WEBVTT 1 00:00:00.720 --> 00:00:03.720 Hi, this is Sue Ludwig, president and founder of NANT. 2 00:00:03.800 --> 00:00:06.800 Thank you for investing your time in this educational offering. 3 00:00:07.240 --> 00:00:10.240 We hope it positively impacts the babies and families 4 00:00:10.240 --> 00:00:13.240 you serve and the colleagues with whom you collaborate. 5 00:00:13.400 --> 00:00:16.400 Enjoy. 6 00:00:21.880 --> 00:00:24.720 Hi, I'm Amber Valentine Forston, and I'm one of the speech 7 00:00:24.720 --> 00:00:27.720 pathologist at Baptist Health Lexington in Lexington, Kentucky. 8 00:00:28.000 --> 00:00:31.800 And we're going to talk a little bit today about like, what's new in tongue ties 9 00:00:31.800 --> 00:00:34.520 and how that impacts feeding and swallowing. 10 00:00:34.520 --> 00:00:37.880 Obviously, most everybody listening to this is probably going to be in the NICU 11 00:00:37.880 --> 00:00:39.000 and in that population. 12 00:00:39.000 --> 00:00:43.080 So just as kind of a sidebar, we'll talk a little bit 13 00:00:43.080 --> 00:00:46.800 about how that impacts feeding in the neonatal population 14 00:00:46.800 --> 00:00:50.320 and some of the things that you may or may not see as interventions. 15 00:00:50.320 --> 00:00:53.680 You know, while the still in the acute versus after discharge, 16 00:00:55.640 --> 00:00:57.800 I'm employed by Baptist Health Lexington, as I said, 17 00:00:57.800 --> 00:01:00.800 and I have no other financial and non-financial disclosures. 18 00:01:02.360 --> 00:01:04.760 So this is just looking at our objectives today, kind of what 19 00:01:04.760 --> 00:01:08.240 we're going to go over looking at different classes or types of ties, 20 00:01:08.560 --> 00:01:10.840 how we would differentiate old and new practice 21 00:01:10.840 --> 00:01:14.600 related to oral restrictions, and looking at ways that as therapist, 22 00:01:14.600 --> 00:01:18.360 we can not only see how they impact feeding and swallowing, 23 00:01:18.360 --> 00:01:19.760 in this population and beyond, 24 00:01:19.760 --> 00:01:24.040 but also, you know, how we can help or mediate that and help with strategies 25 00:01:24.040 --> 00:01:27.160 and so forth and work with our patients and families along this journey. 26 00:01:28.280 --> 00:01:30.440 And then just as another sidebar, 27 00:01:30.440 --> 00:01:34.480 this is not a presentation that's supposed to say, yes, tie release. 28 00:01:34.480 --> 00:01:37.320 No, don't tie release. That's not really what I'm going for here. 29 00:01:37.320 --> 00:01:40.560 When we looked at like building this specific presentation, 30 00:01:40.560 --> 00:01:42.040 it was more like, hey, there's a lot of stuff 31 00:01:42.040 --> 00:01:43.920 that's changed in the last several years. 32 00:01:43.920 --> 00:01:44.760 And we used to kind of 33 00:01:44.760 --> 00:01:48.000 look at this direction, and now we're leaning more towards this 34 00:01:48.000 --> 00:01:50.440 and definitely working as an interdisciplinary team 35 00:01:50.440 --> 00:01:52.680 to help with these feeding and swallowing issues. 36 00:01:52.680 --> 00:01:55.600 So this whole presentation isn't a selling point one way or the other. 37 00:01:55.600 --> 00:01:57.600 It's more like, let's get information out there 38 00:01:57.600 --> 00:02:00.880 so that people can be educated and that we as therapists can continue 39 00:02:00.880 --> 00:02:04.680 educating other practitioners, such as pediatricians and neonatologist 40 00:02:04.680 --> 00:02:07.760 and families and nurse practitioners and, you know, and on down the line. 41 00:02:07.760 --> 00:02:11.080 So anyway, now what we're going to look at is a little bit about trends. 42 00:02:11.360 --> 00:02:13.320 And this is what you'll see in social media. 43 00:02:13.320 --> 00:02:16.560 And this is what you'll see throughout a mixed bag of research. 44 00:02:17.000 --> 00:02:19.400 And you'll kind of see as you go through this presentation 45 00:02:19.400 --> 00:02:22.560 to I've kind of pulled data from from other disciplines, 46 00:02:22.560 --> 00:02:23.400 not just disciplines 47 00:02:23.400 --> 00:02:26.880 from speech pathology, because obviously that's that's my home base. 48 00:02:27.240 --> 00:02:31.360 But we have to look at dental research and we have to look at EMT research, 49 00:02:31.360 --> 00:02:32.880 and we have to look at pulmonary research. 50 00:02:32.880 --> 00:02:35.680 And we're looking at all these pieces and putting them together. 51 00:02:35.680 --> 00:02:38.440 So the biggest question is why are we talking about it right now. 52 00:02:38.440 --> 00:02:41.280 Well when we look at this it looks astronomical. 53 00:02:41.280 --> 00:02:44.280 834% increase in diagnosis, 54 00:02:44.560 --> 00:02:47.920 866% increase in for activities or for not images. 55 00:02:47.960 --> 00:02:49.640 So that looks that looks huge. 56 00:02:49.640 --> 00:02:50.880 And so what it looks like 57 00:02:50.880 --> 00:02:54.080 from the outside looking in is oh, why is this change so much? 58 00:02:54.080 --> 00:02:56.080 Why all of a sudden are we doing all these? 59 00:02:56.080 --> 00:02:57.720 And then at the end of this presentation, 60 00:02:57.720 --> 00:03:00.240 you actually see, I have the New York Times article posted. 61 00:03:00.240 --> 00:03:03.240 You'll see a lot of bad rep too, because then what happens 62 00:03:03.240 --> 00:03:06.240 is it looks like this whole like feedback loop, this whole money game. 63 00:03:06.320 --> 00:03:07.440 And what we need to look at is 64 00:03:07.440 --> 00:03:11.080 we need to dig into the research and see why we're having such a change. 65 00:03:11.840 --> 00:03:15.520 And so when we look at potential outcomes, these are national and global efforts 66 00:03:15.520 --> 00:03:17.000 to support breastfeeding. 67 00:03:17.000 --> 00:03:19.320 There's a lot of increased awareness on oral restrictions. 68 00:03:19.320 --> 00:03:21.960 Like obviously with everything in medicine it's evolutionary. 69 00:03:21.960 --> 00:03:23.200 So things continue to change. 70 00:03:23.200 --> 00:03:26.120 Thank goodness I do not practice like I did 20 years ago. 71 00:03:26.120 --> 00:03:29.120 We would still be doing a lot of things that we definitely were not doing. 72 00:03:29.480 --> 00:03:32.040 I think now because of this, we have earlier diagnoses 73 00:03:32.040 --> 00:03:35.120 and treatments of these issues, especially when we look at breastfeeding. 74 00:03:35.120 --> 00:03:39.400 But I will say as a practitioner, I see equally as many bottle feeding babies 75 00:03:39.400 --> 00:03:43.000 who have may or may not have difficulties because of their oral restrictions. 76 00:03:43.560 --> 00:03:44.760 And then we might. 77 00:03:48.040 --> 00:03:50.400 Have access to 78 00:03:50.400 --> 00:03:52.880 more lactation services or more lactation support. 79 00:03:52.880 --> 00:03:55.760 And then AQ, for example, if that's where we're practicing. 80 00:03:55.760 --> 00:03:58.200 So kind of looking at these things and seeing how 81 00:03:58.200 --> 00:04:01.360 how we're digging through it, if you will, this. 82 00:04:01.360 --> 00:04:04.360 So this was a schematic that an old colleague of mine put up. 83 00:04:05.080 --> 00:04:07.640 And she what she was doing is looking at breastfeeding rates 84 00:04:07.640 --> 00:04:10.000 throughout, you know, the last 100 plus years 85 00:04:10.000 --> 00:04:13.320 and kind of seeing how things have changed and why we're seeing such an impact 86 00:04:13.320 --> 00:04:14.600 and change in feeding rates. 87 00:04:14.600 --> 00:04:18.120 So if you look at, you know, like in 1910 to a little over a hundred years ago, 88 00:04:18.240 --> 00:04:19.600 we had 100% breastfeeding rate. 89 00:04:19.600 --> 00:04:21.480 Everybody breastfed. That's what they did. 90 00:04:21.480 --> 00:04:22.960 And if they didn't, you know, 91 00:04:22.960 --> 00:04:26.880 what they were doing was wet nursing or something like that to that effect. 92 00:04:27.200 --> 00:04:30.800 And so we look at the changes, what happened is when formula was invented 93 00:04:30.800 --> 00:04:36.480 and then how that impacted the status quo of breastfeeding and infant 94 00:04:36.480 --> 00:04:41.360 feeding throughout, you know, that 100 years prior or, that succeeded that. 95 00:04:41.360 --> 00:04:44.480 So when you look at all the way up to 1983, 96 00:04:44.480 --> 00:04:48.000 which was after I was born, we looked at 22%. 97 00:04:48.200 --> 00:04:51.200 So when I was, you know, an infant and when my, 98 00:04:51.360 --> 00:04:54.240 my sibling was born, nobody was breastfeeding. 99 00:04:54.240 --> 00:04:57.080 So these rates had dramatically dropped because we were looking 100 00:04:57.080 --> 00:05:00.120 at a push of a generation of mothers who had gone to work. 101 00:05:00.360 --> 00:05:04.080 And so they were not at home exclusively at risk for feeding their babies. 102 00:05:04.840 --> 00:05:07.480 And then when we look all the way up into the 90s and today, 103 00:05:07.480 --> 00:05:10.360 there's lots of changes in research that's being done about the difference 104 00:05:10.360 --> 00:05:12.400 in breast and bottle feeding and so forth. 105 00:05:12.400 --> 00:05:15.480 And I think what we're looking at is when you look at standards of care, 106 00:05:15.480 --> 00:05:18.840 you know, if you're a hospital facility that works on joint commission standards 107 00:05:18.840 --> 00:05:22.680 or whatever, you know, governing standards that you have, they're really looking at 108 00:05:22.680 --> 00:05:26.840 inclusionary rates of breastfeeding, at least some breastfeeding at like 80%. 109 00:05:27.720 --> 00:05:28.160 And I know 110 00:05:28.160 --> 00:05:31.360 a lot of people don't meet those criteria and we don't at any given time. 111 00:05:31.360 --> 00:05:33.120 But what we're looking at is that's the reason 112 00:05:33.120 --> 00:05:36.400 why some of these things have ebbed and flowed throughout the years 113 00:05:36.600 --> 00:05:40.680 is because of this change in, formula, invention, marketing and formula. 114 00:05:40.680 --> 00:05:43.880 And obviously we all know that work in the Nikkie or, or even an outpatient 115 00:05:43.880 --> 00:05:47.080 feeding that the formula is often very times necessary. 116 00:05:47.080 --> 00:05:50.080 But this is some of the reasons why this stuff has changed. 117 00:05:50.240 --> 00:05:54.400 With a rise in breastfeeding rates comes a new rise in problems that can occur. 118 00:05:54.400 --> 00:05:57.400 And now we have this like, you know, lactation field 119 00:05:57.400 --> 00:05:59.560 that support those things. So this is kind of gives 120 00:05:59.560 --> 00:06:01.920 you a nice demonstration about how things have changed. 121 00:06:03.400 --> 00:06:05.720 So it looks like we're treating more time. 122 00:06:05.720 --> 00:06:08.120 Essentially the bottom line of it. 123 00:06:08.120 --> 00:06:11.120 Why why is that changed breastfeeding or feeding expectations. 124 00:06:11.120 --> 00:06:11.840 Have they changed. 125 00:06:11.840 --> 00:06:14.840 We've always wanted to have babies be successful feeders. 126 00:06:14.920 --> 00:06:16.080 But what has changed? 127 00:06:16.080 --> 00:06:18.240 Is it just these governing bodies that we want, 128 00:06:18.240 --> 00:06:21.320 you know, we want more rules and regulations and pressed on people, 129 00:06:21.320 --> 00:06:24.600 or is it that people are being educated more now that they can do 130 00:06:24.600 --> 00:06:27.600 things like work and breastfeed your baby? 131 00:06:27.760 --> 00:06:30.560 Looking at opinions of different providers and patients, 132 00:06:30.560 --> 00:06:35.080 you know, I think there's still like large populations of cultures that either 133 00:06:35.080 --> 00:06:38.400 strictly breastfeed or haven't because they haven't been educated on it. 134 00:06:38.400 --> 00:06:41.760 And it's just, you know, there's pockets of areas that as therapists 135 00:06:41.760 --> 00:06:44.760 and providers, we can also continue to spread that 136 00:06:44.800 --> 00:06:48.720 about how things can be successful with proper education and resources. 137 00:06:49.360 --> 00:06:52.760 When we really look at why we're treating more Thais from the emotional standpoint, 138 00:06:53.400 --> 00:06:57.160 as therapist, we tend to spend a lot of time 139 00:06:57.160 --> 00:06:57.960 with our families, 140 00:06:57.960 --> 00:07:00.640 and oftentimes we get to know them better than other providers 141 00:07:00.640 --> 00:07:02.320 because we're with them day in and day out. 142 00:07:02.320 --> 00:07:03.840 You know, if you look kind of holistically, 143 00:07:03.840 --> 00:07:06.360 most therapists will tend to work like, you know, 144 00:07:06.360 --> 00:07:09.360 I work for tens or people will work five eights or something like that. 145 00:07:09.360 --> 00:07:12.360 So we do tend to spend a lot of time with our patients and families. 146 00:07:12.480 --> 00:07:16.840 So we get very in tune with these things like anxiety and anger and disappointment 147 00:07:17.080 --> 00:07:22.280 about not being able to breastfeed or it's not working the way maybe a family 148 00:07:22.280 --> 00:07:25.440 thought it would, or it's a milk supply or it's hurting 149 00:07:25.440 --> 00:07:28.160 or they don't have the resources, whatever. 150 00:07:28.160 --> 00:07:30.960 So there's also emotional ties there that I know my colleague 151 00:07:30.960 --> 00:07:35.040 and I specifically see in outpatient, but also in the you that kind of like, 152 00:07:35.920 --> 00:07:38.320 you know, dances around these things 153 00:07:38.320 --> 00:07:41.320 again, global problem, not just regional, local, any of those things. 154 00:07:41.320 --> 00:07:45.000 This looks at like internationally how these things impact feeding. 155 00:07:45.000 --> 00:07:47.640 There's lots and lots of things that talk about. 156 00:07:47.640 --> 00:07:50.360 I know, for example, in Australia, I spoke to a provider there 157 00:07:50.360 --> 00:07:52.440 at a conference once, and she said, 158 00:07:52.440 --> 00:07:55.680 why is everybody not getting releases like for them, the general practice 159 00:07:55.680 --> 00:07:58.920 is that babies who are identified with having or restrict and that's 160 00:07:58.920 --> 00:08:02.240 impacting feeding would just go straight to releases. 161 00:08:02.240 --> 00:08:04.280 This is like in the neonatal ICU. 162 00:08:04.280 --> 00:08:05.880 And that's definitely something that I know for 163 00:08:05.880 --> 00:08:07.560 our facility it's not happening. 164 00:08:07.560 --> 00:08:11.880 But just looking at like it's not just your local issue, so to speak. 165 00:08:12.200 --> 00:08:15.960 Looking at oxygen, a family, resources, time, money, energy. 166 00:08:15.960 --> 00:08:18.240 Again, this goes back to this like back feed loop. 167 00:08:18.240 --> 00:08:20.080 And why are all these things being asked? 168 00:08:20.080 --> 00:08:22.080 Why isn't it just a quick snip and so forth? 169 00:08:22.080 --> 00:08:25.800 So that's kind of where this presentation kind of breathed life into it, 170 00:08:25.800 --> 00:08:26.720 if you will. 171 00:08:26.720 --> 00:08:29.680 And then so much information out there. 172 00:08:29.680 --> 00:08:33.640 And as a family, I can't imagine how hard that is to wade through 173 00:08:33.840 --> 00:08:36.400 when you've got pure circles and social media 174 00:08:36.400 --> 00:08:38.800 and different professional opinions and preferences, 175 00:08:38.800 --> 00:08:40.120 and then you've got grandma 176 00:08:40.120 --> 00:08:44.040 and and cousin and, and maybe even inside the provider group 177 00:08:44.040 --> 00:08:46.440 that these families are working with that have different opinions. 178 00:08:46.440 --> 00:08:48.760 So it's all very hard to put those pieces together, 179 00:08:48.760 --> 00:08:50.960 especially when you're already exhausted and overwhelmed. 180 00:08:52.880 --> 00:08:55.280 So again, some things haven't changed. 181 00:08:55.280 --> 00:08:57.040 Restrictions. This is what they are. 182 00:08:57.040 --> 00:08:59.000 So just the next little bit of this presentation, 183 00:08:59.000 --> 00:09:00.200 we'll just go through the basics. 184 00:09:00.200 --> 00:09:03.200 This is one thing for me as a provider because this is something probably like 185 00:09:03.200 --> 00:09:06.520 five years ago, even I didn't know that I necessarily felt passionate about. 186 00:09:06.720 --> 00:09:09.240 It definitely was rearing its ugly head and why people weren't 187 00:09:09.240 --> 00:09:12.640 having success and feeling not just in the nick, but outside of it. 188 00:09:13.080 --> 00:09:16.920 So I kind of was self educating a little bit, 189 00:09:16.920 --> 00:09:19.080 digging through the literature and kind of seeing what was going on. 190 00:09:19.080 --> 00:09:21.120 And there's just certain things that haven't changed. 191 00:09:21.120 --> 00:09:24.120 The biggest thing that I noticed, though, is how people classify it. 192 00:09:24.280 --> 00:09:29.200 So I've seen very, very commonly you'll see moderate, severe, mild. 193 00:09:29.200 --> 00:09:32.200 And in my head I'm thinking, what are you basing that on? 194 00:09:32.400 --> 00:09:35.760 Because if we're basing a mild, moderate severe on just anatomy, 195 00:09:35.760 --> 00:09:40.080 like just a quick oral Mac, then that's not how you classify this. 196 00:09:40.480 --> 00:09:42.920 So we'll go through these slides and kind of look at class 197 00:09:42.920 --> 00:09:44.400 classifications of tides. 198 00:09:44.400 --> 00:09:46.760 And then we can talk more about what the impact looks like. 199 00:09:49.360 --> 00:09:50.680 So tongue tie crazy. 200 00:09:50.680 --> 00:09:52.800 Here we go. So this is Doctor Larry Cottesloe. 201 00:09:52.800 --> 00:09:54.000 He is a dentist. 202 00:09:54.000 --> 00:09:56.720 And it works very very heavily in the oral restriction world. 203 00:09:56.720 --> 00:09:59.120 If you kind of are just looking out there generically, 204 00:09:59.120 --> 00:10:02.120 you can find loads and loads of research on his website. 205 00:10:02.120 --> 00:10:04.960 He has lots of pictures and diagrams and stuff like that. 206 00:10:04.960 --> 00:10:06.320 I think pictures help people 207 00:10:06.320 --> 00:10:07.200 because when we have this 208 00:10:07.200 --> 00:10:10.600 visual demonstration, sometimes it's much easier to explain things. 209 00:10:11.000 --> 00:10:15.240 So he just talks about restrictions specifically on placement of the 210 00:10:15.240 --> 00:10:15.720 for freedom. 211 00:10:15.720 --> 00:10:18.960 So explain to families very frequently no matter what, you know, area. 212 00:10:18.960 --> 00:10:21.320 I'm working in everybody has a for a film. 213 00:10:21.320 --> 00:10:23.920 But it's also it's supposed to be there. 214 00:10:23.920 --> 00:10:25.480 But what we're looking at is placement 215 00:10:25.480 --> 00:10:28.880 of the pharyngeal to the end to, to the, to the tongue. 216 00:10:29.240 --> 00:10:33.480 And so he breaks it down in class one, class two, class three, and class four. 217 00:10:33.840 --> 00:10:36.000 The class ones are very easily identifiable. 218 00:10:36.000 --> 00:10:37.360 These are the ones that pediatricians 219 00:10:37.360 --> 00:10:39.120 are going to be like, oh yeah, that baby's got a tongue tie. 220 00:10:39.120 --> 00:10:40.360 And you're going to see that in a chart. 221 00:10:40.360 --> 00:10:42.000 You know, you're going to have nursing staff 222 00:10:42.000 --> 00:10:44.680 that maybe aren't as familiar be like, yeah, that baby's tied. 223 00:10:44.680 --> 00:10:46.320 You know, kind of what are we looking at? 224 00:10:46.320 --> 00:10:49.160 So this is the one that people aren't typically going to miss. 225 00:10:49.160 --> 00:10:51.440 It's to the tip. It's that traditional heart shape. 226 00:10:51.440 --> 00:10:53.440 If you Google Tongue type, that's what you're going to pull up 227 00:10:54.560 --> 00:10:55.440 very frequently. 228 00:10:55.440 --> 00:10:56.960 I will still hear it. They'll grow out of it. 229 00:10:56.960 --> 00:10:59.760 That'll stretch. They'll this, this. So we don't know. 230 00:10:59.760 --> 00:11:03.280 And you know, again I tell family very frequently I don't have a crystal ball. 231 00:11:03.280 --> 00:11:04.760 I don't know what's going to happen. 232 00:11:04.760 --> 00:11:07.760 But one of the things that I try to like lead with on the caveat, 233 00:11:07.800 --> 00:11:11.760 especially with these like anterior to the tip, could they have 234 00:11:11.760 --> 00:11:15.080 speech problems potentially could they have speech problems anyway? 235 00:11:15.120 --> 00:11:16.520 I don't know those things. 236 00:11:16.520 --> 00:11:17.720 You know, all I can do is give them 237 00:11:17.720 --> 00:11:19.320 these are the sounds that this might impact 238 00:11:19.320 --> 00:11:21.760 because of reduced movement of the tip of the tongue 239 00:11:21.760 --> 00:11:25.360 and kind of give them not just in the oral anatomy part, but show them what I'm 240 00:11:25.360 --> 00:11:25.800 looking for. 241 00:11:25.800 --> 00:11:28.680 As far as the physiology, we want to look at function. 242 00:11:28.680 --> 00:11:31.440 That's what all of this boils down to is function. 243 00:11:31.440 --> 00:11:34.920 Class two just means that tip that for a limb is a little bit 244 00:11:34.920 --> 00:11:36.080 further back in the tip. 245 00:11:36.080 --> 00:11:38.840 There's a couple other diagrams that do it in millimeters. 246 00:11:38.840 --> 00:11:41.120 I don't know about you guys, but no, I'm not in there 247 00:11:41.120 --> 00:11:43.720 like looking at millimeters on a tiny baby's tongue. 248 00:11:43.720 --> 00:11:44.520 But that's what it means. 249 00:11:44.520 --> 00:11:45.920 It's a little bit further back from the tip, 250 00:11:45.920 --> 00:11:49.600 but you might also have restriction at movement class three to me. 251 00:11:50.000 --> 00:11:54.360 And these class three and four actually probably aren't the most, controversial. 252 00:11:54.720 --> 00:11:57.120 When I see a baby with a class three tie and just like 253 00:11:58.400 --> 00:12:01.040 because it's one of those things that it's always going to get missed, 254 00:12:01.040 --> 00:12:02.400 it looks very normal. 255 00:12:02.400 --> 00:12:05.880 Normal, you know, functional if you will, because it just looks like a tongue. 256 00:12:06.360 --> 00:12:10.160 So again, this is where as practitioners, we have to get into function and how 257 00:12:10.160 --> 00:12:13.440 it's impacting feeding and swallowing and in any other realm of the baby. 258 00:12:14.000 --> 00:12:16.240 And then the class for this posterior type, 259 00:12:16.240 --> 00:12:18.600 there's, there is loads of this research 260 00:12:18.600 --> 00:12:21.600 that goes all over the place about these post posterior ties. 261 00:12:21.600 --> 00:12:23.160 I've even had SLPs 262 00:12:23.160 --> 00:12:26.120 reach out to me and say, let me send you this picture of this baby. 263 00:12:26.120 --> 00:12:29.360 They don't have a formula at all, and it's just because they weren't educated. 264 00:12:29.400 --> 00:12:30.920 And what some of this looked like. 265 00:12:30.920 --> 00:12:33.160 So this is the one that's really, really tricky. 266 00:12:33.160 --> 00:12:35.720 Is these like class for posterior tie kids. 267 00:12:37.400 --> 00:12:38.640 So this just goes through it. 268 00:12:38.640 --> 00:12:40.680 Again some of these are just meant for references. 269 00:12:40.680 --> 00:12:41.800 Because sometimes it's easier 270 00:12:41.800 --> 00:12:43.920 to explain to families, especially if they've been like, 271 00:12:43.920 --> 00:12:47.400 well, they said it wasn't very significant or they said it was just mild. 272 00:12:47.720 --> 00:12:49.200 What does that mean? 273 00:12:49.200 --> 00:12:50.600 And so if you can, as a practitioner, 274 00:12:50.600 --> 00:12:52.720 explain it to families, this is what we're looking for. 275 00:12:52.720 --> 00:12:55.200 And these are the symptoms that we're looking for that 276 00:12:55.200 --> 00:12:58.280 of sometimes kind of like helps make things make a little bit more sense. 277 00:12:59.320 --> 00:13:01.560 The class four essentially is against the base of the tongue 278 00:13:01.560 --> 00:13:04.320 thick, shiny, very inelastic, limited movement. 279 00:13:04.320 --> 00:13:07.160 The biggest thing is I see a lot of limited posterior movement, 280 00:13:07.160 --> 00:13:08.280 which makes sense. 281 00:13:08.280 --> 00:13:11.120 So oftentimes you don't see the back of the tongue moving a lot. 282 00:13:11.120 --> 00:13:14.120 So if you look at feeding and swallowing mechanisms, if you can't 283 00:13:14.280 --> 00:13:16.760 control the back of the tongue, you can't control the bolus flow. 284 00:13:17.760 --> 00:13:18.840 So we'll get into it a little bit. 285 00:13:18.840 --> 00:13:21.520 But we look a lot about symptoms of coughing and choking, 286 00:13:21.520 --> 00:13:23.960 popping off the breast, clicking on the bottle. 287 00:13:23.960 --> 00:13:27.960 These are things that you might see in those, type three class three 288 00:13:27.960 --> 00:13:30.960 and four babies that symptomatic are coming up 289 00:13:30.960 --> 00:13:32.480 and families are like, but they're gaining weight. 290 00:13:32.480 --> 00:13:34.680 They're doing this sometimes, sometimes they're not. 291 00:13:34.680 --> 00:13:36.000 But so that might be what you see. 292 00:13:36.000 --> 00:13:38.720 If you can't move the posterior part of the tongue, what can't you do? 293 00:13:38.720 --> 00:13:41.320 You can't control the bolus because that's how we control the bolus. 294 00:13:41.320 --> 00:13:44.320 To send it a posterior into the pharyngeal cavity. 295 00:13:45.400 --> 00:13:47.680 Again, these are just, different demonstrations. 296 00:13:47.680 --> 00:13:49.720 So it gives you a better idea of what they look like. 297 00:13:49.720 --> 00:13:52.840 I feel like people seeing pictures really hits home. 298 00:13:53.200 --> 00:13:57.600 On the type two, you might not see as much of a heart shape presentation, 299 00:13:57.600 --> 00:13:58.880 but you might still see a dimple. 300 00:13:58.880 --> 00:14:01.880 And even in a three, you might still see a dimple in the tip of the tongue. 301 00:14:01.880 --> 00:14:04.040 That's often a good indicator for people. 302 00:14:04.040 --> 00:14:08.520 Really, honestly, put this in just as a caveat to say this, 303 00:14:08.520 --> 00:14:13.560 like classified as a borderline posterior type, just using words like severity 304 00:14:13.560 --> 00:14:14.480 and borderline and stuff, 305 00:14:14.480 --> 00:14:17.880 it just gets really dicey because sometimes when you use things like that, 306 00:14:18.120 --> 00:14:21.120 parents get stuck on it, practitioners get stuck on words, 307 00:14:21.160 --> 00:14:24.160 and then they can't move past the reasoning behind it. 308 00:14:24.480 --> 00:14:25.120 And of course, that 309 00:14:25.120 --> 00:14:28.520 last picture of that class for a baby is sometimes the bane of any feeding 310 00:14:28.520 --> 00:14:33.440 therapist existence, because nobody understands why feeding is going poorly. 311 00:14:33.760 --> 00:14:36.960 You can see how, like, you know, almost, almost flat. 312 00:14:36.960 --> 00:14:38.760 That baby's not bowling the tongue up well, 313 00:14:38.760 --> 00:14:41.400 so it's not going to be cupping around the bottle or the breast nipple. 314 00:14:41.400 --> 00:14:42.920 It's not going to be controlling the ball's flow. 315 00:14:42.920 --> 00:14:45.880 Well, and all those things that we looked at in physiology. 316 00:14:47.120 --> 00:14:48.400 So this is a different one I found. 317 00:14:48.400 --> 00:14:49.920 It's a little, 2015. 318 00:14:49.920 --> 00:14:53.640 So it's definitely a little in the range, around and Cottesloe and stuff. 319 00:14:53.640 --> 00:14:55.560 But this one looked at a fifth one 320 00:14:55.560 --> 00:14:58.560 and I think it just breaks it down in a little bit more, 321 00:14:59.280 --> 00:15:00.840 micro measurements, if you will. 322 00:15:00.840 --> 00:15:02.760 Again, I'm not getting measuring tools out, but 323 00:15:02.760 --> 00:15:04.640 this is just more like frame of reference. 324 00:15:04.640 --> 00:15:07.640 And if you look at percentages, sometimes that makes sense to people more. 325 00:15:07.840 --> 00:15:12.160 100% of the tongue is anchored down 75% of the tongue, you know. 326 00:15:12.160 --> 00:15:14.760 And sometimes that makes more sense than millimeters. 327 00:15:14.760 --> 00:15:18.360 Because when you're talking about a 4 pound, you know, 35 weaker 328 00:15:18.760 --> 00:15:19.960 millimeters matter. 329 00:15:19.960 --> 00:15:22.360 And so sometimes percentage makes a little bit more sense. 330 00:15:24.120 --> 00:15:26.240 So that was lingual restrictions. 331 00:15:26.240 --> 00:15:27.480 These are labial restrictions. 332 00:15:27.480 --> 00:15:30.720 Again this is Doctor Cottesloe identified in a very similar manner. 333 00:15:30.720 --> 00:15:32.440 They're denoted by classes or types. 334 00:15:32.440 --> 00:15:35.440 And they're identified by placement of the fur on the gum line. 335 00:15:35.640 --> 00:15:36.600 So class one 336 00:15:36.600 --> 00:15:39.680 if you see it, it's been a long attachment towards the top of the gum line. 337 00:15:39.840 --> 00:15:42.240 Class two moves down on the gum ridge. 338 00:15:42.240 --> 00:15:43.120 Class three move 339 00:15:43.120 --> 00:15:47.160 down to the bottom of the ridge, and then class four wraps itself around. 340 00:15:47.160 --> 00:15:50.120 Like moving towards the alveolar ridge in the bag. 341 00:15:50.120 --> 00:15:52.800 So obviously the more involvement that you have, yes, 342 00:15:52.800 --> 00:15:55.800 the classes are placement, but then you can also look at things like 343 00:15:55.800 --> 00:15:58.840 thickness of the band, how much labial movement we have, 344 00:15:59.040 --> 00:16:02.040 what does that look like for function and so forth. 345 00:16:02.160 --> 00:16:05.360 One of the things that you can also kind of educate parents on, 346 00:16:05.360 --> 00:16:08.280 and this is a big one, is like, oh, well, their teeth are going to be separated. 347 00:16:08.280 --> 00:16:12.480 And like, you know that very, very frequently you see that with a thick band 348 00:16:12.480 --> 00:16:16.800 and a labial, upper labial restriction like that, that you will see like, 349 00:16:16.800 --> 00:16:19.800 the dentition coming in with a space between them. 350 00:16:20.640 --> 00:16:23.360 If you look at dental research, what it talks about is 351 00:16:23.360 --> 00:16:24.920 that's not the end of the world. 352 00:16:24.920 --> 00:16:27.360 Because if you look at pediatrics, when their teeth are coming 353 00:16:27.360 --> 00:16:31.080 in, you want spaces in between those baby teeth, because what happens is your baby 354 00:16:31.080 --> 00:16:33.320 teeth are significantly smaller than your permit teeth. 355 00:16:33.320 --> 00:16:35.920 So as those children start to lose their baby teeth, 356 00:16:35.920 --> 00:16:38.520 if they have spaces in them when their larger permanent 357 00:16:38.520 --> 00:16:40.800 teeth start coming in, those spaces allow for that. 358 00:16:40.800 --> 00:16:44.200 The size, and distribution of those teeth coming in. 359 00:16:44.760 --> 00:16:49.640 Because ideally, I do a talk to that, dental hygiene program here, 360 00:16:50.040 --> 00:16:53.040 in Lexington, and we talk a lot about, dentition 361 00:16:53.040 --> 00:16:55.400 and how orthodontics is not a luxury 362 00:16:55.400 --> 00:16:58.280 that what we should be looking at is perfect rows of like, 363 00:16:58.280 --> 00:17:01.720 why do u shaped teeth sitting on top of each other for, for all human beings 364 00:17:02.040 --> 00:17:05.280 and if you look like prehistoric, like that's how dentition was. 365 00:17:05.280 --> 00:17:09.040 If you look at those old, like, models of teeth, that that's what they look like. 366 00:17:09.320 --> 00:17:12.640 And so now what we're seeing is a significantly more narrowing of the jaw. 367 00:17:12.800 --> 00:17:14.280 We're seeing more crowded teeth. 368 00:17:14.280 --> 00:17:17.240 And there's, you know, as we go through, it gets a little scientific and nerdy, 369 00:17:17.240 --> 00:17:19.920 but we talk a lot about why those things might be happening. 370 00:17:19.920 --> 00:17:23.560 But when the orthodontist said that to me, that orthodontics is not a luxury, 371 00:17:23.840 --> 00:17:27.000 it's a function because we're looking at appropriate 372 00:17:27.000 --> 00:17:30.320 articulation, for speech sound, we're looking at airway patency. 373 00:17:30.320 --> 00:17:32.960 That's a big red flag for me. Airway patency. 374 00:17:32.960 --> 00:17:35.520 We're looking at chewing and swallowing. 375 00:17:35.520 --> 00:17:38.240 We're looking at all these things about how it develops the face 376 00:17:38.240 --> 00:17:40.320 then that connects to the neck and so forth. 377 00:17:40.320 --> 00:17:42.080 So these things matter. 378 00:17:42.080 --> 00:17:44.280 And even though it's hard when you have this little 4 pound 379 00:17:44.280 --> 00:17:47.360 baby in the neck that we're looking at, it's like we as therapists have to look 380 00:17:47.360 --> 00:17:48.320 at the bigger picture and say, 381 00:17:48.320 --> 00:17:52.240 how are we going to help these families with like a lifetime of positive feeding? 382 00:17:53.640 --> 00:17:56.120 So this one was a little trickier for me to find. 383 00:17:56.120 --> 00:17:58.640 These look at buckle restrictions or buccal. That's kind of 384 00:17:58.640 --> 00:18:01.320 was a hot topic in our office when we were going through this. 385 00:18:01.320 --> 00:18:03.240 But this is a cheek to us. 386 00:18:03.240 --> 00:18:06.880 So it's one of those things that, we actually had a pediatrician here 387 00:18:06.880 --> 00:18:09.880 in town say, oh, I just thought those were the things that held her face on. 388 00:18:09.880 --> 00:18:11.640 And she was kind of trying to be silly because she said, 389 00:18:11.640 --> 00:18:13.800 you don't believe in ties. 390 00:18:13.800 --> 00:18:14.800 And I kind of juggling. 391 00:18:14.800 --> 00:18:16.280 I was like, I'm not asking you to convert. 392 00:18:16.280 --> 00:18:19.400 We're not asking for a belief system here, but it's whether they exist 393 00:18:19.400 --> 00:18:21.640 or they don't. So these are the best that I can come up with. 394 00:18:21.640 --> 00:18:24.520 I actually had a student who did kind of a loose tie presentation, 395 00:18:24.520 --> 00:18:25.920 and she had some beautiful pictures 396 00:18:25.920 --> 00:18:28.920 of cheek ties that a local dentist of ours had given her. 397 00:18:29.160 --> 00:18:32.680 But we look at what we look at is chart ties mostly up here. 398 00:18:32.680 --> 00:18:34.520 Sometimes you will see them in the bottom gum on, 399 00:18:34.520 --> 00:18:36.640 but mostly at the top is where you see them, 400 00:18:36.640 --> 00:18:40.400 and you will see what happens is even if a baby has a lip and a tongue release 401 00:18:40.400 --> 00:18:43.520 and you release the pressure of the lip, if they still have pressure here, 402 00:18:43.640 --> 00:18:45.880 you see that they're pulling these muscles. 403 00:18:45.880 --> 00:18:47.680 And if you look at mechanics and the muscles 404 00:18:47.680 --> 00:18:49.880 that required for breastfeeding versus bottle feeding, 405 00:18:49.880 --> 00:18:52.680 if you're still having a pull here, oftentimes you will get symptoms 406 00:18:52.680 --> 00:18:56.480 and smacking, lip pulling and tension around the face and neck. 407 00:18:56.840 --> 00:19:01.360 So it's one of those this was a debate you if you will in the research. 408 00:19:02.120 --> 00:19:03.680 So this is here for your information. 409 00:19:05.120 --> 00:19:05.760 Sometimes with the 410 00:19:05.760 --> 00:19:08.760 parents I'm like if they're going in to do this, like 411 00:19:08.880 --> 00:19:11.160 I wouldn't recommend doing the lip and then doing the tongue. 412 00:19:11.160 --> 00:19:11.520 And then, 413 00:19:11.520 --> 00:19:13.800 you know, it's kind of one of those things if you're going in, 414 00:19:13.800 --> 00:19:15.680 maybe just do everything in one fell swoop. 415 00:19:15.680 --> 00:19:19.440 If you feel like that's causing a functional problem as far as releases go. 416 00:19:20.280 --> 00:19:22.360 So what's up with the lip flip? 417 00:19:22.360 --> 00:19:23.400 This is something that you'll see 418 00:19:23.400 --> 00:19:26.400 in literature, especially in lactation literature. 419 00:19:26.640 --> 00:19:28.000 That's a very mixed bag. 420 00:19:28.000 --> 00:19:30.040 If you've ever watched a bottle feeding baby 421 00:19:30.040 --> 00:19:33.040 or a baby at the breastfeeding and their lip is like tucked under, 422 00:19:33.240 --> 00:19:36.720 there is some different differentiation and research that talks about, 423 00:19:38.160 --> 00:19:39.480 does it does it matter? 424 00:19:39.480 --> 00:19:44.360 First of all, is it is it causing pain or is it causing any physiological symptoms? 425 00:19:44.880 --> 00:19:48.720 Do we do it manually and so that's one of those things 426 00:19:48.720 --> 00:19:51.000 I've seen very frequently, you know, a provider who's helping them on 427 00:19:51.000 --> 00:19:53.080 maybe learn to breastfeed or is getting a baby, 428 00:19:53.080 --> 00:19:55.320 like comfortable in the bottle, not flip the lip out. 429 00:19:55.320 --> 00:19:57.280 So that's where the mixed bag of research comes from. 430 00:19:57.280 --> 00:19:58.680 I have definitely seen practitioners 431 00:19:58.680 --> 00:20:01.680 more so in the lactation world who are like, absolutely not. 432 00:20:01.880 --> 00:20:03.360 If you flip the lip out manually, 433 00:20:03.360 --> 00:20:06.360 it changes the baby sucking patterns and and x, y, and z. 434 00:20:07.200 --> 00:20:12.080 So I kind of spent a little bit of time looking at each individual, dyad 435 00:20:12.080 --> 00:20:15.120 that I'm working with and trying to figure out, like as a therapist, 436 00:20:15.120 --> 00:20:19.320 we are trying to produce positive feeding impacts. 437 00:20:19.680 --> 00:20:24.280 So if a baby is using a maladaptive compensation, which essentially flipping 438 00:20:24.280 --> 00:20:25.920 the lip under would be because you're changing 439 00:20:25.920 --> 00:20:29.400 the structure of the musculature and the sucking mechanism, what do we do there? 440 00:20:29.400 --> 00:20:31.080 And that's something maybe chew on that. 441 00:20:31.080 --> 00:20:35.760 You know, as your as you're thinking about your own practice, I feel like 442 00:20:35.760 --> 00:20:41.560 we should be looking at the most, functional swallowing mechanism. 443 00:20:41.560 --> 00:20:45.120 So if that means flipping the lip to help those babies learn, 444 00:20:45.120 --> 00:20:47.640 because we're looking at in the in the neonatal world, 445 00:20:47.640 --> 00:20:50.480 we're looking at habilitation of care, not rehabilitative care. 446 00:20:50.480 --> 00:20:51.480 Obviously. Right. 447 00:20:51.480 --> 00:20:54.240 So we're trying to push for, the most positives 448 00:20:54.240 --> 00:20:56.560 to lay those neural pathways and all that good stuff. 449 00:20:56.560 --> 00:20:58.440 And is the flip of a real strategy. 450 00:20:58.440 --> 00:21:01.440 So the flip was one of those things where they look in breastfeeding medicine, 451 00:21:01.440 --> 00:21:04.640 they look at trying to have the mom, like, flip the babies, 452 00:21:05.360 --> 00:21:06.800 the nipple into the baby's mouth. 453 00:21:06.800 --> 00:21:08.400 If they're having a hard time with opening, 454 00:21:08.400 --> 00:21:10.960 they're not opening the lips wide enough, and so forth. 455 00:21:10.960 --> 00:21:13.000 So it's literally called the flip pull. 456 00:21:13.000 --> 00:21:16.120 And it's one of those things that as a lactation consultant, 457 00:21:16.120 --> 00:21:18.760 because I'm like a speech pathologist who happens to be an OB. Kelsey. 458 00:21:18.760 --> 00:21:21.760 And so as a lactation consultant, what I'm trying to do is set moms up 459 00:21:21.840 --> 00:21:23.960 for the those positive breastfeeding experience, 460 00:21:23.960 --> 00:21:25.840 you know, when we're working on breastfeeding. 461 00:21:25.840 --> 00:21:29.600 So I'm trying to not set her up with maladaptive strategies 462 00:21:29.760 --> 00:21:32.840 and trying to be like, how can we get the best latch with positioning? 463 00:21:32.840 --> 00:21:34.440 How can we work with the baby's mechanics? 464 00:21:34.440 --> 00:21:36.760 Is this something we need to look at further? 465 00:21:36.760 --> 00:21:37.520 But these are all things. 466 00:21:37.520 --> 00:21:39.600 If you look through breastfeeding and feeding 467 00:21:39.600 --> 00:21:41.040 literature that you might come across. 468 00:21:42.000 --> 00:21:43.400 This is Melanie Porter 469 00:21:43.400 --> 00:21:48.440 and Asha, from 2023, and she talks a lot about, lip ties and their implications. 470 00:21:48.680 --> 00:21:51.680 And I love that she looked at the difference in breast and bottle feeding. 471 00:21:51.800 --> 00:21:55.000 I have some slides in an older presentation that I did that like, 472 00:21:55.000 --> 00:21:58.320 you know, until I really got into that, you don't realize the true difference 473 00:21:58.560 --> 00:22:01.920 in, like, the muscles that we use for breastfeeding versus bottle training. 474 00:22:01.920 --> 00:22:03.520 And there is a difference. 475 00:22:03.520 --> 00:22:07.960 So she speaks on it kind of looking at like reflexive stimulation 476 00:22:08.200 --> 00:22:10.920 and how that works in with intraoral pressure 477 00:22:10.920 --> 00:22:13.920 and how it's different for breast and bottle feeding and so forth. 478 00:22:14.200 --> 00:22:18.120 So at the end she's kind of like says releasing the tie resulted in improvement 479 00:22:18.120 --> 00:22:20.280 of ability to breastfeed and progress with solids 480 00:22:20.280 --> 00:22:23.520 when she was looking like strictly, deliberately. 481 00:22:23.520 --> 00:22:26.640 And so she does like that's what I left at the bottom. 482 00:22:26.640 --> 00:22:28.280 It says it's simply a reminder to flip the lid, 483 00:22:28.280 --> 00:22:30.360 because if you look at this like tight restriction 484 00:22:30.360 --> 00:22:33.360 and the liberal under it, it changes the mechanics. 485 00:22:33.480 --> 00:22:35.520 So that's an article that you can pull up from actually. 486 00:22:35.520 --> 00:22:38.560 It's got great stuff in there that she talks kind of extensively about. And. 487 00:22:40.880 --> 00:22:42.840 So again, we look at anatomy 488 00:22:42.840 --> 00:22:45.640 every time we go in seeing a baby we should be looking at the oral 489 00:22:45.640 --> 00:22:47.680 like obviously doesn't matter the baby's age 490 00:22:47.680 --> 00:22:50.800 if it's a 2 pound neonate versus it's, you know, a six month old outpatient. 491 00:22:50.800 --> 00:22:54.360 I'm doing an oral mic because we obviously can't understand 492 00:22:54.360 --> 00:22:56.680 what's going on from a mechanical from a physiology 493 00:22:56.680 --> 00:22:58.400 standpoint, if we don't know what's going on. 494 00:22:58.400 --> 00:22:59.920 From an anatomical standpoint. 495 00:22:59.920 --> 00:23:04.080 Now, that being said, I'm very, very cautious to explain to parents 496 00:23:04.080 --> 00:23:08.040 that just doing an oral Mac is not the end all, be all of identification 497 00:23:08.040 --> 00:23:11.360 of oral restrictions, because you can say is the restriction there yes or no? 498 00:23:11.360 --> 00:23:12.920 Okay, cool. Yeah it's there. 499 00:23:12.920 --> 00:23:15.480 But then what? Why what does that even mean. 500 00:23:15.480 --> 00:23:18.480 So these are the symptoms that we're really looking at 501 00:23:18.720 --> 00:23:21.560 the tween mom and baby, especially when we're looking at breastfeeding. 502 00:23:21.560 --> 00:23:25.320 Obviously when it's just a bottle feeding baby we're looking at baby symptoms. 503 00:23:25.680 --> 00:23:29.120 But gassy fussy spinny colicky. 504 00:23:29.400 --> 00:23:32.040 I have somewhat of a mean stuff. 505 00:23:32.040 --> 00:23:36.160 So I have dug really deeply into the difference in symptoms of problems 506 00:23:36.480 --> 00:23:38.160 and actual problems themselves. 507 00:23:38.160 --> 00:23:40.800 So colic for years got a diagnosis on its own. 508 00:23:40.800 --> 00:23:43.280 It's not really a diagnosis. It's a symptom. 509 00:23:43.280 --> 00:23:45.440 And we have to figure out what what it's a symptom of. 510 00:23:45.440 --> 00:23:47.720 Is it a neurological dysregulation. 511 00:23:47.720 --> 00:23:50.320 Is it a GI symptom. You know what. 512 00:23:50.320 --> 00:23:52.280 Why are we just saying these babies are colicky. 513 00:23:52.280 --> 00:23:55.280 And then just telling parents will hope for the best or grow out of it 514 00:23:55.480 --> 00:23:57.960 as therapist. That's obviously never where our mind is going to go. 515 00:23:57.960 --> 00:23:58.920 We're always going to go to what? 516 00:23:58.920 --> 00:24:00.960 How can we fix this problem? 517 00:24:00.960 --> 00:24:04.080 Fatigue noted by falling asleep at the breast or the bottle. 518 00:24:04.080 --> 00:24:06.440 Obviously with neonates, there's like a mixed bag in there 519 00:24:06.440 --> 00:24:08.840 because we're looking at babies who are sleepy. 520 00:24:08.840 --> 00:24:10.640 Neurologically, they're just not ready for feeds 521 00:24:10.640 --> 00:24:12.000 that we're asking them to do sometimes. 522 00:24:12.000 --> 00:24:14.880 So we kind of have to look at, again, all the parts and pieces. 523 00:24:14.880 --> 00:24:16.800 Discomfort by baby or mom. 524 00:24:16.800 --> 00:24:18.320 Breastfeeding should never be painful. 525 00:24:18.320 --> 00:24:20.040 So what we're looking at, mom, if it's painful, 526 00:24:20.040 --> 00:24:21.960 we have to figure out why it's painful, 527 00:24:21.960 --> 00:24:25.560 shorter, more frequent feeds, especially as a baby gets older and more mature. 528 00:24:25.560 --> 00:24:28.720 Ideally, those feeds should start spacing out. 529 00:24:28.720 --> 00:24:30.360 Babies should be more efficient at the breast 530 00:24:30.360 --> 00:24:32.280 when we're talking about breastfeeding, and same with the bottle. 531 00:24:32.280 --> 00:24:36.440 They should be able to do better and do like a decent amount of volume 532 00:24:36.440 --> 00:24:39.480 and kind of move through and space their feeds out if they're not doing that. 533 00:24:39.480 --> 00:24:42.440 So they're getting older and more mature and they're still doing these shorter, 534 00:24:42.440 --> 00:24:43.480 more frequent feeds. 535 00:24:43.480 --> 00:24:46.440 Why is an endurance can they don't do it? 536 00:24:46.440 --> 00:24:48.240 Is their muscle or their muscles fatiguing? 537 00:24:48.240 --> 00:24:49.560 Is that what's happening. 538 00:24:49.560 --> 00:24:50.640 Poor coordination of sucks. 539 00:24:50.640 --> 00:24:51.280 Well breathe. 540 00:24:51.280 --> 00:24:54.280 Obviously anybody that's working in an acute that's our biggest concern. 541 00:24:54.320 --> 00:24:58.000 Neonates are that's their number one difficulty with feeding is their sex 542 00:24:58.000 --> 00:24:59.280 all the coordination. 543 00:24:59.280 --> 00:25:02.280 So then if we take it is it just that they're in neonatal 544 00:25:02.360 --> 00:25:04.000 or is it their neonatal. 545 00:25:04.000 --> 00:25:05.960 And they have some other things going on. 546 00:25:05.960 --> 00:25:08.400 That's when we can put the pieces together and help them 547 00:25:08.400 --> 00:25:11.160 have a more successful feeding relationship. 548 00:25:11.160 --> 00:25:13.320 Inability to take a pacifier. 549 00:25:13.320 --> 00:25:14.720 Do we care about that? 550 00:25:14.720 --> 00:25:17.640 I see very, very frequently, especially in lactation medicine. 551 00:25:17.640 --> 00:25:21.600 In practice, that that's what they're using is a non-nutritive sucking piece 552 00:25:21.760 --> 00:25:24.600 to indefinitely rule out 553 00:25:24.600 --> 00:25:27.600 or in, if you will, oral restrictions. 554 00:25:27.920 --> 00:25:30.800 And my argument with that is the same thing that we look at in 555 00:25:30.800 --> 00:25:33.400 neonates is, yes, a baby might non-nutritive 556 00:25:33.400 --> 00:25:36.480 really suck on a pacifier, fine, but are they ready for nutritive sucking? 557 00:25:36.480 --> 00:25:39.800 And we all know who have practice and then that's not necessarily a correlation. 558 00:25:40.080 --> 00:25:42.800 So then extrapolate that same information and say, okay, 559 00:25:42.800 --> 00:25:45.960 just because a baby can't non-nutritive 560 00:25:46.440 --> 00:25:49.560 because they can't hold a pacifier in their mouth, is it oral restrictions? 561 00:25:49.560 --> 00:25:50.040 Is it not. 562 00:25:50.040 --> 00:25:53.040 You know, whatever's happening, maybe it's airway patency, maybe it's whatever. 563 00:25:53.240 --> 00:25:55.800 Does that mean that they can't nutritionally feed. 564 00:25:55.800 --> 00:25:57.360 And so that's something that we really have 565 00:25:57.360 --> 00:26:01.160 to look at case by case to see if that makes a difference. 566 00:26:01.160 --> 00:26:04.640 And not always using that non-nutritive second piece as an indication 567 00:26:04.640 --> 00:26:07.680 that nutritive sucking will be successful or not. 568 00:26:10.000 --> 00:26:10.320 Other 569 00:26:10.320 --> 00:26:13.600 symptoms that we can look at for babies and pedes patients is spoon feeding 570 00:26:13.600 --> 00:26:17.040 because obviously, yes, in the next we're working with neonates. 571 00:26:17.040 --> 00:26:18.560 But we we as therapists care 572 00:26:18.560 --> 00:26:20.760 about what happens with them after they leave the doors. 573 00:26:20.760 --> 00:26:22.560 And we're trying to set them up for success. 574 00:26:22.560 --> 00:26:25.160 So we look at things like, what is it going to do with spoon feeding? 575 00:26:25.160 --> 00:26:26.240 So if oral restrictions 576 00:26:26.240 --> 00:26:30.000 could decrease the ability to clean the spoon off with the top lip, 577 00:26:30.520 --> 00:26:34.240 inadequate caloric intake due to inefficiency and feeding ahead a PD 578 00:26:34.280 --> 00:26:37.280 that I work with here, that's baby breast breastfed fine. 579 00:26:37.320 --> 00:26:38.520 You know outwardly look fine. 580 00:26:38.520 --> 00:26:42.440 Gained weight room mom had plenty of milk, never was painful and he was 13 581 00:26:42.440 --> 00:26:45.960 months old and couldn't transition to the next room in his daycare facility. 582 00:26:46.320 --> 00:26:49.080 And she sent me pictures of him, just anatomically. 583 00:26:49.080 --> 00:26:50.320 So I'm just outwardly looking. 584 00:26:50.320 --> 00:26:52.000 But then she's telling me everything that's going on. 585 00:26:52.000 --> 00:26:52.320 I was like, 586 00:26:52.320 --> 00:26:53.160 how did you make it through 587 00:26:53.160 --> 00:26:54.920 your breastfeeding journey? And that little boy we nursed 588 00:26:54.920 --> 00:26:57.240 until he was three, so it wasn't a pressing issue. 589 00:26:57.240 --> 00:27:00.360 He had an probably borderline between the class one or class two 590 00:27:00.360 --> 00:27:01.400 almost to the tip. 591 00:27:01.400 --> 00:27:04.200 And the daycare was saying he just cannot eat solids. 592 00:27:04.200 --> 00:27:06.240 He literally couldn't transit the bolus. 593 00:27:06.240 --> 00:27:09.640 So they absolutely can go beyond just breastfeeding or just bottle feeding, 594 00:27:09.640 --> 00:27:13.400 because parents frequently asked me that, what if it's just a breastfeeding thing? 595 00:27:13.400 --> 00:27:15.640 I'm not going to worry about it. I don't have to breastfeed. 596 00:27:15.640 --> 00:27:18.640 But then we have to think about how these things lingual movement, 597 00:27:18.640 --> 00:27:21.840 oral mechanics work across the lifespan and educate. 598 00:27:21.840 --> 00:27:24.720 If we feel like that's necessary for that patient. 599 00:27:24.720 --> 00:27:26.000 Same thing with finger feeding. 600 00:27:26.000 --> 00:27:27.720 Again, they can't manipulate the food. 601 00:27:27.720 --> 00:27:29.760 They could pocket food up here through the lateral. 602 00:27:29.760 --> 00:27:33.800 So kind oftentimes if you look at these patients 603 00:27:33.840 --> 00:27:38.520 possible development of picky eating, food selection, and then you get into 604 00:27:38.520 --> 00:27:40.240 is it like a weight thing after that 605 00:27:40.240 --> 00:27:43.240 because they're only selectively eating certain things? 606 00:27:43.560 --> 00:27:45.920 Lip restriction may influence swallowing patterns. 607 00:27:45.920 --> 00:27:49.800 Again, we're using those compensatory strategies for sucking and pulling. 608 00:27:50.160 --> 00:27:50.880 And what do those 609 00:27:50.880 --> 00:27:54.640 maladaptive strategies lead to later on from our swallowing mechanism. 610 00:27:54.960 --> 00:27:57.760 And what you know, we know the swallowing works from the 611 00:27:57.760 --> 00:27:59.240 from the top to the bottom. 612 00:27:59.240 --> 00:28:02.240 And because it's an interconnected valvular system, 613 00:28:02.360 --> 00:28:03.080 if you think about 614 00:28:03.080 --> 00:28:05.440 when one part of the system being disrupted, 615 00:28:05.440 --> 00:28:07.400 it can very frequently disrupt the whole system. 616 00:28:07.400 --> 00:28:09.200 And in adults and pediatric patients. 617 00:28:09.200 --> 00:28:10.600 So kind of looking at all that, 618 00:28:12.360 --> 00:28:14.040 let's see, 619 00:28:14.040 --> 00:28:16.720 ties in oral hygiene just briefly spoke to this. 620 00:28:16.720 --> 00:28:19.800 But looking at early dental decay, especially on the teeth, 621 00:28:20.040 --> 00:28:22.320 or food is trapped again in those lateral. 622 00:28:22.320 --> 00:28:26.720 Okay, do big gaps between the teeth even as their permanent teeth are coming in? 623 00:28:26.720 --> 00:28:29.520 Does that mean that food has more tendency to stick there? 624 00:28:29.520 --> 00:28:31.080 Periodontal disease and adult. 625 00:28:31.080 --> 00:28:34.960 In adults, there's lots of correlation between cavities, increased cavities, 626 00:28:34.960 --> 00:28:37.000 and not just the reflux symptoms 627 00:28:37.000 --> 00:28:40.000 that you might have from some of this, but also the same thing pocketing, 628 00:28:40.240 --> 00:28:43.840 possible changes in dentition, the same thing that I talked about. 629 00:28:43.840 --> 00:28:46.840 Like we should have these perfect U-shaped, you know, 630 00:28:48.440 --> 00:28:49.920 teeth alignment, if you will. 631 00:28:49.920 --> 00:28:52.640 And I think later on the presentation, I actually have my, my mouth 632 00:28:52.640 --> 00:28:55.480 so I can give you a idea of what it looks like. 633 00:28:55.480 --> 00:28:58.400 An adult who had ties. And, you know, I didn't know. 634 00:28:58.400 --> 00:29:00.920 I guess, you know, that was eight years ago. 635 00:29:00.920 --> 00:29:03.840 So looking at how those things change throughout the lifespan. 636 00:29:06.560 --> 00:29:09.560 And so obviously do symptoms overlap? 637 00:29:09.920 --> 00:29:11.200 Yes, 100%. 638 00:29:11.200 --> 00:29:13.800 How do we know it's lip, tongue or cheeks or all of the above? 639 00:29:13.800 --> 00:29:16.960 How do we know that it's oral restrictions versus other complications. 640 00:29:17.160 --> 00:29:18.000 And where do we start. 641 00:29:18.000 --> 00:29:21.120 And I think that's the biggest picture that as practitioners we struggle with. 642 00:29:21.440 --> 00:29:23.320 Again, I'd mentioned, I know in my facility 643 00:29:23.320 --> 00:29:26.680 specifically that we don't treat ties in-house. 644 00:29:26.680 --> 00:29:28.080 That's just not something that we do. 645 00:29:28.080 --> 00:29:34.280 It has been a huge struggle over the last several years to even talk about it, 646 00:29:34.520 --> 00:29:36.000 and it's definitely gotten better 647 00:29:36.000 --> 00:29:39.480 because I think practitioners in general are less scared. 648 00:29:39.720 --> 00:29:41.600 They feel like it's a less taboo topic. 649 00:29:41.600 --> 00:29:44.120 And I think parents are much more educated coming in. 650 00:29:44.120 --> 00:29:46.360 And that's the first thing they ask is, is my baby tongue tied? 651 00:29:46.360 --> 00:29:50.640 I mean, so very frequently, I think now our higher practitioners, so our Neos 652 00:29:50.640 --> 00:29:53.920 and our nurse practitioners and so forth are having to address these issues. 653 00:29:54.240 --> 00:29:55.680 I still get a very pained response. 654 00:29:55.680 --> 00:29:58.680 They might grow out of it, see what happens, yada, yada, yada. 655 00:29:58.680 --> 00:30:02.400 And so I've had to be very careful about treading those waters to see what, 656 00:30:03.240 --> 00:30:06.320 what I'm allowed to say as a practitioner, but also not feeling like I have 657 00:30:06.320 --> 00:30:08.960 a gag order, because that's very much what it felt like for a while. 658 00:30:10.120 --> 00:30:12.600 My email will be at the end of this presentation, so feel free 659 00:30:12.600 --> 00:30:16.360 if anybody is having hurdles or issues, I've probably dealt with it. 660 00:30:16.360 --> 00:30:18.920 And even if you just need a sounding board, 661 00:30:18.920 --> 00:30:21.200 bring it on because I know what it feels like. 662 00:30:21.200 --> 00:30:24.400 But also knows what it feels like to advocate for patients and families 663 00:30:24.400 --> 00:30:26.160 and how good it feels when a family and patient 664 00:30:26.160 --> 00:30:29.800 do so well, because of a recommendation that we've been able to help them through. 665 00:30:30.640 --> 00:30:32.920 So here's some of the things that we just talked about. 666 00:30:32.920 --> 00:30:36.800 Just expanding signs and symptoms for babies, losing suction while feeding 667 00:30:36.800 --> 00:30:40.680 breast or bottle, that clicking noise oftentimes parents don't hear it, 668 00:30:40.680 --> 00:30:43.680 I think because they feed their baby so frequently they miss it. 669 00:30:43.680 --> 00:30:47.360 And nursing staff and then again have gotten very, very with it about their, 670 00:30:47.360 --> 00:30:51.520 being attuned to this, like, oh my gosh, this baby's clicking every time. 671 00:30:51.520 --> 00:30:54.440 They're super gassy and fussy. Now they're having these reflux events. 672 00:30:54.440 --> 00:30:57.440 It's making them have difficulty with their oxygen saturation. 673 00:30:57.680 --> 00:30:58.880 Baby failing to gain weight. 674 00:30:58.880 --> 00:31:01.440 Obviously that goes in hand-in-hand with a lot of things. 675 00:31:01.440 --> 00:31:02.720 What do they look like on the bottle. 676 00:31:02.720 --> 00:31:04.960 Are they losing a lot interior loss. 677 00:31:04.960 --> 00:31:05.920 Or if they're clicking, 678 00:31:05.920 --> 00:31:09.480 are they gassy fussy and they're spitting up on the breast? 679 00:31:09.480 --> 00:31:10.800 Are they not transferring milk? 680 00:31:10.800 --> 00:31:12.840 You know, breast feeding is a supply and demand. 681 00:31:12.840 --> 00:31:14.360 And there's lots of things that can go wrong 682 00:31:14.360 --> 00:31:15.760 with oral restrictions and breastfeeding. 683 00:31:15.760 --> 00:31:17.640 But one of the things is babies don't transfer enough. 684 00:31:17.640 --> 00:31:21.600 So even if moms have a beautiful milk supply, they might not be able to transfer 685 00:31:21.600 --> 00:31:22.360 the milk. 686 00:31:22.360 --> 00:31:25.800 The I hate this babies cannot poke his tongue 687 00:31:25.800 --> 00:31:29.040 behind gum line or above the line over the gum on. 688 00:31:29.520 --> 00:31:32.800 And this is something that very frequently I will hear other practitioners says, 689 00:31:32.800 --> 00:31:35.200 oh, they can stick their tongue out and it's fine. It's not a tie. 690 00:31:35.200 --> 00:31:39.720 And my argument now is, what functional tasks do we do as human beings? 691 00:31:40.080 --> 00:31:45.040 Lick a lollipop, suck an ice cream cone, maybe stick your tongue out your brother. 692 00:31:45.040 --> 00:31:47.480 But other than that, we're not using like a tongue. 693 00:31:47.480 --> 00:31:49.240 Pass the gum line as a functional task. 694 00:31:49.240 --> 00:31:51.440 So then I'm asking, what about lateralization? 695 00:31:51.440 --> 00:31:53.680 What about AP movement? How are they holding the bolus? 696 00:31:53.680 --> 00:31:54.800 You know those the of things. 697 00:31:54.800 --> 00:31:57.680 Because just sticking your tongue out is not indicative of a tie or not. 698 00:31:59.040 --> 00:32:00.000 Obviously 699 00:32:00.000 --> 00:32:04.360 lateralization is important for not just, articulation, but movement of the bolus 700 00:32:04.360 --> 00:32:08.440 and cleaning of the oral cavity, tip of the tongue, maybe not sharp shape. 701 00:32:08.440 --> 00:32:10.880 We saw those pictures. Hypersensitive gag. 702 00:32:10.880 --> 00:32:12.160 This is one that if you're not super 703 00:32:12.160 --> 00:32:15.480 well versed in, times you will see this almost 100% of the time. 704 00:32:15.480 --> 00:32:16.680 A baby with ties 705 00:32:16.680 --> 00:32:20.400 typically are very hypersensitive, so anytime you move into the oral cavity, 706 00:32:20.600 --> 00:32:22.320 especially if they're caught off guard, 707 00:32:22.320 --> 00:32:24.480 they might get like an immediate gag response. 708 00:32:24.480 --> 00:32:26.560 Let's try and put the pacifier interact with the bottle. 709 00:32:26.560 --> 00:32:28.080 And this is a very common thing. 710 00:32:28.080 --> 00:32:31.920 And then what does that lead to a picky eating toddler into childhood. 711 00:32:32.280 --> 00:32:33.960 And that is something is feeding therapies 712 00:32:33.960 --> 00:32:37.680 that it's probably the bane of everybody's existence because it's it's hard. 713 00:32:38.040 --> 00:32:40.680 And so this is something that if we look at early on, 714 00:32:40.680 --> 00:32:42.840 those babies are trying to protect their airways 715 00:32:42.840 --> 00:32:44.440 because they're articulators. 716 00:32:44.440 --> 00:32:46.920 Their mechanism is not working the way it's supposed to. 717 00:32:46.920 --> 00:32:48.480 So they're hypersensitive because they're saying, 718 00:32:48.480 --> 00:32:51.440 get out of the airway, get out of the airway. That's their response. 719 00:32:51.440 --> 00:32:53.040 So why are we doing that? 720 00:32:53.040 --> 00:32:54.400 And what can we help with that? 721 00:32:54.400 --> 00:32:58.440 And the lip might look flat instead of coming to a point like it's supposed to. 722 00:32:58.600 --> 00:32:59.640 So you might have a baby who, 723 00:32:59.640 --> 00:33:02.040 when they're trying to bowl up the tongue, it's just what I call it. 724 00:33:02.040 --> 00:33:04.080 The alligator chomp when they're trying to suck. 725 00:33:04.080 --> 00:33:06.280 So they're just mashing at the nipple or the pacifier, 726 00:33:06.280 --> 00:33:07.920 and they're not really getting very much traction. 727 00:33:09.120 --> 00:33:10.000 So for mom, if 728 00:33:10.000 --> 00:33:13.760 it's a breastfeeding diet, nipple pain erosions, nipples look pinched, crease, 729 00:33:13.760 --> 00:33:18.000 bruise, abraded after feeds painful breast fasal spasms. 730 00:33:18.000 --> 00:33:19.080 Low milk supply plug. 731 00:33:19.080 --> 00:33:20.800 That's again if you're working in the acute 732 00:33:20.800 --> 00:33:24.040 and you're not like that's not your wheelhouse is lactation. 733 00:33:24.040 --> 00:33:25.720 Find a lactation consultant that you know 734 00:33:25.720 --> 00:33:27.280 and trust and work hand-in-hand with them. 735 00:33:27.280 --> 00:33:29.800 It works beautifully when that happens. 736 00:33:29.800 --> 00:33:32.640 And if not, there's loads of courses out there 737 00:33:32.640 --> 00:33:36.120 that you can work on, even if it's getting your CLC clinicals and stuff like that. 738 00:33:36.120 --> 00:33:40.560 So, just sorry, warning nipple damage that you might see. 739 00:33:40.560 --> 00:33:42.800 There's lots of different things that look like nipple damage. 740 00:33:42.800 --> 00:33:45.120 Every mom tolerates pain differently, so that's something 741 00:33:45.120 --> 00:33:47.520 you have to kind of work in conjunction with her. 742 00:33:47.520 --> 00:33:50.160 Here's some more examples that far right one. 743 00:33:50.160 --> 00:33:51.560 Right here. 744 00:33:51.560 --> 00:33:55.160 Figure 148 is that, like that lipstick or crease, 745 00:33:55.160 --> 00:33:56.880 white crease and pinch and so forth. 746 00:33:56.880 --> 00:33:58.400 Moms should not have nipple damage. 747 00:33:58.400 --> 00:34:00.240 That is not a normal phenomenon. So 748 00:34:01.400 --> 00:34:03.240 and then when we're looking at one size fits 749 00:34:03.240 --> 00:34:06.840 all, how accurate is that in anything that we do a service. 750 00:34:07.320 --> 00:34:10.280 Absolutely zilch. So how are we diagnosing. 751 00:34:10.280 --> 00:34:12.480 We've talked about that ad infinitum. 752 00:34:12.480 --> 00:34:14.760 How how are decisions made. 753 00:34:14.760 --> 00:34:16.280 And do all ties need to be released. 754 00:34:16.280 --> 00:34:19.280 So this is this is when we get into the brass tacks of it right. 755 00:34:20.280 --> 00:34:21.560 So where do we start. 756 00:34:21.560 --> 00:34:24.440 Evaluation by an associate and or lactation consultant 757 00:34:24.440 --> 00:34:27.960 tends to be the practice that I've seen pretty significantly. 758 00:34:27.960 --> 00:34:31.160 I work with an OT, not in an acute outside of the neck. 759 00:34:31.160 --> 00:34:32.040 You at a private practice? 760 00:34:32.040 --> 00:34:37.320 She's an OT pediatrics obviously, and an RBC LC, and she does amazing work. 761 00:34:37.320 --> 00:34:40.120 So it's not just about sorry. That's just that's my wheelhouse. 762 00:34:40.120 --> 00:34:43.800 So anybody that is well versed in feeding specifically 763 00:34:44.280 --> 00:34:47.040 and has that lactation practice, if we're talking about breastfeeding 764 00:34:47.040 --> 00:34:51.720 or pumping moms, and you need to know what's going on. 765 00:34:51.960 --> 00:34:53.120 Risk rejection. Not all is. 766 00:34:53.120 --> 00:34:55.360 So please are familiar with oral restrictions and that's okay. 767 00:34:55.360 --> 00:34:58.360 Or feeding behaviors history both mom and baby 768 00:34:58.360 --> 00:35:01.600 a thorough oral make of anatomy and physiology. 769 00:35:01.960 --> 00:35:04.240 Looking at reflexes we're going to briefly go over them. 770 00:35:04.240 --> 00:35:06.720 I have reflexes like listed out in the different reflexes 771 00:35:06.720 --> 00:35:09.880 that we're looking at in neonates and and, you know, early infancy 772 00:35:10.240 --> 00:35:13.640 and then looking at a thorough feeding of what are we in breast bottle both. 773 00:35:13.640 --> 00:35:16.200 What are we looking at and some non-nutritive sucking skills. 774 00:35:16.200 --> 00:35:19.840 So that's just kind of a rough, outline of what we'd be looking at. 775 00:35:20.880 --> 00:35:22.120 Again, can't harp enough 776 00:35:22.120 --> 00:35:25.120 about anatomy versus physiology here. 777 00:35:25.920 --> 00:35:27.920 So this is Doctor Johari in this picture. 778 00:35:27.920 --> 00:35:30.120 If you look him up he's an EMT by trade. 779 00:35:30.120 --> 00:35:32.400 He has loads of resources on his website. 780 00:35:32.400 --> 00:35:34.240 Great great great resource for anybody. 781 00:35:34.240 --> 00:35:37.640 And his biggest argument he's got social media outreach. 782 00:35:37.640 --> 00:35:39.920 He really talks a lot about this not being a turf war. 783 00:35:39.920 --> 00:35:40.800 And that's what I appreciate 784 00:35:40.800 --> 00:35:43.920 the most about his his skill and what he's bringing to the field. 785 00:35:44.400 --> 00:35:46.040 Because it shouldn't be about EMT versus 786 00:35:46.040 --> 00:35:48.480 dentist versus pediatrician versus neonatology. 787 00:35:48.480 --> 00:35:51.000 It should be about people who know the skill and understand it. 788 00:35:51.000 --> 00:35:53.280 And their goal is to help moms and baby pairs that. 789 00:35:53.280 --> 00:35:54.840 That's all it boils down to. 790 00:35:54.840 --> 00:35:56.360 So this is how we would do an oral 791 00:35:56.360 --> 00:35:58.800 make appropriately when we're looking for oral restrictions. 792 00:35:58.800 --> 00:36:00.960 Because that's the other thing I say very frequently is, 793 00:36:00.960 --> 00:36:03.880 you know, a practitioner just looking down on a baby in a crib 794 00:36:03.880 --> 00:36:06.320 and kind of just poking around and being like, wow, I don't see anything. 795 00:36:06.320 --> 00:36:09.160 But that's not the best functional task that you can do. 796 00:36:09.160 --> 00:36:10.560 So this is what he recommends. 797 00:36:10.560 --> 00:36:13.920 And this is also what I show parents how I show parents demonstrate 798 00:36:14.440 --> 00:36:17.040 if I feel like an oral restriction might be the problem. 799 00:36:17.040 --> 00:36:20.080 This is also the position you would put them in to do stretches 800 00:36:20.080 --> 00:36:21.760 if they did end up going through releases. 801 00:36:21.760 --> 00:36:23.880 So this is something that I'm like, get familiar with this. 802 00:36:23.880 --> 00:36:25.160 This is the easiest way. 803 00:36:25.160 --> 00:36:28.080 We're obviously assessing all the realm of the mouth, 804 00:36:28.080 --> 00:36:30.280 all the things that we would feel like would be functional 805 00:36:30.280 --> 00:36:31.320 for feeding and swallowing 806 00:36:32.400 --> 00:36:34.240 and later on, speech. 807 00:36:34.240 --> 00:36:35.640 This is just a nice clinic. 808 00:36:35.640 --> 00:36:37.640 I know it's a little older, but it makes so much more sense 809 00:36:37.640 --> 00:36:39.760 when you see what happens with the nipple in the mouth. 810 00:36:39.760 --> 00:36:42.080 This is a breast, but it looks the same. 811 00:36:42.080 --> 00:36:44.560 We we don't want the nipple to be in the front of the mouth. 812 00:36:44.560 --> 00:36:46.320 That's not how sucking mechanics works. 813 00:36:46.320 --> 00:36:49.800 You know, I explain to parents and nursing staff all the time, sucking 814 00:36:49.800 --> 00:36:53.280 is this positive and negative pressure experience that babies have. 815 00:36:53.480 --> 00:36:55.320 And when something's not working 816 00:36:55.320 --> 00:36:57.600 that they can't build up one of those pressure systems. 817 00:36:57.600 --> 00:36:59.840 Again, feeding isn't very functional then. 818 00:36:59.840 --> 00:37:02.280 And so like giving a schematic, I always feel like it 819 00:37:02.280 --> 00:37:05.000 helps when you look at people's learning types and stuff like that. 820 00:37:05.000 --> 00:37:08.320 If you touch on everything to give them a visual demonstration, I very frequently 821 00:37:08.320 --> 00:37:11.320 give, you know, tactile and stuff like that. 822 00:37:11.400 --> 00:37:13.080 Show them what their baby looks like 823 00:37:13.080 --> 00:37:14.880 just to kind of touch on all the points to see, 824 00:37:14.880 --> 00:37:16.600 make sure that they absorb the information. 825 00:37:19.400 --> 00:37:22.400 All that being said, what's the new pipe? 826 00:37:22.480 --> 00:37:24.000 So this is an oral presentation. 827 00:37:24.000 --> 00:37:26.320 Obviously this could go on for days and days and days is something 828 00:37:26.320 --> 00:37:29.840 that I've spent now years trying to learn and educate myself more on. 829 00:37:30.240 --> 00:37:34.560 But these are things that you're going to see out there now that are playing into 830 00:37:34.600 --> 00:37:36.800 maybe five years ago, I sent a baby for release 831 00:37:36.800 --> 00:37:39.520 and we didn't do all these things, and we had pretty good outcomes. 832 00:37:39.520 --> 00:37:41.520 Honestly, the dentists that I was working with, it was amazing. 833 00:37:41.520 --> 00:37:43.440 So I didn't I didn't doubt into the outcomes, 834 00:37:43.440 --> 00:37:46.920 but I also wasn't sending out babies on a regular basis. 835 00:37:47.360 --> 00:37:50.040 Now I see a significantly higher outpatient caseload. 836 00:37:50.040 --> 00:37:51.560 I'm seeing more neonates 837 00:37:51.560 --> 00:37:54.120 that might be having issues because of one thing or the other. 838 00:37:54.120 --> 00:37:55.200 And now I'm figuring out 839 00:37:55.200 --> 00:37:58.200 how we're putting all the pieces together to make it more successful. 840 00:37:58.320 --> 00:37:59.400 So this is one of those things. 841 00:37:59.400 --> 00:38:01.560 What's up with the body work and what do we need it? 842 00:38:01.560 --> 00:38:03.480 As therapists, we should all be working together, right? 843 00:38:03.480 --> 00:38:04.760 We should be each other's best friends. 844 00:38:04.760 --> 00:38:08.200 We only have PT in our neck and we make it work the best we can 845 00:38:08.200 --> 00:38:11.520 because our, we have two parties that are in work and they're phenomenal. 846 00:38:11.800 --> 00:38:14.640 And there's very frequently that I walk out a room and be like, okay, 847 00:38:14.640 --> 00:38:17.640 I'm going to need you to go see this baby because X, Y, and Z what's happening. 848 00:38:17.720 --> 00:38:18.680 And then very frequently 849 00:38:18.680 --> 00:38:21.680 they'll go in and I'll be like, okay, well that's not what I saw. 850 00:38:21.800 --> 00:38:23.000 And I'm like, let's go in together. 851 00:38:23.000 --> 00:38:24.280 So then we go in together 852 00:38:24.280 --> 00:38:26.440 and changing the dynamic of what they're doing 853 00:38:26.440 --> 00:38:28.680 just in their assessment to making a baby work, 854 00:38:28.680 --> 00:38:31.000 for example, at the breast or even bottle feeding 855 00:38:31.000 --> 00:38:34.200 changes their perspective on how the baby's body is working. 856 00:38:34.920 --> 00:38:36.920 So this is what we're looking at for the body asymmetry. 857 00:38:36.920 --> 00:38:39.520 Asymmetry of the face drawn head okay. 858 00:38:39.520 --> 00:38:42.120 If we're asymmetrical something not going to work right. 859 00:38:42.120 --> 00:38:46.560 Probably motor development delays torticollis obviously side preferences 860 00:38:46.920 --> 00:38:50.680 essentially or any of those breech presentation in utero. 861 00:38:50.680 --> 00:38:53.640 If your baby is flipped in the wrong position, chances are 862 00:38:53.640 --> 00:38:55.240 things might be stuck stiff. 863 00:38:55.240 --> 00:38:57.120 Tight, whatever word you want to use. 864 00:38:57.120 --> 00:38:59.360 C-section versus you were setting a baby up 865 00:38:59.360 --> 00:39:02.440 with a C-section birth to have some difficulties. 866 00:39:02.440 --> 00:39:04.280 Potentially. You're not getting the squeeze. 867 00:39:04.280 --> 00:39:07.560 You're not hitting the touch points that you get from that, from vaginal birth. 868 00:39:07.560 --> 00:39:08.200 And there's things that 869 00:39:08.200 --> 00:39:12.360 I've definitely seen from a dysregulation standpoint, from feeding perspectives. 870 00:39:12.360 --> 00:39:14.160 Both of my boys were C-section babies. 871 00:39:14.160 --> 00:39:17.840 Looking back, it is very easy for me to now see what the pitfalls were. 872 00:39:19.080 --> 00:39:20.280 Reflux or colic symptoms. 873 00:39:20.280 --> 00:39:21.120 We talked about latch 874 00:39:21.120 --> 00:39:24.960 or feeding issues, sleeping difficulties and heat the car seat. 875 00:39:24.960 --> 00:39:27.800 And we'll kind of talk about that. 876 00:39:27.800 --> 00:39:29.680 So body work, hands on touch 877 00:39:29.680 --> 00:39:32.760 to allow baby sensation to decrease and help reorganize. 878 00:39:33.120 --> 00:39:37.080 As neonatal therapist, when we go in, we are not just looking 879 00:39:37.080 --> 00:39:38.720 at a single piece of the puzzle. 880 00:39:38.720 --> 00:39:42.080 Obviously, we're looking at light, we're looking at sound. 881 00:39:42.080 --> 00:39:43.360 We're looking at positions. 882 00:39:43.360 --> 00:39:45.520 We're looking at what the baby's being asked to do, 883 00:39:45.520 --> 00:39:48.320 how the baby's being stimulated, what's going on around them. 884 00:39:48.320 --> 00:39:51.920 A complete environmental evaluation, if you will. 885 00:39:52.200 --> 00:39:55.400 And it's the same thing with all the other parts and pieces 886 00:39:55.400 --> 00:40:00.360 to this body work prior to releases leads to better outcomes 887 00:40:00.360 --> 00:40:04.040 for the baby, improved healing, and more successful feeding relationships. 888 00:40:04.800 --> 00:40:08.160 So I have, even in the outpatient world, found body workers. 889 00:40:08.400 --> 00:40:10.080 And it's just generically body workers. 890 00:40:10.080 --> 00:40:12.240 It's easier for me to explain that to parents. 891 00:40:12.240 --> 00:40:13.840 And this becomes a very heated topic. 892 00:40:13.840 --> 00:40:15.600 But we look at PD, we look at O.T., 893 00:40:15.600 --> 00:40:19.840 we look at pediatric chiro, pediatric massage, cranial sacral therapists. 894 00:40:19.840 --> 00:40:24.000 There's lots of people that work together, and everybody has a more palatable 895 00:40:24.000 --> 00:40:27.720 acceptance of what they can do as parents and as providers. 896 00:40:28.000 --> 00:40:31.040 And so that's why for me, it's like I need to find people in my community 897 00:40:31.040 --> 00:40:32.160 that I trust that I work 898 00:40:32.160 --> 00:40:35.880 with, that they understand what's going on so that these families can have success. 899 00:40:36.240 --> 00:40:37.920 Because I've had families who have gone to somebody 900 00:40:37.920 --> 00:40:39.240 like, well, that didn't do anything. 901 00:40:39.240 --> 00:40:39.840 And I'm like, okay, 902 00:40:39.840 --> 00:40:42.840 were these skilled professionals who understood what we were asking for 903 00:40:42.960 --> 00:40:46.200 because it could be an adult therapist who maybe it's like, okay, I can do pedes. 904 00:40:46.600 --> 00:40:49.600 And so we know as neonatal therapists that that's not something 905 00:40:49.600 --> 00:40:51.240 all of my colleagues don't work in the nCCU. 906 00:40:51.240 --> 00:40:55.040 You know, so we, the Nic therapists have very special skill sets that we work with. 907 00:40:55.040 --> 00:40:57.000 It's the same in this area as well. 908 00:40:58.320 --> 00:41:01.080 This is one of the things that our PD gives to everybody. 909 00:41:01.080 --> 00:41:04.080 And it's something that I have like really we hang it on our outpatient. 910 00:41:04.080 --> 00:41:05.800 We give it I love you massages. 911 00:41:05.800 --> 00:41:06.040 Come on. 912 00:41:06.040 --> 00:41:08.600 We talk about body work and releasing tension in the abdomen 913 00:41:08.600 --> 00:41:11.880 because very frequently these babies are gassy, fussy spitting. 914 00:41:11.880 --> 00:41:14.680 They're uncomfortable. They're grunty, they're squirmy. 915 00:41:14.680 --> 00:41:17.360 So this is a simple thing that parents can do. 916 00:41:17.360 --> 00:41:21.960 A very generic massage, if you will, that you can teach them outside of your. 917 00:41:21.960 --> 00:41:25.440 You're doing a pediatric or neonatal massage 918 00:41:27.320 --> 00:41:29.000 container babies. 919 00:41:29.000 --> 00:41:30.680 At first I was like, this is probably going to be 920 00:41:30.680 --> 00:41:32.320 a little bit of a buzzword for people. 921 00:41:32.320 --> 00:41:34.600 But if we look at what is 922 00:41:34.600 --> 00:41:38.200 what is historically happening with babies and feeding what's happening, 923 00:41:38.200 --> 00:41:42.000 babies are spending more time in a swaddle right in our neonates, 924 00:41:42.000 --> 00:41:43.680 obviously, is that neonatal therapist. 925 00:41:43.680 --> 00:41:47.040 We know that they need that for organization very frequently. 926 00:41:47.040 --> 00:41:49.560 Our PDS and I will come in and we are like, okay, well, 927 00:41:49.560 --> 00:41:52.320 maybe they're falling asleep at the breast because they're staying swaddled. 928 00:41:52.320 --> 00:41:55.520 But what if we swaddle them from the crib 929 00:41:55.880 --> 00:41:59.880 to mom just to keep them containment and organization in their state? 930 00:42:00.240 --> 00:42:02.880 And then as they get to the breast or bottle for feeding 931 00:42:02.880 --> 00:42:05.360 and they start looking like they're accepting this, we can start, 932 00:42:05.360 --> 00:42:09.680 you know, taking away some of their, you know, swaddling or whatever. 933 00:42:09.960 --> 00:42:12.520 But babies are significantly spending more time in the swaddle, 934 00:42:12.520 --> 00:42:13.560 not just in the Nikki. 935 00:42:13.560 --> 00:42:15.600 Obviously, we expect neonates to be doing this 936 00:42:15.600 --> 00:42:17.720 because they need that for that state organization, 937 00:42:17.720 --> 00:42:20.000 because their neurological system is underdeveloped. 938 00:42:20.000 --> 00:42:23.000 But this carries through even into like outpatient 939 00:42:23.160 --> 00:42:26.440 and beyond the NICU because babies are spending more time in swaddle. 940 00:42:26.640 --> 00:42:27.480 What is the biggest thing? 941 00:42:28.440 --> 00:42:29.640 Parents need to sleep. 942 00:42:29.640 --> 00:42:30.360 They want to sleep. 943 00:42:30.360 --> 00:42:33.360 And so that's what we're seeing is swaddling very frequently. 944 00:42:33.360 --> 00:42:37.080 If it's used in an extensive amount of time, it can depress the reflexes. 945 00:42:37.440 --> 00:42:41.520 And so then we get into like, you know, what's going on as far as that goes. 946 00:42:41.760 --> 00:42:43.640 Obviously sleeping on the back very frequently. 947 00:42:43.640 --> 00:42:45.800 That's the common complaint I hear from parents is my baby doesn't 948 00:42:45.800 --> 00:42:47.280 wanna sleep on their back. 949 00:42:47.280 --> 00:42:50.520 Times and swings, bouncers, car seats and strollers, mountains. 950 00:42:50.520 --> 00:42:52.200 Oftentimes they're going back to work in six weeks, 951 00:42:52.200 --> 00:42:53.600 even if they've been in the Nic. 952 00:42:53.600 --> 00:42:57.560 So we have to have babies who are contained more because they're in daycare. 953 00:42:57.560 --> 00:42:58.320 They're with grandma. 954 00:42:58.320 --> 00:43:01.920 They're in a situation where there's other, you know, responsibilities. 955 00:43:02.160 --> 00:43:05.960 And again, it can lead to decreased startle, increase play, Joseph, decrease 956 00:43:05.960 --> 00:43:08.560 in mobility and motor development. You know, as they continue on. 957 00:43:10.200 --> 00:43:12.120 So how do we put the pieces together. 958 00:43:12.120 --> 00:43:14.680 This is generically a team that I typically work with. 959 00:43:14.680 --> 00:43:17.680 But obviously everybody's got different pieces to their team. 960 00:43:17.760 --> 00:43:19.560 You have different resources in your community. 961 00:43:19.560 --> 00:43:23.120 And so forth that the biggest thing is looking at parents, 962 00:43:23.360 --> 00:43:26.440 because very frequently as providers, what we get stuck on is what we think 963 00:43:26.440 --> 00:43:27.600 the recommendation should be. 964 00:43:27.600 --> 00:43:29.760 And we forget as parents what their goals are. 965 00:43:29.760 --> 00:43:33.200 So that's always my first question when I go into a room in the Nickie, 966 00:43:33.240 --> 00:43:36.240 what are your goals for breastfeeding, for bottle feeding, for pumping? 967 00:43:36.240 --> 00:43:38.040 What are your goals after you leave the Nikki? 968 00:43:38.040 --> 00:43:38.800 What are your goals? 969 00:43:38.800 --> 00:43:41.200 You know, and same thing when they come to outpatient, 970 00:43:41.200 --> 00:43:43.800 and including any other family members in that conversation 971 00:43:43.800 --> 00:43:47.640 who are going to be part of this, feeding this baby and learning to go along 972 00:43:47.640 --> 00:43:48.360 with this journey. 973 00:43:50.120 --> 00:43:52.440 The next couple of slides and we'll go through this kind of quickly 974 00:43:52.440 --> 00:43:54.480 just to make sure we get through everything is just a 975 00:43:54.480 --> 00:43:57.800 just a basic guideline for reflexes and feeding and how they go together. 976 00:43:57.920 --> 00:44:00.240 For me, it was more about just having it as a reference, 977 00:44:00.240 --> 00:44:03.600 because that helps me show parents things, but also, you know, kind of trigger 978 00:44:03.600 --> 00:44:05.200 some old memories in my mind and be like, 979 00:44:05.200 --> 00:44:08.200 oh yeah, I remember reading about that and so forth. 980 00:44:09.000 --> 00:44:09.800 Rooting. 981 00:44:09.800 --> 00:44:13.120 Obviously that's an easy one, but about four months that reading should subside. 982 00:44:13.120 --> 00:44:15.280 Obviously with neonates we're going to look at just all 983 00:44:15.280 --> 00:44:16.520 and development and so forth. 984 00:44:16.520 --> 00:44:19.160 But that's something that we're going to see very frequently. 985 00:44:19.160 --> 00:44:21.240 Start on Morrow. 986 00:44:21.240 --> 00:44:24.200 How long are they keeping the startle. Is it more significant? 987 00:44:24.200 --> 00:44:27.360 Is it less, you know, different for preemies versus term babies. 988 00:44:27.360 --> 00:44:30.640 And obviously when it works with neonates, they understand that this changes 989 00:44:30.840 --> 00:44:34.800 based on gestational, adjusted developmental ages and so forth. 990 00:44:36.080 --> 00:44:39.960 Grasping may evolutionary may be 991 00:44:39.960 --> 00:44:43.040 evolutionary bonding and holding onto mothers hair, jewelry, clothes. 992 00:44:43.040 --> 00:44:45.680 It's something that I often teach when babies are getting older 993 00:44:45.680 --> 00:44:47.000 and they're distracted during feeding. 994 00:44:47.000 --> 00:44:50.880 What if we give them a teething necklace or something for them to do, and so forth? 995 00:44:50.880 --> 00:44:53.960 So it's again thinking about what reflexes are appropriate for that baby's 996 00:44:54.240 --> 00:44:56.280 not only gestational but developmental age 997 00:44:56.280 --> 00:44:59.280 and how we can make that work for feeding and development. 998 00:44:59.800 --> 00:45:02.280 Head writing 999 00:45:02.280 --> 00:45:04.400 the gag reflex. This is the big one. 1000 00:45:04.400 --> 00:45:07.920 In the first six months, getting stimulated and so forth, 1001 00:45:07.920 --> 00:45:11.520 this is something that we should see integrated and so forth. 1002 00:45:11.520 --> 00:45:13.440 And if they're not, why aren't they? 1003 00:45:13.440 --> 00:45:15.360 Again, we talked about the overactive gag. 1004 00:45:15.360 --> 00:45:18.320 How does that impact feeding of solids as they continue to go on. 1005 00:45:18.320 --> 00:45:20.120 And very frequently we don't I won't see you 1006 00:45:20.120 --> 00:45:23.280 I mean outpatient until they're six weeks, eight weeks, ten weeks, six months, 1007 00:45:23.640 --> 00:45:25.160 because a new problem has developed. 1008 00:45:25.160 --> 00:45:26.840 Maybe they've compensated up to this far. 1009 00:45:26.840 --> 00:45:28.680 Now, now we've got new things that are happening. 1010 00:45:30.120 --> 00:45:31.560 The 18 hour reflex. 1011 00:45:31.560 --> 00:45:34.320 How does that work for or against the baby? 1012 00:45:34.320 --> 00:45:36.800 Again, a lot of these integrate around six months. 1013 00:45:36.800 --> 00:45:38.960 But when we look at developmental and adjusted, 1014 00:45:38.960 --> 00:45:41.160 we have to account for those things. 1015 00:45:41.160 --> 00:45:42.080 Stepping. 1016 00:45:42.080 --> 00:45:44.960 How does that impact baby's feeding? 1017 00:45:44.960 --> 00:45:48.240 Postural support for breast feeding, postural support for bottle feeding, 1018 00:45:48.240 --> 00:45:51.240 motor development as they get older. 1019 00:45:51.440 --> 00:45:53.920 Anatomical crawling, you know, you can look at videos 1020 00:45:53.920 --> 00:45:56.920 of the breast crawl from right after birth and so forth. 1021 00:45:57.480 --> 00:45:58.440 Withdrawal. 1022 00:45:58.440 --> 00:46:02.360 This one should continue throughout life, obviously, but it's something 1023 00:46:02.400 --> 00:46:06.280 you should be able to see following these, in, in newborns. 1024 00:46:07.680 --> 00:46:10.440 So this that's just like a brief demonstration. 1025 00:46:10.440 --> 00:46:11.360 These are the reflexes. 1026 00:46:11.360 --> 00:46:13.800 These are what we might see when we're look at feeding and postures 1027 00:46:13.800 --> 00:46:14.960 pregnancy and birth. 1028 00:46:14.960 --> 00:46:17.160 And so this is this one gets really touchy. 1029 00:46:17.160 --> 00:46:19.800 And these things are both sides go into a little bit of a nerdy 1030 00:46:19.800 --> 00:46:23.880 kind of perspective if you will, on oral restrictions and feeding. 1031 00:46:24.080 --> 00:46:27.360 But we have to look at these pieces not just in breast and bottle feeding, 1032 00:46:27.360 --> 00:46:30.960 but just in our neonates and our newborns that we're seeing in outpatient and, and, 1033 00:46:30.960 --> 00:46:35.080 and how that's impacting their development and therefore everything else. 1034 00:46:35.960 --> 00:46:37.440 How is it impacting feeding? 1035 00:46:37.440 --> 00:46:39.840 We'll look at genetics versus epigenetics briefly, 1036 00:46:39.840 --> 00:46:44.160 because that's when it goes really deep outside of my realm of, perspective. 1037 00:46:44.160 --> 00:46:46.880 If you are, positioning in utero, does that change again? 1038 00:46:46.880 --> 00:46:48.680 Are they breech or are they transverse. 1039 00:46:48.680 --> 00:46:50.080 Have they been head down for too long? 1040 00:46:50.080 --> 00:46:51.920 Is it a tiny mom and a huge baby? 1041 00:46:51.920 --> 00:46:54.920 That's going to make a big difference in positioning and comfort, 1042 00:46:54.920 --> 00:46:56.400 tension, all those things. 1043 00:46:56.400 --> 00:46:58.600 A fast birth versus a slow birth. 1044 00:46:58.600 --> 00:47:00.520 That's when we're missing some of those touch points 1045 00:47:00.520 --> 00:47:02.160 from that nice vaginal squeeze. 1046 00:47:02.160 --> 00:47:05.640 And are they missing these like neuro regulated, stimulated, you know, 1047 00:47:05.960 --> 00:47:08.880 sensory aspects. 1048 00:47:08.880 --> 00:47:13.880 And we'll see that very frequently in a dysregulated baby delivery versus section. 1049 00:47:13.880 --> 00:47:16.360 I kind of touched on body work during pregnancy. 1050 00:47:16.360 --> 00:47:18.760 Does that make a difference if mom is more comfortable during 1051 00:47:18.760 --> 00:47:22.040 pregnancy, does that ease her pregnancy and therefore ease her delivery? 1052 00:47:22.240 --> 00:47:27.600 Birth interventions do things like not just sections, but, 1053 00:47:28.800 --> 00:47:30.720 all the interventions that you would medication 1054 00:47:30.720 --> 00:47:32.960 during birth, magnesium that maybe was given before. 1055 00:47:32.960 --> 00:47:36.200 If we expect a pre-term epidurals finals, you know, 1056 00:47:36.200 --> 00:47:39.760 all those things state all anything that's given to a mom during birth. 1057 00:47:39.760 --> 00:47:42.840 How does that affect the infant in their outcomes for feeding? 1058 00:47:42.840 --> 00:47:45.600 Are they sleepy? Are they not. You know, so forth. 1059 00:47:45.600 --> 00:47:49.320 And then fluid and enigma that very much not only impacts mom's 1060 00:47:49.880 --> 00:47:51.200 ability for breastfeeding, 1061 00:47:51.200 --> 00:47:53.160 their their breast and nipples may be swollen 1062 00:47:53.160 --> 00:47:55.240 and it might make it very difficult for infant to latch. 1063 00:47:55.240 --> 00:47:58.720 But also when we look at fluid overload in an infant, are they heavier at birth? 1064 00:47:58.720 --> 00:48:00.960 And then we look at weight loss and so forth. 1065 00:48:00.960 --> 00:48:05.320 Obviously, vaginal delivery babies have a better chance with birth weight. 1066 00:48:05.320 --> 00:48:09.280 Just looking at they get that squeeze so they get a more accurate baseline 1067 00:48:09.280 --> 00:48:11.880 birth weight. As a section baby gets pulled out and weighed. 1068 00:48:11.880 --> 00:48:13.560 And then they diary's all that extra fluid 1069 00:48:13.560 --> 00:48:17.480 that that federal counterparts, you know, got a chance to ring out, so to speak. 1070 00:48:18.880 --> 00:48:21.840 So this is when you get into genetics versus epigenetics. 1071 00:48:21.840 --> 00:48:24.160 And why does it matter. 1072 00:48:24.160 --> 00:48:27.360 So genetics is DNA sequence variations. 1073 00:48:27.360 --> 00:48:28.360 Gene regulation. 1074 00:48:28.360 --> 00:48:32.520 Genetics is what did you inherit from your mom and dad and what did you inherit? 1075 00:48:32.520 --> 00:48:35.120 You know, from somebody you want and so forth. 1076 00:48:35.120 --> 00:48:39.000 There is lots of information that talks very frequently about oral restrictions 1077 00:48:39.000 --> 00:48:40.160 being genetic. 1078 00:48:40.160 --> 00:48:43.800 So if you see a family that's had a baby and then you might subsequently 1079 00:48:43.800 --> 00:48:47.520 see another baby of theirs, very typically you will see oral restrictions. 1080 00:48:47.720 --> 00:48:50.560 And then when you start talking about family histories, mom will be like, 1081 00:48:50.560 --> 00:48:51.240 oh yeah, X, 1082 00:48:51.240 --> 00:48:55.240 Y and Z, had headgear, I had teeth pulled that had a palatal separator. 1083 00:48:55.240 --> 00:48:56.120 They had this. 1084 00:48:56.120 --> 00:48:59.120 Everybody's got reflux, they have TMJ, they don't sleep well. 1085 00:48:59.360 --> 00:49:00.080 Whatever. 1086 00:49:00.080 --> 00:49:02.880 You kind of start teasing out all these same factors. 1087 00:49:02.880 --> 00:49:05.880 When we look into epigenetics, it gets a little bit deeper 1088 00:49:06.080 --> 00:49:08.400 because it looks a little bit further into. 1089 00:49:10.600 --> 00:49:14.880 DNA methylation metalization like roles in how the body works. 1090 00:49:14.880 --> 00:49:17.960 And we even look at super, super deep into 1091 00:49:18.200 --> 00:49:21.200 not only how does your baby developing in utero 1092 00:49:21.880 --> 00:49:25.880 obviously how that's impacting the baby's development, but how far back does it go? 1093 00:49:25.880 --> 00:49:29.040 And like you as a mom, how did you develop in utero 1094 00:49:29.040 --> 00:49:31.600 and what was happening when your mom was pregnant with you 1095 00:49:31.600 --> 00:49:33.360 that might have changed your gene sequence? 1096 00:49:33.360 --> 00:49:35.400 And how does that pass things on? 1097 00:49:35.400 --> 00:49:38.240 So like I said, this gets a little it gets a little deep. 1098 00:49:38.240 --> 00:49:40.520 There's lots of books out there, like Dirty Genes 1099 00:49:40.520 --> 00:49:43.720 and How to Clean Up your Genes and eating Through your genes and stuff like that. 1100 00:49:44.480 --> 00:49:46.600 Are there things in the environment that change that? 1101 00:49:46.600 --> 00:49:48.680 So you really look at things like that? 1102 00:49:48.680 --> 00:49:50.960 And I had stumbled upon like a, 1103 00:49:52.280 --> 00:49:53.920 like a paleontology kind of thing. 1104 00:49:53.920 --> 00:49:57.960 And when it was talking about the two wide sets of use for our teeth 1105 00:49:57.960 --> 00:50:00.880 on top of each other, and it was showing, like prehistoric, 1106 00:50:00.880 --> 00:50:03.880 how people's jaw lines have changed over the years. 1107 00:50:03.960 --> 00:50:08.640 And essentially it was like looking at things like the types of food 1108 00:50:08.640 --> 00:50:12.200 that we're eating and how that's changed our jaw development and growth. 1109 00:50:12.480 --> 00:50:15.880 Because the foods that we're eating now aren't the same as they were, you know, 1110 00:50:16.240 --> 00:50:19.000 a thousand years ago, 500 years ago or whatever. 1111 00:50:19.000 --> 00:50:20.080 The our teeth are different, 1112 00:50:20.080 --> 00:50:22.240 our muscles are different, our jaw development is different. 1113 00:50:22.240 --> 00:50:24.320 So let's also this gets a little bit tricky 1114 00:50:24.320 --> 00:50:27.320 when we look at genetics and epigenetics and how those things change. 1115 00:50:27.520 --> 00:50:29.280 But they are important when you think about 1116 00:50:29.280 --> 00:50:31.880 because people always wonder why why is this happening. 1117 00:50:31.880 --> 00:50:33.600 And so the biggest thing is it's happening 1118 00:50:33.600 --> 00:50:37.320 because of this, this, this, this, you know, and so forth. 1119 00:50:37.560 --> 00:50:40.680 So this is just a topic that was pretty fascinating, but 1120 00:50:40.680 --> 00:50:43.680 it gets a little deeper than, than I can comprehend. 1121 00:50:44.280 --> 00:50:46.680 This is the end of our genetic mutation. 1122 00:50:46.680 --> 00:50:50.040 This is this is something that you will see is a pretty significant tagline. 1123 00:50:50.040 --> 00:50:52.600 And when you're looking at oral research and research, 1124 00:50:52.600 --> 00:50:54.760 it is a definitely a mixed bag. 1125 00:50:54.760 --> 00:50:58.240 It looks a lot about, the light metabolic deficiency. 1126 00:50:58.240 --> 00:51:01.320 And what I found out from a colleague who actually had had one of her 1127 00:51:01.320 --> 00:51:05.120 children tested that did have the mph of our genetic mutation. 1128 00:51:05.120 --> 00:51:06.160 But I will show you hers. 1129 00:51:06.160 --> 00:51:10.280 There's actually a couple of different types of MDH of our, mutations, 1130 00:51:10.280 --> 00:51:14.040 and one of them may or may not affect the development of the oral, 1131 00:51:15.120 --> 00:51:15.720 anatomy. 1132 00:51:15.720 --> 00:51:19.800 And 1st May, you know, so it gets even further apart than that. 1133 00:51:20.560 --> 00:51:24.320 The difference is looking at full weight versus 1134 00:51:24.320 --> 00:51:25.840 so like I said, and it definitely 1135 00:51:25.840 --> 00:51:29.640 if you'll notice most prenatal vitamins now are folate, not folic acid. 1136 00:51:29.640 --> 00:51:31.680 Whereas you know, back in the day it was folic acid. 1137 00:51:31.680 --> 00:51:32.400 So we're even 1138 00:51:32.400 --> 00:51:36.280 looking at changing things like that and what form we're taking of that 1139 00:51:36.280 --> 00:51:39.320 and how when we started taking it like for example, 1140 00:51:39.560 --> 00:51:43.800 you know, they really want people taking that for conception and so forth. 1141 00:51:43.800 --> 00:51:46.920 Anyway, that gets that gets really into a deep dive. 1142 00:51:48.480 --> 00:51:50.920 This is something that Gary kind of talked about more of 1143 00:51:50.920 --> 00:51:52.480 or like I said, he's got loads of resources 1144 00:51:52.480 --> 00:51:55.920 and, and all over the place, not just from Ian's perspective. 1145 00:51:56.600 --> 00:51:58.760 But one of the things that he's pretty funny. 1146 00:51:58.760 --> 00:52:01.560 So if you ever watch videos on him, here's the kicker that may cause some gas 1147 00:52:01.560 --> 00:52:02.920 and color thorough 1148 00:52:02.920 --> 00:52:06.760 pearl clutching and do not consider tongue or lip tie a midline defect. 1149 00:52:07.040 --> 00:52:11.000 And so then he kind of goes into studies that were from New Zealand and so forth, 1150 00:52:11.000 --> 00:52:14.000 because a lot of people talk about oral restrictions being a midline defect. 1151 00:52:14.280 --> 00:52:17.040 And he talks about the reasons why is it genetics? 1152 00:52:17.040 --> 00:52:20.320 Are there more scientific studies that look at functioning different ways, 1153 00:52:20.320 --> 00:52:22.880 and why are there so much more awareness and stuff like that? 1154 00:52:25.200 --> 00:52:27.360 But like I said, what's causing it and so forth. 1155 00:52:27.360 --> 00:52:31.440 So he has lots of resources on, out there from, from all different 1156 00:52:31.440 --> 00:52:34.720 areas of research that talk about, all these different factors 1157 00:52:34.960 --> 00:52:37.960 and why this is such a more prevalent topic now. 1158 00:52:38.840 --> 00:52:39.920 Sleeping and weaning. 1159 00:52:39.920 --> 00:52:41.560 What causes the difficulties? 1160 00:52:41.560 --> 00:52:44.840 Is it a correlation between reduced milk transfer 1161 00:52:44.880 --> 00:52:46.520 either from the rest of the bottle? 1162 00:52:46.520 --> 00:52:49.040 When we're looking at breastfeeding, is it a low supply? 1163 00:52:49.040 --> 00:52:51.400 Is it a low supply because of the mom. 1164 00:52:51.400 --> 00:52:54.240 Like she has some kind of difficulty making milk. 1165 00:52:54.240 --> 00:52:58.680 And then we have to look at why is it thyroid hormones PCOS. 1166 00:52:58.720 --> 00:52:59.320 Is it. 1167 00:52:59.320 --> 00:53:03.360 IGT there's lots of factors that can impact moms ability to make milk. 1168 00:53:03.600 --> 00:53:04.800 Is it a pumping issue? 1169 00:53:04.800 --> 00:53:07.440 Is it a flange size issue? Is it whatever? 1170 00:53:07.440 --> 00:53:10.800 And or is it a low supply because of baby and babies not stimulating 1171 00:53:10.800 --> 00:53:11.640 mom to make milk. 1172 00:53:11.640 --> 00:53:13.280 So lots of factors, 1173 00:53:13.280 --> 00:53:17.000 poor feeding in general and true oral restrictions versus other complications. 1174 00:53:17.000 --> 00:53:18.320 Obviously we have to look at babies 1175 00:53:18.320 --> 00:53:21.480 that have like metabolic deficiencies and, you know, stuff like that. 1176 00:53:21.480 --> 00:53:23.520 I've had babies who transfer milk fine. 1177 00:53:23.520 --> 00:53:26.640 And maybe they have ties or don't, but they also have some metabolic issue 1178 00:53:26.640 --> 00:53:29.640 that's causing weight to be maybe an issue. 1179 00:53:30.120 --> 00:53:32.320 And so they're not sleeping and so forth. 1180 00:53:32.320 --> 00:53:33.360 Sleeping through the night 1181 00:53:33.360 --> 00:53:36.960 when we look at sleep training and stuff like that one for neonates, 1182 00:53:36.960 --> 00:53:38.720 we're obviously going to look at that very differently. 1183 00:53:38.720 --> 00:53:40.920 We should be educating families that babies, 1184 00:53:40.920 --> 00:53:42.040 especially babies, are leaving the Nic. 1185 00:53:42.040 --> 00:53:44.400 You need to eat at least 8 to 12 times a day. 1186 00:53:44.400 --> 00:53:46.920 So that grossly comes out as every 2 to 3 hours. 1187 00:53:46.920 --> 00:53:48.960 That's where that number came from. 1188 00:53:48.960 --> 00:53:50.440 Essentially breastfed babies. 1189 00:53:50.440 --> 00:53:52.080 That's kind of what they do. 1190 00:53:52.080 --> 00:53:54.920 But if you look at a tiny 4 pound baby going home from the Nikki food, 1191 00:53:54.920 --> 00:53:56.160 they need to eat that way 1192 00:53:56.160 --> 00:53:59.160 to keep up with their calories because they can't they don't 1193 00:53:59.160 --> 00:54:02.920 have the endurance to get enough volume per feed eating less than that. 1194 00:54:03.200 --> 00:54:04.800 So it's important for us to educate. 1195 00:54:04.800 --> 00:54:06.400 Sleeping through the night. 1196 00:54:06.400 --> 00:54:08.200 It's hard. That's a hard sell. 1197 00:54:08.200 --> 00:54:08.920 And that's a very, 1198 00:54:08.920 --> 00:54:12.720 very sore subject for most people, especially very tired parents. 1199 00:54:13.040 --> 00:54:14.520 But if you look at breastfeeding literature, 1200 00:54:14.520 --> 00:54:18.280 it actually talks about a direct correlation, a decrease of milk supply. 1201 00:54:18.440 --> 00:54:21.120 If babies are sleeping ten hours at night, 1202 00:54:21.120 --> 00:54:23.520 and if you're baby sleeping 10 to 12 hours at night, 1203 00:54:23.520 --> 00:54:26.560 so they only have 12 hours or less a day that they're feeding 1204 00:54:26.560 --> 00:54:30.240 what it feeds look like then, because are you compensating for volume? 1205 00:54:30.440 --> 00:54:33.360 So they have to get a volume per feeding to hit 1206 00:54:33.360 --> 00:54:36.360 their caloric necessity to grow and develop. 1207 00:54:36.880 --> 00:54:38.400 Is that causing reflux issues? 1208 00:54:38.400 --> 00:54:41.080 Is that causing more poor sleeping, gassy, fussy spitting? 1209 00:54:41.080 --> 00:54:45.120 So all these things, you know, should be sending out light bulbs to us 1210 00:54:45.120 --> 00:54:49.200 as practitioners that we really, truly have to look at, at all of it. 1211 00:54:49.440 --> 00:54:52.400 One of the first things I ask about low supply in a mom is how often 1212 00:54:52.400 --> 00:54:55.560 are you emptying the breast, and how long is baby sleeping at night? 1213 00:54:55.560 --> 00:54:57.880 Because those are two correlating factors in low supply. 1214 00:55:00.280 --> 00:55:02.640 Behavioral states, this is Lisa Leahy. 1215 00:55:02.640 --> 00:55:06.440 I went to a conference with her, and Maya Bowman a couple of years ago. 1216 00:55:06.440 --> 00:55:09.280 It was a lactation conference, but it was wonderfully eye opening. 1217 00:55:09.280 --> 00:55:11.200 They talk a lot about state organization. 1218 00:55:11.200 --> 00:55:15.440 They work in conjunction with, pitot and speech very frequently. 1219 00:55:15.640 --> 00:55:18.480 And so we look at this and we have to learn these 1220 00:55:18.480 --> 00:55:22.320 behavioral states that are communicating because very frequently what happens is 1221 00:55:22.320 --> 00:55:26.360 they're telling us things, but we have an agenda as parents or providers. 1222 00:55:26.360 --> 00:55:28.680 And if we're not listening to what baby's telling us, 1223 00:55:28.680 --> 00:55:30.480 feelings are not going to be very successful. 1224 00:55:30.480 --> 00:55:33.480 So I kind of give this to parents loosely break it down a little bit more, 1225 00:55:33.480 --> 00:55:36.480 you know, so they can see I even have like a picture. 1226 00:55:36.720 --> 00:55:39.720 These are your baby's early reading cuz these are your babies mid reading. 1227 00:55:39.720 --> 00:55:40.800 Cuz these are your babies. 1228 00:55:40.800 --> 00:55:41.960 You know, like you're hangry. 1229 00:55:41.960 --> 00:55:43.960 You're past the point of no return. 1230 00:55:43.960 --> 00:55:47.760 And that helps parents understand to read their baby's communication 1231 00:55:47.920 --> 00:55:49.840 so that they can all get along better. 1232 00:55:51.760 --> 00:55:53.600 Have been 1233 00:55:53.600 --> 00:55:56.600 practicing for a few minutes, so to oral mode or not, 1234 00:55:56.800 --> 00:56:00.200 when I started practicing, everybody did all my exercises. 1235 00:56:00.200 --> 00:56:03.120 Adults, you know, stroke patients, dysarthria 1236 00:56:03.120 --> 00:56:06.120 kids, everybody did oral motor exercises. 1237 00:56:06.480 --> 00:56:07.800 That's been 20 years ago. 1238 00:56:07.800 --> 00:56:10.200 And then then it kind of fell by the wayside. 1239 00:56:10.200 --> 00:56:12.520 We were not doing or, you know, it was kind of like, nope, no, no, 1240 00:56:12.520 --> 00:56:14.520 don't don't do that anymore. We're not doing that. 1241 00:56:14.520 --> 00:56:17.160 That's like new literature is coming out saying, don't do it. 1242 00:56:17.160 --> 00:56:17.960 It's not working. 1243 00:56:17.960 --> 00:56:20.960 You know, kind of doing just passive range of motion, you know, from 1244 00:56:20.960 --> 00:56:23.960 like think about doing passive, like we're not doing that. 1245 00:56:24.120 --> 00:56:26.880 Then what I've seen is another flip in again 1246 00:56:26.880 --> 00:56:29.880 or just like everything in medicine again, it evolves. 1247 00:56:29.960 --> 00:56:32.520 And so now it's the new this training phenomenon. 1248 00:56:33.960 --> 00:56:37.000 As a therapist, that's a really hard pill to swallow for me because of 1249 00:56:37.000 --> 00:56:40.440 going through this like hierarchy of, you know, changes or whatever. 1250 00:56:40.960 --> 00:56:45.040 And so what I tell parents is instead of using that like buzzword screening, 1251 00:56:45.320 --> 00:56:50.800 what I would prefer to work on is oral exercises for functional purposes. 1252 00:56:50.800 --> 00:56:53.800 And I feel like as therapists we should be working towards functional tasks. 1253 00:56:53.880 --> 00:56:55.320 Just in general. 1254 00:56:55.320 --> 00:56:59.760 So if I'm recommending any kind of work, therapeutic work for a family, 1255 00:56:59.760 --> 00:57:02.520 whether it's in an acute or an outpatient, wherever it might be, 1256 00:57:02.520 --> 00:57:05.040 I want to make sure that it's a functional task. 1257 00:57:05.040 --> 00:57:08.040 So how are we determining what exercises we're using? 1258 00:57:08.040 --> 00:57:09.400 That's a good question. 1259 00:57:09.400 --> 00:57:12.400 In, Lisa and, 1260 00:57:12.440 --> 00:57:15.560 Lisa's, or, I mean, seminar a couple years ago, 1261 00:57:15.560 --> 00:57:18.560 she talked very specifically about oral function tasks. 1262 00:57:18.680 --> 00:57:21.880 There's lots of lactation literature out there that talks very specifically 1263 00:57:21.880 --> 00:57:25.760 about like which ones might be functional for what specific thing. 1264 00:57:25.760 --> 00:57:28.440 So as therapists, we have to look at what we're recommending. 1265 00:57:28.440 --> 00:57:32.320 But we can also look at these other areas in foot massage, all that body work. 1266 00:57:32.640 --> 00:57:36.240 That's such an important part of release success 1267 00:57:36.240 --> 00:57:39.720 that if we're not doing that, oftentimes we're missing the forest for the trees, 1268 00:57:40.080 --> 00:57:43.640 looking at rhythmic movements, oral development norms, 1269 00:57:43.640 --> 00:57:46.640 whether it's functional, dysfunctional patterns, sometimes it's 1270 00:57:47.120 --> 00:57:49.400 functional, meaning the baby's feeding. 1271 00:57:49.400 --> 00:57:50.640 But what does that look like again? 1272 00:57:50.640 --> 00:57:54.600 Is it those maladaptive strategies and what I see very frequently, 1273 00:57:54.600 --> 00:57:56.960 and it's definitely not picking on any group of people, 1274 00:57:56.960 --> 00:58:00.400 but I see very frequently being told to families is they'll grow out of it. 1275 00:58:00.840 --> 00:58:03.840 And I'm like, so what are we asking them to do? 1276 00:58:03.880 --> 00:58:06.120 We are asking them to learn to compensate. 1277 00:58:06.120 --> 00:58:11.160 In my example that I give to work frequently is I see, you know, an 85 year 1278 00:58:11.160 --> 00:58:13.280 old stroke patient who's been NPO 1279 00:58:13.280 --> 00:58:16.040 because their swallowing has been, you know, shot from their stroke. 1280 00:58:16.040 --> 00:58:17.120 And I'll put them on up here. 1281 00:58:17.120 --> 00:58:18.960 Right. And nectar sake liquid diet. 1282 00:58:18.960 --> 00:58:20.760 Are they not eating. 1283 00:58:20.760 --> 00:58:22.440 They're swallowing now they're eating. 1284 00:58:22.440 --> 00:58:25.440 We're on a diet but that is not from level function. 1285 00:58:25.840 --> 00:58:27.120 It's a compensation. 1286 00:58:27.120 --> 00:58:28.600 So why are we stopping at diet. 1287 00:58:28.600 --> 00:58:31.680 And so that's where it's kind of made my wheels start turning, 1288 00:58:31.680 --> 00:58:32.280 because it used to be 1289 00:58:32.280 --> 00:58:36.000 that I was definitely only recommending releases for these X, Y, and Z things. 1290 00:58:36.240 --> 00:58:40.280 And now I'm trying to listen to families and educate on what's out there right 1291 00:58:40.280 --> 00:58:43.880 now, as far as the literature, and help them make informed decisions. 1292 00:58:44.320 --> 00:58:47.280 And then again, looking at, say, organization, looking at infant engagement 1293 00:58:47.280 --> 00:58:50.120 versus disengagement, cuz infants are very, very smart. 1294 00:58:50.120 --> 00:58:51.400 The communicate a lot. 1295 00:58:51.400 --> 00:58:54.000 And are we ignoring their disengagement cues 1296 00:58:54.000 --> 00:58:57.240 and then causing other problems so to speak. So 1297 00:58:58.560 --> 00:58:58.840 all right. 1298 00:58:58.840 --> 00:59:00.840 These are the pictures I was talking about. 1299 00:59:00.840 --> 00:59:05.160 So this is an adult who went through, a release you can see from the bottom up 1300 00:59:05.440 --> 00:59:06.480 and work their way around. 1301 00:59:06.480 --> 00:59:09.840 You can see, how much more function 1302 00:59:09.840 --> 00:59:13.040 that each of those people have gotten just from their releases. 1303 00:59:13.040 --> 00:59:14.360 I mean, you can see the bottom right 1304 00:59:14.360 --> 00:59:16.920 corner is obviously like a pretty significant tie. 1305 00:59:16.920 --> 00:59:20.040 I don't know how they made it that far, but you can see that range of motion 1306 00:59:20.040 --> 00:59:21.440 even from the one on the left, 1307 00:59:21.440 --> 00:59:23.920 that one on the left has significantly more range of motion, 1308 00:59:23.920 --> 00:59:26.280 but they even had more range of motion to start with. 1309 00:59:26.280 --> 00:59:27.560 So how does that work? 1310 00:59:27.560 --> 00:59:31.360 And does it matter if it's infancy or childhood or adults? 1311 00:59:32.800 --> 00:59:35.040 You know, the jury's still out because there's just not enough literature 1312 00:59:35.040 --> 00:59:36.240 for that. 1313 00:59:36.240 --> 00:59:39.120 So here's another adult, obviously, but you can see the difference 1314 00:59:39.120 --> 00:59:40.320 in range of motion. 1315 00:59:40.320 --> 00:59:42.160 I always everybody in my house has done this. 1316 00:59:42.160 --> 00:59:44.240 Or I say drop your jaw open 1317 00:59:44.240 --> 00:59:47.240 as wide as you can, put your tongue up to the roof of your mouth. 1318 00:59:47.400 --> 00:59:50.680 When your jaw is open as wide as it can be, you should be able to put the tip 1319 00:59:50.680 --> 00:59:54.480 of your tongue to the roof of your mouth, and it shouldn't be painful. 1320 00:59:54.720 --> 00:59:57.480 So only about two people in my house could do that. 1321 00:59:57.480 --> 00:59:58.560 Household types. 1322 00:59:58.560 --> 01:00:00.960 But lots of problems because of that. 1323 01:00:00.960 --> 01:00:02.320 So this is one of the things that you can 1324 01:00:02.320 --> 01:00:05.320 kind of show even as adults, these problems can occur. 1325 01:00:05.400 --> 01:00:08.960 So the picture on the left, if you're looking at the screen, that's me. 1326 01:00:09.240 --> 01:00:10.080 That's my mouth. 1327 01:00:10.080 --> 01:00:11.240 I was a horribly fed 1328 01:00:11.240 --> 01:00:15.400 baby, was ended up on soy formula, had loads of orthodontic work. 1329 01:00:15.720 --> 01:00:18.320 I sent this photo actually to one of our pediatric dentists 1330 01:00:18.320 --> 01:00:19.800 that I work really closely with, and she goes, 1331 01:00:19.800 --> 01:00:22.320 oh sweetie, she goes, never lose your bottom teeth. 1332 01:00:22.320 --> 01:00:24.240 And I was like, well, I hope I don't lose my bottom teeth anyway. 1333 01:00:24.240 --> 01:00:27.280 She was like, you'll never be able to wear a bottom plate. 1334 01:00:27.280 --> 01:00:31.280 Well, because those bony growths in the bottom is the main artery. 1335 01:00:31.440 --> 01:00:34.440 So it's literally bony marrow that's pulled out of my mandible. 1336 01:00:34.440 --> 01:00:37.440 From that, I pulled how we're looking tie. 1337 01:00:37.480 --> 01:00:39.600 You can see where our bottom teeth have shifted. 1338 01:00:39.600 --> 01:00:41.880 I had braces, I had a palatal separator. 1339 01:00:41.880 --> 01:00:46.320 I had to, my upper, It's pulled, 1340 01:00:46.640 --> 01:00:49.320 so I'm even missing two extra teeth on top of my wisdom teeth. 1341 01:00:49.320 --> 01:00:52.560 The picture on the right is my son, my youngest. 1342 01:00:52.560 --> 01:00:54.840 His mouth looks pretty identical to mine. 1343 01:00:54.840 --> 01:00:55.640 That's a long time ago. 1344 01:00:55.640 --> 01:00:56.400 He's 13 now, 1345 01:00:56.400 --> 01:00:59.760 but he's actually had a pretty significant amount of issues because of things. 1346 01:00:59.760 --> 01:01:00.440 And he's even 1347 01:01:00.440 --> 01:01:03.520 his incisors have now been worn down, and they're his permanent teeth. 1348 01:01:03.960 --> 01:01:06.600 So now he's requested, releases. 1349 01:01:06.600 --> 01:01:09.200 So we're looking into that. It's different when they're 13. 1350 01:01:09.200 --> 01:01:09.960 But yeah. 1351 01:01:09.960 --> 01:01:13.800 So you can see even into adulthood, things like that can cause some difficulties. 1352 01:01:14.400 --> 01:01:17.600 This is actually the genetic testing for my colleague who had her daughter's 1353 01:01:18.000 --> 01:01:19.120 of our genetic mutation. 1354 01:01:19.120 --> 01:01:23.200 And then she, incidentally, did not have the genotype 1355 01:01:23.200 --> 01:01:26.920 that, was conducive to oral restrictions. 1356 01:01:27.440 --> 01:01:30.080 However, she did have ties. 1357 01:01:30.080 --> 01:01:33.040 I don't know if I can't, I don't think I couldn't pull her pictures up. 1358 01:01:33.040 --> 01:01:35.520 She had her ties released, her lip at two 1359 01:01:35.520 --> 01:01:37.880 and her tongue at eight because she was having migraines. 1360 01:01:37.880 --> 01:01:41.040 So even though this genetic to this actual genetic testing didn't come up. 1361 01:01:41.040 --> 01:01:44.920 And she's also had a few other quirky, like, genetic things, come up, 1362 01:01:44.920 --> 01:01:48.760 she did, in fact, still have ties and so did all four of her children. So. 1363 01:01:48.760 --> 01:01:50.160 And they breastfed beautifully. 1364 01:01:50.160 --> 01:01:53.880 But some other parts and pieces, you know, kind of came together to lead her, 1365 01:01:54.520 --> 01:01:57.200 towards the journey of releases for a few of them. So 1366 01:01:58.440 --> 01:02:00.600 health literacy, and we'll wrap this up. 1367 01:02:00.600 --> 01:02:03.600 But looking at professional health literacy is the degree in which 1368 01:02:03.720 --> 01:02:08.240 individuals have the ability to find, understand and use information services 1369 01:02:08.240 --> 01:02:12.120 to inform health related decisions and actions for themselves and others. 1370 01:02:12.280 --> 01:02:15.720 So this is where it gets really hard for us, because there's so much research out 1371 01:02:15.720 --> 01:02:19.160 there and parents are being inundated with so much information. 1372 01:02:19.640 --> 01:02:25.320 It is is absolutely necessary for us as providers to be able to do this, 1373 01:02:25.640 --> 01:02:29.640 to extrapolate information from all that's out there, bumbling around 1374 01:02:29.640 --> 01:02:33.200 like bingo balls in the world and help families and as providers 1375 01:02:33.200 --> 01:02:36.960 to be open minded to literature outside of our scope of practice. 1376 01:02:36.960 --> 01:02:40.320 That's the biggest thing, is if we can't get past our own scope of practice, 1377 01:02:40.800 --> 01:02:42.320 how are we going to educate people? 1378 01:02:42.320 --> 01:02:44.760 Because that means our box is very closed. 1379 01:02:46.080 --> 01:02:49.280 And this is the New York Times article that caused a big, massive 1380 01:02:49.280 --> 01:02:52.560 stink, inside the booming business of cutting babies tongues. 1381 01:02:52.560 --> 01:02:54.960 These are just snippets from the article. 1382 01:02:54.960 --> 01:02:57.600 It was actually a terrifically written article. 1383 01:02:57.600 --> 01:02:59.800 If you just look at base journalism. 1384 01:02:59.800 --> 01:03:05.000 It really is pretty sad, because there's lots of good things that can come 1385 01:03:05.000 --> 01:03:08.160 from releases, and there's obviously going to be horror stories from everything. 1386 01:03:08.160 --> 01:03:10.560 In my own practice, I've seen it as well, 1387 01:03:10.560 --> 01:03:16.440 and I just try to be very careful to treat every family with their own, 1388 01:03:16.440 --> 01:03:20.440 you know, like, we're going to make your plan of care based on your needs. 1389 01:03:20.920 --> 01:03:25.840 And this article just unfortunately created a lot of issues 1390 01:03:25.840 --> 01:03:27.120 that it didn't need to. 1391 01:03:27.120 --> 01:03:28.480 Because when you read something like this, 1392 01:03:28.480 --> 01:03:29.800 you're like, oh, it's in the New York Times. 1393 01:03:29.800 --> 01:03:33.040 It has to be, you know, and it's just hard because it 1394 01:03:33.040 --> 01:03:36.040 it makes the misinformation spread like wildfire. 1395 01:03:36.120 --> 01:03:38.880 These are voluntary scores, essentially. 1396 01:03:38.880 --> 01:03:42.080 It's a way of measuring the space in your, your airway wall 1397 01:03:42.080 --> 01:03:45.560 and potty scores directly, correlate to your airway patency. 1398 01:03:45.840 --> 01:03:48.840 So not only working with neonates, should we be concerned about that, 1399 01:03:48.840 --> 01:03:52.200 but obviously as those neonates turn into infants and children and so forth, 1400 01:03:52.440 --> 01:03:55.520 we really, as therapists should be looking at airway patency. 1401 01:03:55.520 --> 01:03:58.440 That is a lifetime's skill, not a newborn skill. 1402 01:03:58.440 --> 01:03:59.280 So even though we're looking 1403 01:03:59.280 --> 01:04:02.640 at sexual coordination in these neonates that we're working with, 1404 01:04:03.200 --> 01:04:07.880 as they get older, we should be looking at things like snoring open mouth postures. 1405 01:04:08.080 --> 01:04:12.000 All those things are not functional airway, patency. 1406 01:04:12.640 --> 01:04:15.040 So we should be looking at these scores. 1407 01:04:15.040 --> 01:04:16.400 And it's not really about the scores. 1408 01:04:16.400 --> 01:04:20.000 For me it's more about what do these scores mean for function 1409 01:04:20.160 --> 01:04:21.840 and how does that impact them. 1410 01:04:21.840 --> 01:04:24.360 There's there was lots of research when I was pulling it up 1411 01:04:24.360 --> 01:04:27.000 for my own children about ADHD and poor sleeping. 1412 01:04:27.000 --> 01:04:28.200 So kind of thinking about 1413 01:04:28.200 --> 01:04:32.200 how does this airway patency and all these oral structures go together. 1414 01:04:33.560 --> 01:04:35.840 And these are just classes, them on potty classes. 1415 01:04:35.840 --> 01:04:38.840 Incidentally, my colleagues little girl had a very poor mountain potty score. 1416 01:04:39.120 --> 01:04:42.680 And she's the one that had the the release at eight. 1417 01:04:43.080 --> 01:04:46.640 And then the biggest thing to look at is evidence based practice. 1418 01:04:46.640 --> 01:04:49.960 And I think this is so hard, I've noticed for my younger colleagues. 1419 01:04:49.960 --> 01:04:52.240 But even as we get sometimes it's like younger and older 1420 01:04:52.240 --> 01:04:55.360 and sometimes like us like middle, middle of the road people. 1421 01:04:55.920 --> 01:04:57.680 Evidence based practice is a triad. 1422 01:04:57.680 --> 01:05:00.120 So we have to look at research. 1423 01:05:00.120 --> 01:05:03.080 Obviously, the problem with research is there's just not enough of it. 1424 01:05:03.080 --> 01:05:07.200 We just nobody has the time or funds to do as much research as we'd all like to do. 1425 01:05:07.200 --> 01:05:08.760 And I would love it if there was more out there. 1426 01:05:08.760 --> 01:05:11.200 But we have to dig through the research that's available. 1427 01:05:11.200 --> 01:05:13.200 We have to look at our professional 1428 01:05:13.200 --> 01:05:17.720 experience, our clinical practice, what has worked and not worked, you know, 1429 01:05:17.720 --> 01:05:21.160 historically for us and for our colleagues and for people in the field. 1430 01:05:21.480 --> 01:05:24.360 And then the last thing is patient and family values and expectations, 1431 01:05:24.360 --> 01:05:27.920 because if we're not doing that, we have missed it. 1432 01:05:28.040 --> 01:05:28.520 All of it. 1433 01:05:28.520 --> 01:05:31.080 We've missed the boat because it doesn't matter what we think. 1434 01:05:31.080 --> 01:05:34.600 The family isn't grasping on if they're not buying into it. 1435 01:05:34.600 --> 01:05:37.320 If they don't feel like your services are valuable, 1436 01:05:37.320 --> 01:05:38.880 then we've done a disservice to them. 1437 01:05:38.880 --> 01:05:40.640 So we have to look at this as a triad. 1438 01:05:40.640 --> 01:05:43.600 And while all this is of the research and the clinical practice is 1439 01:05:43.600 --> 01:05:46.440 we have to look at all three pieces together to make it successful. 1440 01:05:48.600 --> 01:05:51.400 And if you have any questions, my contact information is here. 1441 01:05:51.400 --> 01:05:54.120 So feel free to reach out. Like I said, sounding board questions. 1442 01:05:54.120 --> 01:05:57.320 I've kind of kind of worked in a little bit of every part of our field thus far. 1443 01:05:57.320 --> 01:05:59.880 I've been in the Nicki for a long time, and that's kind of my happy place, 1444 01:05:59.880 --> 01:06:02.880 but I've definitely seen it all and would be happy to, you know, 1445 01:06:03.240 --> 01:06:05.960 chat, talk about any questions and so forth. 1446 01:06:05.960 --> 01:06:08.960 Thanks for all you do to improve neonatal care. 1447 01:06:08.960 --> 01:06:11.960 Even the unseen steps like this really matter. 1448 01:06:12.080 --> 01:06:15.120 Your commitment to excellence inspires us every day. 1449 01:06:15.120 --> 01:06:15.800 Have a great one.