Welcome back to Airway First, a podcast from the Children's Airway First Foundation.
I'm your host, Rebecca Downing.
My guest today is Autumn Henning, speech language pathologist, certified oral facial
myologist, and international board certified lactation consultant.
Autumn graduated from the University of Kentucky with a master's degree in communication disorders
and is an assistant professor with a voluntary faculty series in the Department of Communication
Sciences and Disorders at the University of Kentucky College of Health Science.
She was also a founding board member for the ICAP.
Autumn specializes in oral facial function and development throughout the lifespan.
She has spoken at a variety of prestigious conferences and organizations, written articles,
appeared as a guest on several podcasts, and trained thousands of professionals.
You can find out more about Autumn on her website at chrysalisoralfacial.com.
And now here's my interview with Autumn Henning.
Welcome to the show Autumn, thanks so much for being here.
Thank you for having me, I'm excited to dive in today.
Yeah, absolutely.
So as we dive in, let's just start with one of the things that I find so fascinating about
your particular practice.
The website is chrysalisoralfacial.com, hard to say.
It is a little difficult to say, but the story behind it I find quite beautiful and quite
fascinating.
And so I'd like to dig into that a little bit, because on the website you tell the story
about a butterfly.
And I know that it means enough that not only did you put it on the website, clearly there's
a nod to it in the actual name of your practice.
So I'd like to begin there if we could.
Yeah, definitely.
So I treat oral facial dysfunction throughout the lifespan.
So babies on up to adults and elderly even.
And really, there's, I've always loved butterflies and our goal, our mission is to transform people's
lives.
Well, we don't do that alone.
And so the story about the butterfly was about a man found a cocoon.
It's all butterfly, like kind of struggling to get out of it.
And he, you know, was trying to be helpful and cut the cocoon open.
Well, the butterfly did get out, but it never flew because it needed to use its muscles
and reflexes and strengthen to be able to fly.
And so I like to always say if I'm working harder on someone's health than they are,
that's a problem.
And so it's really about the transformation that, you know, no one can do it for you.
It is time, energy, money, effort to make that transformation great results don't just
happen like we do not have magic wands.
And so this is a conversation that I've had with, with many patients and parents over
the years.
And yeah, it kind of became the inspiration for our practice.
And we see patients that are ready to do the work and want here and get to see the benefits
and their health and life changed.
This beautiful transformation takes place.
Yeah, absolutely.
Yeah, and I do think what I'm discovering through these, you know, various podcasts.
I'm hearing this repeated a lot.
I think people are surprised at how much work goes into the my own functional journey.
Yes.
For a patient, you know, they think, okay, we're going to go in, we're going to do some
exercises and we're done.
Right.
And I think people tend to forget that just for one swallow, it uses every, all the body
systems over 26 muscles, six of the cranial nerves.
And so like we just take it for granted because, you know, we eat and chew and swallow and
talk, right?
Now thinking about it, you know, and so these are little muscles and they're very intricate.
And so it is a lot of work.
And not only that, it's not just one time, it's consistency because that's what makes
changes in patterns.
And so it is a commitment and it is a process and it's not like, you know, going to the
dentist every six months.
It's, I mean, we see patients weekly.
We find that if we have kind of space out visits, accountability, momentum at all kind
of slow.
And then it takes longer in the long run.
So we kind of stick to weekly just because, you know, we think that's a good timeframe.
It keeps people in momentum and accountable.
And yeah, but it is, it's definitely, it's definitely work.
Now we like to make it a lot of fun and we have a good time.
Right.
But it is work, right?
Yes.
Yeah.
Well, and you touched on this and you talk about it a little bit more on the website,
which we'll put a link to in the show notes, but you talk about, you teach your patients
how to breathe, posture, swallow and speak correctly and posture.
I mean, that one completely jumped out at me.
Yeah.
As far as, you know, as you're going through this process, you don't think about that.
How does that impact your myofunctional?
Right.
So, you know, I think we think of posture as like shoulders and neck, but we forget that
our mouth has a posture to it as well.
So almost more important than the function we do with our mouth, eating and talking is
what it does at rest.
So where our tongue sits, our teeth together or apart, our lips open or closed or clamped
or our cheeks engaged or relaxed, all of those things because where the pressures and forces
of your mouth are directed changes the shape of your face, airway and can move teeth.
When you think about orthodontics, what does that do?
That's pressures and forces on your teeth and your jaws and the whole cranial area.
And so we have natural ones too.
And so that's really what myofunctional therapy is about is directing and balancing those natural
forces in a positive manner.
Okay.
Now, you mentioned in there the posture of your mouth and I've actually heard you mention
this in a different podcast.
When you talk about posture, you were one of the first people that I ever heard say,
your teeth were apart.
My whole life I've tried to keep my mouth when I think my mouth is closed, your teeth
are closed, but that's apparently not right, is it?
Yeah, you're right.
So usually when people's teeth are together, that's because they're seeking stability and
the tongue should be up on the roof of the mouth, kind of creating like a little suction
cup, and that stabilizes the jaw.
And so we have what we call freeway space.
And that is a couple of millimeters between your teeth when you're at rest.
And so our teeth are meant to be together at the point of chewing, at the point of swallowing,
and if we're doing a smile for a picture, right?
Okay.
So it's less than like one to two percent of our day that our teeth should actually be
an occlusion.
You know, the dental world is all about the occlusion, right?
And so I find that issues with occlusion often come from functional issues driving that.
Okay.
What do you mean by that?
So when you're, like I said, when your tongue isn't up, you're seeking stability and clenching
teeth.
And so with a lot of people think that, oh, I have TMJ or dental issues because my teeth
aren't lined up, well, it's really how you're using your mouth that changes the alignment.
Okay.
Got it.
So kind of a chicken or egg sort of.
Right.
Okay.
I understood.
So what exactly what is proper oral posture?
I mean, you mentioned, all right, the tongue is going to be in the roof.
Yep.
So yeah, correct oral rest posture is lips closed or sealed, but not clenched or pursed.
Okay.
Slightly together, teeth, just a few millimeters apart.
The tip of the tongue should be right behind your top teeth, but not touching them.
And then the rest of your tongue should fill the roof of your mouth.
So that's where it's supposed to be at rest that creates that homeostasis or balance.
So okay.
Again, yeah, the tongue should be behind the teeth, but not touching them.
Really?
Right.
So it's a place called the insides of the pillow.
It's a little nubby spot right behind your top teeth.
And I always, I always tell my families, it's like when you were a kid and your sibling
was really close to you and they were like, I'm not touching you.
It's like so close, but not touching those teeth.
Okay.
Yep.
Wow.
And how do you as a parent typically notice something like this or is, are there signs
parents can see?
Obviously you're not going to notice if the tongue is touching the back of the teeth or
not, but what signs is a parent can you look for, especially in an older child?
So yeah, I mean, all of these, it's interesting how a lot of things come back to myofunctional
issues, right?
And so we look historically, you know, did they have early feeding, breastfeeding issues,
things like that?
Do they have crooked crowded misaligned teeth?
That tells us that the tongue is probably not in the right spot.
Are they a picky eater?
And so they're having trouble chewing certain textures or things like that.
Do they breathe through their mouth or sore?
That's a sign that things are not developed well.
There's an obstruction, whatnot.
So there's lots of signs out there that can relate back to the mouth.
It's so interesting how the way we use our mouth affects things that are seemingly not
related.
Right, that you don't think about.
Like picky eater, for example.
Yeah.
How does that correlate?
So, you know, typically oftentimes it goes along with tongue tie.
And when the tongue can't control the food well, what happens is kids get anxious, they
gag because they can't move the food appropriately, or they spit food out, or they learn to like
swallow it whole.
And so these kids have these bad experiences with a certain texture or type of food, and
then they start avoiding it.
And we tend to think of it like, oh, they just don't like it, or they're just being picky
when really it's an actual physiologic issue.
And so, you know, I always like to find the why.
Why, you know, it's not just that we just don't like that.
Oftentimes.
Yeah.
So that's usually how we see picky eating manifested.
Got it.
And that kind of also relates to the swallowing because I've heard that is another sign, you
know, when they look like they're struggling to swallow.
Right.
Yeah.
If they're using head movement and moving their head forward as they swallow, or cursing
their lips or squeezing their cheeks or kind of grimacing as they swallow.
Yeah.
That can definitely be a sign that, you know, pressures and functions are not balanced.
And so they're compensating and using other ones to move that food back and down.
Gotcha.
And we'll go ahead and put a link to it.
And we'll list a few, but we'll put a link back to you on some of these signs that they
can look for.
Sure.
This is Nina Airway first with today's guest, Autumn Henning.
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 Children's Airway first.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 my interview with Autumn Henning.
I didn't realize until starting this podcast that, and I'm sure other parents didn't either
tongue ties actually start in utero.
Yeah.
And you know, it's not just parents.
It is professionals as well.
It's amazing.
So I teach a course taught training.
It was the first continuing education course out there for people working on oral function
that was accredited and offered for CEUs.
And something that I teach in there, it's amazing how many people are treating tongue
ties and working with children with tongue ties and affected by them that don't know
how it happens.
And you know, it's just something you're just born with.
And so the three year old in me says, but why, but how?
Sure.
They're not just born with it.
How does it happen?
And so it's about weeks five to seven.
The floor of your mouth and your tongue is essentially one structure.
Okay.
And what happens is if you can imagine like plastic wrap or saran wrap around the structures,
that plastic wrap grows downward and that creates the phrenulum and that that dictates
how long it is.
Okay.
So that helps with the range of motion and then part of that saran wrap, it's called the
ectoderm dissipates and just like dies off so that your phrenulum should not be attached
to the tip of your tongue.
And so it's both of those components because some people have tongue ties attached to the
tip, but have really long phrenulums and great range of motion, right?
And then some people have tongue ties that are attached further back, but it's very short
and not great range of motion.
And so it's both of those that, that really dictate how the tongue and the phrenulum
functions is that apoptosis and that downward ectodermal growth.
And so yeah, that happens around five to seven weeks.
And then the tongue also helps to form the palate.
So these babies that are born with high narrow palates, oftentimes it's related to a tongue
tie because the palatal shelves actually how they come together is determined by the upward
pressure of the tongue.
And the upward pressure of the tongue is kind of its landmark.
And so if it's not feeling that pressure, it's going to continue to go together and be
very narrow and high.
And so yeah, it's, it's a huge, it's very interesting.
And you know, I work with a lot of new moms and they're like, is there anything I could
have done?
Did I eat something wrong?
And you know, this is happening at five weeks.
Most people don't even, may not even realize.
Yeah, I have weeks.
And so yeah, I find it really interesting and that just goes along with that even if
someone has a tongue tie release at birth, right early, early on, they've still been
sucking and swallowing amniotic fluid in the womb for months.
Right.
So even early intervention, there is a bit of retraining and therapy that would need
to take place.
So let's kind of dig into that.
I had a follow up question that I'll circle back to.
Let's dig it.
Let's dig into that, that training.
So you know, one of the things they were advocating for at Children's Airway first is during that
initial evaluation at birth, you know, opening the mouth, going up there, checking for that
high arch bowel.
I mean, parents, many parents are surprised to know this doesn't occur, but open that
mouth, look at that palette.
Let's look at the airway.
Let's see what's going on.
If during this evaluation, physician, midwife, whomever it is, discovers a tongue tie.
What are the options?
What kind of journey is this infant on versus, let's say we find it at three years old?
Yeah.
I mean, I think you definitely fare better the earlier it's addressed just because we
haven't had as many cascade effects or compensations or time pass.
Right.
Developing those.
So I think it's definitely better at birth.
I think the issue is, is the training.
So, you know, those folks are more like structural people.
They're looking at the structure of the tongue and the palate and whatnot.
Whereas a therapist, we're looking at the function of it.
And you really need both for a true diagnosis because I say all the time, I don't care what
your tongue looks like if it works.
Right.
If it's not, if it's not impacting you negatively, then I don't care.
And so, yeah, I think earlier intervention and referrals need to happen.
So if they're seeing signs, you know, a short frenulum attaching closer to the tip of the
tongue, a heart shaped tongue, you know, the high arch palate, mouth breathing, you know,
I think there's like things that are definitely apparent.
Then I think that needs to be an automatic referral to someone that can look at the function
and then kind of figure out what to do because just, you know, going for the surgical intervention
and releasing things doesn't mean it works.
Right.
Because there's still all the residual that has to be addressed, right, retrained.
Right.
Got it.
Understood.
And circling back, you know, you kind of touched on, especially with new moms, I'll ask, you
know, is there something I could do?
Is there something I could have done differently?
Yeah.
I think, you know, do we, as medical professionals, understand what causes tongue ties?
Are we that far along yet?
Not fully.
We do.
There are several studies that have established that there's a genetic component.
Okay.
So it is inherited.
It is an autosomal dominant trait.
And then also there's some epigenetic components that can determine it.
Very, very preliminary new research.
There was one study that came out during COVID in 2020.
The author, the lead author was Amity, A-M-I-T-A-I.
And it looked at folic acid supplementation during pregnancy and the incidence of ankle
glasia.
And it showed a positive correlation of using folic acid and tongue tie.
And the authors proposed that this reason is because of a genetic mutation, the MTHFR
mutation, and folic acid is a synthetic form of a vitamin.
The synthetic form, people with that mutation have trouble processing.
And so there have been some groups and organizations that are recommending using folate instead
of folic acid.
Instead of, okay.
Right.
And, you know, tongue tie is in the midline.
We take folic acid to reduce things like clefs, finabifida, other midline issues.
And so, yeah, I think we're going to see a lot more information on this as things progress.
But you know, it's a really hard thing to study, I think, because it's happening in
the womb, right?
Right.
And so early.
Yeah.
And so, you know, there are so many factors, you know, that genetic history and then, you
know, potentially diet and things like that.
So I think there's an interplay of factors.
Okay.
Got it.
And I will do my best to find that study.
And I will include that in the show notes as well for people.
And then I personally just want to read it because that sounds pretty fascinating.
Yeah.
So looking at your blog, there were a couple of things that jumped out at me when you were
discussing the myofunctional journey of a child.
Words are worth a thousand pictures and then abolishing the preferred provider title.
Yeah.
And again, obviously there will be links in the show notes because I encourage people
to go read both of these articles, but I'd love to touch on them a little bit here.
Sure.
So let's see.
Yeah.
Words are worth a thousand pictures.
So I think as providers, we need to be very intentional with our words.
What do you mean by that?
Choosing the correct words that are reflective of the process.
The one example is with tongue tie.
A lot of times people are calling it a revision.
All right.
And to most of us, revision means to do again.
Right?
Right.
And a lot of these families are already worried about the tongue tie growing back or reattaching
or they've heard horror stories of a patient that's had to do it three times.
And so I think I call it a release because that conjures an image of releasing tissue.
Right?
And it doesn't give that negative connotation of having to do something again or feed into
those fears.
And so another thing I talk about is instead of talking about pain medication, I talk about
comfort measures.
Right?
It's kind of that psychological standpoint of like we experience what we think.
And so if you're talking about immense pain and whatnot and what to do for that, I think
patients have this negative expectation and they're like prepared for the worst.
Now I don't mean to sugarcoat things by any means.
I'm definitely truthful and transparent with patients, but I think there's, you can definitely
navigate things better with your words.
Okay.
I totally understand that.
And then abolishing the preferred provider title.
Yeah.
So I have to say before you answer this one, this one to me, I loved.
I mean, I got behind this one 100%.
Yeah.
So there was this list years ago.
It's not even like verified or monitored now, but it was essentially a preferred provider
list is what they called it.
And it was parents that had a good experience at Dr. So-and-Sos with a tongue tie release.
And so that person would go on the list.
Right.
And there was really no criteria, no vetting.
It was just anecdotal.
This patient said they were good.
Right?
Right.
And so the other thing that bugs me about this is preferred provider makes me think
of like insurance, like PPO network.
Yes.
And not all providers doing tongue tie releases that are skilled are in network or they may
or may not be.
Right.
And so I don't really use this term that word preferred.
I don't prefer you.
It's either I recommend you or I don't.
And so, yeah, I think a lot of parent groups and Facebook groups have that out there.
And you know, as far as factors deciding on who I recommend for a procedure and who I
don't, I really have conversations with providers and really talk through what's important to
me and my patients, you know, kind of where my philosophy is and kind of see what theirs
is and what their education experience level is.
And so the things that I look for is that they understand that there's multiple types
of ties.
There's just not one presentation.
It's not only, you know, the to the tip heart shaped tongues.
They understand that it can impact lots of things and throughout the lifespan, it's not
just about breastfeeding babies.
It's not just about speech, but it's about the airway and sleep disorder breathing.
And so, you know, how the the dentition comes in and eating and, you know, all the things
that go along with that.
So, understanding kind of the impact that can happen.
If you're going to do a release, do a release.
Let's not clip a hangnail and, you know, put someone through a procedure for an incomplete
release.
And looking at their work and talking through like what does a complete release look like?
And one of the questions I ask providers is how do you know how far to go?
When do you stop?
How do you decide?
You know, if the if they're not stitches place, they understand that something needs
to be done to make sure that heals correctly.
If they don't understand basic wound healing, they shouldn't be doing a procedure.
And then they're right.
They're really a team player and understands that function.
Just because you fix the structure doesn't mean the function is fixed.
And so, you know, really kind of drives home with their patients that, you know, the release
is a part of the journey, not not the whole picture.
And so, you know, supports that evaluation of function and that follow up.
When some of this research is pointing towards genetics for tongue ties.
Again, I get it's early, but does that support the fact do you see tongue ties often in families?
If you see one kid, you know, they have five, maybe two or three of them are likely to have
that or two to three are likely to have some sort of a myofunctional issue that needs to
be addressed.
Is that kind of what you see?
Yes, absolutely.
And honestly, like, that's my practice.
And that's why I treat the lifespan is because these things do run in families.
Very rarely do we only see one family member.
So what happens is, you know, it just depends who enters the system first.
But so I have one family right now.
Two years ago, they were having trouble breastfeeding.
I saw the baby, there was a tongue tie, we did all the things and got that baby to breast
and doing well and gaining weight and whatnot.
So then she the mom says, okay, my husband needs to come.
He snores and he grinds his teeth.
And, you know, because I educated them on how tongue ties shape the airway and, you
know, later on can cause these issues potentially.
And so now he's my patient.
And then yesterday, the mom called and said, Oh, our daughter, you know, her tongue looks
exactly like my husband's or our older daughter.
And she got flagged in school for speech issues.
And so here are all these different presentations in one family.
And so, yeah, oftentimes we do.
You are definitely more likely to have another family member with a tongue tie if you have
one.
And we do have research that says that as well.
Yeah, so it's very interesting.
That is interesting.
I should mention research is also pointing towards excellent patterns of inheritance.
So more common in boys.
So yeah.
Hmm.
Okay.
And is it ever too late to get a tongue tie released?
No, I don't think so ever.
I see patients into their sixties.
And yeah, it's never too late.
It's more of like, you know, we've had it for a longer time.
So oftentimes we have to do more to overcome it.
And because the tongue shapes the palate and the airway and and all of that, sometimes
there's other things involved that we have to do, not just therapy and a tongue tie release.
Sometimes it's orthodontics.
Sometimes it's a jaw surgery.
Sometimes it's getting, you know, tonsils out or a deviated septum fixed.
And so it's just more involved is what I say.
So definitely easier and more straightforward.
The younger young.
Yes.
Right.
Which is which takes us back to that first evaluation at birth actually opening the
mouth.
I know it's wild.
I've even, you know, I've even had kids that are having trouble feeding and I'm the one
to discover a cleft.
Wow.
Are you kidding me?
Like how many how many providers have have supposed to look in this child's mouth, you
know?
And here we are, you know, a few weeks later.
And yeah, it's it's wild.
And I think it definitely comes back to like training and absolutely education, training
and one of the other things that we're huge advocates for community focused, right?
Kind of back to the preferred provider from a different light from the insurance perspective.
You might have a pediatrician, but that pediatrician also works with this gamut of a team, you know,
that does include your airway centric dentists, your myofunctional therapist.
There's so many others that from for me, part of one of the things that that article you
wrote sparked was the preferred provider in that term.
It's to me, there's this shift that needs to be taking place so that, you know, the
people that are trained can get together and talk to each other and oh, here's what I found
and oh, here's this.
And, you know, so we're looking at the child holistically.
Right.
And I think there's so many challenges to that because of, you know, insurance and reimbursement
and, you know, there are very few private pediatric practices, right?
Because they've all been kind of taken over by the hospital systems.
And a lot of the hospital systems have policies that you have to refer in-house and in their
system instead of and I just think that's terrible because that's, you know, my job is
to refer to the best person for your patient, right?
Whether they're in a system, out of the system, in network, out of the network, whatever it
is, that's, you know, my job is to utmost care the patient.
And so, yeah, I think that's some of the barriers to developing that community as well.
And that's, well, kind of with that in mind then, how do you guide parents to bridge that
gap?
Yeah, yeah.
And I think they already are.
You know, I think talking on some of the groups, the Facebook groups and support groups and
things like that, a resource that I have for families, I have a directory on my website.
And so, instead of taking your chances with, you know, a random dentist or a random speech
therapist, go look on that directory, type in your state or your area and see who's on
there near you.
At least you know they have knowledge of tongue ties, you know, and it's a little less going
in blind.
And so, I think, yeah, doing some of the research, things like this podcast is really
cool and, you know, reach out to us.
I get messages every day on Facebook, Instagram.
Hey, do you know a therapist in my area?
Hey, you know, do you know an ENT in my area?
You know, who should I see first for this issue?
Things like that.
Usually, if I don't know anybody, I can find someone who does.
Awesome.
That is awesome.
What I'd like to just kind of open the floor at this point for you.
Speaking to parents or to medical professionals, what at this point, kind of where we are with
tongue ties, what we know about them, where we need to go as far as, you know, to do the
best for children?
What would you like to say?
What would your final thoughts be?
I am really about creating a standard of care because there is lots of controversy and one
provider says this and another provider says that.
So I think, you know, more well done research can help us there and really bridging the
medical structural and the functional communities.
Like I said, like it really needs to be a co-diagnosis and, you know, in other fields,
orthopedic surgery, they don't do knee replacements without prescribing physical therapy.
Why is that different for the mouse and something that is so musculature, so much, so much musculature
is involved.
And so, you know, I think, yeah, I think that's where I would like to see it go.
A lot more collaboration and, yeah, emphasis on both roles and components.
Awesome.
Well, I absolutely appreciate your time this afternoon.
Thank you so much.
Yeah.
This was great.
And, yeah, I'm excited about Children's Airway First Foundation and all that you guys are
doing and, you know, this is a key component to that advocacy.
It is.
Absolutely.
Thanks.
Thanks so much to today's guest, Autumn Henning, for sharing her medical insight and to each
of you for listening to today's episode.
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Take care, stay safe, and happy breathing, everyone.