1 00:00:00,000 --> 00:00:29,440 Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First 2 00:00:29,440 --> 00:00:36,560 Foundation. I'm your host, Rebecca St. James. My guest today is Michelle Emanuel. 3 00:00:36,560 --> 00:00:41,920 Michelle has more than 27 years of experience as a pediatric occupational 4 00:00:41,920 --> 00:00:48,080 therapist with a specific focus on posture, movement, and connection for the pre-crawling 5 00:00:48,080 --> 00:00:59,240 baby. She has a background in NICU, PICU, SICU, and outpatient population. She has a unique 6 00:00:59,240 --> 00:01:04,520 and interesting way of blending traditional and complementary forms of therapeutic applications, 7 00:01:04,520 --> 00:01:09,320 with her main emphasis being on facilitating healthy nervous system functions. 8 00:01:11,320 --> 00:01:17,160 Michelle is an international board-certified lactation consultant and a national board-certified 9 00:01:17,160 --> 00:01:24,520 reflexologist. She has advanced training and extensive experience in a wide array of manual 10 00:01:24,520 --> 00:01:32,840 therapy and body work techniques, including craniosacral therapy, myofacial release, reflexology, 11 00:01:32,840 --> 00:01:40,040 baby facial massage, and more. Michelle developed a unique curriculum of manual therapy, utilizing 12 00:01:40,040 --> 00:01:47,880 therapeutic skin movement for pediatrics and nervous system regulation. The Tumming Time Method 13 00:01:47,880 --> 00:01:52,600 was developed to address the rising number of babies affected by sleeping on their backs, 14 00:01:52,600 --> 00:02:00,520 developing tension patterns, torticollis, and flat spots. Developed around 2005, it was the first 15 00:02:00,520 --> 00:02:05,960 and still the only program developed directly addressing Tumming Time issues and has been 16 00:02:05,960 --> 00:02:13,800 learned by close to a thousand professionals worldwide. She also developed BabyMayo, a novel 17 00:02:13,800 --> 00:02:19,720 curriculum of oral, habilitation involving optimal strength, endurance, range of motion, 18 00:02:19,720 --> 00:02:28,360 sensory processing, motor patterns, reflexes, oral, and pharyngeal phases of breastfeeding 19 00:02:28,360 --> 00:02:34,840 and bottled feeding for newborns to pre-crawling babies. You can find out more about Michelle 20 00:02:34,840 --> 00:02:42,360 at TummingTimeMethod.com. And now, let's jump into my interview with today's guest, Michelle 21 00:02:42,360 --> 00:02:49,640 Emmanuel. All right, great. Thanks so much for joining me this afternoon, Michelle. You're welcome. 22 00:02:49,640 --> 00:02:54,120 Thanks for having me. I'm very excited to be here. Yeah, I'm super excited. So let's just, 23 00:02:54,120 --> 00:02:59,080 let's jump right in. We're going to come out of the gate talking about the Tumming Time Method. 24 00:02:59,080 --> 00:03:05,080 So let's just start there. What is the, exactly, and why is it so important for infants? 25 00:03:05,080 --> 00:03:11,960 Okay, the Tumming Time Method is a specific sequence way to do a whole body movement, 26 00:03:11,960 --> 00:03:19,640 including tummy time for pre-crawling babies. Now, I developed this many years ago, and it was 27 00:03:19,640 --> 00:03:27,080 specifically for babies I was working with who had all of the symptoms that our babies right now have, 28 00:03:27,720 --> 00:03:34,120 such as persistent asymmetries, meaning looking one way more than another, who were having a 29 00:03:34,120 --> 00:03:40,840 difficulty balancing their postural muscles and having stiffness and imbalance tension, and maybe 30 00:03:40,840 --> 00:03:45,480 even were crying a lot and didn't really want to do it at all. And we all know Tumming Time is 31 00:03:45,480 --> 00:03:51,240 important. So anyway, it's a specific way of doing Tumming Time and problem solving it, etc. 32 00:03:51,800 --> 00:03:57,880 Now, what I do is, and how I learned to do it was really just working with babies and noticing 33 00:03:57,880 --> 00:04:06,520 what was natural for them. So it is based on natural development, and it's very, what we call 34 00:04:06,520 --> 00:04:11,720 co-regulated in the sense that we're working with the baby to stay. We're going to make it 35 00:04:11,720 --> 00:04:15,880 intense a little bit because that's what we all need to develop, but we're not going to make it too 36 00:04:15,880 --> 00:04:23,160 intense. It's not torture time. We make it so that it's actually doable and enjoyable. And I think, 37 00:04:23,160 --> 00:04:29,960 you know, it's important for babies because we live in a culture that doesn't really support 38 00:04:29,960 --> 00:04:36,280 Tumming Time that much and doesn't give us a lot of support around that. And we know it's so important 39 00:04:36,280 --> 00:04:42,440 and our babies are sleeping on their backs. And that's fine for back to sleep, but we need to 40 00:04:42,440 --> 00:04:47,560 really balance that out by doing enough during the day. And that's difficult to do for a variety 41 00:04:47,560 --> 00:04:55,000 of reasons. And so having a way to do it helps us get her done and knowing that we're doing it well 42 00:04:55,000 --> 00:04:59,640 and feeling good like, hey, I did that and that mattered. Right. You know, for a parent, I think 43 00:04:59,640 --> 00:05:04,920 is really important. I remember back, you know, just being a young parent myself like, I'm willing 44 00:05:04,920 --> 00:05:10,360 to do this. This matters. I can see changes. It's really important. And so many of the babies that 45 00:05:10,360 --> 00:05:16,440 we see have problems with their posture, their tongue, or their mouth, or their breathing, or their 46 00:05:16,440 --> 00:05:23,560 GI, or their airway. And so it's working all those muscles to balance it and really mature the nervous 47 00:05:23,560 --> 00:05:29,160 system in a really good way that does that from a naturally development perspective. 48 00:05:29,880 --> 00:05:32,520 How many times a day should we be doing that with our babies? 49 00:05:35,320 --> 00:05:38,280 That's a good question. I mean, tell me how many times we talk about, we like to do it for, 50 00:05:38,920 --> 00:05:45,000 we like to do it for very short, frequent times. So like three to five times a day or so. And 51 00:05:45,000 --> 00:05:50,280 really what the American Academy of Pediatrics recommends is time. You know, so many times 52 00:05:50,280 --> 00:05:56,440 that they say break it up and it's good. But I think the most important thing and what I've seen 53 00:05:56,920 --> 00:06:02,920 over time, babies be successful is just not having a big expectation that they do it for a long time, 54 00:06:02,920 --> 00:06:10,360 but just do it really frequently for short periods of time. And even like if a baby is at the maximal, 55 00:06:10,360 --> 00:06:14,600 like not having a good time in tummy time, what we usually say is do it every day or change. 56 00:06:14,600 --> 00:06:19,640 So we'll say every diaper change you lay them down, just roll them over for five, six seconds, 57 00:06:20,280 --> 00:06:25,320 pick them back up, snuff them. And that's a good reminder is we do a lot of diaper changes. 58 00:06:26,280 --> 00:06:33,480 That's a great way to get a ton of tummy time in with very little adding extra to our day too. 59 00:06:34,520 --> 00:06:38,680 And babies get used to it when they know, hey, I don't have to be here forever. And these little 60 00:06:38,680 --> 00:06:44,440 bitty bites throughout the day help so much. That makes sense, man. I wish I'd known that. 61 00:06:48,200 --> 00:06:52,600 Yeah. We could say that about, I think. Right. Yeah. 62 00:06:52,600 --> 00:06:57,720 I thought it was fun about these conversations because we can pass things along and grow our 63 00:06:57,720 --> 00:07:03,640 network in that situation. Absolutely. Absolutely. So and I'll put the link to all the things we're 64 00:07:03,640 --> 00:07:09,560 going to talk about in the show notes. But on your website, you talk a little bit about 65 00:07:09,560 --> 00:07:14,120 compensatory and is it, I don't know if I'm supposed to be saying novel or no novel novel? 66 00:07:14,680 --> 00:07:17,720 Novel. Okay. So what are they? 67 00:07:19,080 --> 00:07:25,400 That's a great question. Compensatory movements are things that we do because we couldn't do it, 68 00:07:25,400 --> 00:07:33,000 how we were going to do it. So for example, if you have restrictions of your tongue and the tongue 69 00:07:33,000 --> 00:07:38,040 is supposed to do so many different things and say it's inhibited by a tie or some other type of 70 00:07:38,040 --> 00:07:45,240 muscle dysfunction. And so we still need to eat and breathe and do all those things. So the other 71 00:07:45,240 --> 00:07:51,320 muscles and other parts of the neck and the shoulders will compensate. So they'll help, 72 00:07:51,320 --> 00:07:59,560 they'll jump in and they'll lend a hand and do more to compensate for that. So what we see is that 73 00:07:59,560 --> 00:08:05,000 if we stay in our compensatory strategies and we don't ever do anything new, which is what novel 74 00:08:05,000 --> 00:08:12,120 movements are, making new movements, then that's what persists over time as oral dysfunction. 75 00:08:13,480 --> 00:08:21,320 And that's where we see kind of a lack of progress or plateauing type of thing. And novel 76 00:08:21,320 --> 00:08:28,520 movements are new movements. So a lot of times for babies in the pre-crawling period where I really 77 00:08:28,520 --> 00:08:35,800 work with babies is sometimes that's eliciting reflexes because reflexes require sensory input, 78 00:08:35,800 --> 00:08:42,600 such as putting your finger into the palm of the baby grasps. This grasping is a reflex, 79 00:08:42,600 --> 00:08:49,560 but there is a stimulus to that. So we will provide the right stimulus and input to make sure 80 00:08:49,560 --> 00:08:54,760 these reflexes are working. But the other thing we're trying to elicit novel movements is for 81 00:08:54,760 --> 00:09:01,880 volitional movements. And that means these are movements that are the baby does on their own, 82 00:09:01,880 --> 00:09:08,040 autonomously, in generation with engagement in the environment. And yes, babies have volitional 83 00:09:08,040 --> 00:09:19,320 movements. Okay. Okay. Like what? Well, it could be anything, swiping, reaching, orienting, grasping, 84 00:09:19,320 --> 00:09:28,200 you know, and so they're exploring a texture or something on there in their personal vision. 85 00:09:28,840 --> 00:09:37,240 Yeah. And they're not the most sophisticated movements that babies have, but they are there. 86 00:09:37,240 --> 00:09:44,680 And that's what is increasing as they mature. So for example, when we're born, we have a small 87 00:09:44,680 --> 00:09:54,040 repertoire of volitional movements, but by six months, we have a large repertoire. And reflexes, 88 00:09:54,600 --> 00:10:01,800 at birth, we have a large repertoire. And by six months, we want to have very few working for us. 89 00:10:02,840 --> 00:10:09,640 But integration process, using those, and they go into the foundational nature of our brain and 90 00:10:09,640 --> 00:10:16,600 our neuromuscular development, but they're not as like stimulus response that, you know, we switch 91 00:10:16,600 --> 00:10:21,880 over the two volitional systems. So it's really important when it comes to not just the tongue 92 00:10:21,880 --> 00:10:29,880 and the lips and how we maintain our upper airway patency, but our posture and how we move in the 93 00:10:29,880 --> 00:10:36,760 gravitational field and how that actually that experience feels to us and how that stimulates 94 00:10:36,760 --> 00:10:43,880 for babies. We got to put ourselves in this thing, that curiosity, the burning desire to 95 00:10:43,880 --> 00:10:49,960 explore the environment. Right. That's everything. Put it in your mouth, of course, right? Because 96 00:10:49,960 --> 00:10:57,480 that's what they do. Yeah, exactly. Get into it. Put it all in your mouth. Make sense of it. 97 00:10:59,240 --> 00:11:05,320 And that's what they're doing, right? And is this really at the core of why tummy time is so 98 00:11:05,320 --> 00:11:11,800 important? Because I now I'll totally come clean. I did it because I was told to do it. I didn't 99 00:11:11,800 --> 00:11:19,560 understand why I was doing it, but I did it. It's not just for this this oral. I mean, is it for 100 00:11:19,560 --> 00:11:26,200 brain development? And what is that why we're doing tummy time? Well, and that's a good question, 101 00:11:26,200 --> 00:11:33,320 because there's a little bit the difference between general tummy time and tummy time method. So 102 00:11:33,320 --> 00:11:40,600 tummy time method is this really specific sequence. It's actually a whole sequence of movements and 103 00:11:40,600 --> 00:11:46,920 transitional movements. Yeah. And a way of doing it that follows the baby all the way until they're 104 00:11:46,920 --> 00:11:53,720 crawling and versus tummy time itself is just being in the position of prone. So what would still 105 00:11:53,720 --> 00:12:00,200 good and but they're different. This is more intentional. Yeah. And it's like a specific way. 106 00:12:00,200 --> 00:12:06,520 And, you know, it's not just prone, which is another word for tummy time. But you could it's 107 00:12:06,520 --> 00:12:12,040 time to time still an important of prone is still an overall important position for baby all babies 108 00:12:12,040 --> 00:12:17,320 to assume and to achieve. And so we have been focused and we because we knew with the back to 109 00:12:17,320 --> 00:12:24,360 sleep that came out in 1992 ish. And at the same exact time tummy to play came out because they 110 00:12:24,360 --> 00:12:30,200 were they had the foresight and the wisdom to say, Hey, if we're going to do back to sleep, 111 00:12:30,200 --> 00:12:36,760 we need to counteract that with tummy to play. They just didn't foresee the difficulties that 112 00:12:36,760 --> 00:12:42,280 babies were going to do. And I was a young occupational therapist. I graduated in 1996. 113 00:12:42,280 --> 00:12:50,360 I started working in Peds right away. And I had a baby in 1998. So that was a big, you know, 114 00:12:50,360 --> 00:12:57,720 eye opener for me and then another baby in 2001 and another baby in 2003. And so all along growing 115 00:12:57,720 --> 00:13:02,280 and I was working in the NICU at this time and an infant developmental follow up clinic. 116 00:13:02,840 --> 00:13:07,960 And all of these, you know, this was being saturated into me is development from every level 117 00:13:07,960 --> 00:13:16,520 over time, long trajectories, high acuity, etc. So I knew that it was more about sensory processing, 118 00:13:16,520 --> 00:13:21,880 which I'm getting way around to your question now. Yeah, I think a little long winded, but about 119 00:13:21,880 --> 00:13:27,880 processing. And that and I'm occupational therapist. So as what is sensory processing mean, 120 00:13:27,880 --> 00:13:34,760 I think a lot of us know a little bit about it because it's it's gotten out there into social 121 00:13:34,760 --> 00:13:39,240 media and other outlets and a lot of really good blogs and a lot of good therapists putting things 122 00:13:39,240 --> 00:13:48,760 out. But that's how we have all of our senses and how we perceive them. So it's not just eyesight 123 00:13:48,760 --> 00:13:56,360 and smell and here, but it's balance and orientation and it's movement directionality and it's, 124 00:13:57,480 --> 00:14:06,040 you know, our feeling of our insides and it's all these different things. So vestibular is our 125 00:14:06,040 --> 00:14:13,480 kind of balance and orienting. And that is where things can really get a baby having difficulty 126 00:14:13,480 --> 00:14:19,640 with tummy time. So that's why it's really good to work it out with someone because just trying to 127 00:14:19,640 --> 00:14:25,000 get through the tummy time thing without really working through it or avoiding it. We're not 128 00:14:25,000 --> 00:14:30,280 really avoiding the problems. We'll meet them a little bit later. Okay. And this is something 129 00:14:30,280 --> 00:14:36,600 all babies should do. I say should, but it would benefit all babies or is it just a specific 130 00:14:36,600 --> 00:14:42,920 group of babies that this would benefit? Yeah, it benefits all babies and mainly because what I 131 00:14:42,920 --> 00:14:49,400 think is cool that it's also developed tummy time method to be sort of play therapy. So it 132 00:14:49,400 --> 00:15:02,840 organizes the activity and that's how, you know, we kind of play and just relate. And I know I enjoy 133 00:15:02,840 --> 00:15:07,320 sitting at the piano and just, you know, plunking along, but it's so much more enjoyable when I've 134 00:15:07,320 --> 00:15:12,280 learned the notes and where to place my hands and how to move them on the keys and a little bit. I 135 00:15:12,280 --> 00:15:17,880 don't have to be a professional, but I can sort of connect the music to my fingers and just know 136 00:15:17,880 --> 00:15:22,760 a little bit more about it. And so that was where I was going with it, with developing this specific 137 00:15:22,760 --> 00:15:27,720 technique. And I think as another thing about occupational therapists is we love to break 138 00:15:27,720 --> 00:15:35,160 down activities. We call it activity analysis. And so we'll take something and look at it and do 139 00:15:35,160 --> 00:15:41,240 an analysis. And sometimes it's about ergonomics and about how could we do this so that it's better 140 00:15:41,240 --> 00:15:47,080 for your body. It's for, you know, even to the point where we can serve our energy or our joint 141 00:15:47,080 --> 00:15:53,800 protection, et cetera. And or how could we do this so that you can build more strength or have more 142 00:15:53,800 --> 00:16:00,440 challenge and adapt and modify that. So that's what's also built into it because every baby's 143 00:16:00,440 --> 00:16:05,640 different. And even though it's kind of like a little cookie cutter-ish in the way that we do it, 144 00:16:05,640 --> 00:16:11,720 it's individualized to each baby because of their response to it. And that's why I think every baby 145 00:16:11,720 --> 00:16:18,440 can benefit from it. And I've trained a bunch of people. So, you know, we try to, and I try to 146 00:16:18,440 --> 00:16:24,840 keep up with getting them listed on the website. But... And this is, and it's something that 147 00:16:25,640 --> 00:16:31,720 if a parent comes in and they start working with you, obviously they're going to sit and do it 148 00:16:31,720 --> 00:16:38,360 with their baby at home. But then they would have just check-ins with you periodically or how does 149 00:16:38,360 --> 00:16:46,280 that process typically work? Yeah. My favorite way to do this is in groups. To do it like a group 150 00:16:46,280 --> 00:16:53,960 of four, you know, meet weekly as a, with several babies and parents coming and doing this together, 151 00:16:53,960 --> 00:16:58,680 which is that's the most exquisite. And I did that for so, so many years here. And I do, 152 00:16:58,680 --> 00:17:03,800 even from time to time, but I did it like every Thursday at 9.45 for eight years. And it was on 153 00:17:03,800 --> 00:17:12,120 a solid for me. And it was like breathing. And I was so rewarded from that learning about the 154 00:17:12,120 --> 00:17:16,440 benefits of it. Because I thought, oh, this is going to be great for parents. And it really was. 155 00:17:16,440 --> 00:17:21,720 They became friends. And you could see them supporting each other. And I didn't have to do 156 00:17:21,720 --> 00:17:26,280 much supporting because they did it themselves. And I, you know, this is going to be good because 157 00:17:26,840 --> 00:17:31,080 we're going to get, you know, parents doing the hands-on thing. Because I know therapists, 158 00:17:31,080 --> 00:17:35,960 we train to be good with babies. We practice to be good with babies. We have a lot of experience 159 00:17:35,960 --> 00:17:41,960 with it. But the reality is, is like parents need, you know, want to know how to do things with their 160 00:17:41,960 --> 00:17:47,160 babies expertly and well. Right. You know, and that's just the height of really good parenting 161 00:17:47,160 --> 00:17:55,800 and simple things. So I thought that was, but I did not, I underestimated, I did not count on how 162 00:17:55,800 --> 00:18:02,920 the babies would love each other, would look for each other. Yes. And what they're doing. 163 00:18:04,840 --> 00:18:08,200 During tummy time, because, you know, we're a class of what, always in a circle. 164 00:18:08,920 --> 00:18:13,000 And they, I did not. And so that has always touched my heart, you know, over the years, 165 00:18:13,000 --> 00:18:17,160 seeing that in different age groups, because, you know, we'll do sometimes an older baby group 166 00:18:17,160 --> 00:18:24,600 and then a younger baby group. And I see it across the ages. And it's very exquisite. And all of those 167 00:18:24,600 --> 00:18:29,400 things are really good. But then you can do it one on one. And what's really good about this, 168 00:18:29,400 --> 00:18:34,040 you can also do what we call teletummies. And you can do it online and meet like we're doing, 169 00:18:34,040 --> 00:18:42,040 you know, now, right? Because the deal is we work with our baby doll. Okay. And we'll show you with 170 00:18:42,040 --> 00:18:46,200 our baby doll. So when we're teaching tummy time method, you know, we, we should have our baby 171 00:18:46,200 --> 00:18:52,920 doll. And about what age do they start typically? Well, I mean, we do, we have a prenatal program 172 00:18:52,920 --> 00:18:59,800 where you can practice with a doll baby before. And then the first two weeks after birth, most of 173 00:18:59,800 --> 00:19:07,160 it's right here. Okay. All the tummy time is up on the chest. And we're doing it here. And then 174 00:19:07,160 --> 00:19:12,600 after that, so about two weeks, we want to start thinking about the firm flat surface and beginning 175 00:19:12,600 --> 00:19:18,040 to explore other gravitational field a little bit different. Yeah. And again, it's these little 176 00:19:18,040 --> 00:19:25,640 short periods of time, they're super sweet, and always dialed into what the baby needs. And I, 177 00:19:25,640 --> 00:19:32,920 if I ever, if I do, if I am ever able to reach parents in a way, and I love this is a great way 178 00:19:32,920 --> 00:19:39,160 for me to reach parents. But if I get ever like get my point across, is that what our babies really 179 00:19:39,160 --> 00:19:47,080 need is this movement prolific life. They need to struggle in the gravitational field, they need 180 00:19:47,080 --> 00:19:51,800 to be able to move their head anti gravity, they need to be able to turn their head easily. 181 00:19:52,920 --> 00:20:00,680 Side to side. Most of the time, because that turning side to side and also organizing around 182 00:20:00,680 --> 00:20:06,840 the midline here, it's going to be dependent upon what's going on with the tongue and the airway. 183 00:20:08,440 --> 00:20:13,720 Got it. Got it. Because most of the time when you like head turning preference to one side, 184 00:20:13,720 --> 00:20:19,480 it's because of the airway patency. Well, and I guess that kind of leads into another question 185 00:20:19,480 --> 00:20:23,320 that I had, you know, because we talk a lot about tongue ties and things like that on here and 186 00:20:24,040 --> 00:20:32,120 airway and jaw development, but how specifically does the tummy time method help with tongue ties 187 00:20:32,120 --> 00:20:39,400 or lip ties in those kind of restriction? Well, I appreciate all this opportunity to talk about 188 00:20:39,400 --> 00:20:45,960 tongue ties method, but really it's because it's a whole it's specific to getting cranial nerves 189 00:20:45,960 --> 00:20:50,600 moving the muscles of the cranial nerves with the face and the neck and the tongue and the head 190 00:20:50,600 --> 00:20:56,760 and the shoulder girdle, but it's also whole body and it's eliminating compensatory strategies and 191 00:20:56,760 --> 00:21:01,960 eliciting those novel movements, the new movements that take over that are more functional, that 192 00:21:01,960 --> 00:21:07,640 generate suction that have efficient milk transfer that keep the tongue up and keep the airway nice 193 00:21:07,640 --> 00:21:15,560 and huge. So the breath comes in and out and that the tongue feels like it can float to the roof of 194 00:21:15,560 --> 00:21:23,720 the mouth and it doesn't have to be bunched and humpy and retracted in the back as a compensatory 195 00:21:23,720 --> 00:21:29,720 strategy, right? And we need that to happen. Now, one of my other things I'd like to touch base 196 00:21:29,720 --> 00:21:35,800 with parents is because there's a lot of talk about tension and eradicating tension and I just 197 00:21:35,800 --> 00:21:40,920 want to understand tension a little bit more. Okay. And we need tension in the body. 198 00:21:42,200 --> 00:21:49,480 Tension is movement, so we don't want to ever eradicate tension. What we're noticing is imbalanced 199 00:21:49,480 --> 00:21:56,680 tension, tensional imbalances in the body and a lack of soft tissue integrity, 200 00:21:57,400 --> 00:22:05,560 okay, but their compensatory nature, such as these persistent asymmetries in pulling to one 201 00:22:05,560 --> 00:22:14,360 side that has body wide effects and it's felt as tension, but it's really the baby's nervous system 202 00:22:15,080 --> 00:22:22,760 struggling for stability. It doesn't have it on the kind of both sides, right? And in the three 203 00:22:22,760 --> 00:22:30,920 dimension. So it's pulling and it's overacting, over holding because these compensatory muscles, 204 00:22:30,920 --> 00:22:36,200 again, they weren't really supposed to be doing all of the tongue's work. 205 00:23:00,920 --> 00:23:04,200 So, 206 00:23:10,840 --> 00:23:15,400 you're listening to Airway First, the podcast from the Children's Airway First Foundation. 207 00:23:16,040 --> 00:23:21,400 You can find out more about CAF and our mission to fix before six on our website at 208 00:23:21,400 --> 00:23:28,600 childrensairwayfirst.org. The CAF website offers tons of great resources for both parents and 209 00:23:28,600 --> 00:23:34,520 medical professionals. In our parents portal and clinicians corner, you can find educational 210 00:23:34,520 --> 00:23:40,120 and informational content, including videos, blogs, our recommended reading list, comprehensive 211 00:23:40,120 --> 00:23:45,880 medical research, podcasts, events, parent support, and educational opportunities. 212 00:23:47,160 --> 00:23:51,720 Parents are also encouraged to join the Airway Huddle, our Facebook support group, 213 00:23:51,720 --> 00:23:55,560 which was created for parents of children with Airway and sleep-related issues. 214 00:23:55,560 --> 00:24:03,000 You can access the Airway Huddle support group at facebook.com backslashgroups backslash airway 215 00:24:03,000 --> 00:24:09,240 huddle. Are you interested in being a guest on the show? Then shoot us a note via the contacts 216 00:24:09,240 --> 00:24:16,040 page on our website or send us an email directly at infoatchildrensairwayfirst.org. 217 00:24:17,160 --> 00:24:22,440 As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. 218 00:24:22,440 --> 00:24:27,400 If you suspect your child might have an airway issue, contact your pediatric airway dentist 219 00:24:27,400 --> 00:24:32,920 or pediatrician. Thanks again to today's guest, Michelle Emmanuel, for sharing her medical 220 00:24:32,920 --> 00:24:52,920 expertise. And to each of you, for listening to today's episode. 221 00:25:03,160 --> 00:25:11,720 So it's really complicated too, because just like 222 00:25:13,240 --> 00:25:22,200 whole body movement is individualized, babies temperament and even their ability, 223 00:25:22,200 --> 00:25:27,640 even how their GI feels, because some babies don't have a lot of GI issues, even if they're 224 00:25:27,640 --> 00:25:33,880 maybe burping up a little bit, they're not really upset. Some babies are really feeling that and 225 00:25:33,880 --> 00:25:40,360 having significant dysregulation. And that's what I call interoceptive disruption. 226 00:25:42,280 --> 00:25:50,200 There's a fancy word for, I feel like my GI tract is disgruntled. There's 227 00:25:50,200 --> 00:25:58,520 got it. Chaotic signals coming out of our belly. And sometimes that's because of bowel motility or 228 00:25:59,160 --> 00:26:10,360 reflux or trapped gases or air from air swallowing or improper sexual breath coordination. 229 00:26:11,240 --> 00:26:15,720 And are there movements and things that we can do with our babies when you're to help with all of 230 00:26:15,720 --> 00:26:21,480 that? Yeah. And that's where you say like any tummy time, if you get the baby relaxed on the 231 00:26:21,480 --> 00:26:28,040 belly, that will help with some of that, because it gives the optimal, but also that's where keeping 232 00:26:28,040 --> 00:26:33,080 them upright against your body. But again, they're putting a little bit of pressure on the front of 233 00:26:33,080 --> 00:26:38,440 their body, which would be sort of like tummy time on your chest. But I think that 234 00:26:38,440 --> 00:26:50,040 movement in general is important, but babies will often have difficulty with, say, burping. 235 00:26:50,680 --> 00:26:58,280 So even if they're swallowing even a normal amount of air, which would be minimal, hopefully, 236 00:26:58,280 --> 00:27:08,760 but all babies burp just a teeny tiny bit. And it's really difficult to get it up. And for some 237 00:27:08,760 --> 00:27:16,280 babies that causes significant reflux. And for other babies, they just twist their bodies and 238 00:27:16,280 --> 00:27:21,400 can tour and kind of hold their breath a little bit. And so all these different ways are how the 239 00:27:21,400 --> 00:27:29,160 baby then learns to respond. And it becomes a habit. So how we balance all of these intentional 240 00:27:29,160 --> 00:27:36,360 problems is to really equip the baby with new movement. That's the novel movement. So that 241 00:27:36,360 --> 00:27:41,240 they are then equipped with this other thing. And all of these other compensatory strategies can 242 00:27:41,240 --> 00:27:49,480 sort of just fall away. Because it's more balanced. Because we can organize around the midline. 243 00:27:49,480 --> 00:27:55,880 Because we can turn both ways. Because we can keep our airway open by elevating our tongue to the 244 00:27:55,880 --> 00:28:03,720 roof of the mouth. And for babies, it's particularly, I mean, it's their, it's their neural developmental 245 00:28:03,720 --> 00:28:08,680 challenge, just the appropriate thing. But you got to remember their developing head control. We 246 00:28:08,680 --> 00:28:13,320 have developed head control. So we don't remember even what that's like, that they're working on 247 00:28:13,320 --> 00:28:19,080 keeping their upper airway patency at the same time that their head is the heaviest part of their body. 248 00:28:20,280 --> 00:28:26,040 And they don't have head control. Right. So that's why it's perceived as tension. But we want 249 00:28:26,040 --> 00:28:30,360 tension in the body. We just want it to be balanced. We want it to be optimal. 250 00:28:31,640 --> 00:28:38,520 Okay. And that a lot of times means we need to equip with a new movement. We need to get the 251 00:28:38,520 --> 00:28:44,280 baby moving in new directions, equipping with strength, let the muscle tone really inhabit the 252 00:28:44,280 --> 00:28:52,840 muscles. Also working with, you know, from the standpoint of airway and breathing, slowing down 253 00:28:52,840 --> 00:29:00,360 usually the breathing rate. Okay. Slow down the baby's breathing. Exactly. And guess what the best 254 00:29:00,360 --> 00:29:09,080 way really to do that? Singing having parents singing. Really? Right. Because everything in 255 00:29:09,080 --> 00:29:18,360 like the polyvagal and all of the parasympathetic talk is about the lengthy exhale is what lowers 256 00:29:18,360 --> 00:29:26,520 our heart rate. The lengthy exhale lowers our respiratory rate. And so when we're singing, 257 00:29:26,520 --> 00:29:35,080 we're exhaling. And so we are calming down the sense of our physiology. It's as simple as our 258 00:29:35,080 --> 00:29:40,360 physiology sometimes to lower our heart rate and respiratory rate. And the baby does as well. 259 00:29:45,800 --> 00:29:52,360 Yeah. And then when the baby's breathing slows down, then you can feel that sense of tension. 260 00:29:52,360 --> 00:29:57,000 A lot of times we'll be gone in many areas. Like, well, where did that go? Well, that's because 261 00:29:57,000 --> 00:30:05,800 the what you perceive is tension is just the nervous system over recruiting. Got it. But it 262 00:30:05,800 --> 00:30:13,400 almost has to over recruit if you're breathing fast. That's a fight or flight. Yeah. It's a safety 263 00:30:13,400 --> 00:30:20,920 thing. Right. Right. All right. Well, let's let's shift gears just a little bit. And focus on 264 00:30:20,920 --> 00:30:28,680 breastfeeding specifically. I just, you know, we've talked about it on some other podcasts, 265 00:30:28,680 --> 00:30:32,600 but you know, just I would like to get your take on you why it's so important for infant 266 00:30:32,600 --> 00:30:38,520 development and what are some of the options available for new moms, especially those that 267 00:30:38,520 --> 00:30:45,160 are experiencing issues with breastfeeding? Well, the number one thing I want to say is 268 00:30:45,160 --> 00:30:54,040 please work with an IBCLC or the highest train lactation expert in your area. Because it's 269 00:30:54,760 --> 00:31:02,680 it really is the one on one support and problem solving and collaboration and really teamwork 270 00:31:02,680 --> 00:31:11,160 and counseling. It's worth it. And honestly, our insurance companies should be able to reimburse 271 00:31:11,160 --> 00:31:17,400 that. That's one of those things. So that's my number one thing to say. You know, there's other 272 00:31:17,400 --> 00:31:23,720 tips and tricks that we could say, but that is the absolute most important thing. But breastfeeding 273 00:31:23,720 --> 00:31:33,720 itself is it's beyond sleeping, okay, which is the baby's primary occupation and activity of daily 274 00:31:33,720 --> 00:31:41,800 living. Eating and feeding and receiving human milk is the biggest thing they've got going. It's 275 00:31:41,800 --> 00:31:50,680 their activity of daily living. It is their primary occupation behind sleeping again. So when you say 276 00:31:50,680 --> 00:31:57,640 this is that primary occupation, again, the occupational therapist observes this and says 277 00:31:57,640 --> 00:32:01,640 how efficiently is this working? How is this going on all the different levels? 278 00:32:01,640 --> 00:32:12,600 And so it's reflective of reflexes, spontaneous movements, innate biological urges and powerful 279 00:32:12,600 --> 00:32:22,920 forces that drive the baby to connect at the deepest level extra urine, but again becomes one 280 00:32:22,920 --> 00:32:33,480 with the mother's body through nipple, nipple real or complex. And there's lots of really good 281 00:32:33,480 --> 00:32:40,040 products out there to mimic this human nipple real or complex. There really are really some great, 282 00:32:40,040 --> 00:32:47,960 great things. But nothing is like this human tissue thing to the point where it's very unique. 283 00:32:47,960 --> 00:32:57,240 Every woman is a little different. And so it's really neat. So it's also when you look at, hey, 284 00:32:57,240 --> 00:33:03,480 what do babies have reflexes for a lot of them around the mouth? And so that's licking, sucking, 285 00:33:04,360 --> 00:33:11,160 herning the head and licking and sucking, suck searching, tongue darting, snap response, 286 00:33:11,160 --> 00:33:20,440 gaping, all of these different elaborate perioral and even proprioceptive field instincts to feed. 287 00:33:22,520 --> 00:33:28,680 These are urges that are coming from the nervous system and who this little baby is as a human. 288 00:33:30,360 --> 00:33:40,440 It's very sophisticated. And so it is the exact perfect activity to notice where the 289 00:33:40,440 --> 00:33:50,120 vulnerabilities, where are the strengths? Because every baby has both. And sometimes a baby is 290 00:33:50,840 --> 00:33:56,680 nursing with someone who has experienced nursing, has a great supply and doesn't have any pain and 291 00:33:56,680 --> 00:34:03,560 the baby's gaining weight. And other babies have trouble with lots of different things with supply, 292 00:34:03,560 --> 00:34:10,120 with latch, maybe GI stuff, and they may even have the same level of restriction going back to tongue 293 00:34:10,120 --> 00:34:18,040 ties, lip ties and buckle ties. It's variable. You can compare two babies with the exact classification, 294 00:34:19,160 --> 00:34:23,560 which remember, classification is really just where they're attached. It's not a functional 295 00:34:23,560 --> 00:34:30,040 hormones, but and there's a completely different symptomatology list. Now the pattern recognition 296 00:34:30,040 --> 00:34:37,000 is there. This is kind of the same genre, head turning preference to one side, postural pulling 297 00:34:37,000 --> 00:34:45,080 to one side, a distended abdomen, you know, these different things that we can see feet curving in 298 00:34:45,080 --> 00:34:55,560 or the toes clenching. Okay. I thought about looking at their feet. Yeah, I got so excited about the 299 00:34:55,560 --> 00:35:00,280 feet that I actually literally became a national board certified reflexologist, which was not a 300 00:35:00,280 --> 00:35:05,720 waste of my time of any stretch of imagination and became an expert at it. And then I developed the 301 00:35:05,720 --> 00:35:11,720 baby reflexology program. So I also train professionals to do reflexology, you know, with babies. It's 302 00:35:11,720 --> 00:35:18,440 very simple and very gentle, but it's a great adjunct. And it's amazing how much is connected there. 303 00:35:19,320 --> 00:35:24,120 Well, yeah. And we talk about the tongue to the toes connection. A lot of people have heard about 304 00:35:24,120 --> 00:35:31,480 that. That's a physical, you'll think about musculoskeletal. But when we talk about reflexology, 305 00:35:31,480 --> 00:35:37,960 and we talk about, you know, the feet and the toes, that'll make sense how like the tendons and that 306 00:35:37,960 --> 00:35:44,360 and the fascial structures are connected, but how, you know, the whole body is represented 307 00:35:44,360 --> 00:35:52,760 on the bottom of the feet and how that really can be seen or kind of read on the feet. And we can do 308 00:35:52,760 --> 00:35:59,640 certain points and techniques to help a baby, especially with relaxing the nervous system 309 00:35:59,640 --> 00:36:06,920 and also helping the GI systems really reliable for that. And some babies are quite sensitive on 310 00:36:06,920 --> 00:36:13,160 their feet as well. So it's good to know because if we're sensitive on our hands, our feet, our 311 00:36:13,160 --> 00:36:19,400 soles of our feet, a lot of times maybe our mouth can be sensitive too. So when we work with the hands 312 00:36:19,400 --> 00:36:25,000 and the feet that will help optimize sensory processing in the mouth. It's interesting. Yeah. 313 00:36:25,000 --> 00:36:32,440 And it's funny too, because I learned it with my oldest daughter when she was little. Now I was 314 00:36:32,440 --> 00:36:37,160 taught where to rub on her feet to help her relax for nap time and things like that. And so I just 315 00:36:37,160 --> 00:36:41,320 kind of started doing it after she ate when she was little so I could zip her off to sleep. 316 00:36:43,000 --> 00:36:47,080 And it's so funny to me because even as they got older, 317 00:36:49,880 --> 00:36:53,800 anytime I would sit and do that on their feet, you could literally, I would just watch them, 318 00:36:53,800 --> 00:36:59,960 they just kind of turn into this little pool of just jelly. And it was one of those 319 00:37:01,400 --> 00:37:04,920 kind of mom flashback things. You do it when they're little and then you forget about it. 320 00:37:04,920 --> 00:37:08,680 And then you do it when they're older and you have that moment of, oh, I remember that. 321 00:37:09,880 --> 00:37:12,120 But you forget the impact they couldn't have on it. 322 00:37:14,120 --> 00:37:21,880 Right. Yeah. And it's sort of a whole body treatment because we're giving sensation 323 00:37:21,880 --> 00:37:29,400 to the feet. It's picked up by large nerves and taken back up to the spinal cord, 324 00:37:30,360 --> 00:37:39,640 up the spinal cord, into the processing centers of the brain, perceiving it, interpreting it, 325 00:37:39,640 --> 00:37:43,400 doing something with it, and then coming down. 326 00:37:43,400 --> 00:37:50,120 So we do have the largest nerves on the bottom of our feet as well. 327 00:37:51,880 --> 00:37:59,000 It's a powerful way. That is powerful. That is amazing. Amazing. Well, and that's kind of the 328 00:37:59,000 --> 00:38:03,880 funny thing because if you relax them when they go to sleep, sometimes it's like they might not 329 00:38:03,880 --> 00:38:08,760 be sleeping enough. Right. You want to be able to get relaxed without falling asleep. 330 00:38:08,760 --> 00:38:16,280 Yeah. That's true. That's very true. That's very true. One of the things, and I honestly 331 00:38:16,280 --> 00:38:21,400 can't remember if I saw it in the video or if it was on the website or where it was, but the sleeping 332 00:38:21,400 --> 00:38:29,160 tongue posture. So I would love it if we could talk a little bit about what this is and why is that 333 00:38:29,880 --> 00:38:37,240 exercise beneficial. Yeah. So that's a baby myo exercise that I designed many years ago 334 00:38:37,240 --> 00:38:47,400 to address the open mouth, low tongue position that we keep seeing in the face of breathing dysfunction, 335 00:38:48,280 --> 00:38:59,960 tongue tyliptyte, buccal ties, and other symptoms. And what I really like to do is work when babies 336 00:38:59,960 --> 00:39:05,080 are doing what they're supposed to be doing, which is when they're asleep, the tongue should be up 337 00:39:05,080 --> 00:39:11,320 and the lips should be sealed. So it's really working towards that happening while they're asleep, 338 00:39:11,320 --> 00:39:21,320 but it's also a strengthening activity and a, you know, the tongue pulling away from the floor of 339 00:39:21,320 --> 00:39:29,640 the mouth activity and a jaw activity that does generalize over to awake states. So it's done 340 00:39:29,640 --> 00:39:36,440 when the baby's asleep. Okay. And a lot of times held in arms, but it can be done in other positions. 341 00:39:37,080 --> 00:39:44,920 And it's so it's designed to strengthen and really get the tongue away from the floor of the mouth 342 00:39:44,920 --> 00:39:51,000 and to get it elevated up in the roof of the mouth while the jaw is maximally open as possible. 343 00:39:51,000 --> 00:39:59,000 And when babies are asleep, that's the time when we're working with the autonomic nervous system. 344 00:39:59,000 --> 00:40:05,000 It's not their muscle tone isn't really the big thing. They're not moving around. Right. 345 00:40:05,000 --> 00:40:11,000 And so this is the primitive parts that we work with that coordinate sucking, 346 00:40:11,000 --> 00:40:17,000 swallowing and breathing. So it's a really powerful way to make some big functional changes. 347 00:40:17,000 --> 00:40:25,000 And then also it can be used for as an adjunct for wound care, prep and wound care after frenectomy. 348 00:40:25,000 --> 00:40:29,000 Oh, okay. Wow. Awesome. 349 00:40:29,000 --> 00:40:35,000 Yeah. So it got, you know, I, instead of like keeping all these things, you know, I was like, 350 00:40:35,000 --> 00:40:43,000 let's spread this out and get this in parents' hands because it's simple to do. And I'm really reluctant 351 00:40:43,000 --> 00:40:49,000 as both an occupational therapist and an international board certified lactation consultant to say that 352 00:40:49,000 --> 00:40:57,000 I would say the same thing for every baby, but this is one exercise I would do for every single baby. 353 00:40:57,000 --> 00:41:05,000 Oh, wow. Okay. Yeah. Because it can, it will benefit every single baby regardless of what's going on. 354 00:41:05,000 --> 00:41:11,000 And so I could, you know, do a little example of it myself for the baby sleeping. 355 00:41:11,000 --> 00:41:17,000 Now there's two different things you could come upon. So the baby's sleeping and let's say the lips are sealed. 356 00:41:17,000 --> 00:41:25,000 And that's what we want to see, but we can't really just trust that. So what we're going to do gently is use this, 357 00:41:25,000 --> 00:41:33,000 the pad of your finger and pull down on the skin of the chin and check to see where the tongue is. 358 00:41:33,000 --> 00:41:45,000 We look in and we see that the tongue is up. So what we do is then pull down. 359 00:41:45,000 --> 00:41:55,000 You can see I have quite an impressive friend on there myself. Hold down on the skin of the chin to get the tongue away from the floor of the mouth. 360 00:41:55,000 --> 00:42:04,000 And you can see how much range that would take and how much extensibility of the friend on it takes and how we want the floor of the mouth to stay down. 361 00:42:04,000 --> 00:42:11,000 And so it, it strengthens those exact neural patterns to do that. 362 00:42:11,000 --> 00:42:19,000 Now let's say this is a second scenario. We come up on the baby and their mouth is open and we can see the tongue is down. 363 00:42:19,000 --> 00:42:30,000 So what we do is use our finger behind the chin and it's really soft underbelly, press up and then pull down. 364 00:42:30,000 --> 00:42:36,000 And sometimes it takes some repetition because those times sometimes are good to the floor of the mouth. 365 00:42:36,000 --> 00:42:44,000 But I promise you I'm very good at it. And you know why? Because I'm persistent. I do it three times, four times. 366 00:42:44,000 --> 00:42:51,000 And sometimes it's on that fourth time it finally goes up there and me and the parents celebrate in the session. 367 00:42:51,000 --> 00:42:55,000 And then it's so exciting. Yeah. 368 00:42:55,000 --> 00:43:02,000 Because it really truly works at the unconscious level. 369 00:43:02,000 --> 00:43:06,000 Which supports all. Yeah, exactly. Exactly. 370 00:43:06,000 --> 00:43:14,000 And how often would you do it? Would you just do it every time they sleep until you start to see it's just there? They're doing it on their own. 371 00:43:14,000 --> 00:43:20,000 And this is really where it's individualized. You know, some babies are going to need it a bunch because of X, Y and Z. 372 00:43:20,000 --> 00:43:26,000 Other babies are, you know, have more milder symptoms and maybe they only need it one time a day. 373 00:43:26,000 --> 00:43:32,000 Just doing it one really good time a day because we're busy parents. It depends on a lot what's going on. 374 00:43:32,000 --> 00:43:41,000 It depends on how your baby sleeps and what that is. It's a lot easier if you're someone who sleeps with baby in arms all day long. 375 00:43:41,000 --> 00:43:45,000 Not everybody. It's not most people. Yeah. 376 00:43:45,000 --> 00:43:50,000 It's exactly. And so it really depends on the baby's needs at this time. 377 00:43:50,000 --> 00:43:58,000 But I don't think you could overdo it. I think not doing it is something more to worry about than how many times. 378 00:43:58,000 --> 00:44:02,000 Yeah, I would just like parents, you know, to really try it. 379 00:44:02,000 --> 00:44:04,000 And we call it the sleeping tongue posture. 380 00:44:04,000 --> 00:44:12,000 Because it helps us to understand a lot. The baby is sleeping and that we're holding what the tongue should be doing all the time. 381 00:44:12,000 --> 00:44:18,000 It's just like saying, Hey, our posture is upright. We hold our head upright. We stand upright. That's our posture. 382 00:44:18,000 --> 00:44:24,000 Well, the posture for the tongue is we cling to the roof of the mouth. 383 00:44:24,000 --> 00:44:32,000 Here's my little head will go inside. Here's the whole tongue starting at the front of the tongue in the back. 384 00:44:32,000 --> 00:44:39,000 The whole thing needs to be really up. And this is the hard palate where the white bone is. And then this is the soft palate. 385 00:44:39,000 --> 00:44:53,000 And you want this really strong elevation of the whole tongue, which helps to keep our airway open and our upper airway patent from the nose all the way to and through the larynx and lower. 386 00:44:53,000 --> 00:45:11,000 And a lot of times when we see the baby's mouth is open and the tongue is down, it may take some practice to get this to change with the sleeping tongue posture, but it will if you just persist just a little bit. 387 00:45:11,000 --> 00:45:15,000 And there are some videos on my YouTube which are under Michelle Emanuel. 388 00:45:15,000 --> 00:45:17,000 Yeah, and we'll put links to them. 389 00:45:17,000 --> 00:45:25,000 Good. And like lots and lots of people have taken my classes and learned how to do it and even learned from social media. 390 00:45:25,000 --> 00:45:32,000 And it can't really is one of those things that you can't really do it wrong. You might not be doing it fully. 391 00:45:32,000 --> 00:45:36,000 The way it could be helpful, but it's not. You can't mess it up. 392 00:45:36,000 --> 00:45:42,000 Can't hurt a baby doing it anyway. And how it becomes part of the frenectomy wound care. 393 00:45:42,000 --> 00:45:52,000 If there is a tongue tie that needs to be released is that you do this and it pulls the wound bed open as much as you can't replace your wound care. 394 00:45:52,000 --> 00:46:06,000 It's a way to add to your wound care. It doesn't replace what your team is recommending, but it's something you can add pain free because all the other things you're not putting your fingers in there either. 395 00:46:06,000 --> 00:46:15,000 No. And this is comfortable because we don't have pain when we're sleeping and because you're not pulling it open. 396 00:46:15,000 --> 00:46:28,000 It's the tongue. It's the natural opening itself and the wound bed can separate and it can feel like gently pulled because I know when we're doing wound care, it's like we have to sort of pull against the baby. 397 00:46:28,000 --> 00:46:36,000 I can be really challenging and also cause some sensory processing differences in the mouth. 398 00:46:36,000 --> 00:46:39,000 Sure. Yeah. 399 00:46:39,000 --> 00:46:47,000 So at the end of every episode, I always like to hand it back to the guests for the last word is y'all are the experts. 400 00:46:47,000 --> 00:46:52,000 So what final thoughts would you like to leave with our parents? 401 00:46:52,000 --> 00:46:57,000 Wow, I feel so honored to be asked that. Thank you so much. 402 00:46:57,000 --> 00:46:58,000 Yeah. 403 00:46:58,000 --> 00:47:08,000 Well, one, I'm a parent myself and it's my youngest is 20. My middle is 22 and my oldest is 25. 404 00:47:08,000 --> 00:47:18,000 And I felt I felt supported in different ways that I think new moms may not have support. 405 00:47:18,000 --> 00:47:30,000 So what I want to leave it with is to find a little corner of the world that you can get support that you can connect with people who are in the same lifestyle as you. 406 00:47:30,000 --> 00:47:38,000 You're having babies. You're all nursing. You're all working on this. You're all working on that because there are local groups that you can find. 407 00:47:38,000 --> 00:47:49,000 And you just need to ask around, ask doulas or lactation consultants and really get engaged in community because you start feeling normal for your dysfunctional stuff. 408 00:47:49,000 --> 00:47:59,000 And you do it used to and when you realize that, hey, we worked through these problems together that raising children is, you know, it's, it's challenging. 409 00:47:59,000 --> 00:48:12,000 And we, you know, especially if we're dealing with something like tongue ties, lip ties, buckle ties or airway compromise, breathing dysfunction or some sort of, you know, even just GI issues. 410 00:48:12,000 --> 00:48:22,000 So I think that is the wisest thing I can say and what I've learned in 28 plus years of working with babies and also trust yourself. 411 00:48:22,000 --> 00:48:37,000 Now, that doesn't mean we know everything as a parent, but you get the idea that feels right for my kid. This doesn't feel right and really trust that because that's coming from the in that inside sense of the gut feelings. 412 00:48:37,000 --> 00:48:41,000 And we can trust, we can really trust that. 413 00:48:41,000 --> 00:48:48,000 And so once you lean into that and realize that you really know what's best for your kid and you're going to lean on experts to give you advice. 414 00:48:48,000 --> 00:48:51,000 You'll feel what's right for them. 415 00:48:51,000 --> 00:48:58,000 And one last thing is thank you for wanting to optimize your child's health. 416 00:48:58,000 --> 00:49:15,000 Because I think it can be really easy to just want to coast along and not pay attention. But, you know, if you're listening to this podcast, you're thinking about optimizing your child's health about what can I be doing intentionally, mindfully, respectfully, and 417 00:49:15,000 --> 00:49:25,000 you know, really helping your child blossom in a holistic way from their physiology and who they are as a human being. So that's amazing. 418 00:49:25,000 --> 00:49:28,000 Yeah, it's beautiful. Like I said, thank you. 419 00:49:28,000 --> 00:49:33,000 Well, and thank you so much for everything that you've shared today. Truly appreciate it. 420 00:49:33,000 --> 00:49:35,000 Thank you. Appreciate it. It's been really fun. 421 00:49:35,000 --> 00:49:37,000 Yeah. 422 00:49:37,000 --> 00:49:46,000 Thanks again to today's guests, Michelle Emanuel, for sharing her medical insight into each of you from listening to today's episode. 423 00:49:46,000 --> 00:49:49,000 If you're new to our podcast, please don't forget to subscribe. 424 00:49:49,000 --> 00:49:55,000 And if you enjoyed today's episode, leave us a review or comment telling us about what you enjoyed most. 425 00:49:55,000 --> 00:50:05,000 You can stay connected with the Children's Airway First Foundation by following us on Instagram, Facebook, X, LinkedIn, and YouTube. 426 00:50:05,000 --> 00:50:15,000 Parents can also join us via our Facebook support group, the Airway Huddle app, facebook.com backslash groups backslash airway. 427 00:50:15,000 --> 00:50:27,000 You can find tons of great content for parents and medical professionals on our parents portal and clinicians corner on our website at Children's Airway First.org. 428 00:50:27,000 --> 00:50:39,000 If you'd like to be a guest or have an idea for an upcoming episode, shoot us a note via the contact page on our website or send us an email directly at info at childrensairwayfirst.org. 429 00:50:39,000 --> 00:50:48,000 And finally, thanks to all the parents and medical professionals out there that are working to help make the lives of kids around the globe just a little bit better. 430 00:50:48,000 --> 00:50:58,000 Take care, stay safe, and happy breathing everyone.