 the child is eligible, we go out into the community also. So having an extra support 311 00:31:29,840 --> 00:31:34,320 and someone that's sort of, you know, used to it and is, you know, it's okay if your, 312 00:31:34,320 --> 00:31:41,280 if your child is crying, like that's what kids do. If they're scared. And I always recommend 313 00:31:41,280 --> 00:31:48,480 to like a lot of the play groups that are local to my area are at libraries. So I always just say 314 00:31:48,480 --> 00:31:52,080 bring them, you know, bring them to the library before you can even talk to them. This is where 315 00:31:52,080 --> 00:31:56,160 the play group will be here. This is where the music class will be next week when we come back. 316 00:31:57,280 --> 00:32:00,960 You know, so you can do a lot of that like prep work sort of to sort of prepare them. 317 00:32:02,080 --> 00:32:07,680 But play groups are, you know, it's a wonderful way to get some of that socialization in, 318 00:32:07,680 --> 00:32:12,160 especially if they're not in like daycare or if they're, you know, maybe being, you know, 319 00:32:12,160 --> 00:32:15,520 watched at home by a family member and they don't have the opportunity 320 00:32:16,880 --> 00:32:21,440 really socialize. Play groups are definitely great. It's just about finding the right fit. 321 00:32:22,080 --> 00:32:28,000 Sure. And one of the things we see a lot with children with airway dysfunction, 322 00:32:28,000 --> 00:32:37,120 anxiety and depression, just they travel together with it. So, you know, how can occupational therapy 323 00:32:37,920 --> 00:32:45,600 help these kinds of kids? Yeah. So, you know, I think too. So usually what happens is 324 00:32:46,640 --> 00:32:49,680 with the retained reflexes, and it's so hard to know, you know, like what, 325 00:32:50,480 --> 00:32:56,320 what came first in a way, you know, but with these reflexes, I do see a lot of kids, 326 00:32:56,320 --> 00:33:00,560 especially like I'd say eight, nine, 10 that do have anxiety and depression. 327 00:33:01,280 --> 00:33:08,000 They do have this airway disorder, but maybe it hasn't been diagnosed yet. So in, while I refer 328 00:33:08,000 --> 00:33:15,920 out in the meantime, we will work on the fight, flight free cycle, because a lot of the kids that 329 00:33:15,920 --> 00:33:23,440 have anxiety and depression that I'm seeing do have those retained reflexes. So the morrow and the 330 00:33:23,440 --> 00:33:30,160 fear paralysis. So we'll slowly kind of start to integrate those. And then in addition to that, 331 00:33:30,160 --> 00:33:38,080 we kind of will find some of those sensory, you know, strategies that really help the child. So 332 00:33:38,640 --> 00:33:44,480 I always start like it really, again, I would say, you know, it depends, but I really, of course, 333 00:33:44,480 --> 00:33:52,560 sure, see if I feel as though a child is very, very anxious, I'm not going to jump right into 334 00:33:52,560 --> 00:33:56,800 reflex integration with them because it can bring up some sensations in the body, you know, 335 00:33:56,800 --> 00:34:01,440 you can make maybe tightness in their chest or, you know, they might not be ready to kind of 336 00:34:01,440 --> 00:34:08,240 sit with that and sort of like deal with it. So we'll look at, I do a sensory profile, which looks 337 00:34:08,240 --> 00:34:14,400 at different sensory systems and how that then can affect like their behavior or their environment, 338 00:34:14,400 --> 00:34:22,560 their, you know, how they socialize. So I'll pull from that. And then I can kind of then make kind 339 00:34:22,560 --> 00:34:27,520 of like a list of strategies that I can give to the parent or to the child. So for instance, 340 00:34:27,520 --> 00:34:32,000 I talk about the swing a lot, but the swings, I'll usually like, it's kind of like a, 341 00:34:32,880 --> 00:34:37,200 like a likerum material. So it kind of like squeezes them when they sit in it. So they go in the 342 00:34:37,200 --> 00:34:42,880 swing, like fabric, and it gives them that sense of proprioception. And because it's the joint 343 00:34:42,880 --> 00:34:49,760 muscles, it's squeezing. And then the vestibular, that linear movement, which is calming. So we'll 344 00:34:49,760 --> 00:34:57,440 do some of that, like weighted equipment, potentially, anything to kind of like, I think, 345 00:34:57,440 --> 00:35:02,960 regulate them and understand, okay, like I might not feel so great after, because a lot of these, 346 00:35:02,960 --> 00:35:09,120 a lot of the kids too will tell me in so many different ways with reflex integration, you know, 347 00:35:09,120 --> 00:35:14,560 oh, like this hurts or like, I don't like that, or this makes me feel, you know, and I think, 348 00:35:14,560 --> 00:35:21,920 well, I know it's just an uncomfortable, an uncomfortable feeling when, you know, I'll, 349 00:35:21,920 --> 00:35:26,240 again, like when I'm testing the spinal gulat reflex, you touch the child's back and you go down 350 00:35:26,240 --> 00:35:31,280 their, down their back and they don't have control over how they're moving. It's reflective, it just 351 00:35:31,280 --> 00:35:37,760 happens. So instead of you can do that and they don't move. Yeah. So, right. It shouldn't, they 352 00:35:37,760 --> 00:35:44,960 shouldn't move towards the stimulus right after that 12 month mark. So, you know, I just, I just 353 00:35:44,960 --> 00:35:51,360 evaluated a 12 year old. And she said to me, like, Oh my gosh, like that, I couldn't even control how 354 00:35:51,360 --> 00:35:56,400 my body moves when you did that. And I was like, I know, you know, even a five year old that I had 355 00:35:56,400 --> 00:36:01,200 yesterday, I was working on her palmar reflex. And she said to me, when you touch my hand here, 356 00:36:01,200 --> 00:36:07,120 my fingers move and it hurts, I don't like it. So that's not right. Like that Palmer, it's not 357 00:36:07,120 --> 00:36:14,400 supposed to happen. But they just like, it's such an out of control feeling for them. So I have to 358 00:36:14,400 --> 00:36:22,640 kind of be able to say and explain it as best I can to them. You know, this is, this is your right, 359 00:36:22,640 --> 00:36:26,000 like this is how it, you know, how it feels and it might feel a little uncomfortable, but it will 360 00:36:26,000 --> 00:36:33,120 feel better. You know, this is why I'm here and we're working, you know, so I feel as though with 361 00:36:33,120 --> 00:36:39,760 the anxiety and the depression, I would say 95% of the time those children, in addition to the 362 00:36:39,760 --> 00:36:46,640 airway disorder have retained moral or fear paralysis reflexes too. Wow. So what about weighted 363 00:36:46,640 --> 00:36:53,040 blankets for these kids to sleep with? Is that good? Or is that I don't know, does that, does that 364 00:36:53,040 --> 00:36:58,320 help? Or is that something that's going to freak them out? Right. So listen, again, like some, 365 00:36:58,320 --> 00:37:04,400 some kids like them a lot. Other kids will like get this thing off of me. I can't, I can't tolerate 366 00:37:04,400 --> 00:37:08,640 it. So I mean, listen, I sleep with a weighted blanket every single night. So what is my husband? 367 00:37:08,640 --> 00:37:13,680 We have like two of them on the bed, you know, so you're not supposed to technically sleep with 368 00:37:13,680 --> 00:37:20,720 sleep with them on you, but with children because what can happen is their, their body can get 369 00:37:20,720 --> 00:37:26,880 like immune to it and it won't have the same effect. And it should be supervised as well. But 370 00:37:26,880 --> 00:37:32,080 so it's more like, Hey, take a nap or Hey, watch a little TV without a read a book and then take 371 00:37:32,080 --> 00:37:39,600 it away. Yeah. Okay. So and they can kind of sometimes the weighted blankets too. I feel like, 372 00:37:39,600 --> 00:37:45,680 well, some, sometimes these kids like to have like a weighted stuffed animal or like a lap pad, 373 00:37:45,680 --> 00:37:50,160 a little bit, a little bit more, I think it's a little more preferred sometimes, but the weighted 374 00:37:50,160 --> 00:37:54,080 blanket, like a heavier blanket that you have in your house, like a throw blanket, 375 00:37:54,080 --> 00:38:00,240 you know, sometimes that will like do the trick as well. But yeah, I mean, the weighted equipment 376 00:38:00,880 --> 00:38:06,480 when, and again, like, so with weighted equipment too, there's like that tactile 377 00:38:06,480 --> 00:38:11,840 systems or a sense of touch. So some kids, I know, like if they can't tolerate wearing a backpack, 378 00:38:11,840 --> 00:38:16,480 which this time is coming up very, very quickly with the fall, I'm going to have to start working 379 00:38:16,480 --> 00:38:23,680 on pressing wearing backpacks with my little ones. If they don't like how that feels on their body, 380 00:38:23,680 --> 00:38:29,760 usually they won't tolerate any type of weight on them. We'll just have to find other ways. So 381 00:38:29,760 --> 00:38:35,120 different, you know, heavy work activities for them, for them to do, you know, some of the older 382 00:38:35,120 --> 00:38:39,520 kids, like I work with a 12 year old and he'll like, he'll take a theraband and he'll like pull 383 00:38:39,520 --> 00:38:44,480 on the theraband now or like lift like, you know, three pound weights or something with his dad 384 00:38:44,480 --> 00:38:49,760 downstairs, you know, so there's other ways to give them that input if they, if they just can't 385 00:38:49,760 --> 00:38:57,600 tolerate the weighted blanket. But usually that is a more calming strategy. And you, and you mentioned 386 00:38:57,600 --> 00:39:02,720 kids that can't handle, you know, the feeling of a backpack and, you know, we are coming into that 387 00:39:02,720 --> 00:39:10,560 time of year. What about, you know, if you're a parent of that kind of child, you know, what do 388 00:39:10,560 --> 00:39:15,760 you do? Can you do the, are the rollies the way to go until they're used to it or can you ease 389 00:39:15,760 --> 00:39:21,280 them and do it? What's the, what's their right option? Yeah. So I think with OT2, you know, 390 00:39:21,280 --> 00:39:27,360 one of the, one of my favorite, I guess attributes is that we can, yeah, we adapt kind of the 391 00:39:27,360 --> 00:39:32,000 environment or you can use some type of, you know, adaptive equipment. So something like, 392 00:39:32,000 --> 00:39:37,280 yeah, something that does roll, you know, it might look a little bit different. So then they can 393 00:39:37,280 --> 00:39:41,520 just sort of like carry in their hand, like, you know, if we can come up with something like that. 394 00:39:41,520 --> 00:39:47,520 Usually that, that hypersensitive tactile system, in addition to not wanting something on their back, 395 00:39:47,520 --> 00:39:55,520 has a lot to do with those spinal reflexes. So look at those. But yeah, so we can kind of, 396 00:39:55,520 --> 00:40:01,760 I like to say, like, you know, usually we do get there, like we'll start practicing, you know, 397 00:40:01,760 --> 00:40:07,520 next month, I'll just have the parent like bring, you know, bring the backpack. And sometimes if it 398 00:40:07,520 --> 00:40:13,920 is weighted, which it shouldn't be that heavy, but if there is a little bit more, like maybe a couple 399 00:40:13,920 --> 00:40:20,320 of books in there or something, not too heavy, but sometimes kids are more willing to try it. It's 400 00:40:20,320 --> 00:40:25,520 a little bit heavier because it gives them that regulating feeling. Okay. Oh, that's interesting. 401 00:40:25,520 --> 00:40:32,960 So how do I, as a parent, how, how do I know that maybe my child needs occupational therapy? 402 00:40:32,960 --> 00:40:40,960 Yeah. So really, it's if, if they're, you know, if the child's daily life is impacted, and if your 403 00:40:40,960 --> 00:40:48,960 life is impacted too. So, you know, if they're picky eaters, you know, you can't sit down and have 404 00:40:48,960 --> 00:40:54,080 a meal, you know, and I mean, not have a night bar, like if they are looking at food and it makes 405 00:40:54,080 --> 00:41:00,560 them want to gag and they can't smell of the food when you're cooking on the stove. You know, if 406 00:41:00,560 --> 00:41:05,440 they're not meeting those like developmental, you know, I don't love the word milestones, but like 407 00:41:05,440 --> 00:41:12,320 those developmental ranges, you know, if they are going from, you know, they're sitting on the floor 408 00:41:12,320 --> 00:41:18,480 and then they're eight months old and they're standing, it's like we want them to be able to 409 00:41:19,280 --> 00:41:26,160 roll and reach and crawl, you know, the, the it's so important because when we just go to, 410 00:41:26,160 --> 00:41:31,040 you know, maybe just sitting on the floor to then standing, they're locking their joints out and 411 00:41:31,040 --> 00:41:37,440 they're not, they don't have to use that fluid movement or the muscle to stand. It's like, oh, 412 00:41:37,440 --> 00:41:42,000 again, I'm compensating. I've learned how to do this and now I'm just going to start walking. We, 413 00:41:42,000 --> 00:41:48,960 we want kids to crawl. You know, so if, and yeah, they're, if they're sort of, I always say like 414 00:41:48,960 --> 00:41:55,680 anything with like sleep, if they're struggling with potty training, difficult to walk, you know, 415 00:41:55,680 --> 00:42:02,960 difficulty tolerating sensory input. So again, you know, some kids, they just don't love having 416 00:42:02,960 --> 00:42:08,320 their hair washed or, you know, it's, it's bath time is supposed to take, you know, 25 minutes and 417 00:42:08,320 --> 00:42:14,480 it's taking you two hours, you know, start to finish. So any of those occupations that are really, 418 00:42:15,760 --> 00:42:21,440 you know, really impacted, you know, I would also just say if they're toe walking or the open 419 00:42:21,440 --> 00:42:28,080 mouth posture or sitting in that W, they have like some of that low tone emotional dysregulation. 420 00:42:28,080 --> 00:42:33,920 So a lot of the kids with their retained reflexes too, you'll see, I mean, I feel like the majority 421 00:42:33,920 --> 00:42:41,600 of the referrals that I get are for the social emotional piece. So kids that just, you know, 422 00:42:41,600 --> 00:42:48,240 have a lot of trouble interacting with, with their friends or, you know, they lose a game and it's 423 00:42:48,240 --> 00:42:51,920 like they need to throw, throw the game across the room and they run out, you know, and they're 424 00:42:51,920 --> 00:42:58,320 upset with lingers for, you know, an hour or two. You know, so anything like that. But I always say, 425 00:42:58,320 --> 00:43:04,080 if their daily lives are impacted and yours are too, it's definitely time to reach out to an OT. 426 00:43:04,880 --> 00:43:10,320 And when they're, I mean, I know obviously, one of the things we advocate for is this, you know, 427 00:43:10,320 --> 00:43:15,680 holistic ecosystem of providers and let's look at the child as a whole and let's all work together. 428 00:43:15,680 --> 00:43:20,480 You know, Dennis talked to pediatricians, talked to occupational therapists, lactations, let's all 429 00:43:20,480 --> 00:43:28,560 work together. So if your provider doesn't have somebody they can recommend for you and, you know, 430 00:43:28,560 --> 00:43:33,520 you have to go off and Google or have her, when you start the process of looking for an occupational 431 00:43:33,520 --> 00:43:39,840 therapist, what are some things that parents can ask so we can make sure, you know, this is the right 432 00:43:39,840 --> 00:43:48,080 fit for our child? Yeah. So I think honestly, like even if you do, you know, if you do, if you are 433 00:43:48,080 --> 00:43:52,880 doing your own research and you are kind of like Googling and you find a couple, maybe two or three 434 00:43:53,600 --> 00:43:58,880 occupational therapists that you're interested in, I think, you know, whatever your concerns are, 435 00:44:00,160 --> 00:44:05,200 there's nothing wrong with kind of calling and asking for a consult and, you know, a phone consult 436 00:44:05,200 --> 00:44:12,720 and just saying like, these are my concerns, what can you do to help with this? You know, I hate to, 437 00:44:13,520 --> 00:44:18,960 I hate to go back to this, I feel like social media can be a wonderful, wonderful thing and at 438 00:44:18,960 --> 00:44:24,960 times it's not so great, but I feel as though through my social media too, like I'm getting more 439 00:44:24,960 --> 00:44:30,320 referrals that way because people are finding me and reaching out and I always will do a phone 440 00:44:30,320 --> 00:44:37,760 consult, but I feel as though, you know, even reaching out to, you know, people have messaged me from 441 00:44:38,720 --> 00:44:42,560 all across the country, I mean, even outside of the country asking this question, 442 00:44:43,280 --> 00:44:48,800 especially when it comes to routine reflexes in the sensory piece, and I will like, I will try to 443 00:44:48,800 --> 00:44:55,520 find them somebody if they're in Texas or California or wherever they are, I'll send them to, you 444 00:44:55,520 --> 00:45:02,640 know, certain directories to look for OTs that can help them with what they want, you know, 445 00:45:03,200 --> 00:45:08,880 I post a lot about routine reflexes and sensory on my Instagram and that's really, you know, 446 00:45:08,880 --> 00:45:13,040 I'm able to do that and that's partially why I started my own business because I felt like I was 447 00:45:13,040 --> 00:45:20,320 very restricted prior to. So, you know, you can always reach us, I mean, I always get back to 448 00:45:20,320 --> 00:45:26,400 people, I don't know, however, anyone else's I get it, like it could be overwhelming at times, but 449 00:45:26,400 --> 00:45:33,440 I think too, like it doesn't hurt just to reach out to reach out to people, you know, other 450 00:45:33,440 --> 00:45:40,800 professionals on social media and even, you know, asking, you know, sometimes, you know, again, like 451 00:45:40,800 --> 00:45:46,800 if someone's open to talking about it, asking around, you know, I feel like by word of mouth, 452 00:45:46,800 --> 00:45:53,040 you really get better, you know, a true recommendation and someone that had an experience, maybe so 453 00:45:53,040 --> 00:45:58,400 maybe a friend of a friend had, you know, their daughter needed OT and it was the best experience 454 00:45:58,400 --> 00:46:03,600 and she was a great OT and, you know, so I think just kind of asking, unfortunately, 455 00:46:04,960 --> 00:46:10,240 too, with, you know, a lot of pediatricians and not all, but some, it's kind of like this 456 00:46:10,240 --> 00:46:16,800 wait and see approach where like it were me, you know, we would intervene right away, whereas 457 00:46:17,520 --> 00:46:23,040 so parents also have to advocate for that sometimes, like it sometimes. Absolutely. You know, 458 00:46:25,200 --> 00:46:30,560 I think, you know, I'm hoping that this can change, but as far as development, unless you're 459 00:46:30,560 --> 00:46:35,200 seeing a developmental pediatrician, they don't really know a whole bunch about development or, 460 00:46:35,200 --> 00:46:41,200 you know, airway or, you know, anything like that. So yeah, it's very important to follow, 461 00:46:41,920 --> 00:46:45,760 you know, your intuition. If you feel like something is wrong, don't let it go. There's 462 00:46:45,760 --> 00:46:54,320 always outpatient services too. And I always say, you know, like even if you get into an 463 00:46:54,320 --> 00:46:59,920 outpatient or you start with birth through, you start with an OT and it's not going well, you can 464 00:46:59,920 --> 00:47:06,400 always, you know, ask to change providers usually with births to three or outpatient. There's other 465 00:47:06,400 --> 00:47:11,440 therapists and if you sign a good connection, you know, don't be afraid to ask to change, 466 00:47:12,400 --> 00:47:19,520 change providers either. That makes sense. So at the end of every episode, I always like to 467 00:47:19,520 --> 00:47:24,640 hand the floor back to our guests because you know, y'all are the experts, you know, best. So 468 00:47:24,640 --> 00:47:30,240 is there anything else you'd like to add or a last thought to leave with parents or maybe something 469 00:47:30,240 --> 00:47:38,400 we didn't cover that you'd like to share? Yeah, I think, you know, especially with, 470 00:47:39,680 --> 00:47:43,760 I think kind of going off of what I was just saying about following your intuition, 471 00:47:43,760 --> 00:47:50,000 a lot of families that call me, I'm kind of like their last home call, like a lot of them feel, 472 00:47:50,000 --> 00:47:53,440 I think a little bit defeated because they've known for a long time, like something that 473 00:47:53,440 --> 00:47:59,520 is going on and we're not, we can't quite put our finger on it. So I feel as though 474 00:48:01,120 --> 00:48:09,360 something that's very important is to follow, definitely follow your intuition, but then 475 00:48:09,360 --> 00:48:15,840 you have to start really advocating for what you think is right for your child because I have sent 476 00:48:15,840 --> 00:48:22,160 so many kids to an ENT that doesn't have experience with Airway, you know, unbeknownst to me and they've 477 00:48:22,160 --> 00:48:26,800 come back and I'm like, nope, they're fine. And it's like, well, they have circles under their 478 00:48:26,800 --> 00:48:30,480 eyes and they have an open mouth posture and they're storing and they're grinding their teeth at night 479 00:48:30,480 --> 00:48:35,440 and they're waking up and well then, you know, well what is, so I think just unfortunately the 480 00:48:35,440 --> 00:48:40,960 world that we live in, you know, just doing your own research and really trying to figure, 481 00:48:40,960 --> 00:48:46,480 figure it out on your own and then taking that with you to a medical professional or healthcare 482 00:48:46,480 --> 00:48:53,200 professional, you know, I think that when something seems like it's a little bit off, even if it is 483 00:48:53,200 --> 00:48:59,120 just a little bit off, early intervention is, it's priceless, you can never go back, you know, so 484 00:48:59,120 --> 00:49:06,080 that's why especially with birth to three, getting families started, even if they're just on the cusp 485 00:49:06,080 --> 00:49:11,200 of qualifying, I always say just take it, like take it and run, you know, the same thing with 486 00:49:11,200 --> 00:49:16,880 without patient OT, I think that like the earlier that we can get in there and kind of start helping 487 00:49:16,880 --> 00:49:24,880 even with airway, you know, the better the outcome will be. So I always just feel as though if a 488 00:49:24,880 --> 00:49:33,520 parent or caregiver thinks that maybe something might be off, usually they're right. And to kind 489 00:49:33,520 --> 00:49:39,680 of sometimes also just getting a second opinion, you know, if you still feel like, oh, I don't know 490 00:49:39,680 --> 00:49:45,360 I don't know this, you know, I went to the specialist and I'm not really sure definitely getting a 491 00:49:45,360 --> 00:49:50,560 second opinion can, you know, maybe confirm what you were, what you were thinking might be going on. 492 00:49:51,280 --> 00:49:54,800 Right, because you know your child best. Yeah, absolutely. 493 00:49:56,080 --> 00:50:00,960 Thank you so much for being on today and for, you know, sharing your information with us. Really, 494 00:50:00,960 --> 00:50:07,680 really appreciate it. Of course, Rebecca, thanks for having me. Absolutely. Thanks again to today's 495 00:50:07,680 --> 00:50:13,360 guests and Marie DeMarco for sharing her story and medical insight and each of you for listening 496 00:50:13,360 --> 00:50:19,040 to today's episode. If you're new to our podcast, please don't forget to subscribe. And if you 497 00:50:19,040 --> 00:50:24,400 enjoyed today's episode, leave us a review or comment telling us about what you enjoy most. 498 00:50:26,000 --> 00:50:31,120 You can stay connected with the Children's Airway First Foundation by following us on Instagram, 499 00:50:31,120 --> 00:50:38,000 Facebook, Twitter, LinkedIn, and YouTube. Parents can also join us via our Facebook support group, 500 00:50:38,000 --> 00:50:45,360 the Airway Huddle, at facebook.com backslash groups. If you'd like to be a guest or have an idea for 501 00:50:45,360 --> 00:50:50,800 an upcoming episode, shoot us a note via the contacts page on our website or send us an email 502 00:50:50,800 --> 00:50:58,000 directly at info at children'sairwayfirst.org. And finally, thanks to all the parents and medical 503 00:50:58,000 --> 00:51:02,480 professionals out there that are working to help make the lives of kids around the globe just a 504 00:51:02,480 --> 00:51:28,480 little bit better. Take care, stay safe, and happy breathing, everyone. 505 00:51:32,480 --> 00:51:50,480 Bye.