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Welcome back to Airway First, a podcast from the Children's Airway First Foundation.

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I'm your host, Rebecca Downing.

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My guest today is Autumn Henning, speech language pathologist, certified oral facial

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myologist, and international board certified lactation consultant.

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Autumn graduated from the University of Kentucky with a master's degree in communication disorders

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and is an assistant professor with a voluntary faculty series in the Department of Communication

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Sciences and Disorders at the University of Kentucky College of Health Science.

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She was also a founding board member for the ICAP.

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Autumn specializes in oral facial function and development throughout the lifespan.

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She has spoken at a variety of prestigious conferences and organizations, written articles,

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appeared as a guest on several podcasts, and trained thousands of professionals.

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You can find out more about Autumn on her website at chrysalisoralfacial.com.

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And now here's my interview with Autumn Henning.

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Welcome to the show Autumn, thanks so much for being here.

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Thank you for having me, I'm excited to dive in today.

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Yeah, absolutely.

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So as we dive in, let's just start with one of the things that I find so fascinating about

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your particular practice.

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The website is chrysalisoralfacial.com, hard to say.

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It is a little difficult to say, but the story behind it I find quite beautiful and quite

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fascinating.

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And so I'd like to dig into that a little bit, because on the website you tell the story

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about a butterfly.

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And I know that it means enough that not only did you put it on the website, clearly there's

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a nod to it in the actual name of your practice.

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So I'd like to begin there if we could.

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Yeah, definitely.

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So I treat oral facial dysfunction throughout the lifespan.

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So babies on up to adults and elderly even.

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And really, there's, I've always loved butterflies and our goal, our mission is to transform people's

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lives.

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Well, we don't do that alone.

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And so the story about the butterfly was about a man found a cocoon.

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It's all butterfly, like kind of struggling to get out of it.

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And he, you know, was trying to be helpful and cut the cocoon open.

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Well, the butterfly did get out, but it never flew because it needed to use its muscles

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and reflexes and strengthen to be able to fly.

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And so I like to always say if I'm working harder on someone's health than they are,

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that's a problem.

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And so it's really about the transformation that, you know, no one can do it for you.

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It is time, energy, money, effort to make that transformation great results don't just

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happen like we do not have magic wands.

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And so this is a conversation that I've had with, with many patients and parents over

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the years.

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And yeah, it kind of became the inspiration for our practice.

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And we see patients that are ready to do the work and want here and get to see the benefits

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and their health and life changed.

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This beautiful transformation takes place.

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Yeah, absolutely.

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Yeah, and I do think what I'm discovering through these, you know, various podcasts.

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I'm hearing this repeated a lot.

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I think people are surprised at how much work goes into the my own functional journey.

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Yes.

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For a patient, you know, they think, okay, we're going to go in, we're going to do some

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exercises and we're done.

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Right.

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And I think people tend to forget that just for one swallow, it uses every, all the body

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systems over 26 muscles, six of the cranial nerves.

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And so like we just take it for granted because, you know, we eat and chew and swallow and

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talk, right?

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Now thinking about it, you know, and so these are little muscles and they're very intricate.

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And so it is a lot of work.

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And not only that, it's not just one time, it's consistency because that's what makes

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changes in patterns.

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And so it is a commitment and it is a process and it's not like, you know, going to the

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dentist every six months.

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It's, I mean, we see patients weekly.

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We find that if we have kind of space out visits, accountability, momentum at all kind

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of slow.

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And then it takes longer in the long run.

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So we kind of stick to weekly just because, you know, we think that's a good timeframe.

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It keeps people in momentum and accountable.

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And yeah, but it is, it's definitely, it's definitely work.

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Now we like to make it a lot of fun and we have a good time.

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Right.

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But it is work, right?

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Yes.

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Yeah.

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Well, and you touched on this and you talk about it a little bit more on the website,

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which we'll put a link to in the show notes, but you talk about, you teach your patients

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how to breathe, posture, swallow and speak correctly and posture.

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I mean, that one completely jumped out at me.

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Yeah.

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As far as, you know, as you're going through this process, you don't think about that.

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How does that impact your myofunctional?

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Right.

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So, you know, I think we think of posture as like shoulders and neck, but we forget that

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our mouth has a posture to it as well.

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So almost more important than the function we do with our mouth, eating and talking is

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what it does at rest.

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So where our tongue sits, our teeth together or apart, our lips open or closed or clamped

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or our cheeks engaged or relaxed, all of those things because where the pressures and forces

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of your mouth are directed changes the shape of your face, airway and can move teeth.

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When you think about orthodontics, what does that do?

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That's pressures and forces on your teeth and your jaws and the whole cranial area.

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And so we have natural ones too.

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And so that's really what myofunctional therapy is about is directing and balancing those natural

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forces in a positive manner.

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Okay.

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Now, you mentioned in there the posture of your mouth and I've actually heard you mention

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this in a different podcast.

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When you talk about posture, you were one of the first people that I ever heard say,

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your teeth were apart.

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My whole life I've tried to keep my mouth when I think my mouth is closed, your teeth

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are closed, but that's apparently not right, is it?

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Yeah, you're right.

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So usually when people's teeth are together, that's because they're seeking stability and

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the tongue should be up on the roof of the mouth, kind of creating like a little suction

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cup, and that stabilizes the jaw.

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And so we have what we call freeway space.

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And that is a couple of millimeters between your teeth when you're at rest.

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And so our teeth are meant to be together at the point of chewing, at the point of swallowing,

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and if we're doing a smile for a picture, right?

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Okay.

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So it's less than like one to two percent of our day that our teeth should actually be

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an occlusion.

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You know, the dental world is all about the occlusion, right?

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And so I find that issues with occlusion often come from functional issues driving that.

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Okay.

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What do you mean by that?

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So when you're, like I said, when your tongue isn't up, you're seeking stability and clenching

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teeth.

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And so with a lot of people think that, oh, I have TMJ or dental issues because my teeth

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aren't lined up, well, it's really how you're using your mouth that changes the alignment.

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Okay.

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Got it.

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So kind of a chicken or egg sort of.

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Right.

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Okay.

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I understood.

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So what exactly what is proper oral posture?

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I mean, you mentioned, all right, the tongue is going to be in the roof.

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Yep.

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So yeah, correct oral rest posture is lips closed or sealed, but not clenched or pursed.

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Okay.

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Slightly together, teeth, just a few millimeters apart.

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The tip of the tongue should be right behind your top teeth, but not touching them.

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And then the rest of your tongue should fill the roof of your mouth.

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So that's where it's supposed to be at rest that creates that homeostasis or balance.

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So okay.

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Again, yeah, the tongue should be behind the teeth, but not touching them.

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Really?

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Right.

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So it's a place called the insides of the pillow.

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It's a little nubby spot right behind your top teeth.

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And I always, I always tell my families, it's like when you were a kid and your sibling

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was really close to you and they were like, I'm not touching you.

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It's like so close, but not touching those teeth.

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Okay.

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Yep.

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Wow.

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And how do you as a parent typically notice something like this or is, are there signs

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parents can see?

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Obviously you're not going to notice if the tongue is touching the back of the teeth or

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not, but what signs is a parent can you look for, especially in an older child?

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So yeah, I mean, all of these, it's interesting how a lot of things come back to myofunctional

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issues, right?

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And so we look historically, you know, did they have early feeding, breastfeeding issues,

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things like that?

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Do they have crooked crowded misaligned teeth?

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That tells us that the tongue is probably not in the right spot.

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Are they a picky eater?

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And so they're having trouble chewing certain textures or things like that.

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Do they breathe through their mouth or sore?

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That's a sign that things are not developed well.

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There's an obstruction, whatnot.

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So there's lots of signs out there that can relate back to the mouth.

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It's so interesting how the way we use our mouth affects things that are seemingly not

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related.

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Right, that you don't think about.

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Like picky eater, for example.

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Yeah.

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Yeah.

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How does that correlate?

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So, you know, typically oftentimes it goes along with tongue tie.

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And when the tongue can't control the food well, what happens is kids get anxious, they

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gag because they can't move the food appropriately, or they spit food out, or they learn to like

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swallow it whole.

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And so these kids have these bad experiences with a certain texture or type of food, and

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then they start avoiding it.

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And we tend to think of it like, oh, they just don't like it, or they're just being picky

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when really it's an actual physiologic issue.

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And so, you know, I always like to find the why.

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Why, you know, it's not just that we just don't like that.

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Oftentimes.

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Yeah.

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So that's usually how we see picky eating manifested.

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Got it.

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And that kind of also relates to the swallowing because I've heard that is another sign, you

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know, when they look like they're struggling to swallow.

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Right.

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Yeah.

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If they're using head movement and moving their head forward as they swallow, or cursing

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their lips or squeezing their cheeks or kind of grimacing as they swallow.

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Yeah.

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That can definitely be a sign that, you know, pressures and functions are not balanced.

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And so they're compensating and using other ones to move that food back and down.

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Gotcha.

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Gotcha.

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And we'll go ahead and put a link to it.

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And we'll list a few, but we'll put a link back to you on some of these signs that they

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can look for.

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Sure.

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This is Nina Airway first with today's guest, Autumn Henning.

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You can find out more about the Children's Airway first foundation and our mission to

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ensure that every child has access to screening, evaluation and treatment of all children's

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airway disorders before the age of six on our website at Children's Airway first.org.

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You can also find a ton of great resources for parents on our website, including videos,

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blogs, recommended books, comprehensive medical research and more.

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As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.

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If you suspect your child might have an airway issue, contact your pediatric airway dentist

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or pediatrician.

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And now back to my interview with Autumn Henning.

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I didn't realize until starting this podcast that, and I'm sure other parents didn't either

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tongue ties actually start in utero.

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Yeah.

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Yeah.

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And you know, it's not just parents.

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It is professionals as well.

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It's amazing.

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So I teach a course taught training.

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It was the first continuing education course out there for people working on oral function

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that was accredited and offered for CEUs.

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And something that I teach in there, it's amazing how many people are treating tongue

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ties and working with children with tongue ties and affected by them that don't know

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how it happens.

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And you know, it's just something you're just born with.

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And so the three year old in me says, but why, but how?

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Sure.

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They're not just born with it.

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How does it happen?

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And so it's about weeks five to seven.

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The floor of your mouth and your tongue is essentially one structure.

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Okay.

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And what happens is if you can imagine like plastic wrap or saran wrap around the structures,

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that plastic wrap grows downward and that creates the phrenulum and that that dictates

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how long it is.

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Okay.

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So that helps with the range of motion and then part of that saran wrap, it's called the

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ectoderm dissipates and just like dies off so that your phrenulum should not be attached

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to the tip of your tongue.

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And so it's both of those components because some people have tongue ties attached to the

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tip, but have really long phrenulums and great range of motion, right?

244
00:16:58,120 --> 00:17:05,800
And then some people have tongue ties that are attached further back, but it's very short

245
00:17:05,800 --> 00:17:07,880
and not great range of motion.

246
00:17:07,880 --> 00:17:13,960
And so it's both of those that, that really dictate how the tongue and the phrenulum

247
00:17:13,960 --> 00:17:19,760
functions is that apoptosis and that downward ectodermal growth.

248
00:17:19,760 --> 00:17:23,760
And so yeah, that happens around five to seven weeks.

249
00:17:23,760 --> 00:17:26,400
And then the tongue also helps to form the palate.

250
00:17:26,400 --> 00:17:32,320
So these babies that are born with high narrow palates, oftentimes it's related to a tongue

251
00:17:32,320 --> 00:17:41,000
tie because the palatal shelves actually how they come together is determined by the upward

252
00:17:41,000 --> 00:17:42,840
pressure of the tongue.

253
00:17:42,840 --> 00:17:46,460
And the upward pressure of the tongue is kind of its landmark.

254
00:17:46,460 --> 00:17:50,880
And so if it's not feeling that pressure, it's going to continue to go together and be

255
00:17:50,880 --> 00:17:53,200
very narrow and high.

256
00:17:53,200 --> 00:17:57,320
And so yeah, it's, it's a huge, it's very interesting.

257
00:17:57,320 --> 00:18:01,040
And you know, I work with a lot of new moms and they're like, is there anything I could

258
00:18:01,040 --> 00:18:02,040
have done?

259
00:18:02,040 --> 00:18:04,120
Did I eat something wrong?

260
00:18:04,120 --> 00:18:06,840
And you know, this is happening at five weeks.

261
00:18:06,840 --> 00:18:10,120
Most people don't even, may not even realize.

262
00:18:10,120 --> 00:18:11,960
Yeah, I have weeks.

263
00:18:11,960 --> 00:18:20,320
And so yeah, I find it really interesting and that just goes along with that even if

264
00:18:20,320 --> 00:18:27,360
someone has a tongue tie release at birth, right early, early on, they've still been

265
00:18:27,360 --> 00:18:32,240
sucking and swallowing amniotic fluid in the womb for months.

266
00:18:32,240 --> 00:18:33,240
Right.

267
00:18:33,240 --> 00:18:41,400
So even early intervention, there is a bit of retraining and therapy that would need

268
00:18:41,400 --> 00:18:43,400
to take place.

269
00:18:43,400 --> 00:18:45,200
So let's kind of dig into that.

270
00:18:45,200 --> 00:18:49,000
I had a follow up question that I'll circle back to.

271
00:18:49,000 --> 00:18:50,000
Let's dig it.

272
00:18:50,000 --> 00:18:51,840
Let's dig into that, that training.

273
00:18:51,840 --> 00:18:58,800
So you know, one of the things they were advocating for at Children's Airway first is during that

274
00:18:58,800 --> 00:19:04,160
initial evaluation at birth, you know, opening the mouth, going up there, checking for that

275
00:19:04,160 --> 00:19:05,160
high arch bowel.

276
00:19:05,160 --> 00:19:08,920
I mean, parents, many parents are surprised to know this doesn't occur, but open that

277
00:19:08,920 --> 00:19:10,200
mouth, look at that palette.

278
00:19:10,200 --> 00:19:11,200
Let's look at the airway.

279
00:19:11,200 --> 00:19:14,000
Let's see what's going on.

280
00:19:14,000 --> 00:19:23,000
If during this evaluation, physician, midwife, whomever it is, discovers a tongue tie.

281
00:19:23,000 --> 00:19:24,000
What are the options?

282
00:19:24,000 --> 00:19:31,320
What kind of journey is this infant on versus, let's say we find it at three years old?

283
00:19:31,320 --> 00:19:32,320
Yeah.

284
00:19:32,320 --> 00:19:38,160
I mean, I think you definitely fare better the earlier it's addressed just because we

285
00:19:38,160 --> 00:19:44,720
haven't had as many cascade effects or compensations or time pass.

286
00:19:44,720 --> 00:19:45,720
Right.

287
00:19:45,720 --> 00:19:46,720
Right.

288
00:19:46,720 --> 00:19:47,720
Developing those.

289
00:19:47,720 --> 00:19:49,520
So I think it's definitely better at birth.

290
00:19:49,520 --> 00:19:53,800
I think the issue is, is the training.

291
00:19:53,800 --> 00:19:59,600
So, you know, those folks are more like structural people.

292
00:19:59,600 --> 00:20:03,680
They're looking at the structure of the tongue and the palate and whatnot.

293
00:20:03,680 --> 00:20:07,840
Whereas a therapist, we're looking at the function of it.

294
00:20:07,840 --> 00:20:13,360
And you really need both for a true diagnosis because I say all the time, I don't care what

295
00:20:13,360 --> 00:20:15,920
your tongue looks like if it works.

296
00:20:15,920 --> 00:20:16,920
Right.

297
00:20:16,920 --> 00:20:23,120
If it's not, if it's not impacting you negatively, then I don't care.

298
00:20:23,120 --> 00:20:28,280
And so, yeah, I think earlier intervention and referrals need to happen.

299
00:20:28,280 --> 00:20:34,520
So if they're seeing signs, you know, a short frenulum attaching closer to the tip of the

300
00:20:34,520 --> 00:20:44,520
tongue, a heart shaped tongue, you know, the high arch palate, mouth breathing, you know,

301
00:20:44,520 --> 00:20:47,920
I think there's like things that are definitely apparent.

302
00:20:47,920 --> 00:20:53,920
Then I think that needs to be an automatic referral to someone that can look at the function

303
00:20:53,920 --> 00:21:00,720
and then kind of figure out what to do because just, you know, going for the surgical intervention

304
00:21:00,720 --> 00:21:05,040
and releasing things doesn't mean it works.

305
00:21:05,040 --> 00:21:06,040
Right.

306
00:21:06,040 --> 00:21:07,040
Right.

307
00:21:07,040 --> 00:21:13,040
Because there's still all the residual that has to be addressed, right, retrained.

308
00:21:13,040 --> 00:21:14,040
Right.

309
00:21:14,040 --> 00:21:15,040
Got it.

310
00:21:15,040 --> 00:21:16,040
Understood.

311
00:21:16,040 --> 00:21:25,320
And circling back, you know, you kind of touched on, especially with new moms, I'll ask, you

312
00:21:25,320 --> 00:21:26,320
know, is there something I could do?

313
00:21:26,320 --> 00:21:28,520
Is there something I could have done differently?

314
00:21:28,520 --> 00:21:29,520
Yeah.

315
00:21:29,520 --> 00:21:37,520
I think, you know, do we, as medical professionals, understand what causes tongue ties?

316
00:21:37,520 --> 00:21:40,120
Are we that far along yet?

317
00:21:40,120 --> 00:21:43,960
Not fully.

318
00:21:43,960 --> 00:21:44,960
We do.

319
00:21:44,960 --> 00:21:50,640
There are several studies that have established that there's a genetic component.

320
00:21:50,640 --> 00:21:51,640
Okay.

321
00:21:51,640 --> 00:21:54,960
So it is inherited.

322
00:21:54,960 --> 00:21:59,640
It is an autosomal dominant trait.

323
00:21:59,640 --> 00:22:08,320
And then also there's some epigenetic components that can determine it.

324
00:22:08,320 --> 00:22:12,720
Very, very preliminary new research.

325
00:22:12,720 --> 00:22:18,320
There was one study that came out during COVID in 2020.

326
00:22:18,320 --> 00:22:23,760
The author, the lead author was Amity, A-M-I-T-A-I.

327
00:22:23,760 --> 00:22:32,360
And it looked at folic acid supplementation during pregnancy and the incidence of ankle

328
00:22:32,360 --> 00:22:33,360
glasia.

329
00:22:33,360 --> 00:22:44,640
And it showed a positive correlation of using folic acid and tongue tie.

330
00:22:44,640 --> 00:22:52,520
And the authors proposed that this reason is because of a genetic mutation, the MTHFR

331
00:22:52,520 --> 00:22:59,720
mutation, and folic acid is a synthetic form of a vitamin.

332
00:22:59,720 --> 00:23:05,520
The synthetic form, people with that mutation have trouble processing.

333
00:23:05,520 --> 00:23:14,040
And so there have been some groups and organizations that are recommending using folate instead

334
00:23:14,040 --> 00:23:15,040
of folic acid.

335
00:23:15,040 --> 00:23:16,040
Instead of, okay.

336
00:23:16,040 --> 00:23:17,040
Right.

337
00:23:17,040 --> 00:23:19,400
And, you know, tongue tie is in the midline.

338
00:23:19,400 --> 00:23:28,160
We take folic acid to reduce things like clefs, finabifida, other midline issues.

339
00:23:28,160 --> 00:23:37,880
And so, yeah, I think we're going to see a lot more information on this as things progress.

340
00:23:37,880 --> 00:23:43,720
But you know, it's a really hard thing to study, I think, because it's happening in

341
00:23:43,720 --> 00:23:44,720
the womb, right?

342
00:23:44,720 --> 00:23:45,720
Right.

343
00:23:45,720 --> 00:23:46,720
And so early.

344
00:23:46,720 --> 00:23:47,720
Yeah.

345
00:23:47,720 --> 00:23:48,720
Yeah.

346
00:23:48,720 --> 00:23:55,160
And so, you know, there are so many factors, you know, that genetic history and then, you

347
00:23:55,160 --> 00:23:59,000
know, potentially diet and things like that.

348
00:23:59,000 --> 00:24:01,400
So I think there's an interplay of factors.

349
00:24:01,400 --> 00:24:02,400
Okay.

350
00:24:02,400 --> 00:24:03,400
Got it.

351
00:24:03,400 --> 00:24:05,560
And I will do my best to find that study.

352
00:24:05,560 --> 00:24:09,520
And I will include that in the show notes as well for people.

353
00:24:09,520 --> 00:24:13,560
And then I personally just want to read it because that sounds pretty fascinating.

354
00:24:13,560 --> 00:24:14,880
Yeah.

355
00:24:14,880 --> 00:24:20,960
So looking at your blog, there were a couple of things that jumped out at me when you were

356
00:24:20,960 --> 00:24:30,120
discussing the myofunctional journey of a child.

357
00:24:30,120 --> 00:24:38,000
Words are worth a thousand pictures and then abolishing the preferred provider title.

358
00:24:38,000 --> 00:24:39,000
Yeah.

359
00:24:39,000 --> 00:24:43,400
And again, obviously there will be links in the show notes because I encourage people

360
00:24:43,400 --> 00:24:48,280
to go read both of these articles, but I'd love to touch on them a little bit here.

361
00:24:48,280 --> 00:24:49,280
Sure.

362
00:24:49,280 --> 00:24:51,280
So let's see.

363
00:24:51,280 --> 00:24:52,280
Yeah.

364
00:24:52,280 --> 00:24:55,040
Words are worth a thousand pictures.

365
00:24:55,040 --> 00:25:01,920
So I think as providers, we need to be very intentional with our words.

366
00:25:01,920 --> 00:25:05,840
What do you mean by that?

367
00:25:05,840 --> 00:25:11,440
Choosing the correct words that are reflective of the process.

368
00:25:11,440 --> 00:25:16,560
The one example is with tongue tie.

369
00:25:16,560 --> 00:25:19,680
A lot of times people are calling it a revision.

370
00:25:19,680 --> 00:25:21,040
All right.

371
00:25:21,040 --> 00:25:25,920
And to most of us, revision means to do again.

372
00:25:25,920 --> 00:25:26,920
Right?

373
00:25:26,920 --> 00:25:27,920
Right.

374
00:25:27,920 --> 00:25:34,360
And a lot of these families are already worried about the tongue tie growing back or reattaching

375
00:25:34,360 --> 00:25:39,800
or they've heard horror stories of a patient that's had to do it three times.

376
00:25:39,800 --> 00:25:48,720
And so I think I call it a release because that conjures an image of releasing tissue.

377
00:25:48,720 --> 00:25:49,720
Right?

378
00:25:49,720 --> 00:25:56,200
And it doesn't give that negative connotation of having to do something again or feed into

379
00:25:56,200 --> 00:25:58,760
those fears.

380
00:25:58,760 --> 00:26:08,160
And so another thing I talk about is instead of talking about pain medication, I talk about

381
00:26:08,160 --> 00:26:09,960
comfort measures.

382
00:26:09,960 --> 00:26:10,960
Right?

383
00:26:10,960 --> 00:26:18,840
It's kind of that psychological standpoint of like we experience what we think.

384
00:26:18,840 --> 00:26:27,000
And so if you're talking about immense pain and whatnot and what to do for that, I think

385
00:26:27,000 --> 00:26:34,040
patients have this negative expectation and they're like prepared for the worst.

386
00:26:34,040 --> 00:26:37,360
Now I don't mean to sugarcoat things by any means.

387
00:26:37,360 --> 00:26:46,720
I'm definitely truthful and transparent with patients, but I think there's, you can definitely

388
00:26:46,720 --> 00:26:50,040
navigate things better with your words.

389
00:26:50,040 --> 00:26:51,040
Okay.

390
00:26:51,040 --> 00:26:54,400
I totally understand that.

391
00:26:54,400 --> 00:26:58,880
And then abolishing the preferred provider title.

392
00:26:58,880 --> 00:26:59,880
Yeah.

393
00:26:59,880 --> 00:27:07,000
So I have to say before you answer this one, this one to me, I loved.

394
00:27:07,000 --> 00:27:10,760
I mean, I got behind this one 100%.

395
00:27:10,760 --> 00:27:11,760
Yeah.

396
00:27:11,760 --> 00:27:13,240
Yeah.

397
00:27:13,240 --> 00:27:19,040
So there was this list years ago.

398
00:27:19,040 --> 00:27:27,920
It's not even like verified or monitored now, but it was essentially a preferred provider

399
00:27:27,920 --> 00:27:29,840
list is what they called it.

400
00:27:29,840 --> 00:27:36,360
And it was parents that had a good experience at Dr. So-and-Sos with a tongue tie release.

401
00:27:36,360 --> 00:27:38,600
And so that person would go on the list.

402
00:27:38,600 --> 00:27:39,600
Right.

403
00:27:39,600 --> 00:27:44,800
And there was really no criteria, no vetting.

404
00:27:44,800 --> 00:27:46,600
It was just anecdotal.

405
00:27:46,600 --> 00:27:48,560
This patient said they were good.

406
00:27:48,560 --> 00:27:49,560
Right?

407
00:27:49,560 --> 00:27:50,560
Right.

408
00:27:50,560 --> 00:27:56,120
And so the other thing that bugs me about this is preferred provider makes me think

409
00:27:56,120 --> 00:28:00,040
of like insurance, like PPO network.

410
00:28:00,040 --> 00:28:01,040
Yes.

411
00:28:01,040 --> 00:28:09,520
And not all providers doing tongue tie releases that are skilled are in network or they may

412
00:28:09,520 --> 00:28:10,720
or may not be.

413
00:28:10,720 --> 00:28:11,720
Right.

414
00:28:11,720 --> 00:28:17,560
And so I don't really use this term that word preferred.

415
00:28:17,560 --> 00:28:18,920
I don't prefer you.

416
00:28:18,920 --> 00:28:22,880
It's either I recommend you or I don't.

417
00:28:22,880 --> 00:28:30,520
And so, yeah, I think a lot of parent groups and Facebook groups have that out there.

418
00:28:30,520 --> 00:28:38,560
And you know, as far as factors deciding on who I recommend for a procedure and who I

419
00:28:38,560 --> 00:28:45,080
don't, I really have conversations with providers and really talk through what's important to

420
00:28:45,080 --> 00:28:50,880
me and my patients, you know, kind of where my philosophy is and kind of see what theirs

421
00:28:50,880 --> 00:28:54,440
is and what their education experience level is.

422
00:28:54,440 --> 00:29:01,040
And so the things that I look for is that they understand that there's multiple types

423
00:29:01,040 --> 00:29:03,320
of ties.

424
00:29:03,320 --> 00:29:05,640
There's just not one presentation.

425
00:29:05,640 --> 00:29:11,680
It's not only, you know, the to the tip heart shaped tongues.

426
00:29:11,680 --> 00:29:17,480
They understand that it can impact lots of things and throughout the lifespan, it's not

427
00:29:17,480 --> 00:29:19,120
just about breastfeeding babies.

428
00:29:19,120 --> 00:29:24,320
It's not just about speech, but it's about the airway and sleep disorder breathing.

429
00:29:24,320 --> 00:29:33,200
And so, you know, how the the dentition comes in and eating and, you know, all the things

430
00:29:33,200 --> 00:29:34,720
that go along with that.

431
00:29:34,720 --> 00:29:39,160
So, understanding kind of the impact that can happen.

432
00:29:39,160 --> 00:29:41,320
If you're going to do a release, do a release.

433
00:29:41,320 --> 00:29:48,040
Let's not clip a hangnail and, you know, put someone through a procedure for an incomplete

434
00:29:48,040 --> 00:29:49,040
release.

435
00:29:49,040 --> 00:29:56,000
And looking at their work and talking through like what does a complete release look like?

436
00:29:56,000 --> 00:29:59,720
And one of the questions I ask providers is how do you know how far to go?

437
00:29:59,720 --> 00:30:00,720
When do you stop?

438
00:30:00,720 --> 00:30:01,960
How do you decide?

439
00:30:01,960 --> 00:30:11,360
You know, if the if they're not stitches place, they understand that something needs

440
00:30:11,360 --> 00:30:13,960
to be done to make sure that heals correctly.

441
00:30:13,960 --> 00:30:19,200
If they don't understand basic wound healing, they shouldn't be doing a procedure.

442
00:30:19,200 --> 00:30:21,200
And then they're right.

443
00:30:21,200 --> 00:30:27,760
They're really a team player and understands that function.

444
00:30:27,760 --> 00:30:33,600
Just because you fix the structure doesn't mean the function is fixed.

445
00:30:33,600 --> 00:30:38,800
And so, you know, really kind of drives home with their patients that, you know, the release

446
00:30:38,800 --> 00:30:43,440
is a part of the journey, not not the whole picture.

447
00:30:43,440 --> 00:30:52,520
And so, you know, supports that evaluation of function and that follow up.

448
00:30:52,520 --> 00:30:58,480
When some of this research is pointing towards genetics for tongue ties.

449
00:30:58,480 --> 00:31:09,760
Again, I get it's early, but does that support the fact do you see tongue ties often in families?

450
00:31:09,760 --> 00:31:17,000
If you see one kid, you know, they have five, maybe two or three of them are likely to have

451
00:31:17,000 --> 00:31:21,080
that or two to three are likely to have some sort of a myofunctional issue that needs to

452
00:31:21,080 --> 00:31:22,080
be addressed.

453
00:31:22,080 --> 00:31:24,280
Is that kind of what you see?

454
00:31:24,280 --> 00:31:26,040
Yes, absolutely.

455
00:31:26,040 --> 00:31:30,240
And honestly, like, that's my practice.

456
00:31:30,240 --> 00:31:35,360
And that's why I treat the lifespan is because these things do run in families.

457
00:31:35,360 --> 00:31:37,880
Very rarely do we only see one family member.

458
00:31:37,880 --> 00:31:46,240
So what happens is, you know, it just depends who enters the system first.

459
00:31:46,240 --> 00:31:49,560
But so I have one family right now.

460
00:31:49,560 --> 00:31:52,640
Two years ago, they were having trouble breastfeeding.

461
00:31:52,640 --> 00:31:58,200
I saw the baby, there was a tongue tie, we did all the things and got that baby to breast

462
00:31:58,200 --> 00:32:01,400
and doing well and gaining weight and whatnot.

463
00:32:01,400 --> 00:32:07,680
So then she the mom says, okay, my husband needs to come.

464
00:32:07,680 --> 00:32:10,360
He snores and he grinds his teeth.

465
00:32:10,360 --> 00:32:15,280
And, you know, because I educated them on how tongue ties shape the airway and, you

466
00:32:15,280 --> 00:32:19,400
know, later on can cause these issues potentially.

467
00:32:19,400 --> 00:32:22,600
And so now he's my patient.

468
00:32:22,600 --> 00:32:28,360
And then yesterday, the mom called and said, Oh, our daughter, you know, her tongue looks

469
00:32:28,360 --> 00:32:32,320
exactly like my husband's or our older daughter.

470
00:32:32,320 --> 00:32:36,600
And she got flagged in school for speech issues.

471
00:32:36,600 --> 00:32:41,760
And so here are all these different presentations in one family.

472
00:32:41,760 --> 00:32:45,080
And so, yeah, oftentimes we do.

473
00:32:45,080 --> 00:32:51,680
You are definitely more likely to have another family member with a tongue tie if you have

474
00:32:51,680 --> 00:32:53,640
one.

475
00:32:53,640 --> 00:32:57,240
And we do have research that says that as well.

476
00:32:57,240 --> 00:33:02,800
Yeah, so it's very interesting.

477
00:33:02,800 --> 00:33:04,040
That is interesting.

478
00:33:04,040 --> 00:33:09,600
I should mention research is also pointing towards excellent patterns of inheritance.

479
00:33:09,600 --> 00:33:13,000
So more common in boys.

480
00:33:13,000 --> 00:33:14,000
So yeah.

481
00:33:14,000 --> 00:33:15,000
Hmm.

482
00:33:15,000 --> 00:33:16,000
Okay.

483
00:33:16,000 --> 00:33:24,600
And is it ever too late to get a tongue tie released?

484
00:33:24,600 --> 00:33:28,160
No, I don't think so ever.

485
00:33:28,160 --> 00:33:31,320
I see patients into their sixties.

486
00:33:31,320 --> 00:33:35,920
And yeah, it's never too late.

487
00:33:35,920 --> 00:33:39,080
It's more of like, you know, we've had it for a longer time.

488
00:33:39,080 --> 00:33:43,720
So oftentimes we have to do more to overcome it.

489
00:33:43,720 --> 00:33:50,640
And because the tongue shapes the palate and the airway and and all of that, sometimes

490
00:33:50,640 --> 00:33:55,560
there's other things involved that we have to do, not just therapy and a tongue tie release.

491
00:33:55,560 --> 00:33:57,760
Sometimes it's orthodontics.

492
00:33:57,760 --> 00:33:59,760
Sometimes it's a jaw surgery.

493
00:33:59,760 --> 00:34:06,520
Sometimes it's getting, you know, tonsils out or a deviated septum fixed.

494
00:34:06,520 --> 00:34:09,960
And so it's just more involved is what I say.

495
00:34:09,960 --> 00:34:13,480
So definitely easier and more straightforward.

496
00:34:13,480 --> 00:34:15,480
The younger young.

497
00:34:15,480 --> 00:34:16,480
Yes.

498
00:34:16,480 --> 00:34:17,480
Right.

499
00:34:17,480 --> 00:34:22,120
Which is which takes us back to that first evaluation at birth actually opening the

500
00:34:22,120 --> 00:34:23,120
mouth.

501
00:34:23,120 --> 00:34:24,720
I know it's wild.

502
00:34:24,720 --> 00:34:31,040
I've even, you know, I've even had kids that are having trouble feeding and I'm the one

503
00:34:31,040 --> 00:34:33,240
to discover a cleft.

504
00:34:33,240 --> 00:34:34,240
Wow.

505
00:34:34,240 --> 00:34:35,640
Are you kidding me?

506
00:34:35,640 --> 00:34:42,840
Like how many how many providers have have supposed to look in this child's mouth, you

507
00:34:42,840 --> 00:34:43,840
know?

508
00:34:43,840 --> 00:34:47,560
And here we are, you know, a few weeks later.

509
00:34:47,560 --> 00:34:50,480
And yeah, it's it's wild.

510
00:34:50,480 --> 00:34:57,560
And I think it definitely comes back to like training and absolutely education, training

511
00:34:57,560 --> 00:35:04,680
and one of the other things that we're huge advocates for community focused, right?

512
00:35:04,680 --> 00:35:09,760
Kind of back to the preferred provider from a different light from the insurance perspective.

513
00:35:09,760 --> 00:35:18,720
You might have a pediatrician, but that pediatrician also works with this gamut of a team, you know,

514
00:35:18,720 --> 00:35:22,520
that does include your airway centric dentists, your myofunctional therapist.

515
00:35:22,520 --> 00:35:28,400
There's so many others that from for me, part of one of the things that that article you

516
00:35:28,400 --> 00:35:32,480
wrote sparked was the preferred provider in that term.

517
00:35:32,480 --> 00:35:38,520
It's to me, there's this shift that needs to be taking place so that, you know, the

518
00:35:38,520 --> 00:35:41,960
people that are trained can get together and talk to each other and oh, here's what I found

519
00:35:41,960 --> 00:35:42,960
and oh, here's this.

520
00:35:42,960 --> 00:35:46,520
And, you know, so we're looking at the child holistically.

521
00:35:46,520 --> 00:35:47,520
Right.

522
00:35:47,520 --> 00:35:54,960
And I think there's so many challenges to that because of, you know, insurance and reimbursement

523
00:35:54,960 --> 00:36:01,240
and, you know, there are very few private pediatric practices, right?

524
00:36:01,240 --> 00:36:05,000
Because they've all been kind of taken over by the hospital systems.

525
00:36:05,000 --> 00:36:12,800
And a lot of the hospital systems have policies that you have to refer in-house and in their

526
00:36:12,800 --> 00:36:19,520
system instead of and I just think that's terrible because that's, you know, my job is

527
00:36:19,520 --> 00:36:24,920
to refer to the best person for your patient, right?

528
00:36:24,920 --> 00:36:29,640
Whether they're in a system, out of the system, in network, out of the network, whatever it

529
00:36:29,640 --> 00:36:35,080
is, that's, you know, my job is to utmost care the patient.

530
00:36:35,080 --> 00:36:42,560
And so, yeah, I think that's some of the barriers to developing that community as well.

531
00:36:42,560 --> 00:36:47,840
And that's, well, kind of with that in mind then, how do you guide parents to bridge that

532
00:36:47,840 --> 00:36:48,840
gap?

533
00:36:48,840 --> 00:36:51,360
Yeah, yeah.

534
00:36:51,360 --> 00:36:54,200
And I think they already are.

535
00:36:54,200 --> 00:37:00,360
You know, I think talking on some of the groups, the Facebook groups and support groups and

536
00:37:00,360 --> 00:37:08,320
things like that, a resource that I have for families, I have a directory on my website.

537
00:37:08,320 --> 00:37:15,200
And so, instead of taking your chances with, you know, a random dentist or a random speech

538
00:37:15,200 --> 00:37:22,800
therapist, go look on that directory, type in your state or your area and see who's on

539
00:37:22,800 --> 00:37:24,120
there near you.

540
00:37:24,120 --> 00:37:31,720
At least you know they have knowledge of tongue ties, you know, and it's a little less going

541
00:37:31,720 --> 00:37:33,160
in blind.

542
00:37:33,160 --> 00:37:39,360
And so, I think, yeah, doing some of the research, things like this podcast is really

543
00:37:39,360 --> 00:37:42,720
cool and, you know, reach out to us.

544
00:37:42,720 --> 00:37:47,280
I get messages every day on Facebook, Instagram.

545
00:37:47,280 --> 00:37:51,000
Hey, do you know a therapist in my area?

546
00:37:51,000 --> 00:37:55,960
Hey, you know, do you know an ENT in my area?

547
00:37:55,960 --> 00:38:00,480
You know, who should I see first for this issue?

548
00:38:00,480 --> 00:38:01,480
Things like that.

549
00:38:01,480 --> 00:38:06,000
Usually, if I don't know anybody, I can find someone who does.

550
00:38:06,000 --> 00:38:07,000
Awesome.

551
00:38:07,000 --> 00:38:11,400
That is awesome.

552
00:38:11,400 --> 00:38:19,960
What I'd like to just kind of open the floor at this point for you.

553
00:38:19,960 --> 00:38:24,400
Speaking to parents or to medical professionals, what at this point, kind of where we are with

554
00:38:24,400 --> 00:38:30,840
tongue ties, what we know about them, where we need to go as far as, you know, to do the

555
00:38:30,840 --> 00:38:33,360
best for children?

556
00:38:33,360 --> 00:38:34,480
What would you like to say?

557
00:38:34,480 --> 00:38:37,960
What would your final thoughts be?

558
00:38:37,960 --> 00:38:46,440
I am really about creating a standard of care because there is lots of controversy and one

559
00:38:46,440 --> 00:38:49,920
provider says this and another provider says that.

560
00:38:49,920 --> 00:38:59,280
So I think, you know, more well done research can help us there and really bridging the

561
00:38:59,280 --> 00:39:05,680
medical structural and the functional communities.

562
00:39:05,680 --> 00:39:13,320
Like I said, like it really needs to be a co-diagnosis and, you know, in other fields,

563
00:39:13,320 --> 00:39:20,240
orthopedic surgery, they don't do knee replacements without prescribing physical therapy.

564
00:39:20,240 --> 00:39:28,120
Why is that different for the mouse and something that is so musculature, so much, so much musculature

565
00:39:28,120 --> 00:39:29,760
is involved.

566
00:39:29,760 --> 00:39:37,720
And so, you know, I think, yeah, I think that's where I would like to see it go.

567
00:39:37,720 --> 00:39:46,400
A lot more collaboration and, yeah, emphasis on both roles and components.

568
00:39:46,400 --> 00:39:47,400
Awesome.

569
00:39:47,400 --> 00:39:48,400
Awesome.

570
00:39:48,400 --> 00:39:51,480
Well, I absolutely appreciate your time this afternoon.

571
00:39:51,480 --> 00:39:52,680
Thank you so much.

572
00:39:52,680 --> 00:39:53,680
Yeah.

573
00:39:53,680 --> 00:39:54,680
This was great.

574
00:39:54,680 --> 00:40:01,400
And, yeah, I'm excited about Children's Airway First Foundation and all that you guys are

575
00:40:01,400 --> 00:40:07,120
doing and, you know, this is a key component to that advocacy.

576
00:40:07,120 --> 00:40:08,120
It is.

577
00:40:08,120 --> 00:40:09,120
Absolutely.

578
00:40:09,120 --> 00:40:10,120
Thanks.

579
00:40:10,120 --> 00:40:14,400
Thanks so much to today's guest, Autumn Henning, for sharing her medical insight and to each

580
00:40:14,400 --> 00:40:17,280
of you for listening to today's episode.

581
00:40:17,280 --> 00:40:20,600
If you're new to our podcast, please don't forget to subscribe.

582
00:40:20,600 --> 00:40:25,120
And if you enjoyed today's episode, please remember to leave a review or a comment about

583
00:40:25,120 --> 00:40:26,960
what you enjoyed most.

584
00:40:26,960 --> 00:40:30,960
You can stay connected with the Children's Airway First Foundation by following us on

585
00:40:30,960 --> 00:40:34,760
Instagram, Facebook, Twitter, and LinkedIn.

586
00:40:34,760 --> 00:40:38,960
If you'd like to be a guest on an upcoming episode, shoot us a note via our contacts

587
00:40:38,960 --> 00:40:46,840
page on our website or send us an email directly at info at childrensairwayfirst.org.

588
00:40:46,840 --> 00:40:51,200
And finally, thanks to all the parents and medical professionals out there that are working

589
00:40:51,200 --> 00:40:55,600
to help make the lives of kids around the globe just a little bit better.

590
00:40:55,600 --> 00:41:24,600
Take care, stay safe, and happy breathing, everyone.