1 00:00:00,000 --> 00:00:12,000 Hi everyone, and welcome to Airway First, a podcast from the Children's Airway First Foundation. 2 00:00:12,000 --> 00:00:14,040 I'm your host, Rebecca Downing. 3 00:00:14,040 --> 00:00:16,360 My guest today is Lauren Ruffridge. 4 00:00:16,360 --> 00:00:22,800 Lauren is an A-S-H-A certified speech language pathologist with a Master's of Science from 5 00:00:22,800 --> 00:00:24,300 Ithaca College. 6 00:00:24,300 --> 00:00:28,680 While she has experience treating clients from infancy through adulthood, she has found 7 00:00:28,680 --> 00:00:33,040 that her passion lies in pediatrics, with whom she has worked exclusively for the past 8 00:00:33,040 --> 00:00:34,040 10 years. 9 00:00:34,040 --> 00:00:39,320 In 2020, after moving to Manlius, New York, Lauren discovered a lack of availability 10 00:00:39,320 --> 00:00:43,080 and experienced feeding therapists for in-home therapy. 11 00:00:43,080 --> 00:00:46,400 That's when she founded Thrive Spot to fill this need. 12 00:00:46,400 --> 00:00:49,920 Lauren is committed to lifelong learning and advocacy. 13 00:00:49,920 --> 00:00:55,320 She focuses on offering the best evidence-based practice methods for her clients and believes 14 00:00:55,320 --> 00:01:00,320 in creating treatment strategies that are tailored to the unique needs of each family, 15 00:01:00,320 --> 00:01:03,960 while empowering the caregiver to be the child's advocate. 16 00:01:03,960 --> 00:01:08,240 During the interview, Lauren provided so much eye-opening information for me. 17 00:01:08,240 --> 00:01:11,760 I really enjoyed our interview together, and I hope you do too. 18 00:01:11,760 --> 00:01:15,040 And now, here is my interview with Lauren Ruffridge. 19 00:01:15,040 --> 00:01:16,040 All right. 20 00:01:16,040 --> 00:01:17,040 Hi, Lauren. 21 00:01:17,040 --> 00:01:18,040 Welcome. 22 00:01:18,040 --> 00:01:19,040 Thanks for being on our podcast. 23 00:01:19,040 --> 00:01:20,040 Hi. 24 00:01:20,040 --> 00:01:21,040 Thank you for having me. 25 00:01:21,040 --> 00:01:22,960 I really appreciate it. 26 00:01:22,960 --> 00:01:29,320 So before we get started, just kind of level sets so we're all understanding, explain to 27 00:01:29,320 --> 00:01:34,960 people exactly what a speech-language pathologist is and what you do. 28 00:01:34,960 --> 00:01:35,960 Absolutely. 29 00:01:35,960 --> 00:01:39,520 So a speech-language pathologist is also referred to as a speech therapist, so you might hear 30 00:01:39,520 --> 00:01:40,640 them interchangeably. 31 00:01:40,640 --> 00:01:41,640 Okay. 32 00:01:41,640 --> 00:01:46,760 But SLPs can work with people of all ages, from babies to adults, which is sometimes a 33 00:01:46,760 --> 00:01:47,760 misconception. 34 00:01:47,760 --> 00:01:52,160 A lot of people assume we just work in the schools, but we actually work in medical 35 00:01:52,160 --> 00:01:58,000 setting, private practice, and we work with the whole HBN. 36 00:01:58,000 --> 00:02:01,760 We treat many types of communication and swelling problems. 37 00:02:01,760 --> 00:02:08,760 So the main categories are speech sounds, which is articulation, language, social communication, 38 00:02:08,760 --> 00:02:15,160 so the ability to know how to use language socially, voice, fluency, which is also known 39 00:02:15,160 --> 00:02:18,480 as stuttering, cognitive communication. 40 00:02:18,480 --> 00:02:23,240 So anyone who has a traumatic brain injury or any neurological deficits, we would be 41 00:02:23,240 --> 00:02:27,880 working on them to redevelop their cognitive communication skills. 42 00:02:27,880 --> 00:02:32,200 And then what I personally specialize in is feeding and swallowing, and I work in the 43 00:02:32,200 --> 00:02:36,360 pediatric age range, which is from infants through about adolescents. 44 00:02:36,360 --> 00:02:37,360 Okay. 45 00:02:37,360 --> 00:02:38,360 Okay. 46 00:02:38,360 --> 00:02:39,360 Yeah, and I'm not going to lie. 47 00:02:39,360 --> 00:02:45,160 That's what throws me off is when I got your website, which I will put a link in the show 48 00:02:45,160 --> 00:02:52,120 notes for ThriveSpot that I had no idea that you actually worked with something. 49 00:02:52,120 --> 00:02:55,680 Just to me, that's not quote unquote speech. 50 00:02:55,680 --> 00:02:56,840 Of course. 51 00:02:56,840 --> 00:03:02,920 I know there's a whole movement in our profession trying to redefine our title because it doesn't 52 00:03:02,920 --> 00:03:09,880 encompass all that we do, and it sometimes misleads families and knowing what provider, 53 00:03:09,880 --> 00:03:14,040 what professional is there to help you with feeding. 54 00:03:14,040 --> 00:03:18,480 But I will clarify that both speech language pathologist and occupational therapists who 55 00:03:18,480 --> 00:03:24,720 are trained in feeding are both qualified professionals to work on feeding. 56 00:03:24,720 --> 00:03:28,160 And I did want to just highlight for anyone listening who wanted to learn a little bit 57 00:03:28,160 --> 00:03:32,200 more about pediatric feeding disorder. 58 00:03:32,200 --> 00:03:37,200 An organization that I'm a volunteer with is called Feeding Matters, feedingmatters.org. 59 00:03:37,200 --> 00:03:38,680 And they're a wonderful organization. 60 00:03:38,680 --> 00:03:44,120 They have tons of resources for families who are either concerned their child might have 61 00:03:44,120 --> 00:03:48,960 a pediatric feeding disorder, or if their child does have one, there's tons of support 62 00:03:48,960 --> 00:03:53,640 both from professionals and other families who lived through it. 63 00:03:53,640 --> 00:03:55,800 So I love that organization. 64 00:03:55,800 --> 00:04:01,800 But I bring it up because they recently advocated to define what pediatric feeding disorders 65 00:04:01,800 --> 00:04:02,800 are. 66 00:04:02,800 --> 00:04:06,160 And so I'm going to just read the definition because they worked really hard for that. 67 00:04:06,160 --> 00:04:13,040 And so pediatric feeding disorder is impaired oral intake that is not age-appropriate and 68 00:04:13,040 --> 00:04:16,880 is associated with any combination of four different domains. 69 00:04:16,880 --> 00:04:24,680 So those four domains are medical, nutritional, feeding skill, and or psychosocial dysfunction. 70 00:04:24,680 --> 00:04:31,720 So they wanted to break those down more specifically and really encompass all of the ways that having 71 00:04:31,720 --> 00:04:36,800 any type of difficulty in those four domains can qualify you as having a pediatric feeding 72 00:04:36,800 --> 00:04:39,040 disorder. 73 00:04:39,040 --> 00:04:42,400 And so that's now in the diagnostic criteria. 74 00:04:42,400 --> 00:04:47,040 We use that as an ICD-10 code. 75 00:04:47,040 --> 00:04:52,000 So those are the families who I'm working with who fall under that diagnosis. 76 00:04:52,000 --> 00:04:57,080 They can also have other diagnoses going on with them that are contributing to the pediatric 77 00:04:57,080 --> 00:04:58,120 feeding disorder. 78 00:04:58,120 --> 00:05:02,280 But those are my families who I'm working with most of the time. 79 00:05:02,280 --> 00:05:08,360 So as far as your children's airway, the way that this kind of associates with us is I 80 00:05:08,360 --> 00:05:09,800 would correct me if I'm wrong. 81 00:05:09,800 --> 00:05:11,640 It's going to be more on the medical side, right? 82 00:05:11,640 --> 00:05:16,640 Because then you're dealing more with jaw development, high-arge palliates, tongue ties, 83 00:05:16,640 --> 00:05:17,640 that kind of thing. 84 00:05:17,640 --> 00:05:18,640 Absolutely. 85 00:05:18,640 --> 00:05:19,640 Yes. 86 00:05:19,640 --> 00:05:24,640 And so the way it also ties in is that I've studied oral facial myofunctional therapy, 87 00:05:24,640 --> 00:05:27,240 which is what we'll be talking about a little bit later. 88 00:05:27,240 --> 00:05:32,760 And then also oral restrictions or tethered oral tissues, which are more commonly known 89 00:05:32,760 --> 00:05:37,240 as tongue tie, lip tie, cheek ties, or buckle ties. 90 00:05:37,240 --> 00:05:38,720 So cheek ties. 91 00:05:38,720 --> 00:05:39,720 Yeah. 92 00:05:39,720 --> 00:05:44,760 You can even have ties inside of your cheek that can impact feeding. 93 00:05:44,760 --> 00:05:50,320 Those don't impact it the most when you're comparing to the tongue and the lip, but it's 94 00:05:50,320 --> 00:05:53,200 all relevant to each individual. 95 00:05:53,200 --> 00:05:59,880 So I've done continuing education in those areas, but they all tie into airway because 96 00:05:59,880 --> 00:06:00,880 everything starts with our airway. 97 00:06:00,880 --> 00:06:06,760 And if our airway is not intact and if we are not able to adequately breathe through 98 00:06:06,760 --> 00:06:12,200 our noses, which is what we're supposed to be able to do, it then kind of has a ripple 99 00:06:12,200 --> 00:06:19,200 effect on the entire oral facial structure, development, and the functions in which we 100 00:06:19,200 --> 00:06:21,120 use our mouth, our nose for. 101 00:06:21,120 --> 00:06:24,440 No breathing, speaking, and eating. 102 00:06:24,440 --> 00:06:29,440 So that's kind of how it all ties in because those are the areas that I'm working within. 103 00:06:29,440 --> 00:06:36,080 And the airway, of course, dictates so much more than most parents and people know that 104 00:06:36,080 --> 00:06:40,760 that's why I'm so glad that you're bringing awareness to this whole topic. 105 00:06:40,760 --> 00:06:43,440 And I love everything that you guys are doing. 106 00:06:43,440 --> 00:06:44,440 I think it's wonderful. 107 00:06:44,440 --> 00:06:45,440 Yeah. 108 00:06:45,440 --> 00:06:46,440 Well, thank you very much. 109 00:06:46,440 --> 00:06:47,440 Yeah. 110 00:06:47,440 --> 00:06:51,480 I will say, kind of on a personal note, I grew up with a speech impediment. 111 00:06:51,480 --> 00:06:56,480 So I worked with a speech language pathologist, which if anyone ever listens in the airway, 112 00:06:56,480 --> 00:06:57,480 slow down. 113 00:06:57,480 --> 00:07:00,720 That's what I'm doing because I know what's about to happen with my sounds. 114 00:07:00,720 --> 00:07:06,120 But one of the things that surprised me when I was reading, I did go to your website and 115 00:07:06,120 --> 00:07:09,720 did a lot of reading. 116 00:07:09,720 --> 00:07:15,840 These kind of things, even language, somebody that has an impediment like mine, can't impact 117 00:07:15,840 --> 00:07:19,680 your breathing, it can impact how you eat, it can impact. 118 00:07:19,680 --> 00:07:20,840 I never really thought of that. 119 00:07:20,840 --> 00:07:23,440 I just thought it was an annoyance when you talk. 120 00:07:23,440 --> 00:07:24,840 You stumble sometimes. 121 00:07:24,840 --> 00:07:25,840 Yeah. 122 00:07:25,840 --> 00:07:29,440 It's wild how everything is so interconnected. 123 00:07:29,440 --> 00:07:32,600 We learn about things in such silos. 124 00:07:32,600 --> 00:07:35,120 Like this is your speech. 125 00:07:35,120 --> 00:07:36,680 Your mouth is for speaking. 126 00:07:36,680 --> 00:07:40,080 Your belly is for digestion. 127 00:07:40,080 --> 00:07:41,520 Your legs are for walking. 128 00:07:41,520 --> 00:07:46,040 But literally everything in our whole body is very interconnected. 129 00:07:46,040 --> 00:07:51,000 And when one system isn't working, it's usually impacting another one in a different way. 130 00:07:51,000 --> 00:07:53,560 Or it's usually tied to that. 131 00:07:53,560 --> 00:07:57,200 Maybe there's a problem in a different system that's impacting your other system. 132 00:07:57,200 --> 00:08:00,200 So yes, our whole bodies are so interconnected. 133 00:08:00,200 --> 00:08:05,240 And I think that's one thing that is lacking in a lot of the education programs is just 134 00:08:05,240 --> 00:08:10,640 how interconnected every system is within the body, including starting with the airway. 135 00:08:10,640 --> 00:08:11,640 Right. 136 00:08:11,640 --> 00:08:12,640 Right. 137 00:08:12,640 --> 00:08:13,640 Which is crazy. 138 00:08:13,640 --> 00:08:18,840 So let's just say you're working with a child with an impediment. 139 00:08:18,840 --> 00:08:24,560 And first of all, just to clarify, if a parent has a child like that, I'm not trying to send 140 00:08:24,560 --> 00:08:26,560 anybody into panic. 141 00:08:26,560 --> 00:08:28,240 Your child doesn't have an airway issue. 142 00:08:28,240 --> 00:08:29,240 We don't know that. 143 00:08:29,240 --> 00:08:36,120 But let's start with that and work our way into the more airway impactful ones. 144 00:08:36,120 --> 00:08:39,640 What kind of training and work would you do with this child? 145 00:08:39,640 --> 00:08:41,280 Let me obviously, it's age dependent. 146 00:08:41,280 --> 00:08:42,280 Yeah. 147 00:08:42,280 --> 00:08:44,800 So it's for sure age dependent. 148 00:08:44,800 --> 00:08:50,760 And so we're typically talking about kids who are two, three, four or older. 149 00:08:50,760 --> 00:08:54,800 Obviously, we're seeing more speech development come in closer to like three. 150 00:08:54,800 --> 00:09:00,360 You should be saying words and phrases, of course, but we really don't address articulation 151 00:09:00,360 --> 00:09:08,440 or speech sounds until closer to three or four, because most sounds are still developmentally 152 00:09:08,440 --> 00:09:11,280 coming in up until that point. 153 00:09:11,280 --> 00:09:13,520 And some some are even coming in later than four. 154 00:09:13,520 --> 00:09:16,280 So we're talking five, six, seven for certain sounds. 155 00:09:16,280 --> 00:09:23,760 So it we would assess the child and a look at the errors and the patterns because there 156 00:09:23,760 --> 00:09:28,560 are different, different indicators that would tell us how we would address it. 157 00:09:28,560 --> 00:09:34,920 So for instance, so children who are younger will often exhibit phonological processing 158 00:09:34,920 --> 00:09:35,920 disorders. 159 00:09:35,920 --> 00:09:36,920 Okay. 160 00:09:36,920 --> 00:09:43,160 So these are basically patterns where they simplify sounds in words in order to kind 161 00:09:43,160 --> 00:09:45,360 of make it easier for them to say. 162 00:09:45,360 --> 00:09:50,280 So an example of that would be if you have what we call a cluster, like which is an SP 163 00:09:50,280 --> 00:09:51,280 sound. 164 00:09:51,280 --> 00:09:55,440 So in the word spoon, you might hear a younger child say, coon. 165 00:09:55,440 --> 00:09:56,440 Okay. 166 00:09:56,440 --> 00:09:58,520 That of spoon. 167 00:09:58,520 --> 00:10:03,720 You know, so that's a typical error sound up until a certain age. 168 00:10:03,720 --> 00:10:06,800 It's normal for kids to do that up until a certain age. 169 00:10:06,800 --> 00:10:08,880 Usually like three, three and a half. 170 00:10:08,880 --> 00:10:15,080 If it persists beyond that, then we would assess and determine if their patterns like 171 00:10:15,080 --> 00:10:20,480 that, that they are exhibiting, then we would address it in a certain therapeutic way versus 172 00:10:20,480 --> 00:10:29,040 just more of a an error that is not a pattern in terms of the phonological processes. 173 00:10:29,040 --> 00:10:31,920 So that's kind of above this conversational level. 174 00:10:31,920 --> 00:10:32,920 Yeah. 175 00:10:32,920 --> 00:10:33,920 But yeah. 176 00:10:33,920 --> 00:10:37,840 So we would assess their articulation and look at what age they should be saying these 177 00:10:37,840 --> 00:10:43,840 sounds and then go from there and decide how we would address them based on how they're 178 00:10:43,840 --> 00:10:44,840 presenting. 179 00:10:44,840 --> 00:10:53,680 But we would always be looking for if any of their signs or symptoms of speech difficulties 180 00:10:53,680 --> 00:10:55,560 are pointing towards an airway problem. 181 00:10:55,560 --> 00:10:57,280 So what does that mean? 182 00:10:57,280 --> 00:11:04,200 So that would basically be if we're seeing children who exhibit a tongue thrust, which 183 00:11:04,200 --> 00:11:06,600 is basically when you see the tongue pushing forward. 184 00:11:06,600 --> 00:11:07,600 Okay. 185 00:11:07,600 --> 00:11:09,960 The certain sounds. 186 00:11:09,960 --> 00:11:13,720 Sometimes people describe it as a list. 187 00:11:13,720 --> 00:11:19,160 There's research out there that's showing that that could be indicative of an airway 188 00:11:19,160 --> 00:11:24,400 concern because the tongue is pushing forward to try and open up the airway. 189 00:11:24,400 --> 00:11:25,400 Yeah. 190 00:11:25,400 --> 00:11:29,640 Okay, so that's kind of some newer research that I've been hearing about and learning 191 00:11:29,640 --> 00:11:30,640 about by. 192 00:11:30,640 --> 00:11:31,640 Okay. 193 00:11:31,640 --> 00:11:36,480 So, but to go back to your question, it depends on the child's age. 194 00:11:36,480 --> 00:11:41,800 If they're older than four years old, then I would be assessing them from an oral facial 195 00:11:41,800 --> 00:11:49,480 mild functional standpoint, which is different than a traditional articulation assessment. 196 00:11:49,480 --> 00:11:56,200 But if they're younger than four, then we would be using different assessments because 197 00:11:56,200 --> 00:12:00,960 of the developmental age levels that I mentioned before and when the sounds are coming in. 198 00:12:00,960 --> 00:12:01,960 Okay. 199 00:12:01,960 --> 00:12:02,960 Yeah. 200 00:12:02,960 --> 00:12:07,960 And you just touched on the oral facial, myofunctional disorders, which that's a mouthful of itself. 201 00:12:07,960 --> 00:12:10,960 It is a mouthful. 202 00:12:10,960 --> 00:12:15,760 So let's talk a little bit more about what that is. 203 00:12:15,760 --> 00:12:21,480 And then what the disorders are, what parents can look for just to give them a better understanding 204 00:12:21,480 --> 00:12:23,400 of all of it. 205 00:12:23,400 --> 00:12:24,400 Absolutely. 206 00:12:24,400 --> 00:12:25,400 So it is a mouthful. 207 00:12:25,400 --> 00:12:30,960 So for the sake of that, I'll probably refer to it as OMT, which is Oral Facial Myofunctional 208 00:12:30,960 --> 00:12:31,960 Therapy. 209 00:12:31,960 --> 00:12:32,960 Okay. 210 00:12:32,960 --> 00:12:37,280 Or if you hear OMD, that's Oral Facial Myofunctional Disorder. 211 00:12:37,280 --> 00:12:38,280 Okay. 212 00:12:38,280 --> 00:12:39,280 Got it. 213 00:12:39,280 --> 00:12:40,280 So, yeah. 214 00:12:40,280 --> 00:12:43,800 So I'm hoping that this becomes more common knowledge because they're now starting to 215 00:12:43,800 --> 00:12:47,440 require that be taught in graduate programs. 216 00:12:47,440 --> 00:12:50,680 But when I was in graduate school, it wasn't included in the program. 217 00:12:50,680 --> 00:12:51,680 So yeah. 218 00:12:51,680 --> 00:12:56,440 So hopefully that will become more familiar to people. 219 00:12:56,440 --> 00:12:58,360 They won't think, what was that mouthful? 220 00:12:58,360 --> 00:12:59,360 Yeah. 221 00:12:59,360 --> 00:13:00,360 Right. 222 00:13:00,360 --> 00:13:02,920 This is very much the reaction I get when I talk to anyone about it. 223 00:13:02,920 --> 00:13:11,120 But I like to describe it based on the goals that we work on when we're addressing OMDs. 224 00:13:11,120 --> 00:13:17,160 So the goals of Oral Facial Myofunctional Therapy are to establish nasal breathing both 225 00:13:17,160 --> 00:13:18,760 day and night. 226 00:13:18,760 --> 00:13:19,760 That's the first one. 227 00:13:19,760 --> 00:13:20,760 Okay. 228 00:13:20,760 --> 00:13:25,440 The second one is we want the lips touching lightly at rest. 229 00:13:25,440 --> 00:13:32,520 The third is we want the tongue position to be up in the palate and just behind our teeth. 230 00:13:32,520 --> 00:13:33,840 Okay. 231 00:13:33,840 --> 00:13:41,400 And we want that to be whenever we're not speaking or swallowing or eating. 232 00:13:41,400 --> 00:13:47,800 And then the fourth is what I just mentioned, correcting swallowing patterns, which if you're 233 00:13:47,800 --> 00:13:51,320 seeing someone who's trained in Oral Facial Myofunctional Therapy, they will be either 234 00:13:51,320 --> 00:13:57,480 a speech-language pathologist, an occupational therapist, or a registered dental hygienist. 235 00:13:57,480 --> 00:14:02,320 If you're seeing an RDH, they can't work on the swallowing part of it because that's 236 00:14:02,320 --> 00:14:06,040 not within their scope, but the OT and the SLP can. 237 00:14:06,040 --> 00:14:12,840 So I would be addressing if there's any feeding problems associated with it and also any speech 238 00:14:12,840 --> 00:14:15,160 problems that would be associated with. 239 00:14:15,160 --> 00:14:16,840 So quick question on the swallowing. 240 00:14:16,840 --> 00:14:22,440 I mean, obviously, and we'll dig into this a little bit more about nasal because of mouth 241 00:14:22,440 --> 00:14:23,440 breathing. 242 00:14:23,440 --> 00:14:28,080 The rest of them are pretty, I think, intuitive, but swallowing. 243 00:14:28,080 --> 00:14:31,800 How is that a sign of an airway issue? 244 00:14:31,800 --> 00:14:36,880 So I like to use the example of a tongue thrust pattern, which we kind of touched on a little 245 00:14:36,880 --> 00:14:43,960 bit before, but sometimes what people, adults, children, we see it throughout the age range. 246 00:14:43,960 --> 00:14:50,920 They thrust their tongue forward instead of what we want to see, which is like a peristaltic 247 00:14:50,920 --> 00:14:56,760 wave where it goes up and kind of back as you swallow the food or liquid or saliva. 248 00:14:56,760 --> 00:15:03,480 And oftentimes that's a red flag for an airway issue for the same reason because they're 249 00:15:03,480 --> 00:15:09,760 pushing up against the teeth instead and almost opening up the airway to breathe while they're 250 00:15:09,760 --> 00:15:13,720 trying to facilitate the swallow as well. 251 00:15:13,720 --> 00:15:19,400 So we would be, so then the other problem with that is that they're shifting teeth. 252 00:15:19,400 --> 00:15:22,880 And so you often see that shifting teeth. 253 00:15:22,880 --> 00:15:30,520 So what we call our malocclusions are different bite patterns and essentially crooked teeth 254 00:15:30,520 --> 00:15:31,520 in certain ways. 255 00:15:31,520 --> 00:15:36,640 So over by a deep bite, over jet, there's a lot of different terms within malocclusion 256 00:15:36,640 --> 00:15:44,720 that I trust my RDHs and my dental professionals to speak on more comprehensively. 257 00:15:44,720 --> 00:15:52,680 But when we see children or adults, but primarily children with super crowded teeth, that's 258 00:15:52,680 --> 00:15:59,000 usually a red flag for us as providers that their, their pellet is probably too small 259 00:15:59,000 --> 00:16:05,280 or narrow because their tongue was not resting up inside the pellet to give it that good 260 00:16:05,280 --> 00:16:06,480 U shape. 261 00:16:06,480 --> 00:16:11,880 So what we want is the U shape, the nice broad wide U shape. 262 00:16:11,880 --> 00:16:17,480 Instead what we are seeing sometimes is this more narrow V shape. 263 00:16:17,480 --> 00:16:20,400 And then when the teeth are trying to come in, they don't have enough room because it's 264 00:16:20,400 --> 00:16:23,400 not nice and wide from the tongue shaping it. 265 00:16:23,400 --> 00:16:25,600 And so then we get crooked teeth. 266 00:16:25,600 --> 00:16:30,040 And depending on how they're using their tongue when they speak or swallow, that can even 267 00:16:30,040 --> 00:16:34,760 further shift the teeth because the tongue is a very strong group of muscles. 268 00:16:34,760 --> 00:16:37,320 And it's constantly pushing in certain directions. 269 00:16:37,320 --> 00:16:39,000 It's going to shift things. 270 00:16:39,000 --> 00:16:43,760 So that's how we actually get the shape of our palate is by keeping, we want that tongue 271 00:16:43,760 --> 00:16:49,120 to be up within the palate so that it does keep that excuse me, U shape. 272 00:16:49,120 --> 00:16:54,000 But when it doesn't rest up there, that's when we start to see that doesn't hold its 273 00:16:54,000 --> 00:16:56,640 shape as it would otherwise. 274 00:16:56,640 --> 00:16:57,640 Okay. 275 00:16:57,640 --> 00:16:58,640 Yeah. 276 00:16:58,640 --> 00:17:05,720 So those, so that kind of are the goals of oral facial myofunctional therapy. 277 00:17:05,720 --> 00:17:09,160 There are some causes that can contribute to these. 278 00:17:09,160 --> 00:17:15,640 So, so some of the causes, the number one, which is why we're here talking today is airway 279 00:17:15,640 --> 00:17:17,000 obstruction. 280 00:17:17,000 --> 00:17:19,200 So what could be an airway obstruction? 281 00:17:19,200 --> 00:17:25,760 So if a child is not breathing through their nose, we would want to figure out why. 282 00:17:25,760 --> 00:17:30,160 So we would want to know if it's enlarged adenoids, if it's enlarged tonsils, if there's 283 00:17:30,160 --> 00:17:36,360 a deviated septum, if there's seasonal allergies or recurrent allergies to food or something 284 00:17:36,360 --> 00:17:41,920 that's causing congestion all the time and forcing them to breathe through their mouth. 285 00:17:41,920 --> 00:17:46,800 So the airway is what we look at first and foremost, because that's the most important 286 00:17:46,800 --> 00:17:48,640 to the overall function. 287 00:17:48,640 --> 00:17:49,640 Okay. 288 00:17:49,640 --> 00:17:55,320 And in order to do that, we would, we would assess for if they can breathe through their 289 00:17:55,320 --> 00:17:56,320 nose. 290 00:17:56,320 --> 00:17:59,960 So for instance, we could have them keep their lips together and see, like, are they able 291 00:17:59,960 --> 00:18:03,040 to breathe through their nose for short periods in our assessment? 292 00:18:03,040 --> 00:18:09,960 And if they're struggling, we would be immediately referring them to an ENT first, possibly an 293 00:18:09,960 --> 00:18:17,560 allergist to further evaluate these things and try to rule out what is contributing to 294 00:18:17,560 --> 00:18:19,880 them not being able to breathe through their nose. 295 00:18:19,880 --> 00:18:20,880 Okay. 296 00:18:20,880 --> 00:18:24,040 So airway, airway problems are the first thing we would want to look at. 297 00:18:24,040 --> 00:18:28,160 And throughout most of this process, there are more than one provider that may need to 298 00:18:28,160 --> 00:18:33,120 be involved to help support whatever's happening with the child. 299 00:18:33,120 --> 00:18:35,040 The next one would be oral habits. 300 00:18:35,040 --> 00:18:43,320 So that would include things like finger sucking, thumb sucking, extended use of the pacifier, 301 00:18:43,320 --> 00:18:44,720 even nail biting. 302 00:18:44,720 --> 00:18:52,040 If you're someone who all the time sits with your face on your right fist when you're listening 303 00:18:52,040 --> 00:18:58,320 in class or when you're talking or anything, eventually having that fist there is going 304 00:18:58,320 --> 00:19:01,760 to shift things in your mouth and your face. 305 00:19:01,760 --> 00:19:05,720 And so there are habits that we may not even realize that could be contributing, but the 306 00:19:05,720 --> 00:19:10,640 bigger ones are the sucking habits, sucking on anything. 307 00:19:10,640 --> 00:19:15,080 Some kids suck on their t-shirts all the time or their necklaces. 308 00:19:15,080 --> 00:19:16,080 Right. 309 00:19:16,080 --> 00:19:17,080 Yeah. 310 00:19:17,080 --> 00:19:21,160 So the sucking, we want to figure out, well, why do they need to suck? 311 00:19:21,160 --> 00:19:22,600 What is the reason? 312 00:19:22,600 --> 00:19:28,560 Why are they still sucking that thumb beyond the age of one or two? 313 00:19:28,560 --> 00:19:34,280 And we often look to the airway to see if that's helping support their airway almost, 314 00:19:34,280 --> 00:19:38,800 because when we suck on our thumb, we're jutting our jaw forward a little bit, which 315 00:19:38,800 --> 00:19:41,760 is then opening up the airway a little bit more. 316 00:19:41,760 --> 00:19:48,640 So we want to look at, is that part of the problem or is it that they just enjoy the 317 00:19:48,640 --> 00:19:53,640 soothing aspect of sucking still or is it both? 318 00:19:53,640 --> 00:19:54,640 So yeah. 319 00:19:54,640 --> 00:19:58,080 So oral habits aren't always as straightforward as people think. 320 00:19:58,080 --> 00:20:02,440 And I've learned through oral facial myofunctional therapy that these kids that we see who are 321 00:20:02,440 --> 00:20:09,840 still struggling to get rid of sucking their thumb in almost even eight, nine, 10-year-olds, 322 00:20:09,840 --> 00:20:14,400 that's usually a sign that there's something else going on with their airway, and that's 323 00:20:14,400 --> 00:20:16,080 why they can't give that up. 324 00:20:16,080 --> 00:20:21,480 So we would really want to dive deeper into what's going on. 325 00:20:21,480 --> 00:20:26,160 And that would be through an oral facial myofunctional evaluation that would then inform us as to 326 00:20:26,160 --> 00:20:32,160 what other professionals would need to be involved to help alleviate whatever is happening. 327 00:20:32,160 --> 00:20:36,440 You are listening to Airway First with today's guest, Lauren Ruffridge. 328 00:20:36,440 --> 00:20:40,060 You can find out more about the Children's Airway First Foundation and our mission to 329 00:20:40,060 --> 00:20:45,800 ensure that every child has access to screening, evaluation, and treatment of all children's 330 00:20:45,800 --> 00:20:52,320 airway disorders before the age of six on our website at childrensairwayfirst.org. 331 00:20:52,320 --> 00:20:57,080 You can also find a ton of great resources for parents on our website, including videos, 332 00:20:57,080 --> 00:21:01,680 blogs, recommended books, comprehensive medical research, and more. 333 00:21:01,680 --> 00:21:07,240 As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. 334 00:21:07,240 --> 00:21:12,280 If you suspect your child might have an airway issue, contact your pediatric airway dentist 335 00:21:12,280 --> 00:21:13,760 or pediatrician. 336 00:21:13,760 --> 00:21:18,560 And now back to our interview with Lauren Ruffridge. 337 00:21:18,560 --> 00:21:23,520 So then the last one that I wanted to mention that can contribute to an oral facial myofunctional 338 00:21:23,520 --> 00:21:29,400 disorder is those tethered oral tissues, the tongue lip tie. 339 00:21:29,400 --> 00:21:36,280 So when, and I don't want to get too nitty gritty because I might mess up some of the 340 00:21:36,280 --> 00:21:40,560 people, but swallowing starts in utero. 341 00:21:40,560 --> 00:21:44,840 After that first trimester, babies are able to swallow in utero. 342 00:21:44,840 --> 00:21:50,840 So when they are born, the patterns that they're showing, they didn't just start doing the 343 00:21:50,840 --> 00:21:52,440 swallowing when they're born. 344 00:21:52,440 --> 00:21:55,720 They've been doing it for months in utero. 345 00:21:55,720 --> 00:22:02,720 So when they're in the stages of development, they're finding that the tongue tie and the 346 00:22:02,720 --> 00:22:07,000 lip tie form early on in development as well in utero. 347 00:22:07,000 --> 00:22:14,000 And so they're swallowing with that tongue tethered or low lying in their mouth. 348 00:22:14,000 --> 00:22:18,640 And so their palate is not forming correctly because it's not able to reach the palate 349 00:22:18,640 --> 00:22:20,880 when they swallow. 350 00:22:20,880 --> 00:22:27,720 So these anatomical and physiological problems that we're seeing when they're born are happening 351 00:22:27,720 --> 00:22:28,800 in utero sometimes. 352 00:22:28,800 --> 00:22:33,440 So anyway, that's why we see kids who are right off the bat are having trouble with 353 00:22:33,440 --> 00:22:37,000 latching to the breast or even bottle feeding. 354 00:22:37,000 --> 00:22:38,000 It can impact. 355 00:22:38,000 --> 00:22:42,760 However, when we see these children who are a little bit older, who maybe were missed 356 00:22:42,760 --> 00:22:49,640 with the tongue tie, what we see is that their tongue is lying low, which is then not shaping 357 00:22:49,640 --> 00:22:55,120 their palate, which is causing those malocclusions, those crooked teeth, which is also putting 358 00:22:55,120 --> 00:22:57,440 them at risk for the sleep disorder breathing. 359 00:22:57,440 --> 00:23:02,000 Because if you have your tongue lying low and you can't or you're not used to getting 360 00:23:02,000 --> 00:23:06,480 it up in the palate when you lay down, gravity pulls it back. 361 00:23:06,480 --> 00:23:09,880 And it sits further into your airway. 362 00:23:09,880 --> 00:23:14,720 So your airway space is then shrunk down even more. 363 00:23:14,720 --> 00:23:18,240 And that's forcing you then to breathe through your mouth more because you're not getting 364 00:23:18,240 --> 00:23:20,720 enough through your nose. 365 00:23:20,720 --> 00:23:21,720 So. 366 00:23:21,720 --> 00:23:27,600 And is it fair to say for parents that if you see a child breathing through their mouth 367 00:23:27,600 --> 00:23:34,920 consistently, it's not just one night they have a stopping nose that there is an issue. 368 00:23:34,920 --> 00:23:36,760 It's worth coming out. 369 00:23:36,760 --> 00:23:37,760 Oh, yes. 370 00:23:37,760 --> 00:23:39,600 Yes, absolutely. 371 00:23:39,600 --> 00:23:42,920 So if we want to just dive into that topic, because I know that was something we were 372 00:23:42,920 --> 00:23:48,200 going to chat about, how can you tell if your baby or child is mouth breathing or might 373 00:23:48,200 --> 00:23:50,440 have some disorder breathing issues? 374 00:23:50,440 --> 00:23:51,440 Yes. 375 00:23:51,440 --> 00:23:56,720 So I think we kind of said this, but when babies are born, they're supposed to breathe 376 00:23:56,720 --> 00:23:57,720 through their nose. 377 00:23:57,720 --> 00:24:00,200 We are born as obligate nasal breathers. 378 00:24:00,200 --> 00:24:04,240 So if a baby cannot breathe through their nose, they're going to be forced to breathe 379 00:24:04,240 --> 00:24:05,240 through their mouth. 380 00:24:05,240 --> 00:24:06,240 Same with a child, right? 381 00:24:06,240 --> 00:24:10,400 They're going to go to the mouth to help them because they need oxygen to live. 382 00:24:10,400 --> 00:24:13,800 But we're supposed to be able to breathe through our nose. 383 00:24:13,800 --> 00:24:17,120 So why is that important? 384 00:24:17,120 --> 00:24:19,240 Why do we need to breathe through our nose? 385 00:24:19,240 --> 00:24:20,240 Okay. 386 00:24:20,240 --> 00:24:21,240 Okay. 387 00:24:21,240 --> 00:24:26,080 There's so many reasons that nasal breathing is beneficial. 388 00:24:26,080 --> 00:24:28,640 So one, and this is not covering all of them. 389 00:24:28,640 --> 00:24:30,360 This is just going to highlight a couple. 390 00:24:30,360 --> 00:24:31,360 Okay. 391 00:24:31,360 --> 00:24:33,520 Nasal breathing filters airborne pathogens. 392 00:24:33,520 --> 00:24:36,560 So when we are breathing through our nose, it's a filter. 393 00:24:36,560 --> 00:24:40,280 It's kind of sorting through those germs, getting rid of some of that bacteria. 394 00:24:40,280 --> 00:24:43,160 If we're breathing through our mouth, we are not getting that same filter. 395 00:24:43,160 --> 00:24:44,160 Right. 396 00:24:44,160 --> 00:24:47,040 So that means you're more likely to get sick more often. 397 00:24:47,040 --> 00:24:48,520 Okay. 398 00:24:48,520 --> 00:24:53,760 Nasal breathing allows for nitric oxide to be produced. 399 00:24:53,760 --> 00:24:59,600 This is a complicated topic, but if you look up, nasal breathing allows for nitric oxide 400 00:24:59,600 --> 00:25:01,240 to be created. 401 00:25:01,240 --> 00:25:03,600 Nitric oxide is super important. 402 00:25:03,600 --> 00:25:08,280 One of the things that it does is it allows blood, nutrients, and oxygen to travel to 403 00:25:08,280 --> 00:25:11,720 every part of our body efficiently and effectively. 404 00:25:11,720 --> 00:25:17,480 So if we're not creating enough nitric oxide, we're not seeing those benefits, okay, which 405 00:25:17,480 --> 00:25:22,080 can then lead to other hosts of issues, health issues. 406 00:25:22,080 --> 00:25:26,520 And then another thing is nasal breathing serves as a natural bronchodilator. 407 00:25:26,520 --> 00:25:31,800 So it opens up our lower airway, the lungs, the bronchi. 408 00:25:31,800 --> 00:25:35,520 It helps regulate what's called heart rate variability. 409 00:25:35,520 --> 00:25:36,520 And that's a good thing. 410 00:25:36,520 --> 00:25:40,320 We want it to regulate heart rate variability because we need, that's a really important 411 00:25:40,320 --> 00:25:45,200 thing as well, which I'm not going to comprehensively explain well. 412 00:25:45,200 --> 00:25:51,360 So I will just encourage you to look that up and understand how important it is and how 413 00:25:51,360 --> 00:25:53,680 nasal breathing does play a role in that. 414 00:25:53,680 --> 00:25:55,760 And then the last thing I wanted to mention, go ahead. 415 00:25:55,760 --> 00:25:57,800 Oh, no, I was going to say, and we'll put a link. 416 00:25:57,800 --> 00:26:01,320 We have a blog that kind of touches on this, so we'll put a link. 417 00:26:01,320 --> 00:26:03,720 So they can click through and read more. 418 00:26:03,720 --> 00:26:04,720 Perfect. 419 00:26:04,720 --> 00:26:05,720 Yeah. 420 00:26:05,720 --> 00:26:09,160 The last thing I just wanted to mention was that it activates the parasympathetic nervous 421 00:26:09,160 --> 00:26:15,080 system, which is the rest and digest part of our nervous system. 422 00:26:15,080 --> 00:26:20,960 And if we don't have, if we don't activate that part of our nervous system, then we become 423 00:26:20,960 --> 00:26:23,560 very dysregulated. 424 00:26:23,560 --> 00:26:28,240 And then that also in turn impacts our sleep and whether or not we're getting that restful, 425 00:26:28,240 --> 00:26:29,240 restorative sleep. 426 00:26:29,240 --> 00:26:34,240 So again, you're hearing how a lot of the systems are connected. 427 00:26:34,240 --> 00:26:39,720 And we really don't realize it until, well, it's educated until we spread the word, right? 428 00:26:39,720 --> 00:26:40,720 Right, right. 429 00:26:40,720 --> 00:26:44,200 And that's what we're trying to do. 430 00:26:44,200 --> 00:26:48,640 So one of the things, and I have some other things, but I just wanted to kind of go back 431 00:26:48,640 --> 00:26:55,840 to because you touched on something that I don't think a lot of people really comprehend. 432 00:26:55,840 --> 00:27:03,320 One of the things that children's airway first that we're advocating for is this full examination 433 00:27:03,320 --> 00:27:06,120 oral examination at birth. 434 00:27:06,120 --> 00:27:08,680 That just doesn't happen currently. 435 00:27:08,680 --> 00:27:11,880 And you touched on it and why it's so important. 436 00:27:11,880 --> 00:27:15,280 I just thought maybe we could talk about that for a little bit. 437 00:27:15,280 --> 00:27:19,520 That as you mentioned, these things are formed in utero. 438 00:27:19,520 --> 00:27:25,520 So if somebody took the time at birth to look, you'd find a tongue tie or you'd find that 439 00:27:25,520 --> 00:27:31,800 V-shaped palate where it's still malleable, you can kind of adjust it. 440 00:27:31,800 --> 00:27:37,000 Well, so if we identify these things right off the bat, it would better inform our decisions 441 00:27:37,000 --> 00:27:38,840 throughout their early life. 442 00:27:38,840 --> 00:27:42,960 So if we are able to better identify these things, we would better be able to support 443 00:27:42,960 --> 00:27:44,680 their feeding journeys. 444 00:27:44,680 --> 00:27:50,280 So so many moms I talked to say, I just couldn't breastfeed that they couldn't latch. 445 00:27:50,280 --> 00:27:56,400 And there's very few cases where it's an issue with the mom. 446 00:27:56,400 --> 00:28:02,640 Although it may feel like that to the mother, how hard the struggle is, it's usually because 447 00:28:02,640 --> 00:28:06,160 there's some sort of oral dysfunction with the baby. 448 00:28:06,160 --> 00:28:09,200 And that's not to say it's always a tongue tie, it certainly is not. 449 00:28:09,200 --> 00:28:13,080 But if we can identify, if it's because of that high palate, they're not able to get 450 00:28:13,080 --> 00:28:16,480 that good suction on the breast to latch. 451 00:28:16,480 --> 00:28:22,520 If we can identify those things at birth, not only will it set the babies up for more 452 00:28:22,520 --> 00:28:28,000 success, but I think that it would also really largely impact that mother baby dyad if they 453 00:28:28,000 --> 00:28:30,400 do want to breastfeed. 454 00:28:30,400 --> 00:28:31,400 Absolutely. 455 00:28:31,400 --> 00:28:38,800 And also just the mother's emotional journey afterwards, because that's hard when you can't 456 00:28:38,800 --> 00:28:39,800 forget. 457 00:28:39,800 --> 00:28:41,880 But it's absolutely hard. 458 00:28:41,880 --> 00:28:48,200 There's a quote before we move into our next section that I wanted to read that is from 459 00:28:48,200 --> 00:28:51,840 an article that we're I know you're going to you're going to mention and I will put the 460 00:28:51,840 --> 00:28:53,720 link and the show notes. 461 00:28:53,720 --> 00:28:59,400 But the quote is the vast majority of health care professionals are unaware of the negative 462 00:28:59,400 --> 00:29:05,000 impact of upper airway obstruction, which is mouth breathing, on normal facial growth 463 00:29:05,000 --> 00:29:07,160 and physiological health. 464 00:29:07,160 --> 00:29:08,160 Yes. 465 00:29:08,160 --> 00:29:16,080 And then the whole article, which is a little bit mind blowing for me. 466 00:29:16,080 --> 00:29:17,080 Yeah. 467 00:29:17,080 --> 00:29:25,200 That statement you wear in 2022 and that's still just now understood by most. 468 00:29:25,200 --> 00:29:26,800 Yes, I totally agree. 469 00:29:26,800 --> 00:29:32,960 I think that so that article is healthy breathing around the clock by Nicole Archambault. 470 00:29:32,960 --> 00:29:38,840 And there's some other articles that I'm drawing a blank on the name of it, but there's a quote 471 00:29:38,840 --> 00:29:43,400 where this dentist is saying that it's this hidden airway epidemic. 472 00:29:43,400 --> 00:29:49,360 Like all of our children, every single person who works with kids, whether you're a teacher, 473 00:29:49,360 --> 00:29:54,760 a dentist, a doctor, a speech therapist, a daycare provider, if you are someone who comes 474 00:29:54,760 --> 00:30:01,960 into contact with children, you need to be educated on the risks of mouth breathing and 475 00:30:01,960 --> 00:30:08,120 sleep disorder breathing because of how detrimental it is to their overall development. 476 00:30:08,120 --> 00:30:15,520 And in that article specifically, it states quite a few statistics on how sleep disorder 477 00:30:15,520 --> 00:30:23,960 breathing, which is tied to mouth breathing, impacts behavior, cognition, and is misrepresented 478 00:30:23,960 --> 00:30:25,960 as ADHD sometimes. 479 00:30:25,960 --> 00:30:26,960 Yeah. 480 00:30:26,960 --> 00:30:27,960 There's quite a few. 481 00:30:27,960 --> 00:30:32,160 So, by Kevin Boyd, just out of curiosity. 482 00:30:32,160 --> 00:30:33,160 Yes. 483 00:30:33,160 --> 00:30:34,800 I'll make sure that one is linked in here as well. 484 00:30:34,800 --> 00:30:35,800 I've got that one. 485 00:30:35,800 --> 00:30:36,800 Absolutely. 486 00:30:36,800 --> 00:30:38,040 That's a great one. 487 00:30:38,040 --> 00:30:39,800 We know Kevin Boyd very well. 488 00:30:39,800 --> 00:30:40,800 Oh, wow. 489 00:30:40,800 --> 00:30:41,800 That's wonderful. 490 00:30:41,800 --> 00:30:42,800 Yeah. 491 00:30:42,800 --> 00:30:46,480 He's actually one of our board members, one of our advisory board members. 492 00:30:46,480 --> 00:30:47,480 Yeah. 493 00:30:47,480 --> 00:30:48,480 Phenomalyze. 494 00:30:48,480 --> 00:30:52,520 As soon as you got to the point about behavioral and cognition, I knew which dentist you were 495 00:30:52,520 --> 00:30:59,920 referring to because Dr. Boyd has taken this to such. 496 00:30:59,920 --> 00:31:06,920 He looks at it from the traditional medical perspective, but he also has an anthropological 497 00:31:06,920 --> 00:31:08,920 background. 498 00:31:08,920 --> 00:31:15,640 And he's got this really brilliant article that really ties it together with these behavioral 499 00:31:15,640 --> 00:31:25,000 outbursts or how much impulse control you have, and that that somehow ties into airway 500 00:31:25,000 --> 00:31:26,000 obstructions. 501 00:31:26,000 --> 00:31:27,000 It's a sign. 502 00:31:27,000 --> 00:31:28,000 Yeah. 503 00:31:28,000 --> 00:31:34,040 And just to touch on that, I kind of was prepared to chat a little bit about the ADHD misdiagnosis. 504 00:31:34,040 --> 00:31:35,040 Yeah. 505 00:31:35,040 --> 00:31:40,200 Let's do that because that is very common with children with airway disorders. 506 00:31:40,200 --> 00:31:43,760 Somehow are labeled and misdiagnosed as having ADHD. 507 00:31:43,760 --> 00:31:48,280 That's not to say everyone with ADHD has an airway disorder just to clarify. 508 00:31:48,280 --> 00:31:49,280 Right. 509 00:31:49,280 --> 00:31:50,280 Right. 510 00:31:50,280 --> 00:31:54,440 And to be clear, I think the message that we hope parents will take away is that when 511 00:31:54,440 --> 00:31:59,480 going through the process of diagnosing a child, we hope that sleep and breathing and 512 00:31:59,480 --> 00:32:04,680 airway will be taken into consideration and looked at before any child is labeled with 513 00:32:04,680 --> 00:32:12,120 really any diagnosis because of how detrimental sleep disorder breathing is on the brain and 514 00:32:12,120 --> 00:32:16,320 the behavior of our children and our adults actually. 515 00:32:16,320 --> 00:32:17,320 Right. 516 00:32:17,320 --> 00:32:18,320 Right. 517 00:32:18,320 --> 00:32:19,320 Just child. 518 00:32:19,320 --> 00:32:23,800 So what I was going to say is when your child is living with sleep disorder breathing, their 519 00:32:23,800 --> 00:32:29,880 brain and their body are essentially sleep deprived because they are not able to enter 520 00:32:29,880 --> 00:32:35,680 into REM sleep, which is the phase of sleep when our brain is restoring or fixing itself 521 00:32:35,680 --> 00:32:38,680 and all the little problems that build up during the day. 522 00:32:38,680 --> 00:32:45,080 So without REM sleep, we see some or all of the signs of sleep deprivation, which you will 523 00:32:45,080 --> 00:32:51,760 notice are many of the same signs that we see present in children diagnosed with ADHD. 524 00:32:51,760 --> 00:32:59,600 So here are some of the signs that I took from sleepassociation.org of sleep deprivation. 525 00:32:59,600 --> 00:33:05,200 So the impairment of cognitive functioning impacts on your stress hormones, disrupting 526 00:33:05,200 --> 00:33:08,520 your cognition and destabilizing your moods. 527 00:33:08,520 --> 00:33:12,960 For some, this can cause more volatile and intense reactions to everyday life stressors 528 00:33:12,960 --> 00:33:13,960 or situations. 529 00:33:13,960 --> 00:33:18,760 So what may seem like a small task may turn into a huge production and it can also make 530 00:33:18,760 --> 00:33:20,400 you irritable and angry. 531 00:33:20,400 --> 00:33:24,840 I don't know about you, but if you've ever been sleep deprived, you've certainly experienced 532 00:33:24,840 --> 00:33:31,040 of course, impacts that it has on your patients, your ability to focus, your ability to function 533 00:33:31,040 --> 00:33:32,480 and your job. 534 00:33:32,480 --> 00:33:39,960 So now let me on the flip side, we do some of the diagnostic criteria for ADHD. 535 00:33:39,960 --> 00:33:44,880 So it often fails to give close attention to details or makes careless mistakes in schoolwork 536 00:33:44,880 --> 00:33:47,360 at work or with other activities. 537 00:33:47,360 --> 00:33:51,840 Often has trouble holding attention on tasks or play activities, does not seem to listen 538 00:33:51,840 --> 00:33:57,040 when spoken to directly, has trouble organizing tasks and activities. 539 00:33:57,040 --> 00:34:02,960 So all of these things are consistent with signs you would see when someone is sleep deprived. 540 00:34:02,960 --> 00:34:10,040 So it begs the question, is the child truly experiencing attention deficit hyperactivity 541 00:34:10,040 --> 00:34:15,280 disorder or is their brain sleep deprived? 542 00:34:15,280 --> 00:34:21,520 So what we would want is for physicians to say, hey, how is your child sleeping at night? 543 00:34:21,520 --> 00:34:27,360 Like, let's take a look at some of these signs and symptoms that might indicate that they're 544 00:34:27,360 --> 00:34:33,240 experiencing sleep disorder breathing or that they're not breathing effectively at night. 545 00:34:33,240 --> 00:34:38,200 And a lot of times I like to say to parents, you know, once our children, our babies are 546 00:34:38,200 --> 00:34:41,440 sleeping through the night, we don't go in and check on them regularly. 547 00:34:41,440 --> 00:34:46,040 We may check on them right before we go to bed, but we're not listening to the monitor 548 00:34:46,040 --> 00:34:47,040 anymore. 549 00:34:47,040 --> 00:34:49,640 We're not hovering over them, making sure they're okay. 550 00:34:49,640 --> 00:34:54,840 And we might not realize that they're thrashing in their sleep, that they're talking in their 551 00:34:54,840 --> 00:35:00,400 sleep, that they're grinding their teeth or snoring or gasping for air. 552 00:35:00,400 --> 00:35:07,080 You know, one of the things that I like to touch on is that extended bedwetting, like 553 00:35:07,080 --> 00:35:11,960 if a child is having trouble with mastering, you know, holding their urine throughout the 554 00:35:11,960 --> 00:35:17,520 night, that can often be an indicator that they might be having trouble with sleep disorder 555 00:35:17,520 --> 00:35:18,520 breathing. 556 00:35:18,520 --> 00:35:22,240 So, at an older age, we're talking like six, seven, eight. 557 00:35:22,240 --> 00:35:23,240 Yep. 558 00:35:23,240 --> 00:35:24,240 Yep. 559 00:35:24,240 --> 00:35:28,760 So, if it's past like, yeah, past five, six, seven, eight, and we're not really figuring 560 00:35:28,760 --> 00:35:32,080 out why, why are they still having this trouble? 561 00:35:32,080 --> 00:35:35,720 It's not always because of sleep disorder breathing, but it's one thing that should be 562 00:35:35,720 --> 00:35:42,160 looked at that most parents wouldn't, and most really pediatricians aren't speaking 563 00:35:42,160 --> 00:35:43,160 about. 564 00:35:43,160 --> 00:35:48,480 So, but it's really, there's a couple of different ways that it causes extended bedwring 565 00:35:48,480 --> 00:35:50,200 I don't really want to dive into it. 566 00:35:50,200 --> 00:35:54,720 No, I absolutely would because that is something I wonder is, you know, how it's connected 567 00:35:54,720 --> 00:35:57,640 because that's what makes it just isn't obvious to me. 568 00:35:57,640 --> 00:35:58,640 Yeah. 569 00:35:58,640 --> 00:36:03,160 So, okay, so if we're talking about a kid who has what we were referring to as low-tongue 570 00:36:03,160 --> 00:36:08,240 posture, so their tongue is lying low in their mouth, it's also sitting back into their 571 00:36:08,240 --> 00:36:14,200 airway as we touched on and when they lay down, gravity is making that airway smaller. 572 00:36:14,200 --> 00:36:20,120 And so if they're mouth breathing, then they're not exchanging the right amount of oxygen 573 00:36:20,120 --> 00:36:21,680 and carbon dioxide. 574 00:36:21,680 --> 00:36:28,080 And if you have an excess of carbon dioxide in your system, that can contribute to relaxing 575 00:36:28,080 --> 00:36:33,280 smooth muscle and our flatters are smooth muscle. 576 00:36:33,280 --> 00:36:36,640 So then it's relaxing the muscle and then we're peeing. 577 00:36:36,640 --> 00:36:37,640 Okay. 578 00:36:37,640 --> 00:36:40,160 So that's one way that it can contribute. 579 00:36:40,160 --> 00:36:46,320 Another way is that a lack of breaths in the body, so we're talking about sleep apnea. 580 00:36:46,320 --> 00:36:51,440 So a child who's having so much trouble breathing that they may stop for a short period of time 581 00:36:51,440 --> 00:36:52,920 and then gasp for air. 582 00:36:52,920 --> 00:36:58,640 So that lack of breathing then signals, can signal the heart that the body may be in fluid 583 00:36:58,640 --> 00:37:00,400 overload. 584 00:37:00,400 --> 00:37:05,640 And so it then signals the kidneys to release urine and fluids. 585 00:37:05,640 --> 00:37:08,520 So the body is like, oh my gosh, we're in fluid overload. 586 00:37:08,520 --> 00:37:11,840 Like let's just get rid of some of this. 587 00:37:11,840 --> 00:37:18,480 And then the third way is that if we're not getting oxygen in, we go into fight or flight 588 00:37:18,480 --> 00:37:24,120 and everything in our system is focused on our breathing so that we can survive. 589 00:37:24,120 --> 00:37:30,960 And so it's forgetting about our other systems like holding your urine and that system is 590 00:37:30,960 --> 00:37:33,600 ignored in order to prioritize your breathing. 591 00:37:33,600 --> 00:37:42,840 So those are three ways that it can contribute to or can be linked to sleep disorder breathing. 592 00:37:42,840 --> 00:37:46,480 Which I like to chat about because when I was first learning about this, I was like, 593 00:37:46,480 --> 00:37:47,480 what? 594 00:37:47,480 --> 00:37:48,480 I had no idea. 595 00:37:48,480 --> 00:37:49,480 Right. 596 00:37:49,480 --> 00:37:51,960 And it's funny and thank you for explaining it because in all honesty, I've seen it on 597 00:37:51,960 --> 00:37:54,440 lists several times. 598 00:37:54,440 --> 00:37:56,320 I've never been able to make the connection. 599 00:37:56,320 --> 00:37:58,560 Yeah, it's like, how is this possible? 600 00:37:58,560 --> 00:37:59,560 Yeah. 601 00:37:59,560 --> 00:38:03,160 Yeah, I learned that from Autumn Penny who's a leader in our field. 602 00:38:03,160 --> 00:38:08,800 She's an oral functional myofunctional therapist, a speech language pathologist and a certified 603 00:38:08,800 --> 00:38:09,800 lactation consultant. 604 00:38:09,800 --> 00:38:14,520 So she's an educator in the field and she explained it so well. 605 00:38:14,520 --> 00:38:17,720 So I will attribute knowing that to her. 606 00:38:17,720 --> 00:38:18,720 Awesome. 607 00:38:18,720 --> 00:38:19,920 That was absolutely awesome. 608 00:38:19,920 --> 00:38:20,920 All right. 609 00:38:20,920 --> 00:38:29,880 So I'm a parent and I'm noticing that my three-year-old, let's say, is snoring. 610 00:38:29,880 --> 00:38:34,800 I started working with the foundation, I did not realize it was not cute, they don't 611 00:38:34,800 --> 00:38:36,640 know how to out of it, it's a bad thing. 612 00:38:36,640 --> 00:38:43,640 So as a parent, if I see something like that or I'm noticing my child has that kind of 613 00:38:43,640 --> 00:38:48,880 worried expression when they swallow or drink, what do I do? 614 00:38:48,880 --> 00:38:49,880 Okay. 615 00:38:49,880 --> 00:38:54,240 So I always tell parents that if you have concerns, your first stop is always your pediatrician. 616 00:38:54,240 --> 00:38:55,240 Okay. 617 00:38:55,240 --> 00:39:01,360 That shouldn't be your last stop because oftentimes, and I'm not blaming pediatricians 618 00:39:01,360 --> 00:39:05,280 but any stretch because they have so much that they need to be responsible for, but 619 00:39:05,280 --> 00:39:08,400 they are not the specialists in these areas. 620 00:39:08,400 --> 00:39:13,320 So if they say to you, they don't have any huge concerns, but it's still something that 621 00:39:13,320 --> 00:39:18,480 in your gut, yours thinking, I don't think this is normal or I think there's something 622 00:39:18,480 --> 00:39:20,200 more to it. 623 00:39:20,200 --> 00:39:23,960 And then depending on what the concern is, I would find a specialist within that area 624 00:39:23,960 --> 00:39:24,960 of concern. 625 00:39:24,960 --> 00:39:29,640 If it's something that has to do with feeding, I would be looking for a feeding therapist 626 00:39:29,640 --> 00:39:34,320 which would be either the speech language pathologist or the occupational therapist, 627 00:39:34,320 --> 00:39:40,320 but you have to make sure that they have that training and feeding because as I mentioned, 628 00:39:40,320 --> 00:39:44,640 not all graduates come out with extensive training, it depends on their program. 629 00:39:44,640 --> 00:39:48,760 And so if they've taken a special interest, there will be continuing education courses 630 00:39:48,760 --> 00:39:53,720 and they'll be able to speak to their years of experience and working with families or 631 00:39:53,720 --> 00:39:55,400 clients with feeding disorders. 632 00:39:55,400 --> 00:40:03,080 So if there's a feeding concern, you'll look for the SLP or the OT with experience. 633 00:40:03,080 --> 00:40:13,200 And if you're looking for, if you're concerned about breathing, first of course is the pediatrician. 634 00:40:13,200 --> 00:40:19,400 Another one would be an ENT, I would say to ask your pediatrician for referral to an ENT 635 00:40:19,400 --> 00:40:24,400 and say, I totally respect that you're not overly concerned about it, but it would really 636 00:40:24,400 --> 00:40:31,400 make me feel more comfortable if I could give ENT and really have them either scope or look 637 00:40:31,400 --> 00:40:36,400 and give me their insight because it's just really something that's been on my mind. 638 00:40:36,400 --> 00:40:42,920 And hopefully the pediatrician would be willing to refer you to your know-how to go doctor. 639 00:40:42,920 --> 00:40:47,360 And then the other professional would be the oral facial myofunctional therapist. 640 00:40:47,360 --> 00:40:55,160 So why I say them is because their role is really like they're the umbrella person almost. 641 00:40:55,160 --> 00:41:00,520 So they will look at the whole function of what's happening and they will say, or we 642 00:41:00,520 --> 00:41:06,160 will say, this is the professional that you need to see to rule out XYZ. 643 00:41:06,160 --> 00:41:11,760 So we'll be able to kind of parse out what contributing factors might be the most salient 644 00:41:11,760 --> 00:41:16,840 thing to look at first and then point you in the direction of the provider who we think 645 00:41:16,840 --> 00:41:22,280 is kind of looking at it with the same eyes as we are from the airway perspective. 646 00:41:22,280 --> 00:41:28,200 Obviously, all ENTs are looking at the airway, but sometimes you'll hear parents say, the 647 00:41:28,200 --> 00:41:31,560 ENT said the adenoids weren't that bad. 648 00:41:31,560 --> 00:41:34,080 They were only taking up 50% of the airway. 649 00:41:34,080 --> 00:41:35,080 Only. 650 00:41:35,080 --> 00:41:36,080 Is it a lot? 651 00:41:36,080 --> 00:41:37,080 Right. 652 00:41:37,080 --> 00:41:45,040 And so, you know, not all providers are created equal in any profession, you know? 653 00:41:45,040 --> 00:41:49,560 So oftentimes the oral facial myofunctional therapist has been referring to different 654 00:41:49,560 --> 00:41:54,880 providers and knows a little bit more as to who will be looking at it with the same lens 655 00:41:54,880 --> 00:41:59,680 that we would be looking at it with and kind of like looking more closely at those specific 656 00:41:59,680 --> 00:42:01,880 concerns. 657 00:42:01,880 --> 00:42:05,520 So those are the places that I would go. 658 00:42:05,520 --> 00:42:07,760 Did you want to ask something or did I interrupt you? 659 00:42:07,760 --> 00:42:08,760 No, no, no, you're good. 660 00:42:08,760 --> 00:42:15,000 Well, I mean, it's a follow-up question and that is, do you have to be referred to a 661 00:42:15,000 --> 00:42:16,000 myofunctional? 662 00:42:16,000 --> 00:42:18,680 So it depends on what route you're going to go. 663 00:42:18,680 --> 00:42:23,720 So some many, many oral facial myofunctional therapists may be out of network. 664 00:42:23,720 --> 00:42:27,880 If they are out of network, that means that they may not take insurance, but they may 665 00:42:27,880 --> 00:42:34,040 provide you with a super bill that you can submit to your insurance for reimbursement. 666 00:42:34,040 --> 00:42:36,960 So what it would depend on is what your insurance requires. 667 00:42:36,960 --> 00:42:42,040 So if your insurance requires to have a referral, you would want to just call them and check 668 00:42:42,040 --> 00:42:46,920 with them first so that your likelihood of being reimbursed for a portion of the cost 669 00:42:46,920 --> 00:42:51,720 is more likely if you know what the insurance is requiring. 670 00:42:51,720 --> 00:42:55,160 If they're in network, again, you would have to check. 671 00:42:55,160 --> 00:42:57,320 But it just depends on the facility. 672 00:42:57,320 --> 00:43:00,280 If it's a private practice, oftentimes they don't require one. 673 00:43:00,280 --> 00:43:06,200 But if it's affiliated with a hospital like an outpatient center, they might require a 674 00:43:06,200 --> 00:43:08,400 prescription or a referral. 675 00:43:08,400 --> 00:43:09,400 A referral. 676 00:43:09,400 --> 00:43:10,400 Yeah. 677 00:43:10,400 --> 00:43:11,400 Awesome. 678 00:43:11,400 --> 00:43:16,000 Well, as we wrap up, I just open the floor to you at this point for any final thoughts, 679 00:43:16,000 --> 00:43:19,720 any things you want to share, guidance, anything for parents. 680 00:43:19,720 --> 00:43:20,720 Yeah. 681 00:43:20,720 --> 00:43:26,960 I think that I want parents to know that the first thing is to follow your gut. 682 00:43:26,960 --> 00:43:30,560 If you feel like there's something going on with your child, if you're seeing these 683 00:43:30,560 --> 00:43:36,160 behaviors, if you're hearing noisy breathing, if you see some questionable feeding thing, 684 00:43:36,160 --> 00:43:38,360 follow that instinct. 685 00:43:38,360 --> 00:43:47,920 And don't stop with your first Google search or your first provider who you ask if you 686 00:43:47,920 --> 00:43:50,320 feel like something's going on. 687 00:43:50,320 --> 00:43:56,000 Just don't stop until you talk to someone who you feel is really adequately answering 688 00:43:56,000 --> 00:44:03,000 your concerns and helping lead you in a direction that you feel is acknowledging that. 689 00:44:03,000 --> 00:44:09,360 And then I would say that if any professionals are listening out there, it's our role, it's 690 00:44:09,360 --> 00:44:16,200 our obligation to try and continue to spread the word about airway and sleep disorder breathing 691 00:44:16,200 --> 00:44:22,960 and why mouth breathing is a concern and try and help educate anyone who's working with 692 00:44:22,960 --> 00:44:27,200 children, but also parents so that they can be their own best advocate and really advocate 693 00:44:27,200 --> 00:44:33,160 for their kids and get them on the path that they need to be to be successful in their 694 00:44:33,160 --> 00:44:35,280 development. 695 00:44:35,280 --> 00:44:36,280 And I applaud that. 696 00:44:36,280 --> 00:44:37,280 So thank you very much. 697 00:44:37,280 --> 00:44:40,480 You said that beautifully and I appreciate that. 698 00:44:40,480 --> 00:44:46,000 And thank you so much for being on our podcast and really enjoying just shedding the light 699 00:44:46,000 --> 00:44:50,600 on quite a bit of information that I think a lot of us either misunderstood or just didn't 700 00:44:50,600 --> 00:44:52,480 really fully understand. 701 00:44:52,480 --> 00:44:53,480 So thank you. 702 00:44:53,480 --> 00:44:54,480 Thank you so much. 703 00:44:54,480 --> 00:44:56,680 It's an honor to be a part of it. 704 00:44:56,680 --> 00:45:03,240 Thanks again to today's guests Lauren Refridge for sharing her medical insight and for each 705 00:45:03,240 --> 00:45:06,600 of you for listening to today's episode. 706 00:45:06,600 --> 00:45:09,720 If you're new to our podcast, please don't forget to subscribe. 707 00:45:09,720 --> 00:45:13,920 And if you enjoy our episode, please remember to leave us a review or comment about what 708 00:45:13,920 --> 00:45:15,960 you enjoyed most. 709 00:45:15,960 --> 00:45:19,880 You can stay connected with the Children's Airway First Foundation by following us on 710 00:45:19,880 --> 00:45:23,880 Instagram, Facebook, Twitter and LinkedIn. 711 00:45:23,880 --> 00:45:27,920 If you'd like to be a guest on an upcoming episode, shoot us a note via our contacts 712 00:45:27,920 --> 00:45:36,200 page on our website or send us an email directly at info at childrensairwayfirst.org. 713 00:45:36,200 --> 00:45:40,920 Remember this podcast and the opinions expressed here are not a medical diagnosis. 714 00:45:40,920 --> 00:45:45,360 If who's suspect your child might have an airway issue, contact your pediatric airway 715 00:45:45,360 --> 00:45:47,800 dentist or pediatrician. 716 00:45:47,800 --> 00:45:52,480 And finally, thanks to all the parents and medical professionals out there that are working 717 00:45:52,480 --> 00:45:56,840 to help make the lives of kids around the globe just a little bit better. 718 00:45:56,840 --> 00:46:15,000 Take care, stay safe and happy breathing everyone.