We’ve featured various health professionals on our podcast in the past—pediatrician, OT, PT, doula, pediatric chiropractor…. We like to bring you information we think will be helpful and informative. We often learn new things right along with you since—we admit—it’s been a minute since we had babies on our hips and toddlers underfoot, and things are always changing.
Today we’re so happy to have with us another type of therapist you may not be familiar with. We’d like to introduce you to CHELSEA MADISON, owner of the BreatheWell Group, with primary locations in Murfreesboro, Mt Juliet, and Franklin, TN. Additionally, she travels to offices in Jackson and Chattanooga. That’s all in the middle TN area here where we live, but you can likely find similar therapists and offices where YOU live as well.
Welcome Chelsea! Chelsea’s been married 15 yrs and has two children. Her oldest child is now eight and it’s her difficult and frustration experiences with him as an infant that led her from dental hygienist to multiple certifications in OMT and lactation consultation. Painful nursing and feeding issues made for a stressful and disappointing beginning. With her second child, who’s now 1, things were much different and she was able to navigate the world of oral corrections much easier and earlier.
The Breathe Well Group helps with OROFACIAL MYOFUNCTIONAL THERAPY. That’s a mouthful. Can you explain what that means? (oral & facial… myofunction = muscle function)
[Disorders or malfunctions arise when there’s an abnormal lip, jaw, or tongue position during rest, swallowing or speech. It can include exercises that improve the strength, positioning, and coordination of the mouth and throat muscles. That can include the tongue, lips, and pharynx.]
**How is this different from Speech Therapy? Do they overlap? Do children with orofacial issues typically ALSO have speech issues? Or are they mutually exclusive?
Let’s get into some of the issues we’re talking about here. Your average parent (first child) goes to the pediatrician or maybe a first time visit to the pediatric dentist, or even an orthodontist–and what are some things they might discover that could lead to a referral?
Issues from OM disorders can vary—speech, breathing (sleep apnea), eating, swallowing, tongue thrusting, nursing/lactation issues. (Breathe Well in particular also offers lactation consultation…)
WHY IS THE TONGUE SO IMPORTANT?
We notice our tongues only when something’s wrong—maybe an ulcer, or you burn it with too-hot liquid; you bite it by mistake… but turns out, it’s vital for more than just talking, tasting, chewing, and swallowing. Or tying a knot in that cherry stem. 😉
It’s a lymph draining organ… A strong well positioned tongue is an effective toxin cleaning system. Lymph drains via movement…tongue can move in all directions (front to back, from the sides to middle and top to bottom). It’s the only muscle in our body that can contract and extend.
TONGUE THRUSTING: can lead to orthodontic problems like bite misalignments (overbite, underbite, etc.), crooked teeth, crowded teeth and spaced teeth are often caused by childhood habits involving the mouth. When children make a habit of pushing their tongue against their teeth while their teeth and jaw bones are developing, this can lead to a number of difficulties, including long-term speech impediments, an open bite, and gaps between teeth.
Tongue thrusting is the motion of pushing your tongue forward, against the back of the teeth or between the top and bottom teeth, when swallowing, speaking or relaxing
Tongue thrusting can have a number of different causes, including:
- Narrow palate (upper jaw bone)
- Allergies or congestion
- Enlarged tonsils
- Tongue tie
- Using bottles or pacifiers after 4 to 5 years of age
- Using sippy cup after 4 to 5 years of age
- Thumb sucking
TONGUE TIE: It’s everywhere. In online mom groups, it’s blamed for all sorts of parenting woes. Baby isn’t gaining weight, or won’t take a bottle? Have you tried checking for ties? Kid won’t nap? It’s probably related to tongue tie.
Tongue tie, or ankyloglossia, is characterized by an overly tight lingual frenulum, the cord of tissue that anchors the tongue to the bottom of the mouth. It occurs in 4 to 11 percent of newborns,. 3 x more often in boys than girls. A lip tie—a related condition—is an unusually tight labial frenulum, the piece of tissue that keeps the upper lip tethered close to the gum line. Tongue and lip ties often occur in tandem.
From a 2019 Atlantic article by Rachel Cautero: One 2017 study found an 834 percent increase in reported diagnoses of tongue tie in babies from 1997 to 2012, and an 866 percent increase in frenotomies during that time. And those are just inpatient numbers: babies who had tongue-tie revisions shortly after birth, before even leaving the hospital. It doesn’t include babies who get an outpatient procedure later in life.
She goes on to link the increase to increased cultural pressure for mothers to breastfeed. More mothers are nursing, and if there are issues (which a lot of times there can be!), they want to find a reason for it and be “doing it right.”
The frenulum, that tendon-like bit that connects your tongue to the bottom of your mouth is too tight or short. Babies may experience problems breastfeeding, infants may experience feeding difficulties, Ear Infections, children may have speech development challenges (r, s, t, d, l, sounds) and breathing disorders; teenagers may have experienced all the previously mentioned problems in addition to dental and jaws underdevelopment. Breathing problems may include mouth breathing, snoring, and sleep apnea. Adults may be experiencing all the above symptoms in addition to neck tension, headaches, TMJ problems, gagging, etc…
Treatment for tongue-tie is controversial. Some doctors and lactation consultants recommend correcting it right away — even before a newborn is discharged from the hospital. Others prefer to take a wait-and-see approach. Does it depend on the severity?
Left uncorrected, oral issues like this can lead to a cascade of other preventable behaviors such as picky eating, inability to handle certain textures or consistencies in food, and a fear of food introductions. Surprisingly, recommendations are to start your child on solids at 6 months. And not primarily pureed solids, as we’re accustomed to, but the same sorts of foods parents would be eating. This allows children to properly exercise the muscles in cheeks, tongue, and jaw needed for chewing and swallowing. Gagging (not choking!) and learning to spit strips of food out or move them about inside the mouth is necessary and normal.
PACIFIERS/THUMB SUCKING
We did a whole episode on pacifiers: how & when to give them up. What’s your take on them? What do you see in your office? When do you recommend dropping the pacifier? Recommendations are—after that sucking reflex is finished–to drop the pacifier by 6-9 months. Use of a pacifier after this age interferes with proper oral development and can lead to jaw/face formation issues, orthodontic/teeth issues, and even breathing/sleep issues that can worsen behavior during waking hours.
Shape Matters: choose cylindrical pacifiers rather than bulb, “cherry” or flat orthodontic pacifiers.
THERAPIES
So, a parent has been referred to the therapists at your office. What typically happens next? What can they expect?
What sort of therapies/exercises do you use? Are there also at-home exercises you’re recommending in tandem?
EARLY INTERVENTION
As with so many other childhood issues, early detection and intervention is very important. You’re wanting to catch things before habits arise if possible, in the rapid development phase.
So for parents of kids ages 0-4….we def don’t want to be alarmist or add to their worry list! Are there things to look for?
Feeding & Swallowing:
Excessive swallowing of air while feeding
Tongue thrust swallow, poor or inefficient chewing, audible eating
Difficulties with suck-swallow-breathe coordination
Difficulty nursing
Transitions: from breast to cup, puree to solids
Gagging/vomiting before or after meals
Picky eating
Poor latch
Prolonged sucking habits
Oral Habits:
Teeth grinding
Open mouth breathing, audible breathing
Excessive mouthing of objects
Low jaw posture
Nail biting
Tongue protrusion past lower lip at rest
Excessive drooling??
Structural:
Tonsils/adenoids
Crowded teeth
Lip blisters
Palate (high or narrow)
Sleep apnea
Dry mouth or lips
Speech:
Atypical speech sounds