Hi everyone, and welcome to another episode of The
Welcome Back to Airway First, the podcast from the Children's Airway First Foundation.
I'm your host, Rebecca St. James. My guest today is the one and only Sharon Moore,
a speech pathologist and myofunctional practitioner with over 38 years of clinical
experience across a range of communication and swallowing disorders. She has worked in
diverse clinical settings in Australia. Hi everyone, and welcome back to Airway First,
the podcast from the Children's Airway First Foundation. I'm your host, Rebecca St. James.
The integration of oral facial myofunctional principles into traditional speech pathology
work allows a unique approach to managing disorders of the upper airway, including breathing,
swallowing, chewing, resonance, speech, and sleep issues related to upper airway obstruction.
Sharon has a special interest in early identification of craniofacial growth anomalies
in syndromatic and non-syndromatic children. Sharon believes that there has never been a
more important time for medical, dental, and allied health colleagues to work as a team with a
significant consequence of sleep disorders in all ages now widely known. Growing a global medical
acknowledgement of the role of myofunctional therapy in the management of sleep disorders has
held a new era of relevance for work in the upper airway, affirming Sharon's chosen clinical
direction. She believes we have a window of opportunity to help parents get it right before
kids start school. We are also proud to have Sharon as a member of the CAF advisory board.
You can find out more about Sharon at sleeprightkids.com and wellspoken.com.au. And now let's jump
into my interview with today's guest, Sharon Moore. All right, good morning. I guess it's
morning for you, Sharon. It certainly is morning. The birds are singing. The sun shines out and
it's autumn here. I know you call it the fall. We call it autumn and it's the best time of year.
First of all, I agree with that. I do love me some fall and I like autumn because it just sounds
nice. I'm in lovely Michigan where it's spring yet it's snowing. So go figure.
Because you're north. Yeah. Yeah. So it's still pretty cold out there in the northern parts of
the states. Yeah, it's how we roll. Yeah, but that's all right. It's all right. So yeah, and
it's good for breathing. So hey, for people like me that have airway issues, the cold is great for
breathing. So well, the cold, as long as it's not too cold, will shrink some of those tissues in
the nose and open up the nose. There you go. There you go. All right. Well, let's jump in. And now
I'll go ahead and show this. We'll put a link to it in our show notes. Oops, all the way up there
for you. The Sleep Breaks Kids is an amazing book. And in fact, in April, this is our giveaway for
parents. So parents, stay tuned for that on Instagram. That'll be a great book if you haven't
already read it. And let's just start with, because one of the things you say in the book, and it's
everywhere, 40% of children sleep problems, 40. Just right there. That alone as a parent gives me such
pause. So I mean, I think we all kind of understand the impact of the industrial revolution and
your jaw development and everything, but 40%. How is this happening? And it's just not top of mind
for everybody. Yeah, I think I agree. I think the statistics quite alarming. And that's particular
statistic came from Dr. Judy Owens and Dr. Ronald Chirvin, I think around 2017. Don't quote me on
the date. But they wrote up to 40% of 4 to 10 year olds. And then I think if we look at under
10 year olds, the figure is closer to 60%. Because kids younger than four are plagued by more kinds
of sleep challenges. But you're right, it is a lot. And especially when we think about the
consequences of poor sleep, but we say, well, what is contributing to this? And when I wrote
Sleep Rep Kids, I thought long and hard about how do we help parents understand or start to
understand, you know, what is a normal, what is a so-called normal sleep phase or a normal sleep
problem? And when is it an issue that we can actually do something about? And so I divided it
into two sections. One of them I called Disordered Sleep or Out of Order. And the reason that I used
that terminology was because when I was chatting to parents in the clinic, that's what seemed to make
sense to them. But really, it's referring to that area of sleep health practices. We say, well,
what's that? What are sleep health practices? Yeah. And that really boils down to the sleep
environment, the sleep routines and sleep behaviors, healthy sleep practices. Because we know that
there are some things within our everyday environment setting children up for sleep, like
sights and sounds and temperature and hunger and all of those sorts of things, even sensory issues
like how pajamas feel, they can all have an impact on how children, well, the signals in the brain
that help children start to fall asleep. And so there's an awful lot that parents can do to set up
their child's sleep environment well to, you know, the best environment that will give the best chance
of kids falling to sleep and staying asleep. And it's a different-breached child, too. That's one thing
to make sure, just to point out before we get going. It is different. You know, I have one child
that refuses to use the top bed sheet. Once I figured that out, much better. But the other child's fine.
So totally, totally. Yeah. I have one child. Okay. He's now a big man who refuses to have a sheet at all.
Anyway, that's another story. I just want to do now. I don't want the sheet. So I'm not sure what that's about.
But anyway, with the sleep health practices, you know, there's the environment, but also routines.
And so our brain and circadian rhythms that govern the way that respond to when we eat and how we eat
and when we exercise and how we exercise, they are very responsive to sleep cues as well.
And so it's quite important to go to bed at the same time every night and try and get up at the same time
every morning as much as possible because those routines actually train the brain and help the brain
to fall asleep more efficiently or better. And all tied up with those routines, of course, are things around behavior.
And, you know, there's a reason why that book, Get the Beep to Sleep, sold millions of copies is because of that.
Behavior. If you're not familiar with that book, it's definitely worth a read.
It's just a, you know, a book full of rhymes for kids that actually is better for parents because every parent relates to it.
And I'm going to put the link in here, the version where Samuel L. Jackson reads it because it's beautiful.
I'm putting that link. I don't know if I've heard that.
Oh, I'll send you the link. Oh, it's awesome.
So these, the environment and behaviors and the routines, they all fall under that banner of sleep health practices.
And I think it's really good to understand them in that little package because this is where I talk about the family pathway.
And these, there's a lot that families can do. And when they tweak it and when they get it right within two weeks and less,
even for many families, when they get that right, their kids start sleeping better.
Wow. Literally.
So, I guess in the clinic, parents, as soon as they know that there's something that might not be quite right with their children's sleep,
their question is, well, what can I do about it?
You know, the parents that I meet are so proactive. They will do anything for their kids.
So as soon as they know that they didn't previously know it wasn't a normal kind of sleep issue, they just want resources.
They want to know what can I do today. And so I think that is one of the areas where parents can just get really busy, really fast,
and doing a whole lot of things where they feel like they've got more control over what is happening.
And there's lots of fantastic resources out there to look at in terms of setting up a great bedroom environment,
getting routines happening, and helping kids with the right kind of behaviors that lead up to good sleep at bedtime.
By the way, we'll put a link to our website. We've got a section called Sleep Hygiene.
And we created that and we pulled in a whole bunch of different resources, some of which came from your book.
And it just talks about how you create this great sleep hygiene, this environment for your child.
So I'll put that link in there too.
Fantastic. Thank you. There's also, there's a wonderful behavioral pediatrician called Dr. Harriet Hiscock.
And she's based in Melbourne, Australia, and she's written some fantastic books that help kids who aren't able to respond to what we call the usual cues.
You know, so if parents have challenges in terms of setting up the environment and behavior and routines,
but they're having, they're still struggling with some of those simple instructions.
These books are amazing and give very detailed, but fun ways of instructing families and kids on how to, you know, get there.
I can give you a link to those as well. That would be amazing. Yeah.
Yeah.
So of course, you know, there's, there's lots of lifestyle factors and health factors that can also interfere with sleep.
But then then on, on, I talked about the two, the, the two parts of this framework, you know, got healthy sleep practices or sleep hygiene.
And the other side of it is sleep disorders. And it's when there's something else that's medical based that requires medical expertise to solve.
And this is really, really important to understand, you know, and this is where we need screening tools.
All right.
This is why the more I learned about sleep medicine over the years that I felt, even though I'm a speech pathologist and, you know, you think speech sleep,
what have they got to do with each other a lot actually? Yeah.
They have a lot, but it's not a natural connection.
So when parents came come to see me in the clinic with a thumb sucking issue or a speech issue or one of many different kind of issues,
there's sometimes a bit taken aback. Well, why are you asking me these questions about sleep?
But sleep screening, I screen every single child. Every child and have been doing so for about 10 years in my practice and even develop my own screening tools to help me to understand what is going on with a child's sleep
and whether or not it is a problem that may require medical expertise.
Because not every problem is going to be solved by a great sleep environment or great sleep routines or great sleep behaviors.
Right. Airway is wrecked. It's wrecked. It doesn't matter what your environment is.
Exactly. And of course, there are 80 plus different types of sleep disorders that could be wrecking a child's sleep.
And so I felt an obligation the more I understood about sleep and how critical it is to a child's brain development, you know,
especially in those young years, but all the way through, but particularly in those very young years.
I felt an ethical responsibility to be screening kids so that I could be their navigator or their educator to say, well, you know, this isn't the norm.
This doesn't look like the normal kind of sleep problem that we can can easily be fixed at home.
I think we need to go further and investigate a bit further.
So the screening tools were really designed to help parents understand what they're listening for, what they're looking for, what's normal and what's not.
And that's no one else. I don't think parents are really getting that information.
And so I don't think so.
So let's talk a little bit about just some of those. I mean, I know we can't go into the tool itself, but just as a parent, what are some of the more obvious, easily recognizable signs that, hey, my kid might have a sleep issue?
Oh, great question. Very, very, very good question.
Well, one of the ones that I use in the clinic that I didn't put in the book, actually, it's called taking your child's sleep pulse.
And it really is just four very simple questions that requires a yes answer, a no answer, or an I don't know answer.
And so I'd say to the mum or the dad, I'd just say, OK, about every roughly most nights of a week, you know, six nights out of seven over the last month, did your child get the right number of hours of sleep for their age?
And they would say yes, no, or I don't know.
And the next question is, OK, did they have the did they have quiet uninterrupted sleep for the duration of the night?
Yes, no, or I don't know. Did they wake well? That's the third question. Yes, no, or I don't know.
And the fourth question is, is did your child manage those natural energy peaks and troughs through the day?
And yes, no, or I don't know. Now, if we got four yeses to that, well, I would I would think in general, OK, we're probably doing pretty good with this one.
But every so often in the clinic, I might check back in with those four questions.
And the one of the reasons that I like it is because it helps parents to understand what are the key what are the key points we're looking for?
You know, are are they getting the right number of hours? And it's different for every child and it changes with age and hormones and all that good stuff.
Yeah, sure does. But, you know, we don't want parents to get super anxious about the number of hours. But in general, to know, well, in general, you know, what number of hours should my children be getting?
And we know newborns need 14 to 17 hours, infants, 42 months, 12, 16 hours, preschoolers, 10 to 13 hours.
And the list goes on. So it changes. And those figures are based on the American Academy of Sleep Medicine guidelines that were published and are used very widely.
Yeah, very widely. And so I think it's important to give it out as as general information, but really sort of discourage parents for getting from getting to anxious.
And I think you're anxious about the perfect number of hours because there's a range and like you said before, every child is a little bit different.
And it's not just the hours to write so little Susie little Johnny could be asleep or could be in there for eight hours.
That quality wasn't there. They may have only gone through, you know, the rims cycle or it just, it wasn't quality sleep for eight hours. So that's a whole different issue.
That's the next part of the formula. But if we come back to the hours, you know, I cannot tell you how often I've been told by parents that my little person gets eight hours sleep and that's great.
That's enough. So that's what I would consider a really big deviation from what we would expect.
So if you've got a six year old child where they need nine to 12 hours, that's the range, but they're only getting eight, then you would know definitively that that child isn't really getting enough.
And so I guess after the sleep pulse, those four questions, if when we're asking those very general questions, if we get any no, or any I don't know that for me is the queue to go on and do the other sleep screening.
And so in the screening that I use in my clinic about 10 years ago, I developed a screening form called the SSS disturbed rest.
Now that label is not mine. That was an acronym that was developed by Dr Jim Papadopoulos and he is a pediatric sleep specialist from Sydney, Australia.
Now, interestingly, he developed that particular acronym because he wanted allied health people like myself to screen for sleep, because he was so aware as a pediatrician that kids sleep was suffering and that kids with poor sleep weren't being picked up and they weren't getting the help that they needed.
So he developed that particular acronym, and it stands for sleeping sleep, sleepless, sleepy, disturbed sleep and restless sleep.
I won't bore you with all the details on that particular one today.
The acronym is much easier. But he had all of those categories in mind, and he gave me permission to go ahead and develop that acronym into an actual screening form that I could use in the clinic, because I was very aware that there were validated,
statistically validated questionnaires available, but I felt like they weren't giving me enough information.
So I wanted a screening tool that gave me a lot more information, which is why I developed this particular tool, and I also added what's called a triaging component, because of my work, I'm very focused and interested in whether or not there are signs and symptoms of an airway related problem.
And so, you know, breathing dysfunctional breathing that in some way is going to fragment or distort that child's sleep. And so, in on that particular form, they're the triaging questions are in a different color.
And there's also a section that asks questions about how many hours of sleep their children are getting and whether or not they think their children are getting good quality sleep, which is the other part of the formula.
So if we talked about a sleep formula, we say, well, are they getting the right number of hours, the quantity. And when they're getting those hours, are they good quality.
And that means quiet uninterrupted sleep for the duration of night of the night where they wake refreshed.
And then they manage those natural energy peaks and troughs during the day.
So that's the formula that makes sense to me.
And in terms of explaining to parents what sleep quality means.
And one of the other benefits of this screening form I found, because I've been using it for over 10, 10 years now and I still find it really useful.
Is it helps to start conversations, because many parents don't really understand the full impact of why sleep is important.
But then secondly, if they know once they know sleep is important, they say, well, what am I looking for? What am I listening for?
Right.
So there's no one telling them.
You know, which goes back, you mentioned it earlier, and I swear, every podcast it is said, you don't know what you don't know.
So doctors weren't telling parents that you know this.
I mean, think about it, even even as something silly as how many times.
Oh, when you get a little newborn, oh, it's.
Well, okay, I'm on this side of the fence now and now I hear that go, oh, take that child in that there's something wrong.
There shouldn't be storing because we, we snoring is funny on sitcoms and little baby snoring is cute.
But we didn't know.
No, exactly.
And how, how are parents to know and so many people say, well, why did you write sleep wreck kids?
And I think that there's probably 5000 reasons.
But number one is so because kids deserve to get the sleep they need every night to be healthy and happy.
Secondly, but it's not even second, it's equal first is parents deserve to have this science and this knowledge right at their fingertips.
That very science and that very knowledge that got us totally fired up.
If it certainly fired me.
You know, definitely fired up. Yeah.
And I will say also, you wrote it in such a way.
I mean, you can see there's three to ladder it.
It's written in such a great way to for parents to understand because some of this stuff is, it's complex.
It really is. There's no other way around it.
You write it such a great way and it's bite size.
So you can read a little bit and you can digest it and think about it and go watch your child go check their environment go do different things and then come back.
And I also think it's interesting.
I mean, it's one of the ones we recommend this this and brave parent to the ones we always recommend when you know somebody reaches out to us because it allows the parent to have a conversation with the provider.
You're now on the same level of okay, let's talk about this.
Oh, I know that term.
Oh, I understand.
I may not understand the depth you do, but I get it.
Yeah, exactly.
It's powerful.
Yeah.
I think, you know, like, there are so many reasons for writing the book and I think one of the hardest things to do with complex areas is, you know, how do we distill this in a way that is comprehensible to ourselves.
But then to, you know, to the families in our care. And I always talk about frameworks and conversational choreographies.
And I also really.
I think there's great power in visual resources. So if you've ever seen me present, then you will see that I use graphics to tell the story. Yeah, a lot.
And while someone might use 30 graphics, I'll use 90. And I know that's completely over the top. I agree.
And I'm not defending it. Well, kind of maybe I am defending myself anyway. Now, you'd be extra with your slides. I've seen you present.
And you, if you told me there were 90 slides, I couldn't have told you that because there's so much there.
It goes by so fast as well. So.
Well, I think particularly for parents and if we understand the way humans in general learn, we need to be able to provide the frameworks and the resources and the concepts in a way that's very impactful, not just impactful, but that gets an emotional response that creates an inspirational moment that creates that aha moment where they go,
Oh, I get it now. Okay, now I understand.
And so at the, my most recent presentation in New Orleans, I presented the what I call the three step decision making roadmap that I've been using in my clinic for about 10 years because it made sense to me it helped me understand, you know, what do I do first.
And it's literally three circles, three bubbles that intersect.
And in the orange bubble on top, it's screening.
And it goes through there are three parts of that screening. And it's simply what I do in my clinic and for every clinic, it will be a little bit different.
And it will be appropriate to the clinic that that family is attending. But in my clinic, it's the sleep pulse. Then we do the symptom based questionnaire the SSS disturbed rest.
And then if there are indications, I will significant indications, I will then go on to do validated questionnaires with the statistics.
And it might seem like overkill, but honestly, for some for a clinician like me, if I want to then encourage a parent to go to a pediatric sleep physician or an ear nose and throat doctor, or a gastroenterologist or whoever I want them to be able to take that information with them and say,
here, this is what we found. This is what we found. Okay. And I think those visual resources are very helpful for the practitioners because we also have to remember they're on catch up as well.
Right. All of us are still learning. Right. And there's still so much we all still don't know. So in this in this bubble of the we've got the screening at the top.
And then there's a bubble that goes to the right and a bubble that goes to the left. The right hand one is purple. And it's called the patient pathway or the family pathway. And this is where straight after screening, we can say to the parents, this is what you can do at home right now.
You're listening to airway first, the podcast from the Children's Airway First Foundation.
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And now let's jump back into today's podcast.
Okay, and then the left hand side is if that screening has given us cause to think from triage that all there's some things here that really need some medical expertise or some dental expertise or another allied health type of expertise.
That's the pink bubble on the left hand side. And there's no particular order. It might be both at the same time, or it might be we think we have to make a priority of this medical expertise and then we go back gathering all the information that we need to help that parent get the medical expertise that they need.
Or the dental expertise or whatever it might be.
So this is something that has really helped me in my clinical frame of mind, and I know that it helps parents in my care as well.
I also helped write about it. So, you know, one of the other things because sleep disorder breathing is the primary clinical focus for me, because I work on the parts of the airway that can interfere with breathing, or what we call functional breathing.
And so, from the screening forms, I've developed a poster actually that corresponds directly to that screening form. And the more I looked at all the different parts of it.
Because I'm a great fan of Dr. McCarty's work because, yeah, I was analyzing it and I realized that this particular screening rubric corresponds directly to at least four out of the five reasons to treat.
To treat.
And I'll put a link to that if people haven't seen that I'll put a link to the podcast. Yeah, blog that goes with it.
Yeah. And so I was really excited when I saw that congruency and it really made sense.
And that's the way Dr. McCarty talks about those five reasons to treat and how there are practitioners all over the world that are discovering things and developing their ways of getting of discovering this in their patients is that it does boil down to these five reasons to treat which I think is a fantastic rubric to work with.
So, of those five in my screening form it shows it unravels whether they're snoring on any kind of noisy breathing, the sleep experience, the wake experience and also co morbidities.
The other factor that Dr. McCarty talks about is the risk factors, and those will come out in my initial initial consultation in talking to parents so I was pretty chuffed and pretty excited to see that that that congruency was there.
Thank you Dr. McCarty.
And that's one thing I have to say I love about this podcast is because one we're just getting the information out there and we are so passionate everybody that we, we for lack of a better on our term just eat and breathe and sleep this it just it's who we are now is once you know you know.
But to be able to see the sharing of knowledge and hear y'all talk about oh, I got this from McIntosh I got this from McCarty I got you know I got this from Owens.
It's just amazing but this is his book by the way if anybody hasn't it is a wonderful book.
He has a podcast as well season two is just now out, and he co developed a trifold that's in our calf store which will put a link to not for you parents sorry that's actually for clinicians, and it's supposed to help guide this conversation which is exactly what you're
talking about.
You could pull up next to a patient, open this and say okay here are the five reasons.
Let's look at where you are and decided please apply to you.
I mean it's a wonderful tool is a very different approach so I love that.
It's patient centered.
It is it really is it empowers the patient it's in the name of the book it's right there.
Yeah, yeah.
Yeah, yeah, it's it's a it's a fabulous thing so okay so we know that.
Well I guess one of the things I want to touch on is because you mentioned these allied professionals.
And I've heard you speak of this and I do think it was in the book as well.
You have said that there are you know more than 20 specialists that parents that could be involved in this process.
And maybe it's because when I read your book it was when I first started with.
So it's been a while.
20.
That's a lot and as a parent I.
How would you know so maybe we talk about a little bit about how who some of these allied professionals are and how they all work together to help create this.
I guess just kind of overall approach to helping a child.
Yeah, I'm.
Yeah, who are the I think.
Who would be the most common ones and I think that if we're working with those sleep health practices that we were talking about, you might end up working with a psychologist and doing a version of cognitive therapy for insomnia.
So it could be, you know, working with a pediatric psychologist who's very well trained in that area and there are a number of them and they're very, very good.
And there's also behavioral pediatricians like Dr Owens and like Dr Hiscock who I mentioned who this this is what they've been doing for decades.
Who can provide that kind of assistance for some families where there's some people might even need a sleep health nurse to come into the home like a sleep coach and help them set environment behavior and routines.
You know, and in fact, you know, when I wrote sleep, right kids, I always thought of it as a bit of an introductory text. And it was in my head that really every single one of those other doctors or allied health people or even interior designers even needs to write a book as well on the back of this,
because it is such a big complex area.
Anyway, I'm digressing against. No, no, no, you're not but it is it is huge. We were joking earlier about you know let's just throw it all out there were how many hours do we have because there's just so much to it.
Absolutely. Absolutely. But in my clinic. Okay, who would I be most likely to refer a child to I would say ear nose and throat.
And I would say respiratory vision because a much of my case load has issues with function and how things are working in the upper airway. And so the clinical issues that I'm dealing with are a little bit more to do with sleep disorder breathing, although my
my sort of identify something else different going on but then I would refer to a pediatric sleep specialist. If I think that is required.
I would say a gastroenterologist. A neurologist. And it's not me making that referral directly I would talk to the GP or write to the general practitioner and say, This is what I think I'm saying.
Would you please assist with a referral to such and such a specialist. But, and with many of these kids. I, I often end up being the navigator. Actually, that's what I feel like my role is navigator.
I would say that before. Yeah. Yeah, because parents don't understand suddenly they can get very overwhelmed if you're saying, Well, I want you to go to such and such a specialist and say, Well, why.
Why, well, let's not this one out. And sometimes it takes them a little while to understand why.
And just to throw that it is scary as a parent. Hi, here's your tiny person that's three or four years old and we're telling you to go see a GT.
A big scary dog. Right. That's scary. Yeah. Yeah. Yeah, it is. It is. And it's also if we think about the busy lifestyles of our families in today's world.
It's incredibly disruptive.
You know, to take a day off work or a morning off work and grab that little person from daycare or wherever they are and go to school or soccer or whatever else. Right.
Exactly. Exactly. So there are all sorts of confounding factors and I have to say for myself as an allied health practitioner, I have never made those sort of recommendations lightly.
I think about it very, very carefully and spend as long as it takes in conversations and also watching and observing because, you know, what might look like an airway problem one week, you're going to watch over a number of weeks and see what happens.
And then you're going to watch over a number of weeks and see, well, is it still the same, you know, or has it changed, you know, because there are some things that I can give parents to do, for example, in my clinic to clear their nose, which is a very common reason
to have a disruptive breathing during sleep and it's pretty simple in some cases to solve that issue. So, and one of the other things is, which you will see on the new website that I'm developing is something called airway fitness is how do we develop or optimize the way this airway system works.
The simplest way I can put it, and they are literally fitness exercises for the mouth, face and throat. And, you know, mouth and face, everyone knows mouth face knows. Okay, because we can see them.
You can see them. Yeah.
You know, I'd say the one of the most popular posters or visuals that I give parents in the clinic is this poster of the airway. And because suddenly they can see.
There's a whole lot of airway back there that we can't see, you know, the back of the airway, which is critical. It's critical to airway health and often when parents see it, they go, Oh, I just I didn't realize it was so long.
It's wild and as somebody has been scoped, I don't even know how many times I've been scoped because it happens all the time.
That's why it is wild. This is actually connected here and it all go up and down and then you start to get astrophocal cords and wait it keeps going and you don't know.
And not only. Yeah, totally.
When you're in biology in high school, it's like, Oh, your windpipe. That's it. You're done.
And it's off the go. And you don't understand that there's actually a joint pipe there for a second when there's side by side. It's not the same.
It is the same pipe from the back of those to the the esophageal sphincter.
So the air pipe and the food pipe is the same pipe. And that's where some of those problems start and then they split.
Yeah, they go up. Yep.
Air pipe front food pipe at the back. So, and it all needs to be working properly and the same muscles that control how we swallow safely are the exact same 26 muscles that split the airway open in the opposite direction to swallowing.
So I don't want to get too much into like clinical team tax here because I think it's probably a different kind of.
But yeah, it's fascinating. I mean, it really is when you get into it and you see it, it's so complex, but it's just fascinating.
It is. Yeah. And I'm in the middle of developing a brain map that that show all of those complexities within that simple framework that I was talking about earlier.
Because again, I'll keep coming back to this is that I think one of the things that parents in my clinic and that I've seen over the years is they respond to pictures they respond to visual resources.
Yeah.
I didn't mention this yet, but in the sleep screening when we're really starting to drill down into, you know, how is the breathing, how is the breathing in the day how is in the breathing at night.
Well, I get parents to do the snow lab recordings and little videos and photos, because we capture a baseline that is typical a snapshot that is typical of that child's sleep.
And it's a little bit of an imposition. I must say, parents don't always find it easy to do this. And sometimes they think you want them to stay up all night to take the recordings.
Oh, please never do that.
No, no, it doesn't.
I'm going to sleep for what half an hour maybe then go in there.
Don't have to don't have to like surprise them at 2am. We're not asking for that.
No, no, it's it really is a snapshot and so I would ask them if they go to if there is sleep with young children usually they're asleep after their little ones go to sleep, just grab a snapshot then.
And then if you're up before them, grab a snapshot then if you can.
And I think it's very revealing to many, many parents when they start taking these recordings themselves as well.
Yeah, I can remember one particular little guy where I remember asking the mom he was 18 months and he had a syndrome a really unusual syndrome but I said to his mom.
I think he might be now breathing at night. Let's just grab some record. Let's just see. And she said, he's definitely he cannot breathe through his mouth at night because his tongue's always there.
All right, so he's definitely not said. Yeah, okay, well let's just grab some photos and a little bit of video and low and behold, you know, he was sucking that area and through the mouth and through that tongue.
That was also sitting between the lids. And so it can act.
It can be very revealing. I think. And it's a process. It takes time.
You know, we're not going to be able to do this in one night. You know, and so, and it makes sense to write that you would want to do it multiple nights because perhaps they over exerted themselves at school this day, or they didn't sleep well this night or they had allergies
this day or cold this day you've got to kind of you want to space it out.
And so the list goes on and on and on. And you know, in our perfect clinical world, we want to be able to say, well, here's the information that we need and this is how we can optimize your child, we can optimize their health right before they start school.
And in our head that is the perfect world scenario that we can get that little guy or that little girl sort of starting off on that fantastic front foot but it sometimes it just takes more time for parents to understand the pieces of the puzzle because it truly is a puzzle.
And thinking of a little one when I say that who was for when I first started treating her and she came for what was called it like a literally a simple list.
I think the list. I'm going to start calling it the list but never so simple because it's a flag for lots of other things or something else. Sure.
Yeah, there were certainly flags for sleep disorder breathing but also my functional disorder with this little one. And one of the key ones for this family were that she was very narrow and very small.
So, the parts in the front of the airways here the jaws and the nose were teeny tiny and there was literally not enough room for the tongue. But this was three foot age right from.
Six targets three foot cage. Yeah, it's such a great metaphor isn't it. It is.
Yeah, it really did and it puts an in perspective to you because you don't realize it's some people are just petite or their small bones or blah blah blah but when you have a three foot cage.
Has nothing to do with that it's completely different.
Well three foot cage was six foot tongue doesn't kind of work.
That's why it's such a great visual. Yeah.
Yeah. Yeah. And so it but it literally took two and a half years.
So, you know, we can provide information to the parents and one of the confounding things when we were working on chewing and swallowing and breathing as a package to support the changes in speech and we were working on speech as well.
Because the tongue is such an adaptable flexible part of the body.
There were parts of the program the speech correction program that this little one could get right.
So it seemed like she could get right in the very initial stages she could produce the speech sound correctly.
But what never ever happened was this this next stages where that speech sound was able to be produced at speed within a normal context of conversation which is where it matters right.
Right.
Here I'm sort of alluding to the different phases of therapy that we need to go through to literally correct that speech so that it's correct in everyday life.
Right.
So we were at the foundation stage that stage one of four key phases.
And the parents were determined that if she could get that stage one that she should be able to get stage four.
And unfortunately that doesn't you it doesn't always it almost never works that way.
And so they they kept going on their own at home with his four little kid trying to get to conversational level and never got there and they eventually they came back and we revisited the concept.
Well I'm really not confident that she has quite enough room in there for that tongue to move and they were also at that point signs more visible signs of sleep disorder breathing.
And so at that point they agreed to go to the dentist for some guided growth strategies.
So just to help to make a bit more room for that tongue needed to do and also to open things up for breathing at night.
So and this is where I would like to insert the little caveat.
We're talking about growing the face expanding we're not talking about pulling out tea and retractive orthodontics.
To put that out there that is not what we're talking about.
Well I think this this example this case example is a really good one in fact to illustrate that example.
So if we have this little girl and she's already very narrow and there's not enough room for the tongue and her secondary teeth have come in and everything's a bit topsy turvy and Higgledy Higgledy and the crooked teeth thing that shows us is probably not enough room in the jaws.
So what what would happen if we make that space smaller.
My heart just saying.
Yeah, I mean if if teeth were taken out so that the teeth would line up and be straighter.
What how is that going to help the tongue move better.
And how is that going to help to open the airway.
So yeah, that's not I mean that's straight T yeah, it's about space we need a room we need space.
We certainly do need space we need enough space for the muscles to do their job properly.
And the time being one of those primary muscles.
And before we we wrap up you you kind of touched on this earlier and I want to give some time to discuss this you know we're talking about the parent resources and on well spoken which you will put a link in the show notes.
You have coming up some some opportunities for parents.
We're really really good resources, you know, airway fit for life is one of them, as well as the sleep fit for life.
So we take just a few minutes yeah talk about that introduce that to parents.
Yeah, yeah thank you for asking about that that's a resource that I've been trying to pull together for a long long time and and I think it fits very nicely with the conversation.
We've been having and about the importance of the resources for parents, you know where can they go in one place.
Number one to understand why sleep is important.
And that's where I developed the sleep fit for life module, we could call it on an online learning platform, I could show you just a little visual of it here I don't know.
Okay perfect.
Yeah.
But it goes into sleep science in a parent friendly way.
There are interviews with top sleep experts, pediatric sleep experts on there, and there are developing resources, you know posters and charts and visuals and books and things that are coming to support the parents learning journey.
And airway fit for life is that part of the learning that relates specifically to the importance of our airway and what what it means to be airway fit.
Most people don't understand.
Like I said, what constitutes the airway beyond the face mouth and nose, and what can happen in there and how do we keep it healthy and I think there's two main ways to think of it.
The first way is like a fitness program and that is ensuring that little tiny people are able to use the muscles in the airway in a way that supports functional breathing and that supports growth of the airway.
And that many, many more things, but the second part of it is learning to recognize when that airway is not working as well as it should. And what can we do about it with lots of practical resources in there for parents.
I'm very excited for that to come on I cannot wait.
Super super jazz.
You've seen the preliminary planning process.
Yeah, so I'm very excited. I think it's gonna be great.
And once it's out just so everybody knows that there will be a section in our parents portal so that you can find it easily in case you forget.
But yeah, it's going to be amazing.
So at the end of every episode, I always want to hand it back to you, our experts.
Just for the final thought the final words for our parent audience.
Oh, so many things right.
Oh, you've got to trust yourself, you know, some like so many parents have have have little niggles that something's not perfectly right but they don't actually know what it is so I'd say trust yourself.
But I think that there is a story.
Do I have time to tell a little tiny yeah, absolutely.
Because I think it's very, very relevant to sleep but also kids sleep health but also sleep disorder breathing in particular.
And it's that story that came from a book called upstream by Dan Heath. Do you know this?
Yeah. And it's the story that I share is two friends sitting by a riverside on a beautiful Sunday afternoon and they're having picnic but they notice a child drowning so they race in they rescue the child bring them back to shore.
But no sooner are they back to shore than there's another child and another and another and they keep rescuing them but there's too many to rescue them.
So they take a walk upstream because they want to know why are those children falling in.
And that to me is the most important health message and that there are signs and symptoms that are recognizable very early in a child's life when it comes to sleep health and in particular sleep disorder breathing.
And I think we have a magnificent opportunity to nip those things in the bud when children are teeny tiny before they start school.
I will just say that final thought for anybody that doesn't know this is why Sharon Moore is one of my favorite humans on the planet.
You live you breathe this you are so passionate about it you look at it from every angle.
When you see somebody you stop you take time you you work with them.
People don't know you've done that with me.
The fact you guys can actually hear my voice is because Sharon taught me techniques and we've been working on it and you are the type of person out there in the world that is that change that we want to see and I cannot thank you enough on behalf of half as a mom and as a patient.
Thank you.
Thank you so much for what you do.
And for coming on here today.
Oh, it's just it's totally all my pleasure.
Thank you so much for having me.
Absolutely.
Thanks again to today's guests Sharon Moore for sharing her medical insight into each of you for listening to today's episode.
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Take care, stay safe and happy breathing everyone.