1 00:00:00,000 --> 00:00:23,340 ?". 2 00:00:23,340 --> 00:00:33,900 Hi everyone and welcome back to Airway First, the podcast from the Children's Airway First 3 00:00:33,900 --> 00:00:40,640 Foundation. I'm your host, Rebecca St. James. Today on the show I welcome a panel of three 4 00:00:40,640 --> 00:00:50,220 ladies, Amanda Gorolla, Dr. Vanessa Peterson and Jackie Becerra Lysing. Jackie is a dental 5 00:00:50,220 --> 00:00:55,260 hygiene graduate from Loma Linda University and has been practicing as a clinical dental 6 00:00:55,260 --> 00:01:01,260 hygienist for the past 19 years. After having her second child with Down's syndrome and 7 00:01:01,260 --> 00:01:06,740 having limited resources, she decided to specialize her education in the field of myofunctional 8 00:01:06,740 --> 00:01:14,700 therapy and received her certificate of completion from the Mayo Mentor Program in 2021. She 9 00:01:14,700 --> 00:01:22,700 is now the owner and OMT of Upside Down Frown Care LLC. Her passion for knowledge in Airway 10 00:01:22,700 --> 00:01:28,660 includes having taken courses targeting the Down's syndrome population through talk tools. 11 00:01:28,660 --> 00:01:33,860 She has also obtained a level one oral habits program certification through the Breathe 12 00:01:33,860 --> 00:01:39,980 Institute and is currently enrolled to take the TMJ massage therapies course to get a 13 00:01:39,980 --> 00:01:46,500 better understanding of the complexities around TMJ. She currently practices myofunctional 14 00:01:46,500 --> 00:01:53,220 therapy throughout various cities in the Inland Empire located in Southern California. It 15 00:01:53,220 --> 00:01:58,500 was Amanda's passion for working with children and providing for her community that led her 16 00:01:58,500 --> 00:02:04,100 into the field of speech language pathology. Amanda has a background in hospital, public 17 00:02:04,100 --> 00:02:09,940 school and the private clinic settings where she has treated a variety of clients and disorders 18 00:02:09,940 --> 00:02:16,780 including language disorders, articulation and pharyngeology, fluency disorders, Down's syndrome, 19 00:02:16,780 --> 00:02:26,020 ASD, voice disorders, acquired neurological disorders and more. As a former athlete, Amanda 20 00:02:26,020 --> 00:02:31,660 was drawn to Justin Sherman and Associates, strong team-based community and a close family 21 00:02:31,660 --> 00:02:38,460 collaboration. There, her professional focus includes early intervention, articulation and 22 00:02:38,460 --> 00:02:46,220 pharyngeology, and fluency. She is interested in learning more about oral facial myology. 23 00:02:46,220 --> 00:02:53,420 Southern California native, Dr. Vanessa Peterson, studied biology and chemistry at Baylor University 24 00:02:53,420 --> 00:03:01,860 in Waco, Texas. She returned to Southern California to attend dental school at Loma Linda University 25 00:03:01,860 --> 00:03:08,940 School of Dentistry. Vanessa then headed north to Portland, Oregon for her orthodontic residency 26 00:03:08,940 --> 00:03:15,100 at Oregon Health and Science University. She practiced at Kaiser Permanente for three 27 00:03:15,100 --> 00:03:20,740 years and became the chief orthodontic specialist before following her dream to start her own 28 00:03:20,740 --> 00:03:27,420 orthodontic practice in Lake Oswego. After returning to Southern California, she opened 29 00:03:27,420 --> 00:03:34,780 a new practice, synergy orthodontic specialist in the Inland Empire area. All right, great. 30 00:03:34,780 --> 00:03:38,860 Thank you all so much for joining us this evening. I appreciate it. 31 00:03:38,860 --> 00:03:43,540 Thank you for having me on the show. Thank you. 32 00:03:43,540 --> 00:03:50,100 Absolutely. All right. So, Jackie, we're going to start with you before we dig in. If you 33 00:03:50,100 --> 00:03:54,740 wouldn't mind just sharing a little bit about your journey with your daughter and how that 34 00:03:54,740 --> 00:04:00,860 led to your current passion. Okay, yes. So, my daughter who's now seven 35 00:04:00,860 --> 00:04:10,620 years old, she was born at 38 weeks via C-section. We received the postnatal diagnosis of Down 36 00:04:10,620 --> 00:04:15,140 Syndrome. And what that means is during my pregnancy, we didn't know that we were going 37 00:04:15,140 --> 00:04:20,860 to have a baby with Down Syndrome. We did have soft markers for Down Syndrome, which 38 00:04:20,860 --> 00:04:29,100 later on with an ultrasound, the results per my OBGYN were unremarkable. So, you know, 39 00:04:29,100 --> 00:04:35,020 we didn't know until she was born. And so, for your listeners that don't know what Down 40 00:04:35,020 --> 00:04:42,940 Syndrome is, Down Syndrome is a genetic condition that involves either a full or partial copy 41 00:04:42,940 --> 00:04:49,460 of the third copy of the 21st chromosome. So, also known as trisomy 21, the most common 42 00:04:49,460 --> 00:04:55,820 type of Down Syndrome, and that is what my daughter has. And so, the main trait that 43 00:04:55,820 --> 00:04:59,740 comes with the diagnosis of Down Syndrome, and it's the first time I learned about it 44 00:04:59,740 --> 00:05:06,220 is when she was born. And when we got the confirmation of the diagnosis is hypotonia. 45 00:05:06,220 --> 00:05:12,580 So, now I know as a myofunctional therapist what that is, we look for hypotone, tongues 46 00:05:12,580 --> 00:05:20,220 in particular, but that means low muscle tone. And so, I use this analogy with patients 47 00:05:20,220 --> 00:05:24,740 now with low muscle tone and what that really means. And if you don't have a fitness background, 48 00:05:24,740 --> 00:05:32,500 it's kind of hard to understand what hypotone is, hypotonic. And so, I use this analogy 49 00:05:32,500 --> 00:05:37,740 and I want to credit Anna Gross, she's a baby SLP from the Breathe Institute. I took one 50 00:05:37,740 --> 00:05:44,460 of her courses. She used an example of a beanbag. So, imagine a beanbag in your living room 51 00:05:44,460 --> 00:05:51,020 floor, okay? And just how much surface area it takes. It takes up a lot of surface area. 52 00:05:51,020 --> 00:05:55,620 Imagine sitting in a beanbag and all the effort and energy it takes if someone asks 53 00:05:55,620 --> 00:06:01,220 you to stand up. It takes a lot of effort because of the, it's an unstable foundation. 54 00:06:01,220 --> 00:06:07,780 That's how I describe low tone tongues. You know, it takes up a big area inside the mouth. 55 00:06:07,780 --> 00:06:14,340 It makes the tongue appear large at times. And so, oftentimes we miss the fact that we're 56 00:06:14,340 --> 00:06:21,340 looking at maybe smaller jaws, to be honest, and not really looking at the muscle tone. 57 00:06:21,340 --> 00:06:25,940 Versus, so going back to the beanbag analogy versus sitting in a chair with four legs takes 58 00:06:25,940 --> 00:06:32,620 up less space in your living room. You could stand up. The muscles that you have to engage 59 00:06:32,620 --> 00:06:38,620 to stand up from a four-legged chair is quite easy. So, you know, that's how what I use 60 00:06:38,620 --> 00:06:44,100 now, even to explain to parents to understand muscle tone, just takes a lot more energy 61 00:06:44,100 --> 00:06:51,140 and effort where a beanbag is like floppy at rest. Normal muscle tone is, you know, 62 00:06:51,140 --> 00:06:56,580 in contract on command. And so, that's what I use and that's how I understand it now. 63 00:06:56,580 --> 00:07:01,940 But you know, when my daughter was born, you know, we get assigned a social worker, case 64 00:07:01,940 --> 00:07:07,940 worker at the hospital. We're given a brochure with a list of providers. It's a lengthy list 65 00:07:07,940 --> 00:07:12,180 and it's very overwhelming. You know, this is the future, our future, you know, with 66 00:07:12,180 --> 00:07:17,660 our daughter. And one thing I notice is that the list just to name a few has providers 67 00:07:17,660 --> 00:07:27,940 on there like an OT, a PT, an SLP and cardiologist. So, those are a few of the providers that 68 00:07:27,940 --> 00:07:33,500 were on this list. And one thing I noticed that wasn't on this list is like an orthodontist, 69 00:07:33,500 --> 00:07:39,580 you know, for early intervention care. Huge. Yeah, it is. Or even just a dentist in general 70 00:07:39,580 --> 00:07:45,900 and myofunctional therapy wasn't on there. So, I feel that I wasn't, you know, this is 71 00:07:45,900 --> 00:07:51,420 my second child. So, myofunctional therapy wasn't even on my radar. I really didn't know 72 00:07:51,420 --> 00:07:56,940 what myofunctional therapy was at that time. But I feel that whether it was my mama gut 73 00:07:56,940 --> 00:08:03,780 instinct or dental hygiene background that really led me to believe I need to focus on 74 00:08:03,780 --> 00:08:09,300 breastfeeding my daughter to help her. I was thinking of muscles. So, really, I was doing 75 00:08:09,300 --> 00:08:14,260 myofunctional therapy or trying to do it without really understanding it at that point. And 76 00:08:14,260 --> 00:08:21,100 so, I knew this was going to affect her open mouth posture, her protruded tongue and her 77 00:08:21,100 --> 00:08:27,780 speech eventually. Right. So, as a special need parent, we are connected immediately 78 00:08:27,780 --> 00:08:33,940 with this type of diagnosis with our local regional centers, usually they're county-based. 79 00:08:33,940 --> 00:08:42,580 So, with this connection, we're given support and resources. And so, at that time, our case 80 00:08:42,580 --> 00:08:46,500 worker, and I want to say maybe at the age of three, so, you know, this is after we'd 81 00:08:46,500 --> 00:08:50,740 been through therapies, Autumn was going through therapy at the age of three months. We had 82 00:08:50,740 --> 00:08:57,580 a PT coming in-house weekly. So, working with these providers was not new to me and to any 83 00:08:57,580 --> 00:09:02,180 parent with special needs, you will understand collaborative care is important and early 84 00:09:02,180 --> 00:09:09,060 intervention is important. That's not news for us. But our case worker at the time actually 85 00:09:09,060 --> 00:09:14,100 was a retired RN. So, she had medical background and when I asked her, you know, I want to 86 00:09:14,100 --> 00:09:18,820 look for myofunctional therapists in the area, can you find me somebody to help my daughter? 87 00:09:18,820 --> 00:09:22,380 She had not heard of myofunctional therapy at all. And she has a medical background. 88 00:09:22,380 --> 00:09:30,860 Yeah. So, she, but she did try. And I think randomly, we happened to attend a Down syndrome 89 00:09:30,860 --> 00:09:35,140 family like health fair. It must have been for one of the big events like World Down 90 00:09:35,140 --> 00:09:41,380 Syndrome Day. And one of the vendors, this was in 2019, one of the vendors there was, 91 00:09:41,380 --> 00:09:47,620 well, now we know, Amanda's boss. And she was a vendor there and I spoke with her and it 92 00:09:47,620 --> 00:09:52,180 was like awesome. She actually understood and said, yes, I have someone on staff. I have 93 00:09:52,180 --> 00:09:57,860 people on staff that have oral placement therapy background or, you know, myofunctional background. 94 00:09:57,860 --> 00:10:04,740 And so, we connected from there. And I think we were lucky that that led into 2020. So, 95 00:10:04,740 --> 00:10:12,980 with the pandemic, everyone was virtual. And that's how we met Amanda. She was the first 96 00:10:12,980 --> 00:10:18,460 provider that we worked with that had this myofunctional background. And she had that 97 00:10:18,460 --> 00:10:25,060 speech emphasis, obviously. And I think it took maybe a year of working with her later 98 00:10:25,060 --> 00:10:29,060 that I decided to, you know, pursue going into myofunctional therapy myself because 99 00:10:29,060 --> 00:10:34,300 it was a high need in my area. Again, nobody was doing myo at that time. It seemed like 100 00:10:34,300 --> 00:10:40,620 at least in our area. And that's kind of led us here today. So, yeah, thanks, Amanda. 101 00:10:40,620 --> 00:10:47,660 You're so welcome. I'm so honored to have influenced you that way. Amazing. 102 00:10:47,660 --> 00:10:53,260 Yeah, absolutely. And you mentioned that you breastfed Autumn. Did you do the same thing 103 00:10:53,260 --> 00:10:58,300 with your first daughter? So, my oldest is, he's my son. He's 12. 104 00:10:58,300 --> 00:10:59,100 He's a son. Okay. 105 00:10:59,100 --> 00:11:06,660 Yes. And so it's interesting because I am being a new mom. I think that you kind of 106 00:11:06,660 --> 00:11:10,860 accept the hardships that come with breastfeeding. So, you don't have anything to compare it with. 107 00:11:10,860 --> 00:11:17,100 And with him, he also had some sleep disorder breathing symptoms. And I do think that I 108 00:11:17,100 --> 00:11:21,660 missed it with him. I have like with him being 12, I'm like, oh, I just missed that window 109 00:11:21,660 --> 00:11:28,100 of helping him almost missed it. Luckily, he's in expansion now. But I was able to breastfeed 110 00:11:28,100 --> 00:11:33,940 him. Now, he was a little different. He was born emergency C-section at 41 weeks. And so, 111 00:11:33,940 --> 00:11:39,420 with C-section, you know, it takes longer for your milk production to come in. It takes 112 00:11:39,420 --> 00:11:46,020 about five days. And it seems that, you know, milk supply takes longer. So, latching was 113 00:11:46,020 --> 00:11:51,020 difficult. But again, you forget because it's your first time breastfeeding, you think this 114 00:11:51,020 --> 00:11:55,820 is the normal, right? It's normal. This is what I'm going to accept. Now, but what I know now, 115 00:11:55,820 --> 00:12:00,540 it's, you know, just because something is common does not mean it's normal. And I've learned that 116 00:12:00,540 --> 00:12:07,660 the hard way. And most of my parents that see me do. So, you know, he had a hard time latching on 117 00:12:07,660 --> 00:12:15,060 the left side. He had a shallow latch, which I believe to be what's a posterior tie now. The latch 118 00:12:15,060 --> 00:12:21,460 was actually ended up, I had a cracked bleeding nipple on the left side. It was very painful. 119 00:12:21,460 --> 00:12:29,860 He was gassy, had colic. His stomach was really distended. And, you know, again, I ended up just, 120 00:12:29,860 --> 00:12:36,180 you know, kind of changing my diet. I said, okay, let me eliminate dairy. I stopped eating certain 121 00:12:36,180 --> 00:12:41,700 vegetables. And it seemed to help. We even saw a GI specialist for him. But, you know, we were 122 00:12:41,700 --> 00:12:47,380 switching bottles too, because he was bottle fed when I went back to work with breast milk. But we 123 00:12:47,380 --> 00:12:54,020 successfully breastfed for 16 months. So I thought that we were doing great. But he also was a long 124 00:12:54,020 --> 00:13:04,100 time pacifier user. He loved pacifier past the age of two. He also was a sleepwalker. And when I 125 00:13:04,100 --> 00:13:11,220 brought this up to my family, they reassured me, oh, that runs in the family, you know, oh, Uncle 126 00:13:11,220 --> 00:13:16,900 so-and-so, your nephew so-and-so, they did a little sleepwalking too. So, and, you know, he didn't 127 00:13:16,900 --> 00:13:22,020 do it very much to where it was concerning to me. I just kind of accepted it and thought, oh, it's a 128 00:13:22,020 --> 00:13:28,260 genetic, you know, runs in the family. So another thing too that's distinct with both my kids is 129 00:13:28,260 --> 00:13:33,540 we sleep train them. So they didn't have problems going down. So I think that that's why I overlooked 130 00:13:33,540 --> 00:13:39,460 all these little symptoms and little red flags throughout their, you know, you know, upbringing. 131 00:13:39,460 --> 00:13:46,260 And they would go to sleep right away. You know, they would nap fine. My seven year old was in the 132 00:13:46,260 --> 00:13:51,220 NICU. So when we brought her home, the nurses had her on a three-hour schedule. So it was pretty 133 00:13:51,860 --> 00:13:57,140 easy transition for her. Whereas my oldest, you know, being a new mom, we had to use, we use the 134 00:13:57,140 --> 00:14:01,780 baby-wise method. I'm not sure if you're familiar with that. But it just helps you understand the 135 00:14:01,780 --> 00:14:07,140 sleep cycles. So like if they cry in between sleep cycles, you know, to kind of let them cry it out 136 00:14:07,140 --> 00:14:13,860 a little bit. And then instead of jumping in and waking them up. So it worked beautifully for him. 137 00:14:13,860 --> 00:14:21,060 And I think that's why I missed it. And it's because they were both getting good, good amount of hours 138 00:14:21,060 --> 00:14:27,860 of sleep, but they weren't getting good quality sleep. Yeah, which is huge. Right, right. And that's 139 00:14:27,860 --> 00:14:33,380 what I see a lot of my parents come in is they are getting the accurate numbers, you know, a required 140 00:14:33,380 --> 00:14:39,700 number of sleep that they need for their age, but it's the quality. And that's what I started to look 141 00:14:39,700 --> 00:14:48,580 at restorative. Exactly. Exactly. So you said something about that with sleepwalking, you were 142 00:14:48,580 --> 00:14:52,820 told, you know, it's common, it's genetic. And that's something that we've heard a lot of parents, 143 00:14:52,820 --> 00:14:57,860 they're hearing that. But that goes back to just because it's common to me, that's the same kind 144 00:14:57,860 --> 00:15:02,340 of thing that that's great that it's genetic, right? Or that everyone in your family does it. 145 00:15:02,820 --> 00:15:07,300 You know, I expect from a family where people just didn't sleep in and we wore it as a badge 146 00:15:07,300 --> 00:15:10,980 of honor. We're just not sleepers four hours a night. You're thinking you're good, you keep going. 147 00:15:11,540 --> 00:15:16,740 Right. Exactly. You know, now I know that's not a badge of honor. And I have, you know, kind of 148 00:15:17,460 --> 00:15:22,820 backed up on that and you adjusted it. But I think that's really common. And I think that's 149 00:15:22,820 --> 00:15:28,980 something that parents, that's one of the things they hear a lot of. Absolutely. That and and 150 00:15:28,980 --> 00:15:35,620 snoring is also very normalized now. Like, snoring is normal. It's in our books and it's on TV. 151 00:15:35,620 --> 00:15:41,380 It's that's what we do when we sleep. It's not what we should be doing. Yeah. Exactly. Especially 152 00:15:41,380 --> 00:15:45,780 kids. And that's another one, right? It's so cute when a little baby snores. 153 00:15:47,620 --> 00:15:53,540 Not really. Right. But, you know, we didn't know we know now. Right. But we didn't know. 154 00:15:54,340 --> 00:16:00,900 So, Amanda, when you're working with and you can kind of guide me on this, I don't know if I just 155 00:16:00,900 --> 00:16:07,060 say special needs in general or if it's different with, you know, the different, I guess, subsets, 156 00:16:07,060 --> 00:16:12,100 you know, like Down syndrome and because of the different symptoms that they have. 157 00:16:12,100 --> 00:16:16,260 When you're working with them, how is that different than when you're working with a child 158 00:16:16,260 --> 00:16:19,940 that's not special needs? How do you know, what kind of things do you have to look for? And 159 00:16:19,940 --> 00:16:28,500 how does that impact therapy? Right. So I work with children and adults with Down syndrome, 160 00:16:28,500 --> 00:16:33,780 without Down syndrome. And when I'm working with my clients with Down syndrome, sorry, 161 00:16:33,780 --> 00:16:39,380 there's a helicopter one second, I'm working with my clients with Down syndrome. I, first of all, 162 00:16:39,380 --> 00:16:44,340 I'm taking into account that hypotonia, that one that Jackie mentioned, that low tone, that 163 00:16:44,340 --> 00:16:50,660 right rest. We're not sitting, none of our body is sitting how it quote unquote should be. 164 00:16:50,660 --> 00:16:58,420 And that coming from the body, from the PT realm, like the body needs to be stable for the mouth to 165 00:16:58,420 --> 00:17:03,540 be stable, first of all. So that's where it's really taking the full team. So I'm thinking about 166 00:17:03,540 --> 00:17:10,660 that hypotonia, which also can lead to some hyposensitivity or hyposensitivity leads to 167 00:17:10,660 --> 00:17:19,300 hypotonia, I should say, too. So the hyposensitivity piece is where they're, when we are doing a 168 00:17:19,300 --> 00:17:25,620 motor response, or when we're doing an action, we have to first sense where our body is in space 169 00:17:26,180 --> 00:17:33,620 sensory, and then we can respond motorically or our brain can initiate the fire, firing to the 170 00:17:33,620 --> 00:17:39,780 muscles per se. So kids with Down syndrome and adults too, I should say are hyposensitive, 171 00:17:39,780 --> 00:17:47,860 so they don't feel where their body is in space as much as I do. And so we have to take a little 172 00:17:47,860 --> 00:17:54,740 more stimulation to wake up the nerves per se. And that way they can then sense where their 173 00:17:55,380 --> 00:18:01,300 body is in react better and use the muscles. So that's where it's like, what comes first, 174 00:18:01,300 --> 00:18:06,820 the chicken or the egg, the sensory, the low three piece, then if we don't have sensory, 175 00:18:06,820 --> 00:18:13,060 we don't have our muscles being used. And then also without muscles being used, we can't build 176 00:18:13,060 --> 00:18:18,660 muscle tone. So it all relates that way. So I really think about the tone. I'm really thinking 177 00:18:18,660 --> 00:18:24,260 about the sensory. I'm thinking about how maybe they learn differently than other kids. So usually 178 00:18:24,260 --> 00:18:31,540 using multiple visuals, auditory, tactile, kinesthetic, as many senses as I can to 179 00:18:32,420 --> 00:18:41,220 cue them and help them find their placements for articulation or swallowing. And also just also 180 00:18:41,220 --> 00:18:47,220 that airway is a big one as well, because we know that their facial structure is different. And 181 00:18:48,580 --> 00:18:54,340 that that tongue thrusts coming forward isn't just the low tone, but it may be airway related. So 182 00:18:54,340 --> 00:18:59,780 I have to dig down deeper and see if there's something that we need to address first before we 183 00:18:59,780 --> 00:19:05,780 can get to the rest of the treatment. Because without airway open, we're not going to be able to 184 00:19:05,780 --> 00:19:11,140 we're not going to be able to get that tongue in and then start earning place at speech because 185 00:19:11,140 --> 00:19:15,300 where the tongue likes to rest, that's where I like to think like that's their starting point 186 00:19:15,300 --> 00:19:21,060 for speech. So if your tongue is going forward at rest, then it sounds like kind of start here. 187 00:19:22,100 --> 00:19:27,220 So if your tongue is up against the upper back molars, and then lightly section to the 188 00:19:27,220 --> 00:19:31,860 root of the mouth, then you can grasp on to the inside of the upper back molars and these 189 00:19:31,860 --> 00:19:39,220 mouth. This is where our tongue should be resting up all the way back inside. Yeah, 190 00:19:39,220 --> 00:19:45,780 all the way back inside on the spot. What we like what we like to say. And then speech can start from 191 00:19:45,780 --> 00:19:50,660 here where our tongue anchors against the upper back molars on the inside there. And speech can 192 00:19:50,660 --> 00:19:56,420 stay inside the mouth and move quickly and accurately. But if there's low tone, they're 193 00:19:56,420 --> 00:20:00,980 usually down on the floor of the mouth. And the tongue is not anchored and it's flopping all 194 00:20:00,980 --> 00:20:08,100 over the place. So inaccurate speech sounds. So that hypotonia, sense, sensitivity and the airway 195 00:20:08,100 --> 00:20:14,340 all three really come into play when I'm absolutely in the drum. So what happens, you know, going back 196 00:20:14,340 --> 00:20:19,140 to that visual that you had, you had the hand and it went all the way, you know, all the way back, 197 00:20:19,140 --> 00:20:23,700 you know, to the mouth. What if you can only get this much of it up against the roof of your mouth? 198 00:20:23,700 --> 00:20:31,060 The front. Yes. So the front of the tongue is up against the roof of the mouth. Well, 199 00:20:31,700 --> 00:20:39,220 in terms of speech sounds wise, that's like, maybe good for temporary for one sound like your L. 200 00:20:39,220 --> 00:20:43,940 Maybe you have your L sound, which we have worked with Jackie's daughter to. 201 00:20:45,780 --> 00:20:52,980 The tongue is up, back sides are down. For a lot of our sounds, our tongue is anchored 202 00:20:52,980 --> 00:20:58,420 sides of the tongue, upper back or against the upper back, inside of the molars. 203 00:21:00,500 --> 00:21:06,660 And like that's that's also what I wanted to point out to parents and other speech therapists 204 00:21:06,660 --> 00:21:14,740 as well as that we can't just treat the appearance or treat the symptoms of the disorder. Like, oh, 205 00:21:14,740 --> 00:21:18,820 your tongue is interdental when you do an L sound. Let's just teach them to put it here. 206 00:21:18,820 --> 00:21:24,580 Oh, your tongue is out when you're doing S sound. We'll teach you to put it in like close your 207 00:21:24,580 --> 00:21:30,900 teeth, put your teeth back. That's great. And in structure, maybe they can do that when I ask them 208 00:21:30,900 --> 00:21:36,660 to. But when they're out and about, they're not going to generalize because the real issue is 209 00:21:36,660 --> 00:21:40,340 why is that tongue forward in the first place? Right. Right. Back to the root cause, which we 210 00:21:40,340 --> 00:21:47,220 talked about that a lot on here. And so, Dr. Pearson, we talked about how my oh, you adjust 211 00:21:47,220 --> 00:21:54,820 for special needs patients when you're talking dentistry. What about things like these, these 212 00:21:54,820 --> 00:21:59,540 expanders and some of the things we've talked about? Yeah. Any of that change? 213 00:22:00,420 --> 00:22:07,380 It's huge. I mean, an expander is so important in these kids with speech and airway issues. And 214 00:22:07,380 --> 00:22:14,660 it's really interesting in the orthodontic field because I went through residency over a decade ago. 215 00:22:14,660 --> 00:22:21,700 And even in my residency, there was a little talk about oral myofunctional therapy and it was 216 00:22:22,500 --> 00:22:26,500 almost kind of a running joke among the residents of like, okay, give this kids some exercises, 217 00:22:26,500 --> 00:22:31,460 right? Like, okay, they're not going to do it anyway. And it was never really emphasized. And 218 00:22:31,460 --> 00:22:36,420 then the other thing was like, there's a lot of traditional orthodontics of you don't put an 219 00:22:36,420 --> 00:22:46,100 expander in a kid unless they have a cross bite, right? And so, you know, in my, you know, career, 220 00:22:46,100 --> 00:22:51,380 that's kind of what I was trained to do initially. And then as I practiced for over a decade now, 221 00:22:52,020 --> 00:22:58,100 you know, you start to see things in kids and you really pick up on patterns of facial growth. 222 00:22:58,820 --> 00:23:06,260 And you see that in patients who have breathing and signs of snoring and speech issues, you see 223 00:23:06,260 --> 00:23:12,100 that they have low muscle tone, you know, their mouth breathers, their tongue, you know, hangs out 224 00:23:12,100 --> 00:23:15,620 and you're like, no, there's something that needs to be done here. They don't have a cross bite, 225 00:23:15,620 --> 00:23:22,740 but they do not have room for their tongue. And then a big part of my kind of metamorphosis as 226 00:23:22,740 --> 00:23:30,820 far as learning more about how this all interacts is getting a 3D x-ray. So the combi, like once I 227 00:23:30,820 --> 00:23:36,980 had that and I was no longer seeing things in two dimensions, I was seeing the airway, I was seeing 228 00:23:38,100 --> 00:23:44,180 the arch form in three dimension, you know, you can see so much more and it's almost like you 229 00:23:44,180 --> 00:23:51,300 can't unsee it, right? And so at that point, I started doing expanders early and earlier. And 230 00:23:51,300 --> 00:23:58,020 as I did these expanders, you would just anecdotally get these, you know, this feedback from parents 231 00:23:58,020 --> 00:24:02,260 of like, man, his headaches are gone. He's sleeping better. He's doing better in school, 232 00:24:02,260 --> 00:24:08,420 paying attention. He's speaking better. Wow. You know, and it's just like, wow, you can really see 233 00:24:08,420 --> 00:24:13,940 that. And so, you know, I started doing them earlier and earlier. And also the technology 234 00:24:13,940 --> 00:24:20,660 keeps getting better, right? So I'm doing even 3D printed expanders now, which is such a better, 235 00:24:21,540 --> 00:24:26,820 just overall experience for the patients because there's no spacers and there's no bands. So 236 00:24:26,820 --> 00:24:32,500 you need very little compliance to get it on. It's way easier to clean and there's more room for the 237 00:24:32,500 --> 00:24:38,180 tongue. And so a lot of patients can continue to do speech therapy while they have the expander in. 238 00:24:39,140 --> 00:24:43,940 And these are permanent, right? These are ones that can put in and out. These 3D ones. So these 239 00:24:43,940 --> 00:24:48,660 are permanent. These are glued in. You have options. You have options of a removable. I still 240 00:24:48,660 --> 00:24:55,940 believe that the glued on ones are better. And, you know, I'll do them as early as age three. I 241 00:24:55,940 --> 00:25:02,260 really prefer to do them later. Like, you know, if we see a big issue, like four to six, but in a 242 00:25:02,260 --> 00:25:08,420 significant patient, you'll do it as early as that age. And I mean, these patients are wiggling 243 00:25:08,420 --> 00:25:14,260 all over the chair and you can still get it in. No problem, right? There's just so much better for 244 00:25:14,260 --> 00:25:23,140 a patient, right? But I even have that experience with my son, who's six and, you know, has been in 245 00:25:23,140 --> 00:25:29,140 speech therapy since he was three, right? And then you put an expander and you're like, oh, 246 00:25:29,140 --> 00:25:55,140 well, there we go now. Now you sound a lot better, right? And so, yeah, that's just been my experience. 247 00:25:59,140 --> 00:26:13,380 You're listening to Airway First, the podcast from the Children's Airway First Foundation. 248 00:26:14,020 --> 00:26:19,380 You can find out more about CAF and our mission to fix before six on our website at 249 00:26:19,380 --> 00:26:26,580 childrensairwayfirst.org. The CAF website offers tons of great resources for both parents and 250 00:26:26,580 --> 00:26:32,500 medical professionals. In our parents' portal and clinicians' corner, you can find educational 251 00:26:32,500 --> 00:26:38,100 and informational content, including videos, blogs, our recommended reading lists, comprehensive 252 00:26:38,100 --> 00:26:43,860 medical research, podcasts, events, parent support, and educational opportunities. 253 00:26:45,140 --> 00:26:49,700 Parents are also encouraged to join the Airway Huddle, our Facebook support group, 254 00:26:49,700 --> 00:26:53,540 which was created for parents of children with Airway and sleep-related issues. 255 00:26:53,540 --> 00:27:01,300 You can access the Airway Huddle support group at facebook.com backslashgroups backslash airwayheadle. 256 00:27:02,980 --> 00:27:07,620 Are you interested in being a guest on the show? Then shoot us a note via the contacts page on 257 00:27:07,620 --> 00:27:16,020 our website or send us an email directly at infoatchildrensairwayfirst.org. As a reminder, 258 00:27:16,020 --> 00:27:21,620 this podcast and the opinions expressed here are not a medical diagnosis. If you suspect your child 259 00:27:21,620 --> 00:27:28,180 might have an airway issue, contact your pediatric airway dentist or pediatrician. And now let's 260 00:27:28,180 --> 00:27:57,460 jump back into today's podcast. I know that we've heard 261 00:27:58,660 --> 00:28:03,460 what you're saying about getting an orthodontist or having your child seen by an orthodontist 262 00:28:03,460 --> 00:28:13,780 at the age of seven. Is that too late? In some regards, it is. The facial growth is 90% done 263 00:28:13,780 --> 00:28:19,700 by the age of 12. There are different parts of the face that stop growing sooner than that, 264 00:28:19,700 --> 00:28:25,220 like especially a patient with an underbite tendency. There are a lot of things that stop at 265 00:28:25,220 --> 00:28:33,540 age closer to nine. When it comes to the muscles and the balance of the structures, 266 00:28:34,580 --> 00:28:39,060 what I always explain to parents is the sooner you get that muscle memory doing what it's 267 00:28:39,060 --> 00:28:44,020 appropriately supposed to do, rather than the bad habits, the easier it is to undo and have 268 00:28:44,020 --> 00:28:52,180 everything function appropriately. Seven is still a good age for most people, but if they have a 269 00:28:52,180 --> 00:28:57,060 cross fight, if they have breathing issues, if they have speech issues, then sometimes it's 270 00:28:57,060 --> 00:29:03,140 appropriate to bring them in sooner. I'll put some links to some other episodes for parents who 271 00:29:03,140 --> 00:29:08,820 may not have heard them to talk about things such as going and listening to your child sleep at night. 272 00:29:09,860 --> 00:29:15,940 It sounds kind of stalker-ish, but stalk them. Do it. And don't do it just one night. You space it 273 00:29:15,940 --> 00:29:19,780 out because you'll start to see a pattern and you'll see, oh, maybe they were just ingested that 274 00:29:19,780 --> 00:29:25,540 night, or oh, no, it really is an issue. Just some things that parents can watch because, 275 00:29:26,980 --> 00:29:31,940 at least for me, and I assume other parents experience this, when they're teeny teeny, 276 00:29:31,940 --> 00:29:38,260 you're with them all the time. But as they get older, you put them to bed, you go work, or you 277 00:29:38,260 --> 00:29:43,300 watch your show, or you read, or you do whatever because they're in bed, it's your time. So, you 278 00:29:43,300 --> 00:29:50,260 know, so many of us miss these signs and symptoms that are there at night. So, Jackie, and I guess 279 00:29:50,260 --> 00:29:58,500 actually really all of you, when it comes to specifically, let's just focus on Down syndrome 280 00:29:58,500 --> 00:30:06,980 children. Are airway issues more common with them? Just kind of across the board? 281 00:30:06,980 --> 00:30:15,380 Absolutely. I do have a few points, just physical characteristics that are common with Down syndrome. 282 00:30:16,180 --> 00:30:21,140 I did get this from the CDC website, but I'll emphasize a little bit as I go along and kind of 283 00:30:21,140 --> 00:30:28,420 list them. So, we talked about hypotonia a lot between Amanda and I. So, poor muscle tone, 284 00:30:28,420 --> 00:30:34,820 which also means loose joints. And if you think of an infant or child with Down syndrome, 285 00:30:34,820 --> 00:30:39,380 we're talking not just the tongue, we're not just talking low lip tone, low mid-face tone, 286 00:30:39,380 --> 00:30:47,220 we're talking whole body. We're talking organs or low tone. So, you know, with that being said, 287 00:30:47,220 --> 00:30:52,500 then think about the jaw joint, right? So, the muscles surrounding the jaw joint don't have that 288 00:30:52,500 --> 00:30:58,980 strength and support, and that's why you see that open mouth posture. And with the low tone tongue, 289 00:30:58,980 --> 00:31:06,420 well, it's blocking the airway already. So, you know, that's one point. The second point, 290 00:31:06,420 --> 00:31:14,180 flat faces. Usually, flat faces anatomically, so that means they have smaller bridge to their nose, 291 00:31:14,180 --> 00:31:19,780 which then means they have smaller nasal passages. It's going to be a lot harder for them to breathe, 292 00:31:19,780 --> 00:31:24,660 you know, efficiently be nasal breathers, right? When they're, we're talking tiny little spaces. 293 00:31:24,660 --> 00:31:34,580 Number two, short necks, you know, already, that's a smaller, you know, airway. We have small ears, 294 00:31:35,700 --> 00:31:40,420 and so small ears can lead to ear infections. And when we already have that protruded tongue 295 00:31:40,980 --> 00:31:46,900 sitting, you know, outside in this kind of natural tongue thrust, then they're not able to clear the 296 00:31:46,900 --> 00:31:52,260 ear canals properly. So, it puts them at, they're just predisposed to these higher risk, you know, 297 00:31:52,260 --> 00:31:57,780 for ear infections. All of these questions are on my basic intake for any child. But, you know, 298 00:31:57,780 --> 00:32:03,300 I looked down, I'm like, my child with Down syndrome, all of these are marked off. So, you know, 299 00:32:03,300 --> 00:32:09,940 and, and there's other things, you know, that are not completely related to myofunctional therapy, 300 00:32:09,940 --> 00:32:14,180 or oral facial muscular disorders, but, you know, tiny white spots in the iris of the eyes, 301 00:32:14,180 --> 00:32:20,660 small hands and feet, you know, small, smaller height, and also medically compromised. So, 302 00:32:20,660 --> 00:32:26,820 you know, our kids, because of their facial structures naturally, will have, you know, 303 00:32:26,820 --> 00:32:32,180 higher risk for upper respiratory diseases and conditions, like pneumonia, bronchitis, 304 00:32:33,220 --> 00:32:37,780 COVID, you know, and obstructive sleep apnea. Most importantly, obstructive sleep apnea. 305 00:32:38,820 --> 00:32:44,820 So, yeah, it's, and, and I feel that, you know, Autumn was, was her pediatrician 306 00:32:44,820 --> 00:32:52,100 asked me at the age of five, I think it's kind of like a check off the list, right, for her medical 307 00:32:52,100 --> 00:32:58,420 chart. They do check for obstructive sleep apnea, but it literally was her asking, 308 00:32:58,980 --> 00:33:04,740 do you have any concerns with her sleeping? No, that was it. No sleep study was, was done, 309 00:33:04,740 --> 00:33:10,820 even though I felt confident and I knew what I was doing. But nothing else was added to that 310 00:33:10,820 --> 00:33:17,220 screening process. My intakes for screening, kids, typical, or, you know, with Down syndrome or any 311 00:33:17,220 --> 00:33:23,860 type of special needs, their, the parents are filling out three sleep intake, you know, questionnaires 312 00:33:23,860 --> 00:33:30,180 on positions of sleep, different symptoms that will help me either refer them to an ENT to really 313 00:33:30,180 --> 00:33:37,700 request the sleep study, or see if they're, you know, okay to start myofunctional therapy. So, 314 00:33:37,700 --> 00:33:43,220 yeah, it's, we're kind of missing a little bit of that. Yeah. Yeah. And it's, and it's interesting 315 00:33:43,220 --> 00:33:48,420 because you had a real life experience that goes right back to something, another guest, 316 00:33:49,060 --> 00:33:56,180 previous podcast, Dr. David McCarty. And one of the things he shares a story of a patient and he 317 00:33:56,180 --> 00:34:02,740 said, how is your sleeping? And he said, great. Well, that's just such an open question, you know, 318 00:34:02,740 --> 00:34:09,220 and you're an exact case in point, you know, how is your child sleep? Okay, fine. I would have said 319 00:34:09,220 --> 00:34:14,340 the same thing about my children and then you come to find out, well, no one's snore. I didn't know. 320 00:34:14,340 --> 00:34:22,420 So, yeah, you know, from the medical side, we need to ask better questions. Right. Patients come in. 321 00:34:22,420 --> 00:34:28,900 But then also, as it's been mentioned by some other guests, as patients or in this case, parents, 322 00:34:28,900 --> 00:34:33,700 it's our duty to come in with some of these more specific, maybe they're not going to ask us. 323 00:34:34,500 --> 00:34:39,060 So you have to be an advocate. You have to be able to say, Hey, is this normal? 324 00:34:40,420 --> 00:34:47,940 Right. Is this okay? Or I have a concern here. Exactly. And so also just to kind of segue 325 00:34:47,940 --> 00:34:53,860 into breastfeeding and what that was like with our gym. So we were lucky enough to get, you know, 326 00:34:53,860 --> 00:35:00,980 obviously lactation consultant help right away. I'm lucky enough to have a family that's super 327 00:35:00,980 --> 00:35:06,660 supportive in breastfeeding. It's not always a case with everybody. But when it comes to the 328 00:35:06,660 --> 00:35:11,860 physical characteristics, so when we're talking about low tone and the protruded tongues, well, 329 00:35:11,860 --> 00:35:17,300 the latch is going to be more difficult naturally, right? The ability to drain the breast is going to 330 00:35:17,300 --> 00:35:23,460 be harder. And also when we're dealing with heart congenital heart defects, then the endurance is 331 00:35:23,460 --> 00:35:28,260 not there. Already for typical babies, you fall asleep at the breast. That's pretty common. But 332 00:35:28,260 --> 00:35:33,700 when you're dealing with heart defects, it physically is hard. You know, you're going to tire 333 00:35:33,700 --> 00:35:39,140 out and not, you know, the endurance is just not there. So it's even more important, I think, 334 00:35:39,140 --> 00:35:46,740 for our Down syndrome population to get this help early on. Or and if breastfeeding is on an option, 335 00:35:47,300 --> 00:35:53,140 just educate yourself. And like you said, be an advocate for your child and just maybe work with 336 00:35:53,140 --> 00:35:58,420 those early providers that are assigned to you right away, the OTs with feeding specialties, 337 00:35:58,980 --> 00:36:02,820 speech and language therapists have feeding specialties or oral placement therapies. 338 00:36:02,820 --> 00:36:08,420 Know what kind of cups are good to use, you know, what cups to avoid, things like that, 339 00:36:08,420 --> 00:36:14,260 little small changes at the beginning. If you know, you have to bottle feed, that's okay. But 340 00:36:14,260 --> 00:36:20,180 just be aware and know, you know, your child is not using certain muscles. Yeah, that's going to 341 00:36:20,180 --> 00:36:27,620 kind of just lead them into that low tone still that we're trying to improve. Yeah, I can add to 342 00:36:27,620 --> 00:36:34,420 that list. Yeah, please. Yeah, for Down syndrome kids, the other things that I see is, you know, 343 00:36:34,420 --> 00:36:38,980 their mouth breathers, right? Consistently mouth breathers. And that means that they're not using 344 00:36:38,980 --> 00:36:45,460 that belly breathing, they're using the more shallow breathing, right? Getting that connection. 345 00:36:45,460 --> 00:36:51,220 But the other thing, because they're low muscle tone, they're not chewing their food properly 346 00:36:51,220 --> 00:36:57,460 and enough. And so a lot of those kids end up having GI symptoms, right? And then they get 347 00:36:57,460 --> 00:37:03,380 perpetuated because as they're trying to figure out why their tummy hurts and why they're having 348 00:37:03,380 --> 00:37:10,420 issues, right? Then they go on different diets where a lot of them will go to like a liquid 349 00:37:10,420 --> 00:37:13,940 diet or a softer diet to try to correct that, right? And that's almost 350 00:37:13,940 --> 00:37:21,780 no one not doing that exercise that they needed. Yeah. Yeah. That we need there. Right. Right. 351 00:37:21,780 --> 00:37:29,380 All those pouch foods. Right. They became huge recently and yeah, all of us in OM are going, no. 352 00:37:30,500 --> 00:37:37,060 Right. And I used them. Yeah, I was I was about to say this is I swear just about every podcast. 353 00:37:37,060 --> 00:37:40,580 I have to say to parents out there, all right, we've all done this. We just did on something 354 00:37:40,580 --> 00:37:44,660 we've all done. So let's take the mom guilt, the parent guilt. Let's just put it over here. 355 00:37:45,300 --> 00:37:50,180 You didn't know because man, I am just as guilty of taking a pouch and going like this while I'm 356 00:37:50,180 --> 00:37:55,780 driving or you got the grocery store. We've all done it. So it's OK. We're going to start from 357 00:37:55,780 --> 00:38:06,340 where you are and keep going forward. So so Dr. Peterson, that if you are a parent of a Down syndrome 358 00:38:06,340 --> 00:38:12,820 child and you're looking for pediatric dentist or an honest, what are some of the things you 359 00:38:12,820 --> 00:38:17,140 should be looking for specifically when you you're going in and you're looking at their website and 360 00:38:17,140 --> 00:38:22,340 you're interviewing them trying to make sure they're the right medical provider for your child. 361 00:38:22,340 --> 00:38:28,500 Yeah. You know, that's a difficult thing sometimes to find before you enter the office. 362 00:38:29,140 --> 00:38:34,740 But, you know, I think that the intake form, the comprehensiveness of the intake form and the 363 00:38:34,740 --> 00:38:39,300 questions, right? If they're asking about sleeping and breathing and things like that, 364 00:38:40,340 --> 00:38:47,620 you can use some of the like more sleep focused, you know, websites. There's a lot of organizations 365 00:38:47,620 --> 00:38:53,780 right where you can you can try to find providers that way. I think a lot of just, you know, my 366 00:38:53,780 --> 00:39:00,900 experience is the moms in the community, right? That's like the best way. And, you know, I think 367 00:39:00,900 --> 00:39:08,340 that here locally, we're very lucky to have like one of our pediatric dentists is just stellar and 368 00:39:08,340 --> 00:39:14,740 so comprehensive when it comes to this. And she's so in tune, right? And so she's kind of, you know, 369 00:39:14,740 --> 00:39:20,820 the word gets out quickly. But yeah, yeah, looking on your insurance or looking on the website, 370 00:39:20,820 --> 00:39:26,260 you know, it's still very tough to find people focused on that. Sure. Sure. Yeah. And it's, 371 00:39:26,260 --> 00:39:31,780 you know, it's something that I think we've all kind of run into at this point. It's hard to find 372 00:39:31,780 --> 00:39:37,460 just airway specific provider sometimes too, or, you know, somebody that has taken courses and is 373 00:39:37,460 --> 00:39:44,180 actually looking at that. So yeah, it's just it's just not easy. So it's hard to find 374 00:39:44,180 --> 00:39:49,380 therapists, speech therapists with background as well. And that's just I know what we're all 375 00:39:49,380 --> 00:39:57,220 advocating for is having every medical or even academic speech therapist per se having back 376 00:39:57,220 --> 00:40:01,860 background, some sort of background and knowledge in airway, even if it's surface, 377 00:40:01,860 --> 00:40:10,260 just knowing what to recognize to then refer for more support. Because I mean, it goes unnoticed 378 00:40:10,260 --> 00:40:16,500 still even by the professionals who you think should understand that. So yeah, that's very happy 379 00:40:16,500 --> 00:40:23,060 that more and more people are starting trying to spread the word to to your way more. 380 00:40:24,100 --> 00:40:29,940 Yeah, we've even had a discussion, an internal discussion of how do you get they already have 381 00:40:29,940 --> 00:40:34,660 so much on their plate, but how do you get teachers involved for the signs and symptoms 382 00:40:34,660 --> 00:40:40,420 to look for because they're with our children. Yeah, eight to 10 hours a day. And they're going to see 383 00:40:40,420 --> 00:40:45,380 that that, you know, this particular child is a mouth breather. Or when they're younger and 384 00:40:45,380 --> 00:40:51,140 they take naps, I mean, they're going to see some of these things and yeah. So it is all about 385 00:40:51,140 --> 00:40:56,660 getting the word out there. It is. I think it gets a little bit complicated with the public 386 00:40:56,660 --> 00:41:03,540 education system because if a teacher is screening for something like that, the school somehow has 387 00:41:03,540 --> 00:41:07,860 to be able to provide a service that way. It's not as easy as, you know, they can't diagnose 388 00:41:07,860 --> 00:41:13,380 anything like that. So it does get tricky. I know what I do with with my daughter is, 389 00:41:13,380 --> 00:41:21,620 you know, Amanda has a treatment plan and goals for for autumn. You know, we have two speech speech 390 00:41:21,620 --> 00:41:26,180 language pathologists. One is school based and one is through our insurance. So Amanda is through 391 00:41:26,180 --> 00:41:31,460 our insurance. She focuses on certain goals. And I share that that treatment plan and goals with 392 00:41:31,460 --> 00:41:36,820 her school based SLP. So then they're, you know, collaboratively, maybe they don't speak to each 393 00:41:36,820 --> 00:41:41,860 other, but they know what they're working on. And that has seemed to help broaden like what we work 394 00:41:41,860 --> 00:41:47,460 on where I'm lucky enough that autumn gets to have a little bit of, you know, the best of both 395 00:41:47,460 --> 00:41:53,460 worlds, you know, like we get language development, expressive language, you know, and Amanda does that 396 00:41:53,460 --> 00:41:59,940 as well. But we work a lot on articulation, the alveolar sounds. I want her intelligibility. I 397 00:41:59,940 --> 00:42:05,460 have her focus more on that aspect. So unfortunately, I know you're asking more like, how do we 398 00:42:05,460 --> 00:42:11,940 screen? I guess it gets a little bit, you know, sticky. But yeah, not even screening, but just 399 00:42:11,940 --> 00:42:16,500 watching for it, because I'll tell you what, you know, once you've seen it, you can't not see it. 400 00:42:16,500 --> 00:42:21,060 But I have I have stood in the grocery store with my children and you get this kind of 401 00:42:21,860 --> 00:42:25,540 and they're looking over there and you're going, yes, I know that's a mouth breather. Stop because, 402 00:42:25,540 --> 00:42:30,660 you know, now that you've seen it, we're all watching for it. Right. Right. Right. And one of 403 00:42:30,660 --> 00:42:38,340 the things that you mentioned that I think is so huge. And to me, it's it just seems kind of like a 404 00:42:38,340 --> 00:42:45,620 well, no kidding, but it is going to it's such a paradigm shift instead of the silo, this collaborative 405 00:42:45,620 --> 00:42:52,820 approach of providers, you know, as as, you know, orthodontists and dentists and pediatricians and 406 00:42:52,820 --> 00:43:02,580 SLPs and myofunctional there is all together. And, you know, it's you y'all are already doing that, 407 00:43:02,580 --> 00:43:08,980 but not everybody is kind of going that direction yet. How do we get again, it's an opinion, I 408 00:43:08,980 --> 00:43:13,780 understand that, but how do we get the focus moving that way? Because this kind of more 409 00:43:13,780 --> 00:43:17,620 comprehensive holistic approach will allow us to get to the root. 410 00:43:17,620 --> 00:43:25,380 It takes a team. We all know that it takes a team. And sometimes we hear that word team and parents 411 00:43:25,380 --> 00:43:30,900 think, okay, that means like a bunch, a group of professionals that I go to separately, 412 00:43:30,900 --> 00:43:34,100 individually, and then I relay the information from one to the other, 413 00:43:35,220 --> 00:43:40,820 which is very common now. This is like, this is your team, but doesn't mean they're collaborating 414 00:43:40,820 --> 00:43:48,340 together as a team. And so when you take that route, you, you might get some progress, sure, 415 00:43:48,340 --> 00:43:53,460 because information is being shared, but it's not quick enough progress or not quick progress. 416 00:43:54,100 --> 00:44:01,460 And also, like the professionals can't don't, if they don't talk directly, it's the information 417 00:44:02,260 --> 00:44:08,340 could be, you know, misconstrued or or like it's misinterpreted because it's being shared in multiple 418 00:44:08,340 --> 00:44:15,380 multiple ways, like telephone. So that I'm really glad you brought this up because I think 419 00:44:16,020 --> 00:44:22,420 inner collaboration is very important. And if, if a therapist, if you have a therapist as a parent, 420 00:44:23,060 --> 00:44:29,540 ask them to sign that whatever permission form that you need to sign to then have your therapist 421 00:44:29,540 --> 00:44:35,300 directly contact the other professionals so that they can talk directly and then follow up on that 422 00:44:35,300 --> 00:44:41,940 too, because I know like therapists have a lot on their plate. And I when I see a parent 423 00:44:41,940 --> 00:44:48,820 checking with me, hey, how is, how is checking in with the school SLP? That it's a nice friendly 424 00:44:48,820 --> 00:44:55,380 reminder to me. And I also like to keep everybody accountable to do that and actually make the 425 00:44:55,380 --> 00:45:04,500 progress. So look for that inner collaboration and advocate for it. Yeah. I typically get the help 426 00:45:04,500 --> 00:45:10,660 from parents when parents come see me, I might be the third provider they've seen. And then I start 427 00:45:10,660 --> 00:45:15,540 asking questions about maybe their dental or who are they seeing who's your pediatric dentist. 428 00:45:15,540 --> 00:45:20,900 And so if they end up, you know, doing a therapy program, I email them so they know, hey, I'm here. 429 00:45:21,460 --> 00:45:26,580 This is what I'm doing. You know, and I if it's an orthodontist, you know, Dr. Peterson and I, 430 00:45:26,580 --> 00:45:32,100 we have a great collaborative relationship. I work out of her office actually. But just awesome. 431 00:45:32,100 --> 00:45:39,140 If I do have another orthodontist that that sends me a lot of referrals for your typical kind of 432 00:45:39,140 --> 00:45:45,300 tongue thrust open bite relapse cases. So it's interesting because I actually have met some 433 00:45:45,300 --> 00:45:51,620 providers through just like some of the other providers that my parents, you know, the patients 434 00:45:51,620 --> 00:45:57,300 are already seeing. And I just make that like a way like to introduce myself, whether it's email. 435 00:45:57,300 --> 00:46:03,540 And some don't contact me. That's fine. Others do. And those that do wanting to learn. And I've 436 00:46:03,540 --> 00:46:09,220 I've been lucky enough to meet people that way, I think. And then and then and then they're interested 437 00:46:09,220 --> 00:46:15,540 in they want to learn more on how can I screen like what what do I do? Who do I refer to? So 438 00:46:17,140 --> 00:46:21,380 I end up being a little bit of the middle person. But you know, I'm all about like, I can't handle 439 00:46:21,380 --> 00:46:27,940 all the patients in our area. I want more providers to learn so we can help, you know, people that 440 00:46:27,940 --> 00:46:32,820 need it. So I think the more the more that we could get on our team, the more awareness we 441 00:46:32,820 --> 00:46:38,420 could bring and just, you know, comes to town to education, educating our parents. But they really 442 00:46:38,420 --> 00:46:42,900 are the ones like, like Dr. Peterson said, you know, it's the mom, the mom squads that are 443 00:46:43,540 --> 00:46:48,180 you talking about you. It's so funny. I'll have some parents come in and they're like, oh, you 444 00:46:48,180 --> 00:46:53,780 also work on so and so's kid. I'm like, that's hip. I can't say but I can't say I wink at them. 445 00:46:53,780 --> 00:46:58,180 And they're like, yeah, they so it's just so funny because the circle is actually really small. So 446 00:46:58,180 --> 00:47:03,940 yeah, like Dr. Pearson said, the word kind of gets around. And yeah, once once a parent has a good 447 00:47:03,940 --> 00:47:09,780 experience with having their child just thrive by breeding better, they're going to talk, they're 448 00:47:09,780 --> 00:47:14,020 going to it's going to be good things. They're going to want all our friends to bring their kids 449 00:47:14,020 --> 00:47:19,060 in as well. Right. And we call them the airway mama bear army. Oh, there you go. I like that. 450 00:47:20,580 --> 00:47:24,820 Because they do they all work together and they all share and that's what you have to do right. 451 00:47:24,820 --> 00:47:29,780 Yeah, you have to be an advocate. Exactly. Which is, you know, why we do the show because we have 452 00:47:29,780 --> 00:47:35,060 to get more of the information out there so that it's in their hands so they can advocate for their 453 00:47:35,060 --> 00:47:44,180 child. Yeah, absolutely. In the in the orthodontic world, I feel like the field is about 20 years 454 00:47:44,180 --> 00:47:51,140 behind. And right now, we're just trying to advocate for people to come in early, right? 455 00:47:51,140 --> 00:47:57,700 Because still the reason like that like the public mindset is wait for all those baby teeth to come 456 00:47:57,700 --> 00:48:03,460 go out and then see. And by the time you get there, oftentimes it's too late, right? And you're 457 00:48:03,460 --> 00:48:09,540 trying you're trying to squash the narrative of orthodontist just want to do early treatment for 458 00:48:09,540 --> 00:48:14,980 more money in their pocket, right? Because that's like that. That's the fear. And so if your child 459 00:48:14,980 --> 00:48:18,820 has teeth that are all touching when they're little, it's fine. So don't even worry about it. 460 00:48:18,820 --> 00:48:25,300 Right. Right. And so that's the narrative that we're still trying to overcome. We haven't even gotten 461 00:48:25,860 --> 00:48:32,180 really in the public mind to like, oh, you know, orthodontist affect growth and and development 462 00:48:32,180 --> 00:48:38,820 and airway and so much right there's so much more that we're addressing. But one of the things that 463 00:48:38,820 --> 00:48:45,060 I think is helping. And what I see is all of the orthodontic conferences this year, we're focused 464 00:48:45,060 --> 00:48:51,140 on sleep. It's becoming a buzzword. I don't know if any of you guys ever full. Yeah, it's it's super 465 00:48:51,140 --> 00:48:55,060 exciting, right? Because we're getting more and more knowledge and more people are debating it. 466 00:48:55,060 --> 00:49:01,380 I don't know if you guys have seen the Netflix documentary open wide. But you know, people 467 00:49:01,380 --> 00:49:07,460 are starting to talk about it. It's certainly controversial because new information, people 468 00:49:07,460 --> 00:49:15,060 don't like change, right? And so, you know, it the word is getting out slowly, but surely. But the 469 00:49:15,060 --> 00:49:22,740 best way is is the boots on the ground, the moms, whenever you you have a parent that says, wow, 470 00:49:22,740 --> 00:49:29,380 my kid is thriving, I really see this and they're the ones that live, eat, breathe, see their kids, 471 00:49:29,380 --> 00:49:34,740 you know, how they function every day. You have the ability to say, OK, you now have this information. 472 00:49:34,740 --> 00:49:40,340 Tell your friends. Yeah. Yeah. And yeah, for those that are listening, I will put a link to that 473 00:49:40,340 --> 00:49:46,500 documentary as well as heal. Both are on Netflix in the show notes. And there's some conferences 474 00:49:46,500 --> 00:49:52,180 like Airway, Palooza. And there's a dental sleep conference in Houston. It's I believe dental 475 00:49:52,180 --> 00:49:56,980 sleep conference dot com. I'll put all those in the show notes because these are all ones that 476 00:49:56,980 --> 00:50:01,380 I know their collaboration here is another one. So we'll put those in the show notes for people. 477 00:50:01,380 --> 00:50:06,180 This this weekend, the Breathe and Thrive Symposium through the American Laser Study 478 00:50:06,180 --> 00:50:10,980 Club is going on in San Diego. There you go. Yeah. That's right. That's right. Dr. Zaggy's 479 00:50:10,980 --> 00:50:16,340 at that one. I know. And and and Pinto, though. Yeah. Yeah. There's a lot of people. So I'm 480 00:50:16,340 --> 00:50:24,740 getting some FOMO not being there. Are you? I am. Are you? Yeah. Yeah. It should be a good one. 481 00:50:24,740 --> 00:50:28,820 It should definitely be a good one. Yeah. So usually at the end of every episode, 482 00:50:28,820 --> 00:50:33,220 I like to hand it back to our guests because y'all are the experts. You're the ones that have 483 00:50:33,220 --> 00:50:36,740 lived the journey and that are trying to help the kids that are out there. 484 00:50:37,620 --> 00:50:42,420 I will leave it to you for the final word for our parent listening audience. 485 00:50:44,420 --> 00:50:50,500 Jackie, we could start with you. Well, I think a lot has been said already about, you know, 486 00:50:50,500 --> 00:50:59,540 just being an advocate, definitely asking questions. When you're not you, you are the parent, you know, 487 00:50:59,540 --> 00:51:06,820 when something is not right and just find another provider. I think that sometimes even culturally, 488 00:51:06,820 --> 00:51:10,980 you're afraid or you say the doctor is, you know, the say all and then you stop there. 489 00:51:11,620 --> 00:51:18,180 And I think that, you know, that that's that's not a good outlook when you're really striving to 490 00:51:18,180 --> 00:51:25,620 find out what's going on with your child. I tend to when if I've been, you know, getting 491 00:51:26,180 --> 00:51:31,140 if I have a patient that has been through different providers and they come to me, 492 00:51:31,140 --> 00:51:35,540 sometimes there is no diagnosis and I might be part of the journey of getting that diagnosis, 493 00:51:35,540 --> 00:51:41,700 you know, and so I think parents just maybe even just need that guidance a little bit. So 494 00:51:41,700 --> 00:51:49,460 definitely find a provider or therapist that connects with your child. Number one, one that is 495 00:51:50,020 --> 00:51:56,340 in tune with your beliefs and one that's going to advocate for your child as well. So I think that 496 00:51:56,340 --> 00:52:03,220 alone can help a lot. Yeah, I love that being in tune with your child as well. That's huge because 497 00:52:03,220 --> 00:52:09,700 if there's no connection, your child's not on board. Right. Exactly. Amanda. 498 00:52:09,700 --> 00:52:14,660 The other report is that's number one importance versus the report. It doesn't 499 00:52:14,660 --> 00:52:20,580 matter what kind of therapy you're going to do. I figure backing off what Jackie said, 500 00:52:20,580 --> 00:52:26,660 start early, find the professionals that you feel like you need or connect with your child, 501 00:52:26,660 --> 00:52:32,020 and don't be afraid to get second opinions. There have been many times where I've 502 00:52:32,660 --> 00:52:39,060 referred to an ENT for airway obstruction, possibly I can't diagnose, same as having 503 00:52:39,060 --> 00:52:43,780 your own tissues. I can't diagnose, but we work with the repercussions of it every day. 504 00:52:44,740 --> 00:52:50,260 And they still like it brushes off or goes unnoticed. And I say, you know what, don't like, 505 00:52:50,260 --> 00:52:56,100 that doesn't mean it's the end. Find someone who knows what exactly to look for, find that second 506 00:52:56,100 --> 00:53:02,900 opinion. And don't let that, if it feels uneasy, like there's still something wrong, 507 00:53:02,900 --> 00:53:09,220 but they're telling me that it's okay. There's probably still some sort of that instinct. So 508 00:53:09,220 --> 00:53:18,660 follow that instinct. Yeah. And I'll piggyback off of that. Getting multiple opinions is really 509 00:53:18,660 --> 00:53:25,620 helpful to just understand that knowledge and even know what questions to ask. But in my experience, 510 00:53:25,620 --> 00:53:32,820 I get families who've been to multiple consults and they're almost overwhelmed. And so one of 511 00:53:32,820 --> 00:53:38,580 one of the other things is finding practitioners that are willing to help you navigate and understand 512 00:53:38,580 --> 00:53:44,340 all of those different things rather than the paternalistic approach of just do what I say 513 00:53:45,380 --> 00:53:49,620 is right because, you know, I know what I'm doing, right? You want to make sure, like, you know, 514 00:53:49,620 --> 00:53:53,860 these parents, they want to make sure that they're making the best decision for their kid. And so 515 00:53:53,860 --> 00:54:00,180 if there's practitioners and providers that are willing to explain that and do the work of the 516 00:54:00,180 --> 00:54:06,740 communication, right, that's going to help make you feel more comfortable with, okay, we have a 517 00:54:06,740 --> 00:54:14,820 comprehensive plan moving forward. That's excellent. Awesome. I think all three of you for making time 518 00:54:14,820 --> 00:54:20,100 this evening to come on and for, you know, sharing your story and really helping our listeners understand 519 00:54:21,060 --> 00:54:25,620 just the differences that the Down syndrome population is going to have to 520 00:54:25,620 --> 00:54:32,740 contend with when it comes with airway and sleep. So thank you so much. Thank you. Welcome. Yes. 521 00:54:34,020 --> 00:54:40,740 Thanks again to today's panel of guests, Dr. Vanessa Peterson, Amanda Garola, and Jackie 522 00:54:40,740 --> 00:54:47,700 Becerra Lysie. And each of you are listening to today's episode. If you're new to our podcast, 523 00:54:47,700 --> 00:54:52,340 please don't forget to subscribe. And if you enjoyed today's episode, leave us a review or comment 524 00:54:52,340 --> 00:54:57,700 telling us about what you enjoyed the most. You can stay connected with the Children's Airway 525 00:54:57,700 --> 00:55:05,380 Verse Foundation by following us on Instagram, Facebook, X, LinkedIn, and YouTube. Parents can 526 00:55:05,380 --> 00:55:12,420 also join us via our Facebook support group, the airway huddle app, facebook.com, backslash groups, 527 00:55:12,420 --> 00:55:18,820 backslash airway huddle. You can find tons of great content for parents and medical professionals 528 00:55:18,820 --> 00:55:24,980 on our parents portal and clinicians corner on our website at childrensairwayfirst.org. 529 00:55:26,580 --> 00:55:29,940 If you'd like to be a guest or have an idea for an upcoming episode, 530 00:55:29,940 --> 00:55:35,940 shoot us a note via the contacts page on our website or send us an email directly at infoat 531 00:55:35,940 --> 00:55:42,740 childrensairwayfirst.org. And finally, thanks to all the parents and medical professionals out 532 00:55:42,740 --> 00:55:47,460 there that are working to help make the lives of kids around the globe just a little bit better. 533 00:55:47,460 --> 00:55:58,820 Take care, stay safe, and happy breathing everyone.