#274 | Myofunctional Therapy: How To Assess and Help Your Baby

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hi, I'm Jeannie Nelson. And I am a speech language pathologist. And I own a company called Breathe eat sleep talk. And that is what I help with. So it's not just speech like you think about it, with helping kids with their pronunciations of sounds. But it's actually airway development through the lifespan that I like to focus on and help. A lot of this, especially with babies and infants is airway development and preventative things we can do. Because there are a lot of things in our world in development, that are impacting the way our jaws and airways are functioning and developing.

So when most people hear airways, they are thinking, Whoa, hum, this is not important. This is something that everybody has. And why is this important? So I know you have a vast knowledge on this. And you recognize the importance of this from birth. Rebirth really, through old age? And can you just explain to us what we're missing and why this is so unbelievably important and the components of our life that this actually touches?

Yeah, so first of all, all of us just by nature as humans, our nasal breathers and and what's happening, there's this really kind of an epidemic of our jaws are shrinking. Our jaws are not as big and wide as they should be. Even 100 200 years ago, our jaws were around 50 millimeters in width. And now they're much smaller, which as a result causes a smaller nasal cavity. So if you think about anatomy, the top of your mouth is actually the bottom of your nose. And so if you feel inside your mouth right now, with your tongue, if it feels like it goes up really high, that would tell you that that's cutting into that nasal passageway, that nasal cavity and making it a smaller passage into your nasal cavity, which in turn can cause more mouth breathing. So, things like that are concerning because we want to be at our at our nature at our base of being a nasal breather.

Can you explain why it's so important to be to be a nasal breather and not a mouth breather?

Absolutely. So, nasal breathing is kind of an incredible thing that I think a lot of us aren't taught. And I feel like this is one of the first things we should learn as parents like really, before we leave the hospital, I think that this should be discussed for how important this is for even our infants. But Nasal Breathing is so underlooked I think when we learn even our five senses as kids, we learn that the nose is for smelling, right? We don't talk about how the nose is for breathing. But the nose is actually a really fantastic organ that does you know, include smelling, but it also filters the air. It cleans the air, it warms the air and it takes out any like particles or home harmful things that could get into your lungs and body. So it's kind of your body's first line of defense for breathing.

Yeah, it's part of the immune system. Absolutely. And I read that book breath when He was Lester by James Nestor, which was really interesting because he forced himself. I don't know how he did this, I would have gone out of my mind. But he practiced both extremes. It's almost like that documentary fast food. No, no, it wasn't Fast Food Nation, the guy who ate McDonald's for three days and almost killed himself. That was it. It stopped 20 years ago, this James nester, he taped off his nose with of course, under the care of doctors and all he forced himself to mouth grieve, I think it was for 10 days, it sounded like absolute human torture. And then after getting past that, and surviving that you taped his mouth and only breathe through his nose. But the takeaway in the book, if you had one takeaway was always nose breathe, it doesn't matter if you're running on a treadmill, breathe through your nose. And if you think you can't, you, it's only because you haven't been doing it, and you can change that ability of breathing. He knew he had all these breathing problems and allergies, and he was like, rife with issues. And he basically healed himself by training himself to breathe through his nose. Is that in line with the knowledge that you have? Or is it something even beyond that? Absolutely, I wanted you to just can you just bring it back for a minute to the significance of resting tongue posture. And what that means if a baby doesn't have correct resting tongue posture, and how that might correlate with tongue tie? Yes, so proper resting tongue posture has big impact on our jaw development, and really our facial development. So everything with airway health is all about the Oral Facial complex, which is a term coined by Christie T. Christie Gatto, who's a speech language pathologist, who teaches a fantastic myofunctional therapy training. But the tongue resting posture, like I said, the roof of your mouth is the floor of your nose. So if your tongue isn't proper resting tongue posture where it's suction to the roof of your mouth, it acts as an expander in your palate, and you're maxillary bone, this bone right here is actually a really big bone, it even goes slightly under your eyes, it's a really big bone here. If it's, it needs to grow in one way. And there's only two ways for it to grow, it can either grow up and elongate, or it can grow out into a wide motion. So if your tongue is resting up there, it's going to help your jaw develop into a nice wide palate, which in turn, brings your airway more space. If it's If Your Tongue is resting down on the floor of your mouth, your jaw is going to grow up so your maxillary bone is going to grow up, which bumps into that nasal passageway, which then makes nasal breathing more difficult. So when we see adults with long, narrow faces, I have one. So when you see adults with a long, narrow face, that typically indicates there was probably some nasal breathing herbs, mouth breathing as a child, whether it was because of tethered oral tissues or frequent allergies or blocked nasal passages, or, you know, genetics play a role into this, of course. But if all of those factors are there, we have this kind of perfect storm. And we have these long, narrow faces that don't have as much airway in the back because everything is back. And then you have to, when we're looking at adults play into factors like orthodontics, because we want straight teeth. But back in the day, like when I had braces as a kid, everything was pushed back with headgear, because I had, I had kind of an overjet bite. And so they wanted to bring back that top bite that neck sillery bone again that we're talking about bringing that back, which caused a smaller airway. So it didn't help health overall,

you're saying they brought back the teeth, but they didn't widen the upper palate. So that area of the palate that goes up into the nasal cavity, didn't have that opportunity to lower down with an expansion of the upper palate. Exactly, yes. And they just pulled the teeth back.

They called it a day, or would the better option have been that when you were young, you possibly had a tongue tie that was pulling the lower jaw back and had you release the tongue tie as an infant, that lower jaw would have come forward and you wouldn't have had to pull the upper jaw back?

Yep, that's one of the options for sure. Yes. And or early expansion. So what Cynthia was saying to so and I actually want my case, but a lot of cases back in like children of the 80s and in early 90s headgear brings the back molars back which in turn brings teeth back. It does I mean, it impacts that Mac sillery development. So it is kind of the maxillary bone that's going back with headgear with IX palatal expansion is one of the best things you You can do for a child early on to just help that jaw develop and grow. Jeannie,  back to one of the questions I was wondering about earlier. Can you explain why this? So, aesthetically, this is important, it's important for breathing because the nose is the beginning of the immune system, our blood is better oxygenated, which keeps us healthier, fighting cancer, all of the above. What is the importance of this as we grow very old? Because the face changes, the face sinks the whole right? I mean, is that part of it? Or how does it affect us when we get older?

So absolutely. So to answer that question, we have to acknowledge what what is like typical for a typical adult, so I'm almost 40. At rest, our faces should be relaxed. So you should be able to just at rest, close your mouth, have everything kind of turned off in your face, your tongue should be slightly suction to the top of your palate, your teeth should be slightly apart, and your lips should be closed and relaxed, and all the muscles should be able to turn off at rest, as we age, right around 40. And that's I mentioned my age. But as we age, everything, including like, collagen starts to disrupt how we are at rest and what our body is capable of doing. And so if we don't address these things early on in life, we see things like sleep apnea, we see things like autoimmune disease, dysfunction, even Alzheimer's, dementia, some of these things that happen with your mind. Because if you think about a lifelong of not optimal oxygen coming to through your body, you're getting not optimal results for whole body health. Your body is in a constant state of fight or flight, especially with quality sleep. Yep.

Is this the same for men and women? Or does this hit women harder? Because I feel like it is more of a challenge for women in their 40s? And is does that mean then that it's related to the hormonal shift of like, well, we

have smaller jaws to Trisha that might be part of it.

Do? Yeah, it will. So you know what? That's a really good question to ask. And it's interesting that you bring up women because I agree, women have so many changes in our lifespan, especially after having children. And it does impact us a lot. But also, we always hear of these men who are snoring, and have sleep apnea and gasping for air in the middle of the night, and especially middle aged men with CPAP apps. And so that's what we're talking about, too. But yes, so it's really both it's both men and women.

So this isn't because the whole collagen thing you were talking about. That's part of it, I think a lot of it is more related to really airway development and what happens early early on. So back to as we age, collagen, yes, impacts things, muscles are weaker, we're not in our optimal health state. So as we age, things aren't going to grow. So when you're 40, your airway is not going to get bigger, it's only going to get smaller, as things atrophy. And so this is where what I do with myofunctional therapy can help as people are aging, so women or men, it can help tone the muscles of your tongue, jaw, lips, face, to help everything stay in the optimal functioning ability. So tongue is section in the palate, you have a proper swallow. So everything is optimal, optimally functioning and keeping your tongue where it should be and keeping your airway space as large as possible. So you're prompted to breathe through your nose instead of your mouth.

So when someone has a newborn baby, and let's say now not in the case of a tongue tie, what is it they should look out for? Or are there any exercises or things they should be doing to help that development, some red flags for babies when they're first born. One is open mouth breathing. So we so often see, and now that I have learned what I've learned in the myofunctional therapy world, I see all these cute babies with their little mouths open. And it looks so cute, and we love those squishy babies. But the open mouth breathing is a red flag of some kind of airway dysfunction. Or if the tongue is slightly out of their mouth, that's a sign of airway dysfunction. If baby has a side preference, so even with breastfeeding or bottle feeding, if baby's turning their head, well, one way or another, sleeping positions are something to look out for. So if baby sleeps in those really funky positions with their heads, curved to one side, or a really like arched back, or if they're even in that, that little position where they're sleeping upon their belly and their legs are under, and they're, they're curved in a certain way, that's a red, a red flag or a sign that there might be something going on with airway. So really, right at birth, there's some red flags or concerns that we would want to address.

Don't they all do all of those things sometimes, not all. So this is one of those more common, but not normal things that a lot of babies are doing more often. So when we're thinking about red flags, we want to see like, is it a pattern. So of course, if it happens once or twice, that's something. But overall, we want babies to be the biggest one is breathing through their nose. So babies should have a closed mouth posture, almost all of the time, they shouldn't have an open mouth posture, when they're sleeping. One of the biggest tips I'd give to parents is when babies sleeping, if you notice an open mouth posture, gently push with your thumb under their chin, which is their tongue, that's part of their third time, push up and hold, and help them get that suction with their tongue. Because again, our bodies are so incredible, even at that tiny young age, that if you give them just a little bit of pressure, and their tongue can suction onto the roof of their mouth while they're sleeping, it'll become just an automatic response for them as they're growing and developing. So since I've learned these things, that's one of the first things that I tell all mothers to do is if you see your baby's mouth open, start early start even at day two, you can do this, it's just a simple, helping helping baby find the section in the top of their job. It's not sectioned naturally for them. Those are some of like the red flags that I would look for some other preventative things that you can do early early on, is put your hands in your baby's mouth, we're not taught to do this. And it almost seems unnatural or unnormal. Like, you know, bizarre to do seems like an invasion. It seems like an invasion, right? We have to feel comfortable.

I'm always trying to encourage parents to use their index fingers to let babies soothe and suck. And it's, it's really surprises me all the time how uncomfortable most parents are putting their fingers in a baby's mouth. They're like, how, wait, what the nails are making hurt on me, you know, and yes, it's so comforting for them and so helpful for their oral development strength building.

It's so helpful. And I love that you do that because it is so important to just get some like so if we want something other than the breast. So like a lot of times, we're taught, you know, like pacifying is so helpful. But that suck reflex is there. And if we can utilize that suck reflex to our advantage to help, what you're doing is you're teaching another thing that can help develop that oral cavity by putting your fingers in baby's mouth. So breastfeeding is so and this isn't like a breastfeeding bottle feeding debate at all, because I support both and people need to have all the options. But breastfeeding is best not only for nutrition, but it is also best for job growth and development. And dentists will preach this too. But the movement that babies are making at the breast is helping develop the job. And really up to age two, I know that a lot of times here most women will stop by age will earlier but by age one, but up to age two is really helpful for job development. Because of the type of swallow that is required at the breast. Because when you're breastfeeding, your tongue has to elevate. And it's more than just a suckle. It's a whole process of suck, swallow breathe, it's a pattern. And the way your tongue is suctioning up to the palate when you're breastfeeding is helping develop that palate. So that's one of the best preventable helpful things that you can do is breastfeeding for jaw development and getting your fingers in those mouth. So back to that if like so some dads I also encouraged to do this, their hands are bigger. So I say like a pinky finger. But the tip is put your nail down so the nail is on the tongue. And so you're not as worried about scraping their top of their jar hurting them. Your tongue, your finger doesn't have to be shoved into their mouth. This is not a violent, aggressive thing. It's a very gentle, casual thing that you can do even before breastfeeding, breastfeeding to help warm up or before any feeding. I shouldn't say breastfeeding before any feeding, but just warm up even like the cheeks so put your finger on the sides of their cheeks rub along their gum line and then also on that palette. So you'll kind of feel where the palate gets soft as you go back. And that's where you stop but just giving them that feedback that It is really helpful to help their body understand where their tongue should be where there should be consistent feedback.

Janie, what about the women who bottle feed, I'm sure their bums teaching her how valuable breastfeeding is because it's incredibly valuable as far as the mouth development. And you know, my mother is a speech and language pathologist and I know her dissertation was on was related to breastfeeding and how it develops the jaw. And I'm just wondering, What if a woman is bottle feeding? What can she do to try to reap some of the benefits of that muscle development of the breastfed baby?

Absolutely. And again, I want to reiterate that either way is great. And there are still optimal ways to help with that. That's just one, one preventative thing. But if you're bottle feeding, hands in the mouth is, is another really great thing to do. Also stretching whole body. So there's a quote, there's a pose that all moms I think should do before any type of feeding. It's called the Guppy pose. And it's when you help elongate the neck. So when babies lying down on their back, you gently pull up their arms so their neck can elongate, which gives the airway this room because babies are used to being in utero crunched up in this tight position. So it just helps elongate the position. And while they're in that Guppy pose, so you can even lay them on your lap with your head, just elongate it just a little bit off the edge of your lap. You're not doing this for long periods of time, even just a few seconds, whatever you're comfortable with. And you push up on their tongue. So your tongue goes all the way down to the bottom of your jaw push up on their tongue, help you push if you push under their jaw, be just under like an inch beyond their chin or wherever you're exactly. And then you're referring that as to under their tongue, but we think of under the tongue as internally, you're saying yes, on those muscles. And they're going to cause a reaction in the tongue to get the tongue in the right position just by doing that.

Yeah, and let me explain why I was saying tongue. So it's really fascinating. Our tongue is actually two sets of eight muscles. So your tongue is a lot bigger than what we see. So the tongue that we all think of is just that one little mobile part inside our mouth. Your tongue actually goes all the way into your mandibular bone. And if everyone touches their chin, and then puts their finger under their chin, that is your tongue that you're touching. That's part of your tongue muscle.

Oh, how is that possible? I don't get it. That's, that's the muscles under the chin are part of the tongue? Or is it that the tongue is not just what I think it is? Bright? Okay, the tongue that is considered part of the tongue. All of those are not just the part that can wiggle and move and we can stick out of our mouths. That's not the tongue, the tongue is all these other things. Right?

Right. And so when we're talking about like tethered oral tissues, or tongue ties, that's the tongue tied to itself. That frenulum that frenulum there. And I know not all, not everyone listening can see this. But if you suction your tongue to the roof of your mouth, and you open your mouth, you're gonna see tissue on the floor of your mouth. By your teeth, I'm showing you guys, but not everyone can see. But you're gonna see tissue under there. That tissue is still tongue tissue. So your tongue is a moving muscle, the part that we're all familiar with, and it's also the underlying tissue behind your mandibular bone. So yep, your tongue is a lot bigger than what we think. Why do people say your tongue is the strongest muscle in your body?

It is like oh, yeah, is like Like, like, centimeter per centimeter. It's, it's it is it's like if you're taller, the size of your quad, you would be like the Hulk.

Absolutely. So the reason people say that is your tongue. So just for some reference point, if someone has braces, you need about braces apply about two grams of force to move teeth. And really to move teeth, we need about 1.5 grams of force to move teeth. If you thumb suck, that'll provide about 100 200 grams of force to move your teeth. That's why so many kids a thumbs up, have their teeth pulled out. So that's like 10 times more than just what you need for braces. Your tongue though. Your tongue is so strong. It provides about 500 grams of force. So if our tongue is optimally functioning, we're providing 500 grams of force to the roof of our mouth with that leg section. And that's why it's moving bone because it's such a strong muscle. And it's really not one muscle we should even we shouldn't even refer to the tongue as our muscle, literally 16 muscles, it's two pairs. have eight muscles. So it's pretty there's there's four intrinsic and four extrinsic muscles.

And in the tongue, it's much bigger in the oral structure than most people think. But it is also connected to the entire rest of the body. And it can influence everything in the neck, shoulders, chest, abdomen, gut. digestion, feet. Yes. Yes.

What? Yes, yes, yes. To your feet, okay, all the way down to your toes, how far down does the tongue go in the body? Well, so it's not necessarily just the tongue. What we're talking about here is fascia. So fascia is intertwined throughout your whole body, and the tip of your fascia starts under your tongue, so that when you suction your tongue, and you hold it, go out and try it. And it can be hard for some people to do. That is the tip of the fascia for your whole body. So it is a web like material that is throughout your whole body connecting bone tissue, but it's all over our body, and it goes all the way down to your toes, there is fashion other places, but it's all connected.

That's all connected. So what is that connected to? What where does it go next? And is that literature connected to the whole body? Because it turns into all the fascia?

Sure, I think I think that's a big part, when also just our bodies are systems that all work together. So I think we talked about this earlier, but our bodies are not just like a one time machine. So like one of the falls of I think Western medicine is we go to like, one doctor for one thing, and then another doctor for another thing, and we're not connecting all the pieces. But I think the time the side stick Yeah, right. And that's what I was gonna say is on your podcast, you very well describe that in birth, you know, in in pregnancy and birth, everything is connected. So if you have something going on in your head in pregnancy, and you're really stressed, it's going to impact everything going on in your body. And so similarly, if something's going on in your mouth with your tongue, and it's a tight tethered oral tissue, it's going to impact other parts of your body, and presenters, the ear, nose, throat doctor should, in an ideal world now have all the knowledge that you have. No, no, it's truly and you should have all the knowledge that they have. I mean, it should be more holistic, or there should be a team supporting every person with every problem.

That is what I agree with. Yes, I think there should be a team, I think that I don't think I should have all the knowledge of an EMT or they should have all the knowledge that I have. But I think it should be a team approach, where we can all work together to help the body as a whole. And I also think we need to honor that more in ourselves about learning our bodies, because each person is different. So we might have the same degree of tongue tie, but it might present very differently in one person versus another person, because our bodies are all gonna respond differently. Just like birth, in an ideal world, if we had an awesome team of like, a midwife, and a doula and a nurse, and everyone working together, it helps all of the systems and all of the things happening, and we're honoring that woman and her body and what's happening in that time. Same thing with airway, if we have a team of people who are working together to support that person with their symptoms, and what's going on with their airway. Everything else is is is better, but it starts with the person having the autonomy and talking about what's going on, because no one knows your body better than you. And so if you're able to speak to what's happening, what the symptoms are, where things are going, that that'll help the whole process, but so utilizing the knowledge of an EMT and then utilizing knowledge of a speech language pathologist who has this myofunctional knowledge, utilizing, you know, a pediatrician, chiropractor, and taking all of that knowledge and bringing it together is gonna get optimal results for whatever issue the person is facing.

Would it be safe to say that every baby who sleeps with their mouth open persistently, I usually say if your baby's mouth is open more than 80% of the time, we need to address it easily at right do you need? Yeah, less than 80 Right. There's gonna be you know, sometimes babies fall asleep and positions on the parent in their mouth is just lie. You know, I like hanging open because of the relaxes. So I don't like say 100% of the time, but the vast vast majority of the time. And then any adult who snores should be getting myofunctional therapy

-- before or after their divorce?

Yeah, well, so. Yes. So that is a that's a big one. question because there's so many pieces to that. And I'm trying to like, fine tune how to do that. So first of all start with babies. If we're noticing babies have an open mouth posture, I would even say at least, like, if it's open more than half the time just for ease, because I do think our nature as parents, we can't pick up on all of the resting postures of our baby's mouth, because we're thinking about so many other things, especially being a first time parent. But if you're noticing more than half the time that your baby's mouth is open, or you know, like, and I think that's, it really should be almost all the time. It's sorry, I should have said that backwards. percent of the time, the baby's mouth should be closed. Yeah. Okay.

Open. Yeah.

I was like, let's not wait. I was trying to be kind Trisha.

Um, but yes, so we want baby's mouth closed, almost all the time. So if you're noticing an open mouth posture, really any time if you're noticing open mouth posture, start to record them when they're sleeping, start to take note and start to just be aware of it, and do help, even in the early days of life help by gently pushing under the tongue. Another thing to help with is showing the baby your tongue. So when they're awake, even at a few days old, stick your tongue out, wag your tongue side the side. Babies imitate them and babies, babies know on an intrinsic level to imitate. So mirror neurons. I think you've talked about this in another podcast, probably. But mirror neurons are so powerful and so incredible. But our brains, even as infants mirror what we see. So if parents are modeling certain things with their baby, it'll be helpful for airway development. So a couple of those things are, you know, sticking your tongue out to baby showing that also clicking your tongue. Early early on, I wish I'd known this my first two kids, I didn't until my third. And we I click with him all the time. He's He's 18 months old. And he can hold that click now and click down and it's like a game for him. But we started really, really early, just clicking our tongue. Back to what you're saying, Trisha, though, is that early, early on, if you notice mouths open, that's one of the first red flags that you'll you'll have with with airway development. Also audible breathing. So if you're noticing those babies with that audible breathing, that's a concern. Also the baby that is thumb sucking, is thumb sucking beneficial? Yes, to an extent but not prolonged. So we want really pacifier and thumb sucking. Ideally, from a speech pathologist perspective, I'd like them to, you know, discontinue that or replace that behavior or something else around four to six months old, which I know is early. And I know some pediatricians would disagree. That's usually the time you're just getting really hooked on it. That's

Yes. And that's why I say break the habit then. Right, because, and I'm coming at it from the perspective of airway development and maxilla regrowth, but also feeding development and communication development. So when we have habits that little breaking them at that time, it doesn't have to be like a harsh break at that time, because they're not necessarily hooked on it yet. But replacing it with things that they can chew on. So I love the hollowed straws that they can chew on, they can start to play with those, they have that that reflex of of chewing and biting that starts around that time. So giving them that inputs they can chew. Also, there's something called a maya menchi that you can start as early as six months old, that's really helpful for job development and something that they can just chew on. So if you're needing something to help soothe your baby, I would recommend using things that they can chew on versus only stuck on in place of those things are also any kind of gentle vibration toys for babies, those teething toys will help with that chewing and that stimulating that reflex versus just the suckling that's going to not be optimal for maxillary development. I would just say that I I hope that early on. Parents can recognize how important it is to address airway health, to get a team of providers to address head to toe tension, head to toe systems to get baby's help early on, because we really do have this epidemic of babies and jaws not developing as often Willie as they should. So my my big takeaways are get your hands and your baby's mouth Don't be don't be afraid of doing that. Allow them to suck on your fingers rub their gums imitate. Have fun with your baby early on with big smiles sticking your tongue out that Guppy pose, please look it up if you don't have visuals here but gently raising their hands and getting their neck into a full extension and really considering getting rid of the pacifiers earlier on and replacing with chewing to help that Java development.

Just one last question, Jeanne, is it ever too late? No.

I'm so glad you asked that question. Our bodies are ever changing, ever healing and it's never too late to address airway. If you're noticing that your child has signs and symptoms of any of these things, it's not too late. When you're 70 years old, there are still changes that can happen in your body with the right support. So seek care with a trained provider in your area in airway health. A great place to start if your child is under four is a speech language pathologist or occupational therapist trained in feeding therapy. And if you're over for a myofunctional therapist is a great way to go.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

I cannot thank both of you enough for being on this. I'm definitely starstruck, you're both so incredible. And you bring so many wonderful things to the birth space. And I'm just beyond grateful for the knowledge and care that you both provide because we need more of that and more women just feeling empowered and understanding in life. So thank you so much for this opportunity. I really, really appreciate it.