Hi everyone, and welcome to Airway First, a podcast from the Children's Airway First Foundation.
I'm your host, Rebecca Downing.
My guest today is Lauren Ruffridge.
Lauren is an A-S-H-A certified speech language pathologist with a Master's of Science from
Ithaca College.
While she has experience treating clients from infancy through adulthood, she has found
that her passion lies in pediatrics, with whom she has worked exclusively for the past
10 years.
In 2020, after moving to Manlius, New York, Lauren discovered a lack of availability
and experienced feeding therapists for in-home therapy.
That's when she founded Thrive Spot to fill this need.
Lauren is committed to lifelong learning and advocacy.
She focuses on offering the best evidence-based practice methods for her clients and believes
in creating treatment strategies that are tailored to the unique needs of each family,
while empowering the caregiver to be the child's advocate.
During the interview, Lauren provided so much eye-opening information for me.
I really enjoyed our interview together, and I hope you do too.
And now, here is my interview with Lauren Ruffridge.
All right.
Hi, Lauren.
Welcome.
Thanks for being on our podcast.
Hi.
Thank you for having me.
I really appreciate it.
So before we get started, just kind of level sets so we're all understanding, explain to
people exactly what a speech-language pathologist is and what you do.
Absolutely.
So a speech-language pathologist is also referred to as a speech therapist, so you might hear
them interchangeably.
Okay.
But SLPs can work with people of all ages, from babies to adults, which is sometimes a
misconception.
A lot of people assume we just work in the schools, but we actually work in medical
setting, private practice, and we work with the whole HBN.
We treat many types of communication and swelling problems.
So the main categories are speech sounds, which is articulation, language, social communication,
so the ability to know how to use language socially, voice, fluency, which is also known
as stuttering, cognitive communication.
So anyone who has a traumatic brain injury or any neurological deficits, we would be
working on them to redevelop their cognitive communication skills.
And then what I personally specialize in is feeding and swallowing, and I work in the
pediatric age range, which is from infants through about adolescents.
Okay.
Yeah, and I'm not going to lie.
That's what throws me off is when I got your website, which I will put a link in the show
notes for ThriveSpot that I had no idea that you actually worked with something.
Just to me, that's not quote unquote speech.
Of course.
I know there's a whole movement in our profession trying to redefine our title because it doesn't
encompass all that we do, and it sometimes misleads families and knowing what provider,
what professional is there to help you with feeding.
But I will clarify that both speech language pathologist and occupational therapists who
are trained in feeding are both qualified professionals to work on feeding.
And I did want to just highlight for anyone listening who wanted to learn a little bit
more about pediatric feeding disorder.
An organization that I'm a volunteer with is called Feeding Matters, feedingmatters.org.
And they're a wonderful organization.
They have tons of resources for families who are either concerned their child might have
a pediatric feeding disorder, or if their child does have one, there's tons of support
both from professionals and other families who lived through it.
So I love that organization.
But I bring it up because they recently advocated to define what pediatric feeding disorders
are.
And so I'm going to just read the definition because they worked really hard for that.
And so pediatric feeding disorder is impaired oral intake that is not age-appropriate and
is associated with any combination of four different domains.
So those four domains are medical, nutritional, feeding skill, and or psychosocial dysfunction.
So they wanted to break those down more specifically and really encompass all of the ways that having
any type of difficulty in those four domains can qualify you as having a pediatric feeding
disorder.
And so that's now in the diagnostic criteria.
We use that as an ICD-10 code.
So those are the families who I'm working with who fall under that diagnosis.
They can also have other diagnoses going on with them that are contributing to the pediatric
feeding disorder.
But those are my families who I'm working with most of the time.
So as far as your children's airway, the way that this kind of associates with us is I
would correct me if I'm wrong.
It's going to be more on the medical side, right?
Because then you're dealing more with jaw development, high-arge palliates, tongue ties,
that kind of thing.
Absolutely.
Yes.
And so the way it also ties in is that I've studied oral facial myofunctional therapy,
which is what we'll be talking about a little bit later.
And then also oral restrictions or tethered oral tissues, which are more commonly known
as tongue tie, lip tie, cheek ties, or buckle ties.
So cheek ties.
Yeah.
You can even have ties inside of your cheek that can impact feeding.
Those don't impact it the most when you're comparing to the tongue and the lip, but it's
all relevant to each individual.
So I've done continuing education in those areas, but they all tie into airway because
everything starts with our airway.
And if our airway is not intact and if we are not able to adequately breathe through
our noses, which is what we're supposed to be able to do, it then kind of has a ripple
effect on the entire oral facial structure, development, and the functions in which we
use our mouth, our nose for.
No breathing, speaking, and eating.
So that's kind of how it all ties in because those are the areas that I'm working within.
And the airway, of course, dictates so much more than most parents and people know that
that's why I'm so glad that you're bringing awareness to this whole topic.
And I love everything that you guys are doing.
I think it's wonderful.
Yeah.
Well, thank you very much.
Yeah.
I will say, kind of on a personal note, I grew up with a speech impediment.
So I worked with a speech language pathologist, which if anyone ever listens in the airway,
slow down.
That's what I'm doing because I know what's about to happen with my sounds.
But one of the things that surprised me when I was reading, I did go to your website and
did a lot of reading.
These kind of things, even language, somebody that has an impediment like mine, can't impact
your breathing, it can impact how you eat, it can impact.
I never really thought of that.
I just thought it was an annoyance when you talk.
You stumble sometimes.
Yeah.
It's wild how everything is so interconnected.
We learn about things in such silos.
Like this is your speech.
Your mouth is for speaking.
Your belly is for digestion.
Your legs are for walking.
But literally everything in our whole body is very interconnected.
And when one system isn't working, it's usually impacting another one in a different way.
Or it's usually tied to that.
Maybe there's a problem in a different system that's impacting your other system.
So yes, our whole bodies are so interconnected.
And I think that's one thing that is lacking in a lot of the education programs is just
how interconnected every system is within the body, including starting with the airway.
Right.
Which is crazy.
So let's just say you're working with a child with an impediment.
And first of all, just to clarify, if a parent has a child like that, I'm not trying to send
anybody into panic.
Your child doesn't have an airway issue.
We don't know that.
But let's start with that and work our way into the more airway impactful ones.
What kind of training and work would you do with this child?
Let me obviously, it's age dependent.
Yeah.
So it's for sure age dependent.
And so we're typically talking about kids who are two, three, four or older.
Obviously, we're seeing more speech development come in closer to like three.
You should be saying words and phrases, of course, but we really don't address articulation
or speech sounds until closer to three or four, because most sounds are still developmentally
coming in up until that point.
And some some are even coming in later than four.
So we're talking five, six, seven for certain sounds.
So it we would assess the child and a look at the errors and the patterns because there
are different, different indicators that would tell us how we would address it.
So for instance, so children who are younger will often exhibit phonological processing
disorders.
Okay.
So these are basically patterns where they simplify sounds in words in order to kind
of make it easier for them to say.
So an example of that would be if you have what we call a cluster, like which is an SP
sound.
So in the word spoon, you might hear a younger child say, coon.
Okay.
That of spoon.
You know, so that's a typical error sound up until a certain age.
It's normal for kids to do that up until a certain age.
Usually like three, three and a half.
If it persists beyond that, then we would assess and determine if their patterns like
that, that they are exhibiting, then we would address it in a certain therapeutic way versus
just more of a an error that is not a pattern in terms of the phonological processes.
So that's kind of above this conversational level.
Yeah.
But yeah.
So we would assess their articulation and look at what age they should be saying these
sounds and then go from there and decide how we would address them based on how they're
presenting.
But we would always be looking for if any of their signs or symptoms of speech difficulties
are pointing towards an airway problem.
So what does that mean?
So that would basically be if we're seeing children who exhibit a tongue thrust, which
is basically when you see the tongue pushing forward.
Okay.
The certain sounds.
Sometimes people describe it as a list.
There's research out there that's showing that that could be indicative of an airway
concern because the tongue is pushing forward to try and open up the airway.
Yeah.
Okay, so that's kind of some newer research that I've been hearing about and learning
about by.
Okay.
So, but to go back to your question, it depends on the child's age.
If they're older than four years old, then I would be assessing them from an oral facial
mild functional standpoint, which is different than a traditional articulation assessment.
But if they're younger than four, then we would be using different assessments because
of the developmental age levels that I mentioned before and when the sounds are coming in.
Okay.
Yeah.
And you just touched on the oral facial, myofunctional disorders, which that's a mouthful of itself.
It is a mouthful.
So let's talk a little bit more about what that is.
And then what the disorders are, what parents can look for just to give them a better understanding
of all of it.
Absolutely.
So it is a mouthful.
So for the sake of that, I'll probably refer to it as OMT, which is Oral Facial Myofunctional
Therapy.
Okay.
Or if you hear OMD, that's Oral Facial Myofunctional Disorder.
Okay.
Got it.
So, yeah.
So I'm hoping that this becomes more common knowledge because they're now starting to
require that be taught in graduate programs.
But when I was in graduate school, it wasn't included in the program.
So yeah.
So hopefully that will become more familiar to people.
They won't think, what was that mouthful?
Yeah.
Right.
This is very much the reaction I get when I talk to anyone about it.
But I like to describe it based on the goals that we work on when we're addressing OMDs.
So the goals of Oral Facial Myofunctional Therapy are to establish nasal breathing both
day and night.
That's the first one.
Okay.
The second one is we want the lips touching lightly at rest.
The third is we want the tongue position to be up in the palate and just behind our teeth.
Okay.
And we want that to be whenever we're not speaking or swallowing or eating.
And then the fourth is what I just mentioned, correcting swallowing patterns, which if you're
seeing someone who's trained in Oral Facial Myofunctional Therapy, they will be either
a speech-language pathologist, an occupational therapist, or a registered dental hygienist.
If you're seeing an RDH, they can't work on the swallowing part of it because that's
not within their scope, but the OT and the SLP can.
So I would be addressing if there's any feeding problems associated with it and also any speech
problems that would be associated with.
So quick question on the swallowing.
I mean, obviously, and we'll dig into this a little bit more about nasal because of mouth
breathing.
The rest of them are pretty, I think, intuitive, but swallowing.
How is that a sign of an airway issue?
So I like to use the example of a tongue thrust pattern, which we kind of touched on a little
bit before, but sometimes what people, adults, children, we see it throughout the age range.
They thrust their tongue forward instead of what we want to see, which is like a peristaltic
wave where it goes up and kind of back as you swallow the food or liquid or saliva.
And oftentimes that's a red flag for an airway issue for the same reason because they're
pushing up against the teeth instead and almost opening up the airway to breathe while they're
trying to facilitate the swallow as well.
So we would be, so then the other problem with that is that they're shifting teeth.
And so you often see that shifting teeth.
So what we call our malocclusions are different bite patterns and essentially crooked teeth
in certain ways.
So over by a deep bite, over jet, there's a lot of different terms within malocclusion
that I trust my RDHs and my dental professionals to speak on more comprehensively.
But when we see children or adults, but primarily children with super crowded teeth, that's
usually a red flag for us as providers that their, their pellet is probably too small
or narrow because their tongue was not resting up inside the pellet to give it that good
U shape.
So what we want is the U shape, the nice broad wide U shape.
Instead what we are seeing sometimes is this more narrow V shape.
And then when the teeth are trying to come in, they don't have enough room because it's
not nice and wide from the tongue shaping it.
And so then we get crooked teeth.
And depending on how they're using their tongue when they speak or swallow, that can even
further shift the teeth because the tongue is a very strong group of muscles.
And it's constantly pushing in certain directions.
It's going to shift things.
So that's how we actually get the shape of our palate is by keeping, we want that tongue
to be up within the palate so that it does keep that excuse me, U shape.
But when it doesn't rest up there, that's when we start to see that doesn't hold its
shape as it would otherwise.
Okay.
Yeah.
So those, so that kind of are the goals of oral facial myofunctional therapy.
There are some causes that can contribute to these.
So, so some of the causes, the number one, which is why we're here talking today is airway
obstruction.
So what could be an airway obstruction?
So if a child is not breathing through their nose, we would want to figure out why.
So we would want to know if it's enlarged adenoids, if it's enlarged tonsils, if there's
a deviated septum, if there's seasonal allergies or recurrent allergies to food or something
that's causing congestion all the time and forcing them to breathe through their mouth.
So the airway is what we look at first and foremost, because that's the most important
to the overall function.
Okay.
And in order to do that, we would, we would assess for if they can breathe through their
nose.
So for instance, we could have them keep their lips together and see, like, are they able
to breathe through their nose for short periods in our assessment?
And if they're struggling, we would be immediately referring them to an ENT first, possibly an
allergist to further evaluate these things and try to rule out what is contributing to
them not being able to breathe through their nose.
Okay.
So airway, airway problems are the first thing we would want to look at.
And throughout most of this process, there are more than one provider that may need to
be involved to help support whatever's happening with the child.
The next one would be oral habits.
So that would include things like finger sucking, thumb sucking, extended use of the pacifier,
even nail biting.
If you're someone who all the time sits with your face on your right fist when you're listening
in class or when you're talking or anything, eventually having that fist there is going
to shift things in your mouth and your face.
And so there are habits that we may not even realize that could be contributing, but the
bigger ones are the sucking habits, sucking on anything.
Some kids suck on their t-shirts all the time or their necklaces.
Right.
Yeah.
So the sucking, we want to figure out, well, why do they need to suck?
What is the reason?
Why are they still sucking that thumb beyond the age of one or two?
And we often look to the airway to see if that's helping support their airway almost,
because when we suck on our thumb, we're jutting our jaw forward a little bit, which
is then opening up the airway a little bit more.
So we want to look at, is that part of the problem or is it that they just enjoy the
soothing aspect of sucking still or is it both?
So yeah.
So oral habits aren't always as straightforward as people think.
And I've learned through oral facial myofunctional therapy that these kids that we see who are
still struggling to get rid of sucking their thumb in almost even eight, nine, 10-year-olds,
that's usually a sign that there's something else going on with their airway, and that's
why they can't give that up.
So we would really want to dive deeper into what's going on.
And that would be through an oral facial myofunctional evaluation that would then inform us as to
what other professionals would need to be involved to help alleviate whatever is happening.
You are listening to Airway First with today's guest, Lauren Ruffridge.
You can find out more about the Children's Airway First Foundation and our mission to
ensure that every child has access to screening, evaluation, and treatment of all children's
airway disorders before the age of six on our website at childrensairwayfirst.org.
You can also find a ton of great resources for parents on our website, including videos,
blogs, recommended books, comprehensive medical research, and more.
As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.
If you suspect your child might have an airway issue, contact your pediatric airway dentist
or pediatrician.
And now back to our interview with Lauren Ruffridge.
So then the last one that I wanted to mention that can contribute to an oral facial myofunctional
disorder is those tethered oral tissues, the tongue lip tie.
So when, and I don't want to get too nitty gritty because I might mess up some of the
people, but swallowing starts in utero.
After that first trimester, babies are able to swallow in utero.
So when they are born, the patterns that they're showing, they didn't just start doing the
swallowing when they're born.
They've been doing it for months in utero.
So when they're in the stages of development, they're finding that the tongue tie and the
lip tie form early on in development as well in utero.
And so they're swallowing with that tongue tethered or low lying in their mouth.
And so their palate is not forming correctly because it's not able to reach the palate
when they swallow.
So these anatomical and physiological problems that we're seeing when they're born are happening
in utero sometimes.
So anyway, that's why we see kids who are right off the bat are having trouble with
latching to the breast or even bottle feeding.
It can impact.
However, when we see these children who are a little bit older, who maybe were missed
with the tongue tie, what we see is that their tongue is lying low, which is then not shaping
their palate, which is causing those malocclusions, those crooked teeth, which is also putting
them at risk for the sleep disorder breathing.
Because if you have your tongue lying low and you can't or you're not used to getting
it up in the palate when you lay down, gravity pulls it back.
And it sits further into your airway.
So your airway space is then shrunk down even more.
And that's forcing you then to breathe through your mouth more because you're not getting
enough through your nose.
So.
And is it fair to say for parents that if you see a child breathing through their mouth
consistently, it's not just one night they have a stopping nose that there is an issue.
It's worth coming out.
Oh, yes.
Yes, absolutely.
So if we want to just dive into that topic, because I know that was something we were
going to chat about, how can you tell if your baby or child is mouth breathing or might
have some disorder breathing issues?
Yes.
So I think we kind of said this, but when babies are born, they're supposed to breathe
through their nose.
We are born as obligate nasal breathers.
So if a baby cannot breathe through their nose, they're going to be forced to breathe
through their mouth.
Same with a child, right?
They're going to go to the mouth to help them because they need oxygen to live.
But we're supposed to be able to breathe through our nose.
So why is that important?
Why do we need to breathe through our nose?
Okay.
There's so many reasons that nasal breathing is beneficial.
So one, and this is not covering all of them.
This is just going to highlight a couple.
Okay.
Nasal breathing filters airborne pathogens.
So when we are breathing through our nose, it's a filter.
It's kind of sorting through those germs, getting rid of some of that bacteria.
If we're breathing through our mouth, we are not getting that same filter.
Right.
So that means you're more likely to get sick more often.
Okay.
Nasal breathing allows for nitric oxide to be produced.
This is a complicated topic, but if you look up, nasal breathing allows for nitric oxide
to be created.
Nitric oxide is super important.
One of the things that it does is it allows blood, nutrients, and oxygen to travel to
every part of our body efficiently and effectively.
So if we're not creating enough nitric oxide, we're not seeing those benefits, okay, which
can then lead to other hosts of issues, health issues.
And then another thing is nasal breathing serves as a natural bronchodilator.
So it opens up our lower airway, the lungs, the bronchi.
It helps regulate what's called heart rate variability.
And that's a good thing.
We want it to regulate heart rate variability because we need, that's a really important
thing as well, which I'm not going to comprehensively explain well.
So I will just encourage you to look that up and understand how important it is and how
nasal breathing does play a role in that.
And then the last thing I wanted to mention, go ahead.
Oh, no, I was going to say, and we'll put a link.
We have a blog that kind of touches on this, so we'll put a link.
So they can click through and read more.
Perfect.
Yeah.
The last thing I just wanted to mention was that it activates the parasympathetic nervous
system, which is the rest and digest part of our nervous system.
And if we don't have, if we don't activate that part of our nervous system, then we become
very dysregulated.
And then that also in turn impacts our sleep and whether or not we're getting that restful,
restorative sleep.
So again, you're hearing how a lot of the systems are connected.
And we really don't realize it until, well, it's educated until we spread the word, right?
Right, right.
And that's what we're trying to do.
So one of the things, and I have some other things, but I just wanted to kind of go back
to because you touched on something that I don't think a lot of people really comprehend.
One of the things that children's airway first that we're advocating for is this full examination
oral examination at birth.
That just doesn't happen currently.
And you touched on it and why it's so important.
I just thought maybe we could talk about that for a little bit.
That as you mentioned, these things are formed in utero.
So if somebody took the time at birth to look, you'd find a tongue tie or you'd find that
V-shaped palate where it's still malleable, you can kind of adjust it.
Well, so if we identify these things right off the bat, it would better inform our decisions
throughout their early life.
So if we are able to better identify these things, we would better be able to support
their feeding journeys.
So so many moms I talked to say, I just couldn't breastfeed that they couldn't latch.
And there's very few cases where it's an issue with the mom.
Although it may feel like that to the mother, how hard the struggle is, it's usually because
there's some sort of oral dysfunction with the baby.
And that's not to say it's always a tongue tie, it certainly is not.
But if we can identify, if it's because of that high palate, they're not able to get
that good suction on the breast to latch.
If we can identify those things at birth, not only will it set the babies up for more
success, but I think that it would also really largely impact that mother baby dyad if they
do want to breastfeed.
Absolutely.
And also just the mother's emotional journey afterwards, because that's hard when you can't
forget.
But it's absolutely hard.
There's a quote before we move into our next section that I wanted to read that is from
an article that we're I know you're going to you're going to mention and I will put the
link and the show notes.
But the quote is the vast majority of health care professionals are unaware of the negative
impact of upper airway obstruction, which is mouth breathing, on normal facial growth
and physiological health.
Yes.
And then the whole article, which is a little bit mind blowing for me.
Yeah.
That statement you wear in 2022 and that's still just now understood by most.
Yes, I totally agree.
I think that so that article is healthy breathing around the clock by Nicole Archambault.
And there's some other articles that I'm drawing a blank on the name of it, but there's a quote
where this dentist is saying that it's this hidden airway epidemic.
Like all of our children, every single person who works with kids, whether you're a teacher,
a dentist, a doctor, a speech therapist, a daycare provider, if you are someone who comes
into contact with children, you need to be educated on the risks of mouth breathing and
sleep disorder breathing because of how detrimental it is to their overall development.
And in that article specifically, it states quite a few statistics on how sleep disorder
breathing, which is tied to mouth breathing, impacts behavior, cognition, and is misrepresented
as ADHD sometimes.
Yeah.
There's quite a few.
So, by Kevin Boyd, just out of curiosity.
Yes.
I'll make sure that one is linked in here as well.
I've got that one.
Absolutely.
That's a great one.
We know Kevin Boyd very well.
Oh, wow.
That's wonderful.
Yeah.
He's actually one of our board members, one of our advisory board members.
Yeah.
Phenomalyze.
As soon as you got to the point about behavioral and cognition, I knew which dentist you were
referring to because Dr. Boyd has taken this to such.
He looks at it from the traditional medical perspective, but he also has an anthropological
background.
And he's got this really brilliant article that really ties it together with these behavioral
outbursts or how much impulse control you have, and that that somehow ties into airway
obstructions.
It's a sign.
Yeah.
And just to touch on that, I kind of was prepared to chat a little bit about the ADHD misdiagnosis.
Yeah.
Let's do that because that is very common with children with airway disorders.
Somehow are labeled and misdiagnosed as having ADHD.
That's not to say everyone with ADHD has an airway disorder just to clarify.
Right.
And to be clear, I think the message that we hope parents will take away is that when
going through the process of diagnosing a child, we hope that sleep and breathing and
airway will be taken into consideration and looked at before any child is labeled with
really any diagnosis because of how detrimental sleep disorder breathing is on the brain and
the behavior of our children and our adults actually.
Right.
Just child.
So what I was going to say is when your child is living with sleep disorder breathing, their
brain and their body are essentially sleep deprived because they are not able to enter
into REM sleep, which is the phase of sleep when our brain is restoring or fixing itself
and all the little problems that build up during the day.
So without REM sleep, we see some or all of the signs of sleep deprivation, which you will
notice are many of the same signs that we see present in children diagnosed with ADHD.
So here are some of the signs that I took from sleepassociation.org of sleep deprivation.
So the impairment of cognitive functioning impacts on your stress hormones, disrupting
your cognition and destabilizing your moods.
For some, this can cause more volatile and intense reactions to everyday life stressors
or situations.
So what may seem like a small task may turn into a huge production and it can also make
you irritable and angry.
I don't know about you, but if you've ever been sleep deprived, you've certainly experienced
of course, impacts that it has on your patients, your ability to focus, your ability to function
and your job.
So now let me on the flip side, we do some of the diagnostic criteria for ADHD.
So it often fails to give close attention to details or makes careless mistakes in schoolwork
at work or with other activities.
Often has trouble holding attention on tasks or play activities, does not seem to listen
when spoken to directly, has trouble organizing tasks and activities.
So all of these things are consistent with signs you would see when someone is sleep deprived.
So it begs the question, is the child truly experiencing attention deficit hyperactivity
disorder or is their brain sleep deprived?
So what we would want is for physicians to say, hey, how is your child sleeping at night?
Like, let's take a look at some of these signs and symptoms that might indicate that they're
experiencing sleep disorder breathing or that they're not breathing effectively at night.
And a lot of times I like to say to parents, you know, once our children, our babies are
sleeping through the night, we don't go in and check on them regularly.
We may check on them right before we go to bed, but we're not listening to the monitor
anymore.
We're not hovering over them, making sure they're okay.
And we might not realize that they're thrashing in their sleep, that they're talking in their
sleep, that they're grinding their teeth or snoring or gasping for air.
You know, one of the things that I like to touch on is that extended bedwetting, like
if a child is having trouble with mastering, you know, holding their urine throughout the
night, that can often be an indicator that they might be having trouble with sleep disorder
breathing.
So, at an older age, we're talking like six, seven, eight.
Yep.
So, if it's past like, yeah, past five, six, seven, eight, and we're not really figuring
out why, why are they still having this trouble?
It's not always because of sleep disorder breathing, but it's one thing that should be
looked at that most parents wouldn't, and most really pediatricians aren't speaking
about.
So, but it's really, there's a couple of different ways that it causes extended bedwring
I don't really want to dive into it.
No, I absolutely would because that is something I wonder is, you know, how it's connected
because that's what makes it just isn't obvious to me.
Yeah.
So, okay, so if we're talking about a kid who has what we were referring to as low-tongue
posture, so their tongue is lying low in their mouth, it's also sitting back into their
airway as we touched on and when they lay down, gravity is making that airway smaller.
And so if they're mouth breathing, then they're not exchanging the right amount of oxygen
and carbon dioxide.
And if you have an excess of carbon dioxide in your system, that can contribute to relaxing
smooth muscle and our flatters are smooth muscle.
So then it's relaxing the muscle and then we're peeing.
Okay.
So that's one way that it can contribute.
Another way is that a lack of breaths in the body, so we're talking about sleep apnea.
So a child who's having so much trouble breathing that they may stop for a short period of time
and then gasp for air.
So that lack of breathing then signals, can signal the heart that the body may be in fluid
overload.
And so it then signals the kidneys to release urine and fluids.
So the body is like, oh my gosh, we're in fluid overload.
Like let's just get rid of some of this.
And then the third way is that if we're not getting oxygen in, we go into fight or flight
and everything in our system is focused on our breathing so that we can survive.
And so it's forgetting about our other systems like holding your urine and that system is
ignored in order to prioritize your breathing.
So those are three ways that it can contribute to or can be linked to sleep disorder breathing.
Which I like to chat about because when I was first learning about this, I was like,
what?
I had no idea.
Right.
And it's funny and thank you for explaining it because in all honesty, I've seen it on
lists several times.
I've never been able to make the connection.
Yeah, it's like, how is this possible?
Yeah.
Yeah, I learned that from Autumn Penny who's a leader in our field.
She's an oral functional myofunctional therapist, a speech language pathologist and a certified
lactation consultant.
So she's an educator in the field and she explained it so well.
So I will attribute knowing that to her.
Awesome.
That was absolutely awesome.
All right.
So I'm a parent and I'm noticing that my three-year-old, let's say, is snoring.
I started working with the foundation, I did not realize it was not cute, they don't
know how to out of it, it's a bad thing.
So as a parent, if I see something like that or I'm noticing my child has that kind of
worried expression when they swallow or drink, what do I do?
Okay.
So I always tell parents that if you have concerns, your first stop is always your pediatrician.
Okay.
That shouldn't be your last stop because oftentimes, and I'm not blaming pediatricians
but any stretch because they have so much that they need to be responsible for, but
they are not the specialists in these areas.
So if they say to you, they don't have any huge concerns, but it's still something that
in your gut, yours thinking, I don't think this is normal or I think there's something
more to it.
And then depending on what the concern is, I would find a specialist within that area
of concern.
If it's something that has to do with feeding, I would be looking for a feeding therapist
which would be either the speech language pathologist or the occupational therapist,
but you have to make sure that they have that training and feeding because as I mentioned,
not all graduates come out with extensive training, it depends on their program.
And so if they've taken a special interest, there will be continuing education courses
and they'll be able to speak to their years of experience and working with families or
clients with feeding disorders.
So if there's a feeding concern, you'll look for the SLP or the OT with experience.
And if you're looking for, if you're concerned about breathing, first of course is the pediatrician.
Another one would be an ENT, I would say to ask your pediatrician for referral to an ENT
and say, I totally respect that you're not overly concerned about it, but it would really
make me feel more comfortable if I could give ENT and really have them either scope or look
and give me their insight because it's just really something that's been on my mind.
And hopefully the pediatrician would be willing to refer you to your know-how to go doctor.
And then the other professional would be the oral facial myofunctional therapist.
So why I say them is because their role is really like they're the umbrella person almost.
So they will look at the whole function of what's happening and they will say, or we
will say, this is the professional that you need to see to rule out XYZ.
So we'll be able to kind of parse out what contributing factors might be the most salient
thing to look at first and then point you in the direction of the provider who we think
is kind of looking at it with the same eyes as we are from the airway perspective.
Obviously, all ENTs are looking at the airway, but sometimes you'll hear parents say, the
ENT said the adenoids weren't that bad.
They were only taking up 50% of the airway.
Only.
Is it a lot?
Right.
And so, you know, not all providers are created equal in any profession, you know?
So oftentimes the oral facial myofunctional therapist has been referring to different
providers and knows a little bit more as to who will be looking at it with the same lens
that we would be looking at it with and kind of like looking more closely at those specific
concerns.
So those are the places that I would go.
Did you want to ask something or did I interrupt you?
No, no, no, you're good.
Well, I mean, it's a follow-up question and that is, do you have to be referred to a
myofunctional?
So it depends on what route you're going to go.
So some many, many oral facial myofunctional therapists may be out of network.
If they are out of network, that means that they may not take insurance, but they may
provide you with a super bill that you can submit to your insurance for reimbursement.
So what it would depend on is what your insurance requires.
So if your insurance requires to have a referral, you would want to just call them and check
with them first so that your likelihood of being reimbursed for a portion of the cost
is more likely if you know what the insurance is requiring.
If they're in network, again, you would have to check.
But it just depends on the facility.
If it's a private practice, oftentimes they don't require one.
But if it's affiliated with a hospital like an outpatient center, they might require a
prescription or a referral.
A referral.
Yeah.
Awesome.
Well, as we wrap up, I just open the floor to you at this point for any final thoughts,
any things you want to share, guidance, anything for parents.
Yeah.
I think that I want parents to know that the first thing is to follow your gut.
If you feel like there's something going on with your child, if you're seeing these
behaviors, if you're hearing noisy breathing, if you see some questionable feeding thing,
follow that instinct.
And don't stop with your first Google search or your first provider who you ask if you
feel like something's going on.
Just don't stop until you talk to someone who you feel is really adequately answering
your concerns and helping lead you in a direction that you feel is acknowledging that.
And then I would say that if any professionals are listening out there, it's our role, it's
our obligation to try and continue to spread the word about airway and sleep disorder breathing
and why mouth breathing is a concern and try and help educate anyone who's working with
children, but also parents so that they can be their own best advocate and really advocate
for their kids and get them on the path that they need to be to be successful in their
development.
And I applaud that.
So thank you very much.
You said that beautifully and I appreciate that.
And thank you so much for being on our podcast and really enjoying just shedding the light
on quite a bit of information that I think a lot of us either misunderstood or just didn't
really fully understand.
So thank you.
Thank you so much.
It's an honor to be a part of it.
Thanks again to today's guests Lauren Refridge for sharing her medical insight and for each
of you for listening to today's episode.
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If who's suspect your child might have an airway issue, contact your pediatric airway
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And finally, thanks to all the parents and medical professionals out there that are working
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Take care, stay safe and happy breathing everyone.