Katie The Traveling Lactation Consultant
Katie The Traveling Lactation Consultant
Ep 71 Jenae Ciuffreda, Oral Posture
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Katie Oshita sees tongue-tied babies and discusses oral function for infants. But what happens if not treated, or if full oral function is not achieved? Jenae Ciuffreda sees kids and adults with oral ties and other oral function dysfunction. In this episode, Katie and Jenae discuss expansion, nasal breathing, and airway health. If you have questions about kids and adults who weren't released as babies, this is a great episode to hear about some options for them.
Podcast Guest: Jenae Ciuffreda BS, RDH, CBBA, CSOM is a Certified Specialist in Orofascial Myology and a Certified Breathing Behavior Analyst/Therapist practicing in North San Diego County. Jenae sees both children and adults with orofasial myofunctional disorders (tongue thrust, low tongue posture, weak lip seal, open mouth posture, mouth breathing). Jenae is trained as an Orofacial Myofunctional Therapist and Breathing Behavior Analyst/Therapistunder the Academy of Orofacial Myofunctional Myology (IAOM). Jenae has attended over 15 certification courses in restorative breathing, orofacial myofunctional therapy, airway and facial growth and development, TMD, sleep, and tethered oral tissues (frenectomy) in order to provide the absolute best solutions and care for her patients. Jenae develops customized programs for her patients to achieve maximum results. Jenae is extremely passionate about helping her patients succeed and achieve results that are life changing.
Jenae was born and raised in Southern California. She has her BS and RDH through Loma Linda University. She graduated with honors and was awarded clinical practitioner of the dental hygiene program by her instructors and the dean of the school of dentistry. Jenae resides in Escondido, CA with her husband and two children. They love getting out in sunny San Diego and exploring all that it has to offer.
Podcast host: Katie Oshita, RN, BSN, IBCLC has over 22 years of experience working in Maternal-Infant Medicine. Katie is a telehealth lactation consultant believing that clients anywhere in the world deserve the best care possible for their needs. Being an expert on TOTs, Katie helps families everywhere navigate breastfeeding struggles, especially when related to tongue tie or low supply. Katie is also passionate about finding the root cause of symptoms, using Functional Medicine practices to help client not just survive, but truly thrive. Email katie@cuddlesandmilk.com or www.cuddlesandmilk.com
Disclaimer, this content is meant for information only and not as a diagnosis or medical treatment for any condition. If you or a loved one needs help, please seek out a qualified medical professional for assistance. Welcome to the podcast. I'm your host, Katie Ostkaff, BSN, RN, IBCLC, and infant feeding specialist. Quench your thirst for knowledge and travel with me across the nation to discover, learn, collaborate, and better serve clients from all over the globe. Let's ride and thrive together. Today on the podcast, I have Janae Perfetto, BSRDH, C B V A, C S O M. Janae is a certified specialist in orofacial myology and a certified breathing behavior analysis and therapist practicing in North San Diego County. Janae sees both children and adults with orofacial myofunctional disorders such as tongue thrust, low tongue posture, weak lip seal, open mouth posture, and mouth breathing. Janae is trained as an oralfacial myofunctional therapist and a breathing behavioral analysis and therapist under the Academy of Orofacial Myofunctional Therapy, AOMT, as well as the Graduate School of Behavioral Sciences and International Association of Oralfacial Myology, IAOM. Janae has attended over 15 certification courses in restorative breathing, oroffacial and myofunctional therapy, airway and facial growth, development, TMD, sleep, and tethered oral tissues for nectomy in order to provide the absolute best solutions in care for her patients. Janae develops customized programs for her patients to achieve maximum result results. Janae is extremely passionate about helping her patients succeed and achieve the results that are life-changing. Janae was born and raised in Southern California and has her bachelor's degree and RDH license through Woma Linda University. Janae graduated with honors and was awarded a clinical practitioner of the dental hygiene program by her instructors and the dean of the School of Dentistry. Janae resides in Escondia, California with her husband and two children, and they love getting out in sunny San Diego and exploring all that it has to offer. Please welcome Janae to the podcast today. Thank you so much for joining me today, Janae. I'm so excited to talk with you. I think this airway space is so important. And what I see and talk about is the, you know, the really littles and a lot of breastfeeding and a lot of airway stuff there, but you see everybody throughout the lifespan. And I think that's just such a wide range and a really important perspective to give people that this isn't just about breastfeeding. So I first and foremost want to thank you for your time today. I know you're very busy.
SPEAKER_00Well, thank you for having me. I'm very excited to be here.
SPEAKER_01Thank you. So, you know, this is something that I I've talked about some, but I haven't talked about a ton. A lot of times I'll I'll talk more about my background of how I got into tongue tie space with my own kids, with breastfeeding being so difficult. And when I started to learn more in lactation, it was like, oh, that's why that happened. And it explained a lot. But I was just thinking too, with with as we were chatting before we started recording, my own personal tongue tie journey that I spent, you know, I had so many issues as a kid. I spent 10, eight, 10 years going to speech, never getting sounds that changed, you know, never getting to that point where I could say certain sounds. And I had so many physical and airway issues. It's really amazing to me as I look back that I'm like, you know, they were so close. My dentists and doctors and some of them were so close and yet didn't quite figure out what was going on. Right. Just did the same things again and again, right? Like I had braces, headgear, bionator, retainers. I had everything for like 10 years.
SPEAKER_00Yeah.
SPEAKER_01And it's I'm glad to see that there's more stuff changing because when I was a kid, they just pulled a bunch of teeth, right? Like I don't have all my teeth. And I love to hear that people are saying more and more, oh, well, that's when you do expansion, you know. So I'm I'm finding that parents are getting more knowledgeable about that. But I tell people all the time, this isn't about breastfeeding. If you were gonna formula bottle feed your baby, fine. Doesn't matter, right? I mean, I don't mean to say that breastfeeding doesn't matter. I mean to say that the tongue tie is not just about breastfeeding, right? It's about airway health for life. And every baby needs that, whether they breastfeed or bottle feed. And you could almost argue that those bottle feeding babies might need it more because they're not getting the breastfeeding to help shape that palate and that whole orofacial space. Correct.
SPEAKER_00Yes, absolutely. I a hundred percent agree with everything that you just said. My background is dental. I went into this space searching for answers as far as when I say the space, my orofacial myofunctional therapy training and my breathing training that I have was all spurred by asking questions as to why things were happening in my dental practice and seeing that not a lot of people had answers as to why there was orthodontic relapse. That was my main, main thing that I was seeing all the time, amongst other things. But doing braces again for the second or third time really wasn't a solution. It was just doing the same thing that didn't work the first time. So when I went back to school and I started this educational journey, which it definitely has been because I have taken so many courses in this space trying to find answers for my patients, it was mind-blowing to me how much what the muscles of the mouth and face do for us. Like it's not just about teeth. You know, my focus was teeth because I was trained in the dental world. But then when I went to my first course, I just came home just mind-blown that this is so much more than that. It is about the growth and development of the upper and lower jaw, which defines the functional space that is the airway. And if we don't have a well-defined airway, upper airway, which is just a functional space between anatomy and the anatomy that defines that space is the upper and lower jaw, then we are going to have a lifelong symptom list that just does not go away and it gets worse with age. And so, yes, I see all ages all the way through end of life. And when we get older, these symptoms just get worse and worse. And so treating patients young is beautiful because we get to set them up for success for life, but there's rewarding aspects in all of my patients because helping an adult get rid of symptoms they've had their whole life is life-changing for them. So it's a very exciting job that I have. And I'm so happy you asked me to be here to talk about it.
SPEAKER_01Well, it is amazing. I think that you're right. I think there's something to to see in older children and adults when that those problems, those nagging things that they thought were just normal go away. I mean, I did not even realize that I had reflux until 2022. I got COVID really badly and spent like a month being pretty sick. And when I got better, I just could not stop clearing my throat. I couldn't lay down. I felt like there was something in my throat at all times. I was just constantly, you know, drinking. And it took me a little bit and I figured it out and was like, oh, this is reflex. Like, I see babies with this all the time. I should know this. Um, and I was able to get some pretty good results with some DGL and some slippery elm and do some supportive therapies. But it was really eye-opening for me. And what was interesting too was that I realized I had reflex for, you know, decades, if not my whole life. It's why I am known for drinking, you know, five glasses of water at a meal. Like I, you know, I used to, if I was out at a restaurant, people would joke that the server should just like leave the whole carafe right next to my glass. Like I just drink a lot of water. And um, I would always clear my throat after meals or in the morning and always feel like I was swallowing something. But I honestly didn't ever give those any thought because they were just my normal, right?
SPEAKER_00Yeah. I hear this all the time when I do an assessment on an adult patient. I'm asking symptom-related questions and they're like, wait, that's a symptom. That's just my life, you know, and it's so interesting that as we start doing the therapy together, these symptoms just start going away. And they're like, I had no idea that I was living like that. They, that's just their norm and they've lived like that for their whole life. So we're as we're optimizing function, it's literally changing their entire life. It's pretty cool.
SPEAKER_01Yeah, it's crazy to think of, you know, it the same thing happens when I talk with clients and I tell them, you know, when I'm talking about airway stuff for baby, I'll say, you know, they baby shouldn't snore. And they're like, oh, not even cute little baby snores. I'm like, nope. And then a lot of times one parent will look at the other and say, Well, then should you snore? I'm like, nope, nope. We're really good in this country at normalizing dysfunction. We call things normal when we really mean common.
SPEAKER_00Yeah, and I say that all the time. It's common, but not normal.
SPEAKER_01Yeah, I think there's a healthy part where we just don't, we either as a culture, either don't truly understand and aren't able to recognize the dysfunction, or we just not willing to admit that there's so much dysfunction, and then we'd have to deal with it. So it's easier to just kind of claim that everything is normal.
SPEAKER_00Right. Well, and I think when something becomes so common, it almost feels normal, right? So to the general population, you know, grandma snores or grandpa snores or dad snores or mom snores, and so I snore, and that's common, you know, it's common, so it's normal, or you know, or it's normal to them, I should say, because I see it so much. Or, you know, everybody has braces in my class. So I should have braces too. It's extremely common, but not normal, that we have crowded teeth. And then when we look at, you know, airway dementia and CPAPs and sleep apnea diagnosis, and so many are undiagnosed, but there's a lot that have been diagnosed. And it's like, oh yeah, my my grandpa wears a CPAP or my mom wears a CPAP. So, you know, that's pretty normal. No, it's common, but not normal. So it's just, you know, it's the way that the general public just sees the other people around them, you know, the people in their family, the people in their friend circles, they all have the same thing going on. So they think it's normal. And so when I talk about how breathing should be silent and calm and quiet and non-existent, like you can't see it, you can't hear it, that is powerful because people start looking around and seeing that, oh, I can hear that person breathing while they're awake, just right next to me. That's not normal, right? Or wow, if I should be able to go into my child's room and not even know they're in there. That's how quiet it should be. And if you can hear any breathing, it's a sign of a dysfunction. So bringing awareness to my patients and to the public is one of my passions. I really want people to understand that they can identify these things and then seek help. It's unfortunate that I find that the medical profession is not jumping on board with this stuff as fast as I would like. And when I go and speak about it, I don't get as many referrals from them as I know that they they could see and identify. So that's where I get discouraged. But what's very encouraging is that the general public has more access to information and they're able to identify their own symptoms and seek help for their families. And that's exciting because we are able to help people more right now, I think than ever before.
SPEAKER_01Absolutely. I would agree. But I would say that yeah, the families are generally kind of crowdsourcing their medical, dental, and holistic health. I think our system is kind of failing people overall, that we're not doing a good job of identifying dysfunction, supporting normal growth and development. You know, I think our medical system is very much set up to either deal with the very sick or, you know, find the very sick. I mean, I've talked to plenty of pediatricians who've said they've had more training on the most rare cancers that they're most likely never going to see in their career than they have on tongue tie that, you know, we know that probably one in four babies is dealing with oral dysfunction. And it's astounding to me that that is not something that we can spend a little bit more time covering. You know, I mean, we could have such good screening if that was happening.
SPEAKER_00Right, right. So the the pediatricians and pediatric dentists are that first source, I think, of being able to diagnose this at a young age, which is powerful for these kids so that we can prevent the symptoms that occur as we age and prevent surgical intervention, which is so important.
SPEAKER_01Yeah. I mean, if if we can get all of these things working better with very minimal or non-invasive or very minimally invasive, it would be better. I mean, I'm one of those who had enlarged tonsils and adenoids as a kid and had them removed. And I've never come across this. I I haven't really looked that hard, but I don't know if anyone has ever noted this before. But when I was a kid, I had I had major sleep issues. I had breastfeeding issues, I had colic. I had all of the symptoms. Okay. But when I was five, I started having seizures in my sleep. I had grandma seizures. And around seven, my pediatrician really felt that it was my enlarged tonsils and adenoids, that they were compressing my trachea and my brain was causing a seizure to be able to move them and wake up. And I had my tonsils and adenoids removed. My neurologist very much disagreed and felt that this was something else. I don't, I don't know exactly. My mom doesn't remember what she thought it was because they went away after my tonsils and adenoids were removed. And, you know, I wound up as a kid staying on meds for a few more years and finally getting off of them, thank God, because I can remember quite a few years of grammar school that were pretty brutal being on things like phenobarb. But it was such a big airway issue, right? Such a massive thing of I'm was mouth breathing and super enlarging those tonsils and adenoids. And if, you know, had we talked about airway before, had my parents or my providers been aware that, you know, mouth breathing can lead to enlarged tonsils and adenoids, it's like I always feel like my pediatrician got so close by figuring out the tonsils and adenoids, but unfortunately hadn't hadn't known about tongue tie. And so that part was never addressed until a couple of years ago.
SPEAKER_00Right.
SPEAKER_01Right. I got that addressed as an adult, but it's it's just astounding the things that the body can and will do to compensate. And our body will find a way, but just because we find a way does not mean that it's the right way. Right, a good way that's going to happen without a lot of dysfunction or pain or difficulty being caused.
SPEAKER_00Right. Yeah, a hundred percent. So when I'm looking at a child who has a mouth breathing problem, I am looking at what is causing that. And when we are having mouth breathing, we are having low tongue posture. The tongue is living in the floor of the mouth versus suction cup to the roof of the mouth. And when the tongue is low, we also have a down and forward swallow instead of the tongue pushing into the palate and going up and back. And so not only is the mouth breathing causing a lack of filtration of the air and air is hitting those tonsils directly, we also are not having the lymphatic drainage that the tongue provides. And so then we have this lymphatic tissue back there that is the only way the lymphatic system moves is with a series of muscular squishes. And the tongue is a group of 16 muscles that's supposed to provide that squish every time we swallow, which is right around a thousand times a day or more. So we've got this low tongue that's not squishing that lymphatic tissue. And then we've got a low tongue, which means an open mouth posture for some or all of the day, where we're taking in air through a huge hole with zero filtration, and then everything in the environment is landing on this lymphatic tissue, and then there's no way to drain and move that lymphatic system because the tongue isn't doing its job. And then we have the perfect storm. We have a perfect storm of having lymphatic tissue get enlarged and obstruct the airway. So yeah, it was good that the pediatrician recognized that we had swollen tissue. That's the alarm. That's the alarm of something bigger happening. The dysfunction is that low tongue posture. And whether or not that's a, that is a posture that you're taking because the tongue is physically stuck to the floor of the mouth by a frenum, or is the tongue low because of a neurological deficiency where there's low tone? Or is the tongue low because it's a habit? It's just a bad habit that has been formed at some point in in the life of the child because of things that push the tongue down, like bottles or pacifiers or thumb sucking or a cold that was early onset that nobody restored nasal breathing again, and the body decided that the mouth was easier to breathe through and it took that route instead of using the nose. And the body forgot the nose existed. So we're looking at, you know, is it is it a tongue tie that's causing this low tongue posture, or is this just a thing that's been learned over time due to an environmental change, an epigenetic shift that caused the low tongue? So we're looking at all of these things and trying to figure out why, and then addressing the root cause, which is beautiful because if we address the root cause and we we get the muscles functioning the way that they're supposed to, the way that they're meant to, in this 24-hour period of that we, there's not a point in a 24-hour period that we do not breathe, right? There's not a point in a 24-hour period that we do not sleep and need an airway. There's not a point where we don't swallow or we don't drink, we don't eat. We're talking about muscles that we we need and we use them all day, every day, all night, every night. And if we're not using those correctly, the symptoms that arise are the list is long. And the things that you've mentioned, swollen tonsils, swollen adenoids, not enough space for your teeth, you know, not enough jaw growth and development, not enough airway, acid reflux, you know, all of these things are things that we see on a daily basis when we're assessing our patients and treating our patients.
SPEAKER_01Absolutely. And I I spend a lot of time talking about this with new parents, that while, yes, I'm here to help with breastfeeding or bottle feeding, however, they're feeding their baby, but that regardless of this feeding, we need to get this baby to a good airway space, right? That we have this gift of being able to do it while they're young and malleable and and much more receptive to these things with years ahead of them for really good growth. And even when I have a good result with a client and we get to a really good point and we've got, you know, good nasal breathing and no snoring and no noisy breath and all this type of stuff and no more symptoms, feeding's going well, I still always recommend that my clients get, you know, meet with an airway orthodontist or airway-focused dentist in a couple of years and just evaluate space as teeth start coming in and everything else, because I know that this is a complex thing. And as they grow and as they change, as we introduce solids, as you know, they wean off breastfeeding, if a habit like thumb sucking comes up at one or two, all these types of things can change and affect growth and development. And so it's something that I just generally recommend that they have a check-in, especially because I see so many high palettes. And as you know, that palate doesn't just drop overnight. And that's gonna need to be kind of checked in on and, you know, make sure that we're progressing towards a more functional palette for the baby.
SPEAKER_00Yeah, a hundred percent. Doing regular check-ins with somebody who is a functional, holistic-minded, airway-focused dental professional is gonna be a great person to connect with because they will be able to monitor the growth and development and see if there's going to need to be a safe functional intervention to help guide that or to help stimulate, I should say, that growth and development even more. There's genetic and epigenetic components at play. So, you know, even and we know that three generations of genetics will affect the current generation. So we have to look at the way mom and dad, the way their jaws formed, and as kind of something to watch for as well, right? So we want to look at the environment, how the environment is influencing this baby and then this child. And then also we're looking at the genetic components because even with the best epigenetic environment, the way that the environment is influencing our gene expression, we can still have genetic components that we need growth and development. So working with somebody that's functional and looking for these measurements and looking at the way that the jaws are growing is super important because it's again, it's just not about just the teeth, it's about the airway. And as we develop the upper and lower teeth. Jaw, we're developing the upper airway. And it really is a huge, huge benefit to start young because training the jaws is a lot easier to do than when we get older. And then we're looking at more of breaking the jaws, which is much more traumatic and just doesn't work as well. Ouch.
SPEAKER_01Yeah.
SPEAKER_00I would say that sounds dramatic. I would not want my jaw broken. So for instance, with my kiddos, of course, being an orofacial myofunctional therapist and breathing therapist and starting this career right when I was having my kids, it gave me, it's, you know, I called them myo eyes, my myo eyes. And I try to train all of my parents to have myo eyes so that they can identify as their child is growing if they need to come in and have another session or, you know, if if we need to make a referral to a functional airway dentist to help. But as I was doing this with my own children, of course, I was working on them at a very young age, teaching them how to nose breathe and get their tongue section cup to the roof of the mouth day and night, and making sure that they're chewing a lot at the molars. We know that chewing grows the jaws. We know that a lack of chewing, you know, over generations has caused our jaws to get smaller. So if we chew more, we're gonna start to change that and help those jaws grow. So doing all the right things with my kids from birth, essentially, and seeing how they grew and developed. And, you know, I thought I was doing a really great job. You know, they had really nice wide palettes. They had space between all of their baby teeth. I thought I had this in the bag. And then with my daughter, she was great. With my son, um, his father is six, four and a big guy. And as his adult teeth started coming in, he, even though his palate was nice and wide, still needed more space. So I got him in a functional appliance, a removable functional appliance that stimulated that growth. And at a young age, so I started him right when he started to get his adult teeth. So he was about five and a half. And uh he's got, you know, this wide 42 millimeter palette with enough space for all of his adult teeth, zero crowding, and he'll never need braces. And so we can do, and and this is an appliance that's removable. He could take it out when he ate, he could take it out when he went to school, he only wore it when he was at home and at night. And then we got all this growth and development and with no pain, it never was forceful. He never complained about it once. And it's so cool, you know. But even if you're doing all the right things, what I'm saying is this it's still good to have good dental eyes on your child because you can do this type of intervention that is going to guide or stimulate their growth and development, the way that's going to support their genetics. Because, you know, even my kiddos that had all the great training I was giving them needed a little bit more support. So when I'm working with kids, you know, I do all of the things to help them gain tongue suction to the roof of the mouth, teeth apart at all times, lips closed, nose breathing day and night, um, getting them chewing correctly on both sides to stimulate proper growth and development, swallowing correctly with the tip and middle of the tongue pressing firmly into the roof of the mouth, the back of the tongue, dumping the saliva back, getting good lymphatic drainage of all the lymphatic systems, not just the adenoids and the and the um tonsils we're so familiar with, but also the tubal tonsils, the lingual tonsils, all those are so many different tonsils in this space. It's all lymphatic tissue. It all needs that tongue to perform correctly to get that working well. My kids have never had an ear infection, they've never been on antibiotics. You know, we can do things with the tongue that help to clear the ears, drain the ears, um, do all of these things to help support their health and well-being as they grow so that they don't need all this medical intervention. And then we are able to check in on their growth and development and intervene if they need more stimulation of growth based on their genetics. So it's just so important to make sure that we follow these kids as they grow and be in good dental hands so that that provider can help you so that you can avoid, you know, all of the things that need to sometimes occur. You know, the in the general population, a lot of people do rapid palatal expansion, which is, you know, a fixed bonded expander where they turn the key twice a day, sometimes, sometimes once a day. And it's turning a key inside the palate that turns it so much that it breaks open the suture in the palate. And that is not as nice as just stimulating growth, right? So it's just much less invasive if we can catch these kiddos early and help stimulate their growth appropriately.
SPEAKER_01Oh, yeah. As a mama, I would agree. My kiddo underwent that type of palate expansion. And it was not, it was not the worst thing ever, but it was definitely now. I'm like, I wish we had known more. I wish we had done something different. You know, it was not, it was definitely not comfortable. It was not something that she liked going through. And it was definitely much, much helped with body work. You know, going to myofascial release a lot while that while that was on was really big. There were points where we were going weekly and that helped a lot, got rid of headaches and helped with calming the system down and, you know, allowing for growth and movement in that fascia. But it is still a hard thing to go through. So when there's other options out there, I just I was just having this feeling that as a parent, it's it's so hard to know all the things, right? And it's not just this type of stuff. I mean, there's there's tons of other things out there. There's mental health stuff or educational, like, you know, people when you talk to someone who does work with kids with learning disabilities or differences, they're able to spot these things right away. And the rest of us are like, oh, I had no idea. We were told that was normal. You know, it's there's so much in our world that is not being supported in a very easy system, right? That you really have to go searching and you really have to dive into these rabbit holes and work really hard to find the right type of provider who has the education to support you. Cause I can tell you from my experience and definitely what I hear from clients, I had asked for years about things before I knew what was going on. I had asked for years when my youngest was grinding her teeth at night, clenching her jaw. I mean, at four or five, the jaw clicking and unable to eat, you know, a big sandwich or raw carrots or raw apples because the TMJ was so bad and just being told, kids, you know, have TMJ. Sometimes that happens. And I'm just like, this doesn't seem right. Right.
SPEAKER_00You know, Mama Gut was like, I don't think so.
SPEAKER_01But it also gets hard that when you keep going again and again and getting told by provider after provider that no, it's fine, it's all in your head. It does start to make you wonder. It's like, maybe it is all in my head. Maybe I am just looking for something. And then everyone's telling you, well, this is fine, leave it alone, right? It's such a hard thing. And there's so many areas that can be like that, that it's it can be really overwhelming for families. I know. So I see about 90% of my clients virtually, and you know, worldwide, and most of those are, I'd say three to 12 months. I tend to see more older babies. I don't have as many of the tinies, at least not virtually, unless they're a repeat client. I will see small newborns in my local practice, but virtually they're usually older. And usually they have seen two, three, four IBCLCs and not gotten answers or support or to a good function, right? They've been told the baby's gaining weight, they're fine, they're transferring, we don't see a tongue tie, everything's good, and things never improved. So I see that from clients as well, that we are all searching and working so hard to finally get there that there are times that by the time you get there or you get close, it's just you're just exhausted.
SPEAKER_00Totally. I hear on a daily basis, why am I hearing this? Or why is this the why are you the first person that's telling me this? I have seen so many people, or how come I've never heard this before? Or I'm so glad I found you. Why did I have to go through so much before I found you? You know, it's I feel for parents, it's um scary out there, and all providers are so different. They're so different. And this is across the board, you know, every dentist is different and has different education and different training. Every, as you said, every lactation, you know, consultant is different. IB IBCLC, everyone is different. They saw multiple people before they saw you and they weren't able to get the answers. So what I tell parents is if you have that gut feeling, don't stop searching for answers. And I know that that's hard. It's hard on us as parents, but that was me. You know, I had my daughter and I was in this world and I was traveling everywhere trying to figure out what was going on with her, and nobody could figure it out. And I had to go on a journey that led me to figure it out for her, but it wasn't easy. And we all have these struggles, but it teaches us a lot and it develops who we are. And it, everything she went through has made me who I am and be able to help so many more people because of her. So it's a journey for sure. Parenting is a journey, figuring out all of these things is a journey. But if you are getting an answer that you aren't happy with or that you just have a gut feeling like that doesn't feel right, then you have to keep searching for answers. And you will find the person if you keep searching.
SPEAKER_01Absolutely. It's just navigating our health is is hard in the system we have, whether it's newborn health, airway health, you know, or general health, mental anything. It is so challenging to find. I mean, I know I've been looking and working with a naturopath, and now I'm looking for another one because it's so hard to find the right provider that is, you know, going to have that training and experience that you need to support what you're looking for and to get those answers. And it's, you know, I will say it, I can see how it can be hard to stay up as a provider, right? And that it is a lot of work. Absolutely it is. I mean, I take so many classes, I have so many books, I have so many things going on. I definitely love learning and education. I would say that I'm, you know, maybe slightly addicted to it. It's it's definitely something that I do a lot. I'm in a year-long course right now, and it's absolutely wonderful. But it's it's a lot. It's a lot to be constantly learning. So I can understand how it can be hard to maintain that, but I also know that I wouldn't want to provide care any other way. And that I would really like to be seeing providers who value that, who try to stay up on studies, who are learning from other providers, both in their exact profession and outside and in ancillary things. I mean, I learned from myofunctional therapists like you. I learned from physical therapists and myofascial and pediatric dentists and SLPs. Like, I can kind of borrow your myo eyes for a little bit and just see and be like, oh, okay. So that's what it looks like from that side. And I'm never trying to replicate that. I'm not trying to copy and become a Mayo or to become a PT or to become a cranial cycle. That's not my goal. You know, my goal is the more I can understand what other providers do, the more I can support these families and also really recognize when they need somebody else brought in.
SPEAKER_00Right. And that's a hundred, that is you said that so beautifully. Like that is exactly how it should be. We need to be enough educated in these other areas that we can make an educated referral and that we can help parents get into the right hands. If we don't know, you know, anything about speech or, you know, anything about physical therapy or anything about occupational therapy, then we can't identify when to make a referral. And then I feel like that's a loss for that family because we could have been one of those providers that made the recommendation to help that child thrive. And I believe we should all collaborate. We should all work as a team and help these families thrive. And if we can have these eyes that can identify a need and make the referral, we can really, really help these families.
SPEAKER_01Absolutely. And I always say that, you know, you don't have to be an expert at everything, right? I don't do or I very, very rarely do multiples. I've had, I don't know, three or four sets of multiples in the last six years. Like I just don't really do it. I I didn't have multiples. It's not in my background. I've worked with a few and I they were all tongue tie babies. And I did say to them, look, I can support the tongue tie, but I also can refer you to someone who does multiples because that is not what I do. And, you know, for a couple of different reasons, a couple of them were previous clients. They were like, nope, I've got the multiples thing. I'm good there. I just want your support with this tongue tie stuff. And so we did it. But it's important to know your limitations too, and to not try to do everything. Like, I don't, I don't work with micropremis. I actually worked in the NICU and for a couple of years after labor and delivery. And I have worked with micropremis in the hospital in the NICU. And it's not something I really want to do. I just don't. I I like newborns that react with typical reflexes on demand that I can count on. So that's, you know, where I like it to be. And I refer out. There are plenty of really excellent IBCLCs that work with NICU babies, and that is wonderful for them. And that family should get the best care. So I don't expect all IBCLCs to understand tongue tie. I expect all of them to understand enough to know when to refer. And I expect the same, you know, of other providers. I think we should just know enough so that we can, we can at least acknow, you know, assess, acknowledge, and refer.
SPEAKER_00Right. Yeah. So I mean, just with the tongue tie topic, it's definitely something that more people are becoming aware of, which is exciting. But then there's a lot of confusion around that. There's providers that will do releases without any prep for the family or postoperative instruction, not just for wound care, but for how to re-establish function. And that's a big deal in my mind. We want to make sure that, yes, we're identifying tongue ties or, you know, labial ties or buckle ties or whatever, whatever frontum restriction exists, and then supporting the family in the best way possible so that the result of the release is successful, but then also that we're able to rehabilitate function. Just because we release a tied tissue doesn't mean that the tongue or the lips are going to know what to do after that. And I'm not talking about wound care. I'm talking about rehabilitating that function. So supporting the family to know how to do all of the preoperative and post-operative work is a big passion of mine and helping patients get successful outcomes, not just of the release, but also of a re-establishing function of the tongue, knowing how to rest in the mouth and reestablishing nasal breathing and making sure that the airway is good and making sure sleep is good, and then making sure we rehabilitate not only that static function that I just talked about, but also the dynamic function of chewing and swallowing, because the tongue is very involved in that. And if we don't rehabilitate that, it's not just going to automatically know what to do after being released. So that's a big focus of our practice as well. And I think that because these frontum restrictions have gotten more popularity, I should say, or at least just more awareness. I've come across so many providers just doing the release without the correct prep or post-operative work. And that's where my my emergency calls come in, where they like figure it out after the fact. They're like, oh no, you know, now what do I do? So that's that's a big passion of mine is getting the word out for that as well.
SPEAKER_01Absolutely. I think that we just need to work on educating these parents and families. But it is a lot that they're, you know, a lot that they're trying to do. I mean, this week I've had three in-person visits with three local families, all the babies under two weeks old. Right. And they are struggling with everything from massive sleep deprivation, right? And exhaustion that we all get as new parents to feeding struggles and weight gain and, you know, and all of them are tied. And it's so interesting. I usually get the response of one of two things when I when we talk about this. I I'll explain, you know, what I'm seeing, both anatomy, but really very function. And, you know, where am I seeing these things? What can't this baby do? And everything. And I either get a, well, I I really just don't want to cut the baby's tongue. And I'm like, okay, let's go down this path and you know, do all the things that I would have done first normally, anyways. Or I get the, okay, when can I make an appointment? Who do I go see tomorrow? And I'm like, no one. Like, we don't get a good result when we jump into this. And I think that that's really hard for people too, because there are so many that you can just, you know, Google and find someone and go get released tomorrow. And many of them will tell you, it's gonna be great. Just come in, I'll cut it and it'll fix it, and it'll be totally fine. I've heard them say it. I've stood there and watched uh release providers say to families, this will fix everything. And I'm just shaking my head going, am I invisible here? Like it's not gonna fix everything, you know, and I'm constantly telling them too, just because we have a better range of motion does not give us strength and endurance. It doesn't teach us what to do with that.
SPEAKER_00Right. It's a group of muscles that needs to be reeducated. And it's just that's not an uncommon concept within the medical world. It's just they're not thinking about it that way. You know, if you had a leg that never worked, you know, and there was a surgery that they could do something to make it work again. It's not like your muscles would just automatically know how to walk, jump, run. You'd have to go to physical therapy. You know, if you had a cast on your leg your whole life and the doctor's like, why do you have that cast on your leg? Let's just take it off. There's no way that that doctor would just take it off and not send you to a year of physical therapy or however long it took to rehabilitate those muscles. We have to look at it that way. This is a tongue that has been physically tied to the floor of the mouth and has not figured out how to do anything that is good function. And so we have to rehabilitate that function and getting the parents and the baby regulated prior to a release and like getting parents used to working in the mouth and and the baby used to having their parents work in the mouth. That's a huge portion of that pre-operative work that needs to occur to help these releases be successful.
SPEAKER_01Absolutely. I um so for a lactation consultant, many don't work with older babies. And by older, you can get, I mean, some people will say older babies at four months, six months, a year, you know, different terms. But I have worked with many toddlers and love that age. And that's, I will say uncommon for lactation consultants, but I love it. I think that the older babies give you so many clues, everything they do, how they move their body, right? How they come at the breast, how they twist and turn, and how they sleep and how they sit. And it's just so many clues. So they give you all this, all these information of what they're doing and what's working and what's not. But it's a it's a tough age. And there are times when I have told parents we're not ready for release, or I really just don't recommend it. I had a couple a couple months ago and I had one that I said no. I said, I really just don't recommend doing this release. And I recommend either something changes or you wait, right? That this is they couldn't put their hands in to brush baby's teeth, they weren't flossing the teeth, they weren't brushing the teeth, they couldn't play with baby's mouth at all. She was two, and she was very orally defensive. And I was like, something needs to change before you do a release, right? And if you're not ready to make that change, then wait. Wait. And I think she was surprised when I said that. But it when we do a release that's unprepared, and in this case, when we know we're not going to be able to do wound care or oral exercises and work on strength and function, it is only gonna get worse.
SPEAKER_00Right. And I I would just add to that, instead of wait, work with somebody who can bridge that and you know, it make her not orally defensive, right? So get get working with somebody immediately that's going to, you know, teach how to brush the teeth and in what position to work in and in and what position to get the body regulated and comfortable before you're able to go into the mouth with comfort with her not her being comfortable and you being comfortable. I mean, these are things that we can do. We can, you know, get Speaking dentally, prior to any of my orofacial myofunctional training, I was work, you know, I was working with parents on positioning the child to brush the teeth correctly, starting at six months old or younger. And, you know, even and then in the toddler age, the younger you do it, the better. Because the child gets used to it earlier and it's not so foreign, right? The older the child is, the harder it becomes because you've never done it before and they're more independent. But there are ways that we can get these kiddos to feel comfortable with mom, dad, any provider, you know, anybody working in the mouth. And that is a hundred percent needing to happen prior to a release at that age of any oral tissue. And it's going to help the release be more successful. It's because not only can the provider do a better job because the child's more comfortable, but then also mom and dad or any care provider can get in there and help with the wound care and then help rehabilitate function with oral exercises after.
SPEAKER_01Absolutely. Absolutely. And uh what I what I really tried to explain to the family was that it comes down to what you can do right now. And if you can do more, we can, you know, discuss with other providers, other types of therapy, different things that can help her. And I said, but if you can't, right? Because that's this mom was newly diagnosed or newly pregnant with her second and was not feeling great. And I said, then hold off, right? Like if we cannot do this with steps that we really think are going to bring a good result, don't do it. Right. Wait. And I do advocate for doing things within those, you know, first four to six years is really great for that optimal oral facial and airway growth and all of that. And I'm not, I'm not at all saying in any way that I wouldn't focus on that. I just think that too often when families do understand or learn about tongue tie, there is this rush and this want to just go off and get the release done and not as much thought into the preparation and the post-care and really making sure that we are prepared, that we are expecting a good result with this, right? That we we feel great about the plan. I mean, I've worked with I had like three, three-year-olds in the last six months that I was so surprised how well they did. But all of their parents were like, we can do all these exercises. They've been doing them, they felt good about it, they felt good about wound care. They had all had been clients that we'd worked together and they had released their younger babies and um they really felt good about it. And you know what? It all went really great. It's not that it can't go well at a certain age, it's just important to have someone who's looking at it and willing to say, you guys aren't ready, right? And if we're not prepared, we're not going to expect a great result and we shouldn't do it because we really, you know, it it is nice to only do this once if you only have to.
SPEAKER_00Right. You know, I do see a lot of kids that are in that older range that have even those kiddos, when I look at their history and they've been released as an infant, sometimes they only released what the anatomy would allow during infancy that got optimal function during that time of their life. But then when I'm looking at how much range of motion and function that they have later on, because that is a big, you know, part of our patient base, we we see that sometimes they need even more of a release. And parents are like, oh, was it not successful? Was the release as an infant not successful? And it's that's just not the case sometimes. It's just that they could only release to what the anatomy allowed them to release. And now that you've gotten bigger and and you know, there's more anatomy available, and we can define that anatomy with exercises. Sometimes we can see more of that kind of posterior restriction or that submucosal restriction that's limiting the middle and the back of the tongue. So it's important, it's really just it's important to look at it from a functional aspect and identify frontum restrictions based on functionally what this group of muscles is able to do, or is the frontum still limiting it? So I just adding that kind of in there because sometimes it the thought is, oh, that doctor didn't do a successful release. And I'd never say that. Like, you know, I say, well, they probably just did what they could with the given anatomy at that time. So just food for thought also with older kiddos, is that because I do get to see them and follow them as they grow and watch their symptoms, I can sometimes see that there's also a second release needed, even though they already went through it as an infant.
SPEAKER_01Yes. And I do talk about that. That there's, you know, we talk about the words reattachment, and even though reattachment isn't correct because we're with a laser, we're vaporizing that tissue. So it's really not reattached. I talk about, you know, the importance of bodies and effective body work, right? That's a big part of it, not just any cranial sacral therapist or any chiropractor or anything is going to get us to a really good functional point. And it should be supported with that, you know, that IBCLC guiding and hopefully, you know, communicating with that body worker and saying, look, this is what I'm seeing. Um, what are you seeing? And how can we work together to optimize function? You know, how can what I do as a lactation consultant benefit what you're doing as that chiropractor and how can we get these babies to thrive together? And um, I think that that piece is really crucial. And without body work, oh it would be terrible to do my job. Like it would be really, really terrible because I can't I can't get a baby effectively feeding whose fascia is pulling, whose bones are tight, whose body is tense, who cannot move, who cannot create lip seal, who cannot have strong intra-oral suction, right? Like it's really challenging to get a baby to feed well without body work.
SPEAKER_00Right. That's yeah, collaboration is key for sure. And getting the right members on the team is is such a huge part of this. And being able to then communicate between those team members, like you're doing, is so perfect because if you're seeing, like, wait, I see, you know, I'm looking at this function here and I'm seeing that it's not optimal, you know, and and then can communicating that to the body worker, they will oftentimes it'll pop into their head exactly what they need to do to release in order for that function to get on board. And so that's just so huge, is that communication that we can do within each, you know, and within the team to make sure that we're optimizing care for that patient. That's great.
SPEAKER_01Yeah, absolutely. And I think that we all get better results when that happens, right? And that's kind of across the board. That's not unique to lactation or or airway space. Like when providers collaborate, we get better results. So that should be the goal here for all of us to work together and to help these families really thrive because they're working so hard to find us, right? I mean, they are trudging through this airway, tongue tie space, and it is hard. And so it's so many turns they're getting told no, no, no. And it's a lot of work. So, you know, I think we all need to communicate really well and try to get more and more providers kind of embracing and understanding the space to support these families.
SPEAKER_00Absolutely. Yes, for sure. And as we do that, my hope is that the word spreads and that we get more and more capable providers that can induce this change that is, you know, this lifelong change of towards better health. And patients don't have to search so hard and they're not, you know, exhausted by the time that they find us. So I'm grateful for people like you that put these podcasts together and and help to bring us all together so that we can learn from each other and so that we can get the word out there so that families can find us easier.
SPEAKER_01Thank you. I'm so grateful for you too for the, I mean, for joining me today, but also for the work that you're doing and really advocating for good airway health because I think there's I'm very holistically minded. I'm really trying to focus in on that space and supporting health and wellness in our bodies. And I don't think there's a whole lot of health and wellness you'll get without good oxygenation. So I think so much of it starts with good airway health because all the nutrition and all the sleep you get are not going to optimize your health without good oxygenation. It's essential, right?
SPEAKER_00That is so true. And we really can't good get good sleep and good sleep health without correct breathing and correct airway. And sleep is when we heal. So you're a hundred percent right. We've got to get breathing and airway on board. And that has everything to do with that tongue because the tongue is the biggest offender of the airway. If it's low in the mouth, it will fall back and obstruct the airway and the mouth will open and there will be disordered breathing, sleep disordered breathing. And so we've got to, we've got to focus on breath. We've got to focus on how we're getting the air. And I always say our nose is our breather, our mouth is our talker and our eater. And that is just the way it is. So if you ever see the mouth open, if you ever see that mouth open, we've got to figure out why it is open. And we've got to get to that root cause of dysfunction and we've got to get to that, to the root cause of all these symptoms. And um, all the things, all the symptoms we've discussed today, those are symptoms from a bigger issue, right? We got to get to that root cause and fix that, and then those symptoms will go away and not just stay in that treatment of symptom realm. Because if we can do that, we can really change lives. And that's just so important. So yeah, I'm right on board with you. I am very holistic, very trying to get to full body health and wellness. And I really do believe that what you're doing and what we are doing in our practice is essential to that. Uh, it really sets the stage for health for the rest of the life.
SPEAKER_01Absolutely. I couldn't have set up better myself. So thank you so much for your time today, Janae. I think this was really informative. And I hope that providers listening are gonna start thinking about that tongue oral rest posture and start thinking about where where is it hanging out and what is that root cause? Totally. Me too. Thank you for joining me.
SPEAKER_00You're welcome.
SPEAKER_01When you change the way you look at things, the things you look at change you. I hope that you enjoyed the podcast today and learned something new. If you know someone who would benefit from this podcast, please share.