50: Rethinking Feeding, Myofunctional Therapy & Communication with Hallie Bulkin

Hallie Bulkin, an SLP and expert in pediatric feeding and myofunctional therapy, reveals the interconnected web of mouth, airway, and systemic health that often goes unnoticed but impacts children and adults deeply. This episode isn't just about feeding ; it's about transforming how we see health from the inside out! It's about terapy that heals the entire system from the airway to the brain. Cross-disciplinary collaboration is explored further as it is an integral part of assessing, diagnosing and treating feeding and myofunctional disorders.

Connect with Hallie:

Instagram: @HallieBulkan

https://halliebulkin.com/

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Transcript

SPEAKER_00 0:03

Welcome to Unmasking Social, where we talk about building real friendships and meaningful connections without masking who we truly are. I'm your host, Sharon Bowen, a speech and language pathologist with an expertise in social thinking and how it relates to autism and ADHD. Specifically with our teams and twins. Let's dive in. Hello, everybody, and welcome back to Unmasking Social. Today I have a fellow SLP on the podcast, Hallie Bulkin. Hallie has a tremendous wealth of information to share with us today about feeding, anything related to myofunctional therapy. And Hallie, thank you so much for being here. You're my first feeding specialist. I feel like after 48 episodes, it's time to have someone break down feeding. So Hallie, can you tell us a little bit about your background and your journey as a fellow SLP who now is an expert in all of this and has such a huge Instagram presence with very funny reels, actually.

SPEAKER_01 1:08

Well, thank you. And thank you for having me. I'm excited to be here. And as your first, you know, feeding person. So I'm Holly Bulkin. I am a speech pathologist by trade. I, you know, started out like most of us in the schools, really was not super specialized, was always very interested in feeding. And then working with children with autism actually is what really helped me find my love for feeding because so many of them were not ready and available for therapy because they were dealing with digestive issues. They were, you know, constipated or they were withholding bowel movements. Or anyway, so I started looking into, you know, what they were eating and how they were chewing. And I just noticed they tend to like lean towards bland foods and eat a lot of, you know, foods that were easier to digest. And I went, huh, this is interesting. And so that's where it all began. And so I kind of started, you know, I'd been taking a bunch of feeding courses and was doing, you know, dabbling and feeding and everything early in my career. But then this really just threw me into the deep end. And from there I had my own children with tongue ties and feeding struggles and oral facial myofunctional disorder type of symptoms. And that just threw me even deeper into that specialty to the point where I was really working more before having kids with toddlers on up and dove into the infant, you know, side of pediatrics with feeding and went, huh? We really don't want to wait until a child is five years old to start addressing myofunctional goals. We're kind of already doing some of this in feeding. Can we just address the rest of the goals and adapt it to these kids? And so that's where my own business evolved. And I went, why is nobody teaching this? Why why do we learn none of this? None of the feeding, the Mayo, the airway, the tethered roll tissues, none of this in grad school. And yeah, so from that, my current business evolved at the end of 2019. I started my podcast that summer. We launched the business in the fall, but launched our first official course and program March 16, 2020, as the roll shut down. Um that was my flagship Feed the Beats program. And it really took off because being an Eurodivergent myself, I have a very special way that I learn. And it's much more, I think, um, intensive in some people's eyes compared to how the average person might, you know, learn something. And I basically took all of my learning and all of my strategies and all of my ways of having to learn it for myself and put that into how I teach and what I was teaching. And that's really what Feed the Peds became. And ever since then, we've evolved into we've got the podcast, we've got multiple courses, memberships, certifications, and I do business mentorship on the side as well. And now we're actually jumping into a really cool new project that I haven't talked about too much, you know, out there, but I'll share it here. And that's breaking news. Yeah, breaking news. Going into hospitals and changing how we approach pediatric feeding from the get-go, like from birth and from all four pediatric forward-facing professionals, because that's where it all begins. And these kids are missed, or the wrong kids are referred, certain kids that don't need therapies get them. Um, some who need it don't get it. And how can we all talk the same language and take a really integrated approach and collaborate and look at the whole child and not just treat in silos like the system currently does? So that's a whole nother conversation and ballgame. But it's really cool to see how this has evolved. Cause if you had asked me even two years ago, but if I would be doing this right now, it would have been like, what are you talking about? My neurodivergent brain is constantly thinking and like, how do we, how do we make it better for everybody? And how do we actually change the system? And that's why I even launched Feed the I wanted to get out there and change how we approach pediatric feeding, make things more readily accessible for therapists so that families and children can get the help they need. And I knew that I couldn't do that by myself with my own private practice, which I also have a private practice. Yes.

SPEAKER_00 4:41

So we don't have enough going on. You just had to throw that in there too, because it's not I'm not as involved in that.

SPEAKER_01 4:46

And I'm not treating right now. I'm on a statical. And you know, so there's definitely I'm not a superwoman. I don't do all the things. I have teams to support me. I am just one person and I do believe in rest also. That's been a big journey for me, is not burning out.

SPEAKER_00 4:58

You've taken the feeding world by storm. And I was following you on Instagram years ago, actually. So you were you were already a face of feeding. Like you said, 2019 you started and it really took off. And I think people were just really eager and curious. Even colleagues of mine, I know, are learning from you each day just by little videos you post. And I think there's a fear within our fields, whether it's speech, OT, in terms of learning this and doing it, because we feel like we're gonna do it wrong. And we're always in um a sphere where we can we're protected. If the individual doesn't make progress, at least we won't hurt them physically. And and we're worried about that physical, I think, harm. I think, I think that's where it comes from a lot. Uh, but again, with more and more time, I've learned a lot more about the myofunctional piece also and how we've regressed as people just because of things like posture. And I remember I went to this uh convention and there were people from oral surgeons to speech therapists to anybody you can think of that works on the mouth area. And and I learned that like this myofunctional piece is also a big piece that connects pretty much everything. And I know you're an expert in that. Can you speak about how this myofunctional piece is is really interfering with the way that we're eating, the way that we're sleeping, the way that we're breathing.

SPEAKER_01 6:12

Absolutely. Yeah. So we can't truly separate like feeding, sensory processing, oral motor function, myofunctional disorders, um, airway, sleep, like they're all different expressions of the same system. Or I guess a even easier way of saying this would be like the mouth doesn't have different jobs. It basically has to breathe, right? Has to eat, it speaks, it's involved in sleep. Uh, it develops as one integrated system. And we are actually, even in my own business, like looking at more of this integration because we talk about it behind the scenes a lot. We really shouldn't treat these functions in isolation, right? And so I think we've spent so many decades putting children into silos. We got the feeding kid, we got the speech kid, the mayo kid, the sensory kid, the AD kid, um, the kid with autism, like all the things, but our body doesn't work that way. Like we don't, we don't work in silos. And I will tell you, some of my favorite patient cases have been like my tween. And because they can start to communicate with you oftentimes in a very different way than some of the younger kids can. And then even working with adults, hearing how adults share things with me and their perspectives, what they're feeling, how it impacts their life, how you know, I've had uh older kids and adults who were severely tongue-tied and they went through myofunctional therapy and they shared with me after they're like, I didn't know what I was missing out on until I knew what I was missing out on because that was their everyday normal. And you only know what you know and what you experience. And you can hear from other people, but until you experience it yourself, yeah, you know, it's it's different. So it's interesting because we've got these kids, right, who are exhausted. They're mouth breathing, they're avoiding foods, maybe they've got a tongue thrust, maybe they're struggling to focus in school. And those honestly are not five separate problems. They it's one developing child whose systems are all influencing the next, right? And so, you know, I think instead of like asking, like, does the does this child in front of me need feeding therapy or myofunctional therapy? Because I get that a lot. That's a very popular question. People say, or they'll even say, Hallley, should I take your feeding course or your myo course? And I'm like, I have them separated because it's a lot of content, but I integrate the Mayo stuff into my like my feeding course, which is for all pediatrics, but really we go really deep into birth to five because that's where all the skills are developed. And it applies to any other child that's older. And we get a lot of children that we work with that maybe their cognitive age is not five or it's not four. You know, maybe they're functioning lower, or maybe they're 12, you know, 12, but they're actually functioning at a lower level. And so it applies to everybody, right? Our approach. But then Mayo really requires the cognitive ability of at least a four to five-year-old. And children that age are not even always ready because of the type of instructions that we're giving them and what we're asking them to do, like, you know, physically. And so arguably, like we have to be really integrated in our approach to really help these kids, especially, you know, the kids who are kind of at that one, you know, that four or five-year-old range. And we have to look at how everything's functioning and then where are things breaking down, like the breathing, right? The sleeping. I mentioned these things, eating, chewing, swallowing, speaking. Are they regulated? Like is their nervous regulated? Um, how are they managing sensory input, right? Because once we start to actually look at all those things, then we're looking at the whole picture.

SPEAKER_00 9:17

Yeah, I know. And to your point, one of the things that I've observed over the years is that a child will have an expressive receptive language disorder, and we love treating those in the school setting, right? Some are tick, as they get older, maybe they wean off our tick and fluency, but they still need it, but we're limited in the school setting and very siloed in terms of what we're working on. And then I will hear, oh, and by the way, they have some issues with sensory, or I'll notice that they come hungry to my room and I say, wait, you have lunch before this. Like, why are you hungry? And I start noticing that there's a pattern of basically them not eating lunch because they only eat specific lunches when I speak to the parents. But this is something that's not been addressed for many years. Some of these kids are in second grade, some of these kids are in sixth grade. And it's kind of an add-on. And you made me think about that now because I I didn't really think about it. Like I didn't really integrate it before you were just speaking, but it's almost as if that sensory peace that they're having with food is not just an add-on. It's not just a separate issue. It's it's tied in, it seems like, to everything, their whole system, right? Yeah, yeah.

SPEAKER_01 10:21

Feeding doesn't end after toddlerhood, right? And I think that's really huge in the point you just made because I think a lot of people actually don't talk about it in that sense. It's almost like we look at the little ones and focus on feeding there. And unless somebody maybe has a lot, is med maybe medically complex, then it's like feeding is not like a common conversation. Um, people just assume feeding is for babies and toddlers, right? And and that's obviously not true. We see these older kids and these teens who might have picky eating, which we're kind of like, is it picky or is it actually something else? It's typically there's more going on. Um, but those restricted diets like you're talking about. And you know, I started in the schools, which I actually I was miserable at the time. I never really wanted to work in the schools, but I ended up, it ended up being such a blessing because I was able to learn the intricacies of working in the schools, be sitting on IEP teams, creating IEPs. And then when I opened my own private practice, I was able to then guide families that I was working with to help them get services for their kids to, you know, because if the kid cannot eat, right, and they're sitting in the lunchroom and they're overstimulated by all the sensory input because of other things going on and everything's interconnected and they can't eat their lunch or they are not had there aren't foods being presented that are feeling safe for them, you know, they're not gonna have proper nutrition during the school day, or the parents just gonna send the safe foods and maybe they're not wholly nutritious foods that really are gonna help them get through the rest of the school day after lunch. And so I always like to describe these buckets of energy. Like your kid starts with 10 buckets in the morning, and if they've got a sensory, uh sensory oral motor issue, right? Mayo issue, maybe they're not sleeping well, they wake up, they're exhausted. There goes a bucket. Now you're fighting with them to brush their teeth because that's sensory is that's not a good sensory feeling for them. There goes a bucket. By the time they get downstairs for breakfast, now they got to put the clothes on and maybe the socks don't feel good, right? There goes another bucket. So we're already gone. We got three buckets gone. We got seven left to go for an entire day of school. By the time the kid goes through school and gets home, they have exhausted those buckets, right? And then you've got these kids who just melt down after school and parents are like, oh, it's because I'm the safe place. Yes, and like two things can be true, right? They've also just exhausted all of their ability to, you know, behave well, if you will, right? Because of everything they went through during that school day. And I had a kid once who he actually had a really severe tongue tie, very unique case. This is not common, but his severe tongue tie, his sensory system was so on alert, he would go into the the um school lunchroom and he would vomit from the sights, the sounds, the smells. And everyone was like, Oh, he's got such a sensory processing disorder. And, you know, and then they would offer him to sit in the principal's office. What kid at like eight wants to sit in the principal's office? So I think mom was like, he's actually been able to stay for eight total days for a full day this school year, and they're about three quarters of the way through the year when she called me in for an email. I looked under his tongue, I was like, he's got a pretty restricted tongue tie here. And I can see maybe I'm like, I can't promise you anything, but like, let's address this and see if maybe this is impacting his nervous system, his sleep, his sensory, you know, all the things. That kid, we went through the whole thing, pre-op release, post-op, went back to school, never vomited again because he's he was now sleeping, his nervous system was in check, like he had full function of his mouth. He could now handle being in that environment where maybe it still didn't feel like the best environment to be in for him, but he had the ability to actually function within that environment. And mom was like, I'm at my wit's end. So that just goes back to like what we do see in some of these older kids, right? I mentioned the picky eating, which often is more than just picky eating, restricted diets, but a lot of them have very inefficient chewing. They fatigue really easily while they're eating, and that's where that like energy, those buckets kind of disappear. Right. Your mealtimes are often longer because it takes them longer to eat, and we don't have a long time in school either. So that's really an important factor to consider. Right. Um, you know, some of them may be pocketing food, maybe there's a history of choking, you know, not as common, but it might be there. Maybe there's texture avoidance because the sensory system just can't handle certain textures, you know, with everything else going on, they tend to be messier eaters. They have more oral awareness, you know. So there's usually a lot more going on that we're just not picking up on. And many of them have learned a lot of compensations. And some of them are compensating well, and some of them are not compensating well at all.

SPEAKER_00 14:22

Yeah, I mean, the compensatory strategies and all of these areas and speech and language are just so prominent, and then the kids get overlooked, and it's almost as if like we're the first line of defense because we see them in the school setting in a small group, and that's when we're able to get more information. Whereas classroom teacher of 35 kids these days is not necessarily honed in on if what they're eating, what's going on in their digestive system and things like that. But what's interesting also is that there is sometimes what people perceive a behavioral piece. So let's start with some myths, if you don't mind. I remember I had a friend, and this was like my first real life introduction to feeding, because I learned about dysphagia in graduate school, like the rest of us, and you know, it didn't really even scratch the surface of what dysphagia really was. And then I had a friend who had a child, a baby who just would not want to eat basically most of the foods. And because of that, the child had a feeding disorder. Uh, however, many suspected that, oh, this is a behavioral response because the mom is not reacting in a way that she should be. The mom should be more calming and less maybe punitive because she said if, you know, if you don't, if you don't try to eat, the kid was really young at this point, but people had, you know, were suspecting that this was a behavioral response. And then I, my limited knowledge of feeding, led me to believe, well, actually, I mean, the kid has a feeding disorder. The kid is not eating most foods. And so this goes beyond that. And in the end, she was taken to a specialized program where they did support her with feeding from many different lenses, but they still viewed it as a behavioral problem.

SPEAKER_01 15:52

Yeah. I mean, we hear this a lot. Oh, they're just picky, they're just being picky. And the reality is that like food refusal, sure, it is a behavior if you want to qualify it as that, but behaviors always have a reason, right? They're not just behaving that way to piss you off. I hear people, right? I mean, I've had, and it's it'd be very rare. Like, obviously, is there always the exception to the rule? Sure. But we've got, you know, parents who are like, oh, my baby's a little, a really lazy feeder. No, your baby's not lazy. Like, there's something more going on. And it's just, I think it's a baby to be lazy.

SPEAKER_00 16:23

A baby's supposed to be lazy, no?

SPEAKER_01 16:25

They're supposed to relax and be fed and you know, taken care of, yeah. Yeah, you know, and so I think it's like that's where we really have to stop as therapists and we have to start asking the right questions. Like, can they chew efficiently? Can they actually breathe while eating? Do you know how many kids struggle to breathe properly while they're eating because they're mouth breathers and it's really hard to breathe through your mouth, chew, and swallow at the same time? Are they in any pain? Is there any discomfort? Is there some kind of oral sensory sensitivity going on? The big one too is like poor tongue mobility. They just don't have good range of motion. They really can't move the food from one set of molars to the other. They can't form the bolus on their tongue. They don't suction their tongue up to the roof of their mouth, which then starts to get into the myo side of things because that focuses on the oral phase of like the bolus prep and, you know, up until triggering the actual swallow. Um, beyond that, like is the swallowing actually difficult for them? Do they have enlarged tonsils? Does it not feel good to swallow? And are they not breaking their food down enough so that when it actually passes by the tonsils as we're swallowing it, like it maybe it hurts? Watch a kid's face. Do they grimace when they swallow? Like, do they, you know, you see so many kids squint their eyes when they're swallowing because they're not properly chewing to break their food down. It's not mixing with the saliva the way it's supposed to be because it's still in full little pieces, right? Right. And have they had negative feeding experiences? I think a lot of people fail to even think about what their history looks like, right? And you know, I know a lot of like school SLPs, for example, are not necessarily trained in all this because they're not the feeding experts usually. I think it's rare to find a uh feeding program in an elementary school or in a middle school or high school. I know there are some evolving out there and there's some counties that do have them, but it's again, it's rare, right? So a lot of I get really excited when a school SLP shows up in one of our courses. Cause I'm yes, like this is how we change things. I'm so excited you're here, you know? Um, but anyways, I want to go back to like what you were talking about because the behavior is what we see. And that's also what the family sees, right? That's what the caregivers see. That's what they're gonna typically come forward with as like a chief complaint. They're picky, they only eat five foods. I have to run around and buy the food in the same container from the grocery store. And if they don't have it, I'm going to the next grocery store to find it because they won't eat that yogurt in any other container. Because the child's learned that's what's safe. They know that they can eat that, right? It's so that behavior is a reflection of something deeper. And that why, that root behind it, like that's what I feel like it's our job to investigate.

SPEAKER_00 18:39

Yeah, and I think it's so hard because in the younger years, the child can't really communicate other than through behaviors, right? And through frustration. I mean, when they're hungry in general, even if they don't have a feeding issue, usually that's their way of communicating, crying, showing that they need food. And so uh this added layer of something is bothering them, something is frustrating them. It could be rooted in sensory, rooted in something structural, but this is kind of like their cry for help is how they're gonna manifest that it's so hard to really figure out what's going on as a feeding specialist in the younger years because they can't really speak for themselves yet. And so, do you find that age group is a bit more challenging, or in some ways easier because it's like early intervention? So you're getting, you're catching something right away.

SPEAKER_01 19:23

I feel like it's become easier to assess and investigate because if you're asking, like you learn to ask the right questions, you actually get a lot of really helpful information from the caregivers, the parents, even teachers, if you're going into some of the preschool settings and early, you know, early EI type of settings. And then, you know, but what I do hear a lot too is like, oh, it's just this, oh, it's just that. Like I get it, and I would say the hardest part with treating the population is they have teeth in the toddler years and they also start to learn autonomy sometimes, where they're like, no, I don't have to do that. Right. And so it's a little bit harder to reason with a two and three year old than it did than it is to do more passive exercises on like an infant or, you know, work with a kid who maybe is like three going on four into five. But you just get really playful and creative and you help them become the teacher and you model things and you do things together and you make it silly. And I think once you can kind of just like take a deep breath and let go and know that like your therapy may not go the way that you think it's gonna go today. But if you have the goal in mind and you can be like creative and think through like how do we make this fun for them, like we have a blast in therapy and they make progress and they do hard things. And sometimes they may hesitate and sometimes they may absolutely refuse, and that's okay. We pivot. And maybe today's not the day. Maybe their nervous system is not regulated enough for what you thought you were gonna work on today. And so you gotta back it up a little, you know, or you gotta try something else. So it's I I really I joke that it's not joke. I mean, it's true. What we do is a dance between art and science. Like we have to be so creative while keeping in mind like what the actual goal is that we're working towards. And it can be exhausting sometimes. So big kudos to all, you know, all the pediatric therapists out there.

SPEAKER_00 20:59

Yeah. And I mean, as a school SLP myself, I, you know, this is something that we're not even allowed to in my city, in New York City, we're not even allowed to write feeding goals, right? We're not allowed to address feeding because technically that's not academically driven, even though as our conversation is continuing, we know that that causes a dysregulated nervous system. A dysregulated nervous system impacts academics, but again, it's not viewed like that. So we also have to change, I guess, the way people are viewing things, which is why you're gonna be going into hospitals, changing, trying to change that system, because parallels unfortunately between both. That being said, myth number two, let's come up with another myth. There's another myth that says that, okay, they're not eating this. Okay, let's try some other foods because they're not eating these specific foods, let's just try other foods. Now, in that situation, what is the problem with just saying, hey, let's give you some other foods right now because you're not, you're not eating that.

SPEAKER_01 21:51

So if someone just wants to pivot to other foods, you know, we have to look at a lot of characteristics of what they are currently eating, what they are accepting, and what they're not, right? So, you know, not to go into like the INSI levels for people who are like really involved in dysphagia and talk about, well, level one food and level two food and, you know, the different types of variations there. Make it really simple for our little ones, especially the kids who are safe to eat. We're not like worried about aspiration. There isn't something more medical going on. And this is all medical still, but I mean like medically complex. Kidddos with like maybe lower respiratory issues or, you know, things where it's like, is it safe? Do we need to get clearance first? Like we know the kid is safe to eat. We have to look at a couple of things. One, airway. Two, how are they chewing? Like, what are the two that what are the mechanics of the oral, you know, system, the sensory, combined with that, because we cannot separate oral from sensory, even though we teach it in silos and a lot of people treat in silos. That doesn't work that way in the human body. Right. And then three, like I was saying, like what are the actual characteristics of the foods, right? Because a lot of these kids will go to what's easy to chew, break down, and swallow. What do I mean by that? If you put a goldfish cracker and on your tongue and you mash it between your tongue and the roof of your mouth, it's gonna break down. It might not feel the best, but it's gonna break down without you actually chewing it. You could just mash, mash, mash, mash. It's gonna break down enough for them to swallow it versus give them a piece, uh, give them a carrot or give them a piece of grilled chicken or, you know, something harder to chew, even an apple. They're gonna be less likely to chew something like that because they can't mash that between their tongue and their palate. They have to move that to their teeth. Now, a lot of our kids figure out a way to put it in on their teeth and they'll chew too, chew. And then it's interesting, you can see on their faces sometimes the side they chew on because it will be more developed than the other side of their face. It will actually protrude a little bit more. I can look at a kid and go, they chew on their left side. It's really interesting, right? And so, but even so, if they're struggling to lateralize the food across the tongue to the other set of molars, you know, and we just need those. We actually, I'll back it up. If even infants learning to eat in right in like the right size pieces can still break these things down with their gums because we've got teeth underneath. It's pretty, you know, we've got bone in that jaw. And it's it's, you know, people go, but they don't have teeth, they can't eat that. They can. We just have to make sure it's appropriately sized for what, you know, their age. But these older kids, they'll chew, chew, chew and then swallow back from their teeth and the food is all over their tongue. It's a mess. They need water to wash it down. It doesn't feel good. They're drinking a ton of liquids to wash down what they can't chew. They fill up way faster. They're not getting enough calories, right? There's just so many things going on. And then if you've got the kids who are really focused on like the beige foods, as I like to call them, the yellow, brown, you know, beige foods, the breads, the crackers, the goldfish, the yogurt, you know, their digestion at a certain point starts to fight back, right? They're like, we're not getting enough roughage to actually have regular bowel movements. And now we're constipated and now we're uncomfortable. And sometimes the foods they're eating, they're not chewing properly, and maybe they're swallowing too much air when they're eating. And so their bellies are distended and they have tummy aches and they don't feel good, right? And when you don't feel good, you don't want to do anything else. So it's not just a matter of like providing other foods, right? It's actually helping them build the sensory oral motor skills to be able to eat what they're currently eating and then branch off to other foods, you know, as appropriate that they can break down. But we can't expect them to do that until we give them the sensory motor skills to do so.

SPEAKER_00 25:06

Right. No, I mean that's a great point because a lot of times I see new foods being introduced before you've already addressed the characteristics of the texture of the food that they're not eating. You know, it may not be the food itself that's the problem, but the breakdown, like you said. And another thing that comes up a lot is also the nervous system versus sensory. People like to silo everything out separately, where it's like, okay, there's a nervous system issue, that nervous system issue is causing this feeding uh challenge, but that's different than if it's a sensory response to the texture. So in our teens and tweens, for example, what would you say about that, about the nervous system versus sensory? Is there an overlap between the two or are they really just separate?

SPEAKER_01 25:47

No, I mean it's all interconnected, right? I mean, I just keep going back to the same thing. So sensory processing, and I'm not a sensory processing expert per se, but I've been diving deeper into it. Um it's one of the, it's one part of how our nervous system functions, right? So the nervous system is the larger system, if you will, if I'm trying to like put this in like easier, you know, easier explanation. And the sensory system is really the way that it kind of gathers information and interprets it, and then responds to that information from the body, from the environment, right? The surroundings. And so it's I like to explain to parents, like to think of the sensory system as like the operating system on your iPhone or on your computer, right? And um, I'm sorry, the nervous system is like the operating system. And then the sensory processing is just like one of the apps or one of the programs that's running on that operating system, because that operating system also controls all these other things we're talking about. Breathing, heart, your heart rate, your digestion, we talked about, muscle tone. We haven't really mentioned that, but that comes up a lot with my OTs and sensory and hypo, you know, hypertonicity, because that can impact feeding and myo and all these other things. Sleep wake cycles are a really big one too. A lot of these kids who have, you know, nervous system dysregulation because they have airway issues, they're also their sleep is majorly impacted. And then they're often getting labeled with sensory processing disorder and ADHD, but no one's ever actually looked at how they breathe and where their tongue exists in their mouth. And we haven't ruled out a sleep disorder, you know, sleep disorder breathing. And, you know, people go, oh, well, that's just sleep. That impacts every single other thing we do, including like how they respond to stressful things. Like, what is that stress response and what capacity do they have to respond to it? Their motor planning can be impacted. Their attention is definitely gonna be impacted. Um, their emotional regulation is gonna be impacted, right? So when someone's like, it's sensory, it's just one piece of the larger picture. And, you know, it all it all interconnects. And like if you dove into the feeding side of things where we actually look at the sensory, you know, part of it, like with taste and temperature and, you know, all the things, that's also a piece of the puzzle because our nervous system's constantly integrating all of these things.

SPEAKER_00 27:50

Yeah. And so I mean, I love the fact that you keep bringing it back because whoever's listening, if you haven't gotten the point yet, all of these things are interconnected and therefore we have to look at it holistically. We look at everything holistically, or rather we should, but especially when it comes to this feeding aspect, we can't separate all of it because myofunctional structure, characteristics, texture, sensory, you name it, they're all going to impact each other. And this sleep piece, which is impacted a lot by the myofunctional or even just the nervous system or whatever systems that control sleep, it seems like that will also play play a pivotal role in terms of what is going on during the day. So one of the biggest things that I've seen also is that a lot of these individuals, especially when they reach the teen and tween years, a lot of them end up developing gastrointestinal issues, like you had stated, right? The constipation or the diarrhea or whatever it may be, and they're in pain a lot. And because of that, they miss a lot of days of school. I know you mentioned the tongue thruster who nobody knew that the tongue thrust was causing all these challenges and he was vomiting, and therefore he was barely in school. And so there's definitely a problem with this because kids miss like a really large percentage of days of school is because of these GI issues that are related to feeding. Do you find that we're collaborating enough with GIs? Are GIs welcoming us into the field? Like, is there a disconnect between us?

SPEAKER_01 29:06

Yes and no. I think part of the problem is that, and so my uncle is actually a GI and he he's, I think, is more towards retirement now in like Washington, D.C. Let him enjoy his retirement. Yeah, and he right, and he uh like he does more stuff on like the CEO like level. I don't think he's a CEO anymore. But anyways, he worked mostly with adults. And one of the things when I reached out to him, I was like, hey, Uncle Mike, like can you connect me with some pediatric GIs? Like they don't have to be local, but he was like the he's like part of the problem is we have so few pediatric GIs in this country. Like there might be a couple hundred of them versus like thousands of other doctors specialized, you know, in other types of issues that I think that's our first issue is there just aren't enough. And then to try and collaborate with them can be really tricky. And so obviously, a lot of like the children's hospitals, like they've got their pediatric GIs, but your access to them, if you're not having some grander issue, is really challenging and tricky because they've got these really lengthy wait lists and typically it's reserved for kids in certain programs or with certain diagnoses or, you know, and like you can make an appointment, but you're gonna be waiting, it could be a year to go see. And you do these kids don't have that kind of time. Like it's kind of silly, right? And so what I will say is, and not to write off every GI issue, because I've had a history of GI issues and not everything is caused by a tongue tie or inefficient feeding or, you know, all the things we've talked about, there could be other etiologies for sure. But if you sus if your child has issues with like, let's say, smell and taste and texture and temperature, and they feel like pressure around food, and maybe, you know, you're looking at them and you notice their mouth breathing and they're really picky and they have a very small number of foods that they accept and they have certain responses, right? Where you just feel like they feel like eating is hard or it's uncomfortable or it's it appears unsafe. Maybe they're avoiding foods, they're gagging, maybe they just refuse foods, or they seem really distressed. Like you watch their body, you watch what's happening, you see these secondary behaviors, meaning like physically on their face, they turn their head away, or they push the plate away, or they push the food around on their plate, you know, or there's something else, there's other things you're noticing. It doesn't automatically mean the kid even has a sensory prosting disorder, right? There could be other things going on. And that's why it's like we have to start figuring out like the why behind what is going on with the nervous system, why it's responding that way. And arguably for an older kid like that, I wouldn't, you know, I would, you could always do a feeding evaluation, but maybe jump to a myo evaluation because with an SLP specifically, or an OT who also specializes in pediatric feeding, because then you're gonna get a really good integrated approach to someone who can address both like maybe the mouth breathing, the airway stuff, and refer you to specialists that they feel are necessary, right? And so I feel like it's it's really hard for parents and even specialists, like, you know, to sometimes navigate who do I go to first?

SPEAKER_00 31:46

Yeah.

SPEAKER_01 31:46

And I really, really highly recommend a myofunctional therapist who is also a feeding therapist so that, like I said, who's maybe tied, you know, tongue tie is also something they're trained in. So they can really take that holistic look at your child and go, you know what? I do think we need to go to GI. Or, you know what? Before we go down that road, I would like you to go to um the ENT first and let's check the airway and let's rule out, you know, enlarged tonsils and adenoids, and let's rule out, you know, some of these kids even have deviated septums. Maybe they've had orthodontia already and it's relapsed. Why is it relapsed? Because the tongue is not living on the roof of the mouth, it's sitting on the floor of the mouth and they're mouth breathing, they're pushing their teeth back out of alignment, even with retainers in place. Um, there's all a whole host of things that could be going on and nobody's looking at that. They're just hyper focused on the digestive stuff because that's obviously very impactful in a very in a negative way for the kid and the family. But could there be other things going on that we can help them with that may also then help us like chew better and breathe better and sleep better and the nervous system starts to go like, oh my gosh, okay, I I can handle life again. And some of those other symptoms start to fall by the wayside.

SPEAKER_00 32:54

Yeah. And so it's interesting because it seems like going to a myofunctional speech therapist, someone who specializes in the myofunctional realm is really the first line of defense. However, the problem that I see is that there aren't so many. And I know that you have, you know, you're doing the Lord's work because you're spreading the news and people are taking your course, but there still is just a lack of support in that area, just like there are lack of GIs and a lack of so many other things. Are there other collaborators that we have that people can go to that, you know, in the event that they're waiting for, you know, an SLP specializing in myofunctional challenges that can support them?

SPEAKER_01 33:32

Yeah, I just think that one of the things that ends up happening is the parents start case managing, they get really burnt out and then they don't do anything at all. So my argument would actually be if there isn't somebody local to you, find somebody who offers virtual services. Maybe they don't live in your state. And I tell parents all the time, you're welcome to reach out to me on Instagram and I will do my best to connect you with somebody in your area or that is licensed in your state, and you can do a virtual evaluation. And, you know, and if not, like we do, and I think it's very rare that I can't find somebody to connect a parent with. And that goes both for feeding and Maya. And part of it is just a passion project because I felt really unprepared with my own kids. And I felt like even as someone who was in the feeding space, I wasn't yet in the Maya space with my youngest who, or my oldest, sorry, who is now turning 11 in August. And so I was like, I never want any other parent to have to go through what I went through with my my first, my second, I was like, who was two and a half years after. I was already so much better equipped and prepared and certified in Mayo at that point. And I was like, it changed so much for me. Even being the pediatric feeding specialist, having that Mayo training and then also tongue tie training, like it all changed. It changed everything for how I practiced, how I approached my own kid. And I was like, We need more of this, please. Yeah. We have directories and everything, but not everybody puts themselves on there. And that's why I invite parents and even other providers to just reach out and say, Hey, I'm looking for this. Who do you know here? Um, and I get it daily in my DMs, and I'm constantly going to my own communities and saying, Hey, who is licensed here, you know, or provides virtual therapy here? Like one of the mentors in my programs, right? She lives in New York, but she's licensed in New York, New Jersey, and Florida. And she can do this for anybody in those states. So that really just helps to like open, you know, access. And I just think parents are not able to always find it as easily.

SPEAKER_00 35:17

Yeah, that's a pro of the virtual world now, is that you could be licensed in so many states and provide care and make things more accessible, especially in an area that needs more people specializing. And so there's also some confusion between the SLP and the OT role because I know we keep coming back to the SLP being the myofunctional therapists who are going to be delivering this treatment, but then there are the occupational therapists who also work on this, right? And I know that it gets a little touchy in the hospitals. I've never worked in one, but I've had colleagues that work together and they're they're both kind of working on feeding together as allied professionals, but no one knows like who's doing what. So when it comes to this piece, are OTs and SLPs doing the same thing or are they doing something separate?

SPEAKER_01 35:56

It's a great question. So, and I should include OT in most of what I'm saying. The only time that I would arguably say an SLP is necessary over OT is if there's also a speech sound disorder, right? And then you could, because you could also work on myo feeding, speech sound disorder all together with an SLP. We train SLPs, OTs, and PTs in our programs. PTs technically can also do pediatric feeding and myofunctional therapy. Most of them just don't. You know, in the hospitals, actually, it's very interesting because in the NICUs, you get a lot more OTPT than you do SLP, which is fascinating. And not for lack of SLPs wanting to be in the NICU. That's just hospital policy and how they've done it. And that's just working the SLP into there can be really tricky. So arguably, I think the way that a lot of people teach it, at least for SLP versus OT, is like, oh, SLPs deal with the entire swallowing system. OTs don't. OTs only deal with like the chewing and getting everything ready to swallow. And that's true. Like the OTs don't really, like, once you move past the oral phase, which is more of your Mayo stuff, the OTs are not really working on like the pharyngeal and esophageal phases of dysphagia. That is, that is solely like SLP world. But also there's SLPs now who have learned about sensory. So it's not just OTs doing sensory. We've also got SLPs doing sensory. There's actually a ton of overlap. And if you can only find an SLP, an OT, or even a PT who offers this, that's okay. Like you can go to any of them. So I apologize for not like clarifying that earlier because and like as an SLP, I tend to just go SLP. Yeah, you know, all of them in our programs and arguably all of them could help.

SPEAKER_00 37:24

Yeah, and you're right. I mean, there has been such an overlap between our fields in general, just from the beginning of time, but now it's become more prominent because the sensory piece, now we're addressing. We have the sensory SLP, Jesse Ginsburg, who was on here. So there is a lot of overlap, even just the way that we're working. Sometimes I work in the school and I say, oh wow, we're kind of doing the same thing a little bit. You know, obviously there are differences and we're trained differently, but we are overlapping now more than ever, in my opinion. Um, because they've also adopted some of the communication things because regulation is tied to communication. And if you can't communicate, obviously you're going to be dysregulated. So they're also sometimes I hear the OT in my room administering language therapy in a way, you know, indirectly. Like they prompt them or the choices they give. Yeah, so part of therapy, yeah. Yeah. So we we we are, and we should collaborate more. But it seems like what you're doing is you're allowing a lot of people to work on this because that everyone, we're called related services in the schools, but the OTs, PTs, at speech pathologists can all do this. And so you're really bridging that gap by bringing everybody together. Unfortunately, there are still not enough SLPs that are coming to the table. And hopefully after this episode, and hopefully after many other appearances that you're doing on Instagram and everything, more people will be interested. Because I know people interested, even on my end, it's just that part of them do they don't feel ready. So, for example, they've done so much research. They've taken, I'm thinking of one specific person, they've done so much coursework already, and they have a lot of knowledge and they can impart that knowledge and give a course on it, but they still are not ready yet. They feel like they're not ready, even though they have a knowledge base and you have to start somewhere. But there's something that just kind of feels almost like it's not good enough. You know, we're not good enough. This is not our sphere.

SPEAKER_01 39:01

Graduate programs don't even provide any. Oh, we I got zero pediatric feeding, nothing Mayo, nothing tongue tie. I was told that oral motor is basically a dirty word based on like regular research. It was very and and I love the school I went to. I have nothing poor to say about it aside from that. And I love my professors, like it was a research-based program. Um, did some really cool stuff there. And I didn't know what I didn't know, right, until after school. And so, you know, while yes, we get a certain foundation in graduate school and certain things, that expertise really comes from what you choose to learn after graduation. Of course, yeah, anyways. Um, but the thing is, so I always do this like free training for three days, teaching everyone how to use my pediatric feeding screening packet. So I'm like, no matter if you want to do feeding or not, I believe every SLP, OT, PT, even teachers, arguably, should know how to screen so they know if they need to refer for an evaluation, whether it's with them or not with them. And so in that, though, I talk about what I call my elevation movement. And that has three components to it. And one is identity, identity, skill set, and mentorship. And I'll go back to identity in a second, but like skill set, everybody teaches that. You can get that in any course, right? Doesn't mean you're actually gonna go out and do the work. I also arguably, being someone who's neurodivergent, cannot sit in the course and learn how to functionally apply something outside of maybe three of the kids on my caseload. I would go to courses, by the end of the course, they'd be like, this is amazing. I got this. And I would have notes on the back of like the packet for like three kids on my caseload. This is what we're gonna do. I would go do it, and then I'd be like, now what? And what about the rest of the kids on my caseload? And so I always thought that was a me issue until I until I started talking to lots of other therapists who were like, oh no, that's me too. And I was like, So, like, I give lifetime access to my two primary courses, my Maya one and my feeding one, because I want people to be able to go back and watch what's relevant when they have a patient, like, you paid for it, you can have it. Like it's it's yours. And I do have people who started with me in 2020 that tell me they still go back now to their course to actually like rewatch portions based on patients that they've received. And I'm like, that makes my heart so happy. Um, because I always go, I just wish I could go back and hear this one portion on this, these two slides. When she was talking about this, this feels important. I my notes are not, my notes are not doing this justice, right? Mentorship, a lot of people promise it. They don't deliver it or they don't actually know how to mentor. They're doing more coaching. And there's a difference between being a coach and being a mentor. A coach tells you what to do, a mentor kind of guides you into actually like becoming a critical thinker and learning how to do for yourself so that you can go out and actually work with patients repeatedly and apply it to different patients, not just the three. And then the other piece is identity. And so I teach this whole thing of like be do have. Most of us work backwards where you go have, do be. When I have the time, the resources, the patience, then I can go do the things and then I will be the therapist. I'll be that feeding therapist. Unfortunately, that's a very backwards way of approaching this. And that's why so many therapists get stuck in this cycle of like, I got this, I'm gonna do it. No, I'm too scared. I'm not gonna do it. Not today, tomorrow. Yeah. Because what we actually have to do is be do have. We have to be the person. We have to learn how to step into the identity of the therapist that actually is being a pediatric feeding therapist, is being a myofunctional therapist, is the person who has the knowledge, can go and treat the patients, can collaborate with other providers, knows when to say, I don't know, but let me research that for you. Cause I don't know everything. None of us know everything. And that's something we also have to get really comfortable with. I tell people like parents really appreciate when you can admit that you don't know something, but you're willing to go do the research for them and their child. Like they really appreciate that. And like they can tell if you're BSing, right? Right. Well, you know, it's really stepping into that identity so that you can be the person who then does the things that that person would do. And then you have that title or that I, you know, that, you know, oh, I am the feeding therapist. I am, I have the caseload. I have the kids I can help. And so that's just one piece of it. The other side of it too is there's something called the Dunning-Kruger effect. And I don't know if you've heard of this, but I always talk about it and people are like the Dunning Kruger.

SPEAKER_00 42:49

Dunning Kruger effect. Well, Kruger, the Dunning-Kruger. It sounds familiar, but maybe it's just because it's Kruger. It's my Jewish name, but yeah.

SPEAKER_01 42:55

Yeah, I mean, in in in like layman terms, it's basically like, you know, you graduate from grad school and you don't have you actually you think you have a lot of information, but you don't have a lot of information yet, right? And you like have barely any experience, and you think you know everything and you are ready to conquer the world, right? On the flip side, the experts who have all the knowledge, who have been learning for they've got decades of experience, are like, I don't know enough. I don't think I have enough. And so it's actually like the more you learn, the more you second guess yourself and the less you think you know. And it's in that that's why I think so many of us who have all the courses and all the knowledge, and maybe we've had some of the patients, we still second guess ourselves. We still go, I'm not good enough, right? Right. Here's a thing like you are good enough. Cause if not you, then who? And how are these kids gonna get the help they need, right? And so I really encourage therapists that are struggling with this, like go out there and see if one, you can find a mentor. You know, I will plug my programs. We offer that. Um, but two, you know, if you can't even if you can't find a mentor that's not where you're at right now, take one patient case, take one case, start with one, figure out how you can help that kid. Cause once you start getting into it, you're, you know, the doing is. What builds confidence, not the you don't build confidence from just getting information, right? You've got to actually work with the patients.

SPEAKER_00 44:06

Yeah. I mean, like they say, do it scared, right? That's like the message I'm hearing from you, which I feel like you would be a great mentor to have because you're so motivational in the way that you phrase things, which is like, you got this, you can do this, right? And and I think that's part of it's okay. Yeah, right. I mean, this whole feeding thing, I think, has become scary. It's taken a life of its own because also one of the things is sometimes you leave graduate school, you become an SLP, and you spend many years doing something repetitively, or you develop an expertise accidentally. Like a lot of us accidentally fall into something, like I did, and I loved it, and I still love it. Uh, working with the individuals with the formerly known as Asperger's, social communication deficits with autism, who had a lot of sensory deficits intertwined with feeding as well. But uh, but again, then then you think that that's your identity, and then it's hard to kind of shift because there's so many layers to our field. It's not just speech, it's not just language. There's also the anything that involves our our oral structure or even below that is speech. And so people have these other areas, and then I think we sometimes think, wait, we're we're adding another area now. Like, how can we be an expert in multiple things, right? Like, that's my expertise. This is gonna be my expertise too. It's not that you're an expert in one thing forever. You can also develop an expertise later on, right?

SPEAKER_01 45:23

100%, 100% agree with that. And then, like, even if I can be vulner vulnerable for a minute, like I feel like that identity shift happens in different parts of your career. And so many of us are so afraid of that because it's the identity we've known so long. It's like in our subconscious, it's like who we are, right? Yeah. And so when I pivoted into feeding and was no longer doing like early language, I was like, oh my gosh, like what are people gonna think of me? Like, what are the patients gonna think? What are the therapists gonna think? Nobody thought anything. Like it was all in my head. It was a story I made up, right? And then it was like when I pivoted into adding in Maya and talking about tongue ties. And then the most controversial of it all is talking about how tongue ties impact speech sound development and a production of speech sounds, and that there is absolutely an impact and there's more data coming out around airway and tongue ties and speech and feeding and sleep and mayo. And it's it's all the same expertise because it's all so interconnected. And so, you know, I got to the point where I was like, I can't care what other people think about me, not in a bad way. Like, I obviously have some humility, but like I can't care what people think about me if I actually want to go out and help patients. I need to focus on what I like. I'm a visionary. Like, what do I see? What are the patterns I'm picking up on? Maybe there isn't enough research to support what I'm seeing yet, but I'm not causing harm. I'm helping my patients. They're getting out of therapy faster, they're gaining skills. Like, there's something here that I just feel like I need to trust. And that's what I feel like I was like, I feel like I have a due diligence to bring this forward and share this with others. And now there's others in the space that are doing that too. And I'm like, okay, well, I'm glad it's not just me, right? Um, but it kind of just goes back to if I had pigeonholed myself into being the expert in just one space or in not like pivoting to another one, like, where would I even be today? Right. Where would all these patients be? You know?

SPEAKER_00 47:01

So Holly Bulkan, you wouldn't be, yeah. I mean, that's it. That's you, I mean, that is like what you live and breathe right now. You could see it, you could hear it in your voice, you could see it and in your work that you do. Like this is your new found identity. I'm sure there are other identities that you have also as a mom and as you know, a mentor.

SPEAKER_01 47:18

A Mahjong player, a wife, you know, a beef shower, all the things, right? And I think that even I've talked about this with some private practice owners that want to stop treating, right? Like I had a major like cognitive dissonance like issue where I wanted to basically go on sabbatical when I was launching my online business and not treat for a little while. And then like I'm not treating right now because I'm so involved. I'm I'm gonna be writing a book. We're launching a program, I'm doing this hospital licensing. Like, there's only so many hours in the day. And I was like, well, who am I as a therapist to be teaching other people and mentoring people if I'm not treating? I'm not in the day-to-day. I'm not, you know, and so I share that because I want everyone to hear like it's normal to have these thoughts and these questions and like to ask yourself these things, but also you get to decide who you are. You get to define who you are. And the way that I dealt with that was I'm not actually doing direct patient consulting right now. I'm not mentoring inside my programs on like I do my tots and my Maya modules and feed the Peds and I do those calls and we have cases that are established in there. But because I'm not the one who's actually in the day-to-day, all of my mentors in the program, they are the ones who are in the day-to-day. They're doing the clinical mentorship. I'm doing business mentorship, right? And so I that's just the season of life I'm in. But there was a major like, I really struggled with that for a little while because I was like, what are people gonna think of me? At the end of the day, it it's made absolutely no difference. Like and I'm a very honest person. I will always tell you 100% like what I'm doing, what I'm not doing, who I am. Like, believe me when I tell you who I am. Like I am.

SPEAKER_00 48:45

Yeah, yeah. I mean, I it's pretty obvious. I mean, you're you're very transparent about all of it, but I think also a lot of it is uh, and this is goes on with everything in life, uh, just the judgment that you feel from others, or even the fact that some people might be saying, Oh, you're not treating, so what are you doing? Like, who what business do you have? And people will speak. There's no way that you can't have people speak about you, especially when you have a large platform and you're impacting people. And and I think the key that I found in dealing with this just from a personal perspective, is the let them theory doesn't always help me. Mel Robbins is wonderful and everything, but sometimes you just can't let them because it's too much. I agree. But I think what's helped me is just kind of like, okay, so I know people are gonna have thoughts about me. That's normal, right? But and at the same time, I'm going to pursue what I feel like is important and impactful, and I'm gonna go with my purpose. And especially as women, I mean, I hate to go down the gender route, but as women, I feel like we really have a large part of that. I mean, I have a good friend who has a baby now, she's staying at home with the baby and people are looking. There's always these judgments that we cast on each other as women that I feel like we need to stop doing. But that's for another podcast. But it is relevant to this because we are in a female-dominated field and it's so easy to get trapped in that mean girl talk, I feel like, of well, that one's not doing it that way and that one. But your model that you set up seems like such a great model because you have the mentors there that are actually monitoring the people or guiding the people that are in treatment ship in 2018.

SPEAKER_01 50:08

It was a male actually, and he said, Hallie, you have to, because he would watch me spiral, right? And he was like, This is not gonna serve you. Anyways, he was like, People are going to judge you good or bad. So do the thing anyways because they're gonna go, I don't like your hair today. I don't like the color straight you're wearing. That makeup doesn't look good on you. He's like, How is that gonna impact your life? I was like, Well, it's not. And he was like, Okay, so go do the thing you want to do anyways, because how think about all the people that you won't be helping if you decide to let those stories in your head or like what other people think about you stop you in your tracks. And people are like, Well, how do you get over imposter syndrome and how do you work through this? And I'm like, I did that back in 2018. And honestly, it's rare that I feel anything when, you know, like feel that come up for me anymore because I've just decided. Like, I am here for the people that want to hear it and the people that don't, and that want to judge me and I want to think certain things about me, that's their prerogative. And I have like, that's them, not me. And so when I was creating my programs, because I was also in the Maya space more specifically, but it's happened a lot in the pediatric feeding space in the last couple of years too. People are just not nice. Like that whole mean world thing is there, and regardless of whether it's clinical or not clinical. And I basically set the rule in in 2020 when we launched our programs that this is a safe space inside of our communities. There is no bullying, there is no gaslighting, there is no speaking down to one another. You don't have to agree with everybody, but you have to be respectful. And let me tell you, I have never had a problem inside of my any of my programs. This is the place. There were so many people who are afraid to ask questions in the beginning because of how they've been treated in Facebook groups. I don't want that here. You guys are paying to be here. And I want this to be as I was like, there's no stupid questions. You come, you ask, we are here to support you, and so are your colleagues. And it's been a beautiful thing. And so we became we had a whole marketing campaign at one point to get people in because they were so afraid to join something because they weren't sure what it was gonna be like inside after those other experiences. But we started marketing, that's them, not us. And it really helped, and it's just it's been such a beautiful thing to create that space for therapists.

SPEAKER_00 52:02

That's really wonderful because again, a lot of therapists don't feel safe. I don't even post in these groups because I don't even know what's gonna be controversial and what's not. I feel like anything worth the energy. Well, it's not even worth the energy anymore, right? Yeah, yeah. It's just kind of like everything's a controversy. You mentioned oral motor being a controversy, you mentioned uh tongue thrust being a controversy, and then soon they won't be controversies anymore. People are gonna accept them as these are actually real legitimate things that we have to look at, and then something else is gonna become a controversy. So I feel like it's the tides are always changing in terms of what's controversial. I still don't understand what's controversial about oral motor because oral motor was the foundation of the building block of everything we do with our mouth. So communicate, speak, sleep, and and all that. So I'm still confused about that one. And now there's like the whole prompt thing that made a resurgence of the oral motor because it's all based on oral motor. So and prompt is the trendy thing to do. I haven't been certified yet in that, but but yeah, it seems like things are changing. Um before we log off, I just want I have a um a very it's gonna sound like a random question, but it is related and this is a safe space, but posture, right? So I hear so much about posture, and when I think of myofunctional, for some reason, the first thing that comes to mind is posture. And I see my own posture, I see my niece's posture, who's going to physical therapy now because this phone and now she has a little bit of a hunch and and unfortunately has to treat that before it escalates. And so this whole posture thing that we're doing is like, are we regressing back to the days when we were like all the way crouching down? So how does this impact us?

SPEAKER_01 53:34

Yeah, I mean, sitting at computers and the phones obviously don't help. But what I will tell you is so posture, right? If we're sitting up straight and we're in like a 90, 90, 90 in terms of like our knees, our ankles, and I'm like our hips, our knees, and our ankles are all in like a 90 degree position to each other and our backs are straight up. Our head, our ear is supposed to sit over like the center of our shoulder. Okay. And when we see that it doesn't, we have that like head forward, neck forward posturing, it's often airway related. Why does that happen to some people and not others? Why do people who are on their phones all day not have a posture issue? Right. Well, one, it could be core, right? I'm I'm low tone. And so I go to Pilates because I was told by a physical therapist that will help you build core strength, that will help you sit up straighter. But beyond that, the mouth breathing epidemic that we have going on, and what happens is we push our head and our neck forward to actually open our airway more, and our body is gonna do like follow the path of least resistance. And so when that happens, hello, like ears sitting, right? Right. And it becomes habitual, then our muscles start to follow that pattern, and then we kind of get stuck there. So it all goes back to airway. If you got core posture and you've tried everything under the sun and nothing's working, maybe go to a myofunctional therapist and have it eval to see if there's a issue. I think I'm going to talk to her parents after this. And honestly, any kid who needs orthodontia has a myofunctional disorder. Any child who needs orthodontia, like expansion and uh braces or invisalign or any of that, they have an oral facial myofunctional disorder by definition. Okay. And so every child going into that should have myo to teach where the tongue goes, how to breathe through the nose. A lot of them have been mouth breathing, and we need to, you know, even if they're not sick, even if there is an obstruction, it becomes habitual. And we need to teach them, like retrain the system, like neuromuscular re-education, where the tongue lives and how to breathe through the nose and where the jaw should be and where the teeth should be sitting in relation to each other. And then beyond that, even I think it's like 97.89. I'm totally messing it up, but it's almost 98% of adults with temporomandibular joint issues. Yes, T and J have a myofunctional disorder. So you could also benefit from a myo e-valve if you're on a sleep, a CPAP, if you have sleep issues, if you like all these things we've been talking about, you're tired all the time and nobody can figure out why, and you've gone through all kinds of testing. Have a my maybe go for a myo eval, right? Yeah. All of this goes back to how we're breathing and our bodies just following path of least resistance.

SPEAKER_00 55:54

Wow, this is also enlightening because I think that so many people listening are gonna be checked in more with what's going on in their bodies and how it pertains to the airways and the the whole system. Because even for me, like I'm thinking, you know, poor posture is being caused by certain things that we're doing. But actually, no, what came first, right? And what came first is that you're having uh airway, air breathing. Airway issue, right? The there's something going on here where you're maybe mouth breathing and that's causing you naturally to kind of go down. Or maybe uh because of your mouth breathing, you had also mentioned that's also causing TMJ, right? Which we don't think about, or the orthodontia, right? That also was tied in. So everything seems to be tied in. It seems like so many challenges that we are experiencing go back to Maya.

SPEAKER_01 56:40

Yeah, and ruling out airway issues. Like that is number one, right? It's it's very morbid, but I say if you can't breathe, you're dead, right? So our number one biological need in life is to breathe and then to eat. So if we think about it, like the airway is the foundation for breathing, for you know, feeding, for swallowing, speaking, movement in general. And so if one part of the system is working harder than it should, the rest of the body is going to compensate. And so instead of just chasing those compensations, like I like to figure out what's driving them, and that's what that myo eval is gonna help you do.

SPEAKER_00 57:10

Okay. Hallie, this has been so informative. I appreciate your time and commitment to all of this because this is something that we all should be trained in. So thank you so much for your time. This is gonna be an eye-opener for so many listening. And maybe some people listening will be less afraid to kind of dip their feet in and and treat this. But yeah, I just want to thank you so much for coming on. And just as a last piece, where can everybody connect with you in terms of your coursework that you're providing and all the other projects that you're working on so that they can really learn more?

SPEAKER_01 57:39

Absolutely. So either by going to at Hallibulkan on Instagram or even my Facebook, um Hallibulkan Biz, but most of it's on Instagram more easily, or just going to Hallibulkan.com. We've got pretty much everything on that website. Um, but yeah, you can always reach out to me if you're looking for something specific on Instagram. I'm the one in my DMs, so I will, you know, happily direct you towards what you need. Thank you.

SPEAKER_00 58:00

You really are an expert on this matter, so thank you so much for being here. Thank you for having me. Thanks for joining us on Unmasking Social, where we neurodiverse advocates and those who support them. Explore how real friendship begins when we start showing up as ourselves. If today's episode resonated with you, please share it with a friend, leave a review, or follow me for more conversations that provide information on neurodivergent ways of thinking, communicating. Until next time, keep staying social.