Oral Myofunctional Therapy (OMT) is all about the interconnectedness of eating, speaking, and sleeping. Yes - these things are all related! Discover how common issues like pacifier use, mouth breathing, and tongue ties can shake this delicate balance. We dive into the importance of proper nasal breathing and touch on structural issues such as enlarged tonsils and tongue ties, reinforcing why understanding this interconnectedness is both important for children's overall health as well as their outcomes in therapy. Listen for real-talk on OMT and whether it's the right fit for a child.
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Follow Kim and Mary on IG here! - https://www.instagram.com/thespeechsource/
For more information on speech, language, feeding and play - visit The Speech Source Website - https://www.thespeechsource.com/
Oral Myofunctional Therapy (OMT) is all about the interconnectedness of eating, speaking, and sleeping. Yes - these things are all related! Discover how common issues like pacifier use, mouth breathing, and tongue ties can shake this delicate balance. We dive into the importance of proper nasal breathing and touch on structural issues such as enlarged tonsils and tongue ties, reinforcing why understanding this interconnectedness is both important for children's overall health as well as their outcomes in therapy. Listen for real-talk on OMT and whether it's the right fit for a child.
Also, if you haven't done so already, follow our podcast! You will be the first to know when new episodes release. We would also love for you to leave a review and rate our show. The Speech Source appreciates your feedback and support! Follow here!
Follow Kim and Mary on IG here! - https://www.instagram.com/thespeechsource/
For more information on speech, language, feeding and play - visit The Speech Source Website - https://www.thespeechsource.com/
Welcome to the Speech Source Podcast. My name is Mary Brazeek and I'm Kim Dillon.
Speaker 2:We are two pediatric speech language pathologists with a combined 25 years of experience.
Speaker 1:We are your source for speech, language, feeding, play and much more in between.
Speaker 2:In today's episode, we are talking about oral myofunctional therapy, or OMT is what it is commonly called and what you most likely have heard. And this is going to be a great episode, because I don't know a lot about this topic and Mary does and I'm excited to hear her thoughts on it and learn a little bit more, and I hope this will be helpful for everyone listening as well. So, mary, can you tell us exactly what OMT is?
Speaker 1:Sure, omt or Oral Myofunctional Therapy. It's talking about the foundational aspect that, basically, the way that your mouth was designed was in connection and in harmony the way that we eat, the way that we speak and the way that we sleep, and so all of those areas are connected. We were designed to be nose breathers. The ideal way that our body was created is to breathe in and out of our nose, with our tongue up at the roof of our mouth and our lips gently closed, and our teeth actually don't make contact when we're resting. They have this little bit of space, and that does make sure that there's no grinding or excess tension in our jaw. But this is really home base, and I think that that is a concept that I really wish was taught in grad school, because I don't know why it wasn't.
Speaker 1:Is that this whole idea that there is actually this ideal way that our body was designed to be able to work in harmony? So if you have frequent pacifier use or thumb sucking, where the tongue is physically forced to be down a lot, then you know that your tongue's not able to go up. So that's important. If we know that a child is snoring at night or they're a really heavy mouth breather, their tongue is out or forward, or their mouth is open when they're just running around or breathing, those are signs again that this is not working well, because if you want the tongue to be up, you can't be a mouth breather because the tongue would block your airway right or it'd block the air coming in. If you're a mouth breather, you can also fatigue, you can have more allergies, your posture can get forward and we call it kyphotic when it's rounded, and your spine that can create some tension around your neck, and so you can kind of snowball with this.
Speaker 1:The whole concept of OMT is that instead of saying, man, we just need to bring that tongue back and fix the S, looking at a child's body and saying you know what? This is actually a foundational issue If we just bring their tongue back and fix S, that is, a bandaid on top of a bigger issue that they have a tongue thrust because they're not able to breathe well, or because they're a mouth breather, or they have all these other things going on. And so I think that it's a great thing to keep in mind. That all clinicians should be understanding is the whole idea that everything is connected, and so I think that it's great that so many more clinicians dentists, pediatricians, our ENTs are learning more about how these functions all relate to each other.
Speaker 2:Who's the point Like, is it dentist telling you or you telling dentist? Like, who's the fixer, who's the finder and who's the fixer, I guess, when it comes to this concept Because I get what you're saying it happens a lot of different ways, so there isn't just one answer.
Speaker 1:In the dental world there's definitely been a trend more in airway-centric practices or dentists who will be a lot more trained in this whole concept of how the airway and the resting posture of the tongue is going to affect the mouth. So a lot of times it will originate from a dentist who is trained in these areas. A lot of times it's originating from a speech pathologist to say, hey, you know what they came in for, an S. But it's actually bigger than that. It's actually more foundational than that, as we need to retrain and make new habits. It's not just isolated to S.
Speaker 2:But sometimes structural too right.
Speaker 1:Yes, so that's when I would send to ENT. I actually had an avowel like this just last week where it was for a dentist, had initiated the referral and so referred to me to do an OMT avowel. But this particular child had very enlarged tonsils, which not my words, I don't diagnose that but was a huge snorer at night and open mouth breather. The thing is when you think about, okay, how do you fix this? Though that's the first step is just acknowledging being aware that this is even all related. Cool, that's actually the easy part. The hard part is fixing it. Given the structure we have, how does our body function with that? How do we eat with that? How do we speak with that? But sometimes we can't get the function we want because the structure is not allowing the best function. And that's when we get into saying, okay, what's going on with tonsils and adenoids? Because if they're enlarged they're at the back of the throat, they're gonna push that back of the tongue, forward and out of the mouth, and it's gonna be even harder for kids to eat, swallow, make back sounds, do all these kinds of things.
Speaker 1:The other structural thing that we run into a lot is tongue ties, and so it makes sense. If your body is supposed to have your tongue up at rest, then your tongue has got to be able to get there. And so if your tongue is anchored on the bottom of your mouth and it can't elevate to the top, then we've got a problem. And then the last structural issue is really it's nasal. So we've got to be able to be nose breathers, and there are so many kids I don't know how it is in all parts of the country, but in Fort Texas there are a lot of allergies here and there are so many kids who are struggling to be able to breathe.
Speaker 1:And if you have a stopped up nose, forget it. Your tongue has to be down because the body will always prioritize breathing first. So part of OMT, or when I do an assessment, is figuring out okay, is this a good match for the patient? So the first thing that we look at is there anything structurally that's going to get in the way of me teaching the good tongue position? Because that's what therapy is all about. As we're gonna teach, we need that tongue to be up and we need to train that habit. But if we can't breathe through our nose, if we can't swallow and if we're snoring at night, or if our tongue can't get to the top of our mouth because of a tie, those are all gonna get in the way of what I wanna be able to teach them.
Speaker 2:That makes a lot of sense. And so at that point that's when you're going to make a referral somewhere else to have that be a priority before your therapy, because you wouldn't be able to work on those things if they're not able to do that because something's in the way, right, and you just won't be successful right at all.
Speaker 1:The child just won't transition it over if they're not able to do it. But it's not a quick fix because there's also that muscular memory component, so it could be habit. You can fix the structure, but it doesn't mean that the tongue's going to do anything different than what it's known its whole life. So that's kind of the issue. The body is a creature of habit and its function is determined by the structure, and so you have to figure out what's going on structurally and what's going on with the habit piece, and then how do we form new habits? And you might be getting a new structure in the meantime with some kind of surgery. So it is quite involved and it's fun. It's a lot of moving pieces.
Speaker 2:So what does OMT look like in the therapy room and is it going to look different for speech?
Speaker 1:So OMT, by definition, is going to always be speech and feeding, because if it's true OMT, then that tongue is going to be down when you're breathing, when you're swallowing and when you're making certain sounds when it should be up, and so OMT is going to be those three areas every time, and so each session, you're taking in some foundational skills. So one of the first things you do is mobility, strength and stamina. So you're going to put your tongue to the top and down and up and down. You're going to get that mobility, and then you're going to say, okay, we're going to put our tongue up and we're going to hold it for 30 seconds. You're going to hold it for 30, then you're going to go up to five minutes, up to 30 minutes. That takes strength, that takes mental retraining. That that's where we should be, and then that's going to set you up for having the habit and the practice to be able to breathe out your nose and have your tongue in the right position when you're just sitting and playing or coloring or listening to your teacher while they're talking.
Speaker 1:Nothing is new about this at all. The concepts aren't new, it's just a package. So OMT is just a treatment method that someone has come along and said hey, I know the best way to fix this. It's when you put these three together and you do this over 12 weeks and the kid works on exercises three times a day. Now, kim, have you ever followed a protocol like that with one of your children? No, I mean, this is where it gets kind of tricky. There's ideal and then there's okay, but who is actually able to do that? And what I've found is and this is kind of real talk about OMT it can really be a beating in therapy. It really can. Not every family is well suited to it because it takes consistent practice, not every day, multiple times a day and very specific movements.
Speaker 2:I mean you have to be retraining the way that your body has been literally breathing, what position it has been in as you grow as a therapist, you kind of incorporate everything and I'm sure you're doing that as you're working with a child, as you have this knowledge about something specific, but you're also pulling from your feeding and swallowing knowledge and your speech sound knowledge and putting it together. So whenever you're getting an OMT of Val and you're assessing the child and you know that they need to work on some of these skills, how are you taking what you know?
Speaker 1:Yeah, kim, you're killing it with the questions here. They're good ones.
Speaker 2:I'm really very curious.
Speaker 1:Yeah, no, it's true, though I mean so. Definitely think again that it was an integral training in my career. I think that every speech pathologist needs to have this. You too, Kim. You can sign up today.
Speaker 2:I'm learning right now from you. Yeah, there you go, you have the best teacher.
Speaker 1:No, no. So what I've done in practice is you take the good from everything and you customize a plan for the child. So what OMT does really well is it has exercises that are for the tongue, and so I customize those in conjunction with speech. I use it like a warmup that's a better way to put it To say, hey, you know what? We need to work on the sound T, because it doesn't sound sharp, and so it sounds like a lot more flat and round, and so we need to be sharp at the top. And so to do that, we might start with some tongue clicks going To be like okay, here's our spot, this is where our tongue is gonna go. Remember, remember we're going up. We might tap and go tch, tch, tch. Okay, sharp, sharp, here we go to the top and I use it as kind of warmups to be like okay, here we go, let's get our mind ready. Now let's apply it. But that's the difference is, I don't stay there.
Speaker 1:I don't say okay, now you're just doing that, because this is a big thing in our field, is like rote oral motor exercises are not successful or helpful. You have to always pair it with what you're gonna do Like a physical therapist. They're gonna stretch out your leg after you've had a knee replacement and then you're gonna go walk and it's gonna stretch. You've gotta do what you need to do with that muscle. And so the same is true with speech is that we're gonna teach that tongue. I might do the clicks, do the tch, the tapping, and then we're gonna say, okay, now let's apply it, let's apply it to T, let's go tch, tch, tattletail, and you know, get that tongue Up, up, up, and then we're gonna say, okay, now let's switch it to swallowing. Okay, put your tongue to the top and swallow back.
Speaker 1:It's a really helpful way of your exercises being the glue in between the speech and the feeding world, and so I've actually made my own flashcards that I use with kids. I just found that parents really needed a visual to go home with, and kids did too. Just a little reminder. So I have created a visual, some flashcards that are on our TPT store that anyone is welcome to go check it out if you're a speciatologist or if you are a parent of a child who needs to work on these things. There are things you can work on too, but I designed my own visuals of where the tongue should be and different positions and exercises that I could use as this warmup and home base for applying my feeding and speech onto it.
Speaker 2:I'm really glad you talked about the oral motor piece, because I think and I don't have experience doing this but I love the way that you've designed these cards and the way you're explaining it, because it's another prompt or another cue. It's a teaching tool that you're using for the child, explaining where their tongue needs to be, practicing how that feels.
Speaker 1:The way that I get buy-in and that's how you get success and change is when you get the child to understand the why, or to be motivated. Oh wait, I do wanna do this. And why is because their friends understand them, or it's because they're not embarrassed that someone's making fun of their mouth hanging open all the time, or they're drooling, or they are taking 45 minutes to eat a burger because their tongue's not moving really well to be able to point to those back molars and chew food efficiently. That's what kids care about, and I'm talking like lower grade school, for sure, with those things. But all these exercises are ways that you can do your strength training. It's the strength and conditioning that you're doing behind the scenes to play the game. But if you just do strength and conditioning and you aren't gonna apply it to anything, then you can't expect any kind of difference in your life.
Speaker 2:That makes sense and I feel like I really do have a better understanding of exactly what it is, and even just understanding that it is a packaged technique is really helpful, because I think a lot of people here own tea and they think it's a diagnosis. It's almost like a diagnosis, or I mean that's not the right word.
Speaker 1:No, that is. It is actually a diagnosis. So oral myofunctional disorder, omd, would be the diagnosis that you would use with it. I've found that more speech therapists are recognizing that OM the therapy is needed and that it is a more foundational problem, but they themselves are not trained in that. It's a huge thing with dentists as well, because it will greatly affect their dentition, so their teeth structure, and it's honestly a lot of times OMT is a fancy word for tongue thrust Not fully, I mean, it's oversimplification, but still it's a.
Speaker 1:Tongue thrust is when the tongue is going forward instead of staying up, and tongue thrusts absolutely affect your teeth, and so a lot of times dentists and orthodontists will refer specifically for tongue thrust therapy, which is OMT. And so to fix that, you need to tell the tongue hold on, you can't go out anymore, but you need to know where to go. In the past sometimes tongue thrust might have been treated like hey, just don't go out, don't push your tongue out, just stay back in. But that's actually not how you teach it. You don't teach the tongue to just stay flat and retract. Stay flat, get back. That's not it. You tell the tongue hey, get back and up. That's where you're supposed to be. The tongue wants to be pushing on something. It needs an anchor. So the force needs to be against the roof of our mouth, which can totally handle it. With bone it can't handle it. Our teeth cannot handle the force of our tongue. So so much of therapy is going to be retraining going up to the roof of your mouth and really rechanneling that force and that pressure upwards, and it really does help with posture.
Speaker 1:I think that if you Google it, there's a lot of big promises with OMT that I don't know, that I've necessarily seen happen in actuality. Things about really fixing behavior, adhd, attention, you can get down a rabbit hole there. Those are pretty big things. I think there's some merit to that to say that, hey, if we can breathe well, speak well, eat well, it's going to affect our whole life. But I don't know. Those are really quick Passing comment just to say I should probably mention there is a whole world out there in OMT.
Speaker 1:Again, I don't do it by the book, I take the best and integrate it with the rest of what I know. So if you're someone who is looking for OMT, with the capitals and all the periods and all the things, then you should probably do your research online. There are differences in the type of OMT provider and it's not a bad question to ask, hey, what is OMT first, and how do you plan on using it? Is it a good fit for them? And then also, I would ask them their success rates. Say, how long have you been using OMT? Have you seen OMT be successful with children like mine? How do?
Speaker 2:you differentiate between saying we're going to work on a traditional approach for fixing the S sound versus we're going all the way back to the foundation, or do you blend that, like, how has your therapy approach changed now, as far as just like where you're starting?
Speaker 1:Yeah, another good question, kim. I think that it's definitely changed the way that I do evaluations. Now that I'm trained in OMT. I'm looking very purposely at all those areas. For every single child I'm always mentally screening. I'm much more aware of just watching as they're playing Legos with me or just talking. I'm very purposefully watching what their tongue is doing, how are they breathing, what's their posture like, and so it's definitely affected my mindset for every child thinking about those things that from the moment I see them, even in the waiting room, I am watching their entire body and how their entire body functions, even for breathing, not just speech and swallowing. So I'm always going to look at the whole picture and I'm always going to look at feeding as well.
Speaker 1:Omt, their tongue is going to be out for SZ, shch these are the big ones as well as their tongue flat for TDML. So that pattern is telltale. So to go tch, dd, nn, ul, your tongue is tap, tap, tap. You've got two more taps for CH and J. So go tch, jj, your teeth are tight, your tongue is pushing off, and then SC and SH are teeth tight and that tongue is back. So SZ, shh those are really really quick way to explain all of the sounds. There'll be a quiz later.
Speaker 2:They're just kidding.
Speaker 1:But for all of the sounds we want to make sure that it's not a pattern and that it's an isolated sound. So that's something that has definitely changed since I have been trained in this is that I'm looking more for patterns and I'm much more aware, holistically, of how the body functioning and what's playing off each other. Because If I know that two things are playing off each other, then I can use the strength to try to help out the weakness. If feeding they're better at pointing their tongue to the when they're eating a goldfish at their molars, then I can use that point and try to get it over to their L. So I want to understand the whole picture so that I can use what I need to get those problem areas better.
Speaker 2:So let's go back to 10 years ago, when OMT was not talked about or mentioned in speech therapy and a child came in and had S, z, s, h, c, h and it's like your approaches to working on each one of those sounds until they are mastered. And do you see that as just being a longer approach or do you feel like it still wouldn't have as successful of an outcome if you didn't go back to that foundation? Or do you think that those treatment approaches can reverse fix? Resting tongue position.
Speaker 1:Wow, good one again. Ok, so I think it's a really heck of a patch job. It probably took a really long time to go through every single one of those sounds, and you probably still have dental issues, in the sense that, I bet you anything, those people are still wearing their retainers at night or your tongue is thrusted their teeth forward.
Speaker 1:Yeah, and I actually I have a perfect example of this. It's one of my sisters, I will not name which one. I have three, so you know you probably can't guess odds are growing up. She did every single sound that you just mentioned. All of them went through one, two, three, four and she just went like that and was in speech for many years, very, very, very highly educated, but there is still a tongue thrust. She'll take a sip of wine or coffee and I see that little tongue comfort.
Speaker 1:I think again that it's just. It's a really good patch job. Does it fix everything? No, because you still probably are going to have that tongue thrust for swallowing. That's a big, big deal, especially with your teeth. There's enamel on the back of your teeth. You do not want to be thrusting and wearing down that enamel over time. The way that the tongue is supposed to be up and against our teeth and the way that saliva is in our mouth is all protection for our teeth, and so it's very important actually for our health that we are able to be nose breathers and we're able to keep our oral hygiene in a good spot. So does it all work out, of course, but are there some issues that weren't resolved. I think so.
Speaker 2:That makes sense and I hope this podcast episode is a testament to how broad our field is and how the different trainings that each of us have in different areas and again, just for the parents to understand, finding the right speech therapist is such an important part of your journey with speech therapy because it matters with the long term progress. So it's been interesting to see just how closely you and I work, how long we worked in the same setting and how I did not have this training and that you did and you have so many trainings that I have never had and same with you.
Speaker 1:With your school experience too, we do see a base of the same people, but then there were many people that we saw that were different too. It's definitely a good course to take in continuing education and grad school. We're very like head, neck anatomy physiology, but it's so easy to take that information and quickly forget it once you start going in treatment. But actually understanding the muscles of the tongue is so important to be able to functionally fix when it goes wrong and understand what muscles we're even talking about, so that you can target exactly what muscles you're talking about. And that's exactly that part of the tongue and I know exactly the exercise because you know exactly where the breakdown is. So I do think that OMT serves as a really good bridge in between the anatomy and physiology courses and treatment.
Speaker 2:And that idea of treating the whole child because everything is connected. Thank you, mary, and we hope you enjoyed the episode. Don't forget to follow our show on whatever listening app that you listen to the podcast. Thanks for listening. Make sure you subscribe to our podcast and check out our website, thespeechsourcecom.
Speaker 1:Also check us out on Instagram for more ideas on speech, language, feeding and play.