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Mouth Breathing in Kids: Snoring, Sleep & Oral Habits · Root Cause Conversations

• 0:00
  SPEAKER_00: Okay, I want you to think about something for just a minute.
• 0:04
  SPEAKER_00: Have you ever walked into your kiddo's bedroom at night and you've noticed that they're sleeping, but their mouth is actually wide open, and maybe they're snoring a little bit, or perhaps you've noticed they are tossing and turning a lot.
• 0:20
  SPEAKER_00: I kind of refer to that as being an agitated sleeper.
• 0:23
  SPEAKER_00: And then when you walk in their bedroom in the morning, they've turned themselves completely sideways in the bed, and then you think, oh, well, it looks like they're sound asleep, so it's gotta be fine, right?
• 0:35
  SPEAKER_00: Or maybe you've got a kiddo who's still sucking their thumb.
• 0:39
  SPEAKER_00: That's tough.
• 0:41
  SPEAKER_00: Or even like chewing on their shirt, and you've been told at some point, like, hey, they're gonna grow out of these things.
• 0:50
  SPEAKER_00: But what if all of these things could really be connected?
• 0:55
  SPEAKER_00: What if the way your child is breathing, how well they're sleeping at night, where their tongue is resting in their mouth, and even some of those habits that you've been trying to get rid of are giving us some little clues.
• 1:09
  SPEAKER_00: And that is exactly what I want to talk about today.
• 1:13
  SPEAKER_00: One thing that I hear at the clinic from parents on a weekly basis is why didn't anybody tell me these things sooner?
• 1:23
  SPEAKER_00: And you know what, guys, that is a totally valid question.
• 1:27
  SPEAKER_00: So today we're gonna talk about some of the things that you may be noticing at home, what they could mean, and when it might be time to start asking a few more questions.
• 1:39
  SPEAKER_00: I want this to be a conversation like you and I are sitting down together in my office chatting.
• 1:50
  SPEAKER_00: Hey everyone, welcome back to Root Cause Conversations.
• 1:54
  SPEAKER_00: I am Amanda Mavrokis, a speech language pathologist, an oral facial myofunctional therapist, and the owner of Salt and Light Speech and Language Resources right here in Alabama.
• 2:06
  SPEAKER_00: And today, guys, it's just me.
• 2:09
  SPEAKER_00: If you've listened to some of my previous episodes, you know that I love having conversations with other providers about a lot of different things that contribute to what we're seeing in our children and also in ourselves.
• 2:24
  SPEAKER_00: But today I want to talk about something that's really at the heart of what I do every day at my practice, and that's looking beyond the obvious symptoms.
• 2:34
  SPEAKER_00: Looking beyond that initial complaint.
• 2:37
  SPEAKER_00: Why did you come into my office in the first place?
• 2:40
  SPEAKER_00: Because sometimes a parent comes to see me because their child is having trouble saying some of their speech sounds.
• 2:47
  SPEAKER_00: They can't make their S.
• 2:49
  SPEAKER_00: They're having trouble with their R sound.
• 2:52
  SPEAKER_00: Or somebody's mentioned that their kiddo might be tongue thrusting.
• 2:56
  SPEAKER_00: And that's when we want to start looking a little bit deeper.
• 2:59
  SPEAKER_00: And then we start discovering that their kiddo is also like mouth breathing, they're snoring at night, they wake up tired, they don't feel rested, and mom has been reading a line and she's noticed that maybe her child has crowded teeth or even a narrow palate.
• 3:19
  SPEAKER_00: And suddenly we're looking at a much bigger picture than just that speech sound issue that was the initial concern in the first place.
• 3:28
  SPEAKER_00: That's why during the intake and that initial evaluation, we have to dig deep and ask lots of important questions.
• 3:36
  SPEAKER_00: And honestly, that's why I decided to start doing this podcast in the first place.
• 3:42
  SPEAKER_00: I really want people to understand that sometimes what they're seeing, they're not isolated problems.
• 3:50
  SPEAKER_00: They very well could be connected.
• 3:53
  SPEAKER_00: So before we jump in today, I want to mention something that I have created specifically for you guys, the parents, and even the grandparents out there.
• 4:02
  SPEAKER_00: It's called the Root Cause Resource Library, and it is completely free.
• 4:06
  SPEAKER_00: It's an interactive digital library that you can access from your phone, and it's designed to help you start connecting some of these dots and start putting some of the pieces together.
• 4:18
  SPEAKER_00: Now, I do want to say that the resources are for educational purposes only.
• 4:23
  SPEAKER_00: There's nothing on the podcast or in the resource library that is meant to diagnose or treat anything or replace an evaluation or a treatment intervention from a qualified professional.
• 4:35
  SPEAKER_00: The tools that are in the resource library are to help you recognize patterns that you've been seeing.
• 4:42
  SPEAKER_00: It helps you understand what you might be seeing and know what questions to ask the next provider that you see.
• 4:49
  SPEAKER_00: I'll talk a little bit more about what's inside as we go, but the link is right below in the show notes if you wanted to open it up and look at it as we're going through the podcast today.
• 4:59
  SPEAKER_00: So let's just hop into our topics.
• 5:02
  SPEAKER_00: First question I get why does my child have their mouth open a lot?
• 5:08
  SPEAKER_00: Like the parents are reading, they're seeing all the things online about mouth breathing.
• 5:13
  SPEAKER_00: And this is one of the most common things that I see.
• 5:16
  SPEAKER_00: And I know some of you guys are thinking, like, okay, Amanda, my child breathes through their mouth sometimes.
• 5:21
  SPEAKER_00: Is that really a big deal?
• 5:23
  SPEAKER_00: No, it's not, but it really depends on certain things that we're seeing in conjunction with that.
• 5:30
  SPEAKER_00: We all breathe through our mouth sometime.
• 5:33
  SPEAKER_00: If you get a cold and your nose is completely stopped up, then you are absolutely gonna breathe through your mouth.
• 5:39
  SPEAKER_00: If you are exercising really hard, you may breathe through your mouth.
• 5:44
  SPEAKER_00: This is not what I'm talking about, guys.
• 5:46
  SPEAKER_00: I'm talking about your child who is sitting on the couch watching a TV show and their mouth is open.
• 5:53
  SPEAKER_00: Or you're riding in the car and you look back in the back seat and their mouth is not like wide open, but their lips are parted and you can tell their mouth is open a little bit.
• 6:04
  SPEAKER_00: I'm also talking about the child who may be concentrating really hard on a task or coloring or drawing this picture, and their mouth is just open.
• 6:16
  SPEAKER_00: Okay, so these are all patterns that they want to start putting together, and these are things that we want to pay attention to because it really does matter.
• 6:26
  SPEAKER_00: And let me explain to you why.
• 6:29
  SPEAKER_00: Our nose was designed for breathing, and it has a really important job.
• 6:34
  SPEAKER_00: When we breathe through our nose, it does multiple things.
• 6:38
  SPEAKER_00: First of all, it's going to filter the air that you're breathing.
• 6:42
  SPEAKER_00: If it's really cold outside, it's going to warm the air up and it's also going to humidify the air before it reaches our lungs.
• 6:51
  SPEAKER_00: Our nose is designed to do all of those things.
• 6:55
  SPEAKER_00: But when we are consistently breathing through our mouth instead, we are bypassing some of these really important functions that our nose was designed to do in the first place.
• 7:06
  SPEAKER_00: Now, here's where it gets a little interesting for me, okay?
• 7:10
  SPEAKER_00: So if your child's mouth is open, what's usually happening with their tongue?
• 7:15
  SPEAKER_00: I want you to think about it.
• 7:16
  SPEAKER_00: And even open your mouth and think about where is your tongue.
• 7:20
  SPEAKER_00: Guess what?
• 7:21
  SPEAKER_00: It's probably not resting up in the roof of their mouth where we would like to see it.
• 7:26
  SPEAKER_00: It's probably laying down in the bottom of their mouth.
• 7:29
  SPEAKER_00: And that's important because the tongue plays a very, very important role in oral development.
• 7:37
  SPEAKER_00: So if we look at the tongue, the lips, the cheeks, the jaw, all of these things need to work together.
• 7:46
  SPEAKER_00: And the way all of those muscles function and how they rest over time can really influence how the mouth is going to grow and develop.
• 7:56
  SPEAKER_00: So we want our mouth and our face to grow forward and out.
• 8:01
  SPEAKER_00: So when I am looking at a child or even an adult, I'm not just looking at can they say their speech sounds?
• 8:08
  SPEAKER_00: I'm also looking at where is their tongue resting in their mouth?
• 8:12
  SPEAKER_00: Are they able to keep their lips closed and breathe through their nose?
• 8:16
  SPEAKER_00: And I'm going to ask a lot of questions about sleep, attention, focus, behavior, because those things may explain some of what we're seeing, which is the bigger picture of your child.
• 8:29
  SPEAKER_00: Remember what we said earlier?
• 8:31
  SPEAKER_00: You may be noticing four separate things, but all of those things may be connected.
• 8:37
  SPEAKER_00: So let's look at why your child might be mouth breathing or why you might be mouth breathing.
• 8:45
  SPEAKER_00: And it's really important that we stop and ask why.
• 8:48
  SPEAKER_00: Sometimes there could be something physical going on to make nasal breathing difficult.
• 8:55
  SPEAKER_00: My husband went to the ENT a couple of weeks ago.
• 8:58
  SPEAKER_00: He's having some issues breathing through his nose properly.
• 9:02
  SPEAKER_00: And on the right side, he has nasal valve collapse.
• 9:05
  SPEAKER_00: He has a deviated septum, and there's also a spur in his nose.
• 9:10
  SPEAKER_00: So that's a functional, physical, anatomical issue that's going on with him.
• 9:16
  SPEAKER_00: But you or your child could have allergies, and that could be food allergies or environmental allergies.
• 9:22
  SPEAKER_00: We also want to rule out enlarged tonsils, adenoids, and we want to look at their turbinates.
• 9:29
  SPEAKER_00: Maybe you or your kiddo is dealing with chronic congestion or another nasal obstruction, like I mentioned with my husband.
• 9:37
  SPEAKER_00: Like he has a few different things going on there that's impacting his ability to breathe through his nose properly.
• 9:44
  SPEAKER_00: And sometimes we see differences in oral structure or function that could be contributing to this as well.
• 9:53
  SPEAKER_00: So sometimes mouth breathing can totally become a learned pattern, even after the original issue has improved.
• 10:02
  SPEAKER_00: But here's something I really want to spend a little bit of time emphasizing.
• 10:06
  SPEAKER_00: We shouldn't just assume that mouth breathing is a bad habit.
• 10:11
  SPEAKER_00: Because if your child is having a hard time breathing through their nose, telling them to close their mouth is not going to be helpful.
• 10:19
  SPEAKER_00: They still have to breathe, they still have to get air.
• 10:22
  SPEAKER_00: So we need to figure out why and what exactly is happening.
• 10:26
  SPEAKER_00: And this is where other professionals may need to be involved.
• 10:31
  SPEAKER_00: An ENT, an orthodontist, an allergist.
• 10:35
  SPEAKER_00: There are a lot of different providers that could be involved in this.
• 10:38
  SPEAKER_00: Now I also want to talk really quickly about some challenges in oral structure that could be contributing to that.
• 10:46
  SPEAKER_00: So let's talk about the space between the top of your mouth and the floor of your nose.
• 10:53
  SPEAKER_00: There's not a lot of space there.
• 10:54
  SPEAKER_00: So if your kiddo has a narrow, vaulted palate, that means that palate is kind of going up higher than it should.
• 11:03
  SPEAKER_00: It could be potentially encroaching on the space within the nasal cavity.
• 11:08
  SPEAKER_00: So again, this is why we loop in other providers.
• 11:11
  SPEAKER_00: And this is why we don't just tell our kiddos to close their mouth.
• 11:15
  SPEAKER_00: We want to make sure that they have the ability to breathe through their nose properly.
• 11:22
  SPEAKER_00: I see this in my clinic a lot.
• 11:24
  SPEAKER_00: I have kiddos that come in with ongoing challenges with environmental allergies.
• 11:31
  SPEAKER_00: And, you know, I mean, from a speech language pathology standpoint, I have to stay within my scope of practice.
• 11:39
  SPEAKER_00: And so if there's something visual I see going on, I'm gonna ask the mom or the parent, hey, let's go see the ENT and see if there's any kind of like physical or anatomical things going on that's preventing your kiddo from being able to breathe through their nose.
• 11:56
  SPEAKER_00: So that's why it's important that we work together as a team and focus on collaborative care.
• 12:02
  SPEAKER_00: Here are a few things that you can do at home.
• 12:05
  SPEAKER_00: Over the next few days, just observe your child.
• 12:10
  SPEAKER_00: Don't mention anything, don't remind them of anything.
• 12:13
  SPEAKER_00: Just notice when they're not using their mouth, when they're sitting quietly, whether that's watching TV, reading a book, doing homework, riding in the car.
• 12:23
  SPEAKER_00: You want to look at their face and their mouth.
• 12:26
  SPEAKER_00: First of all, are their lips together or apart?
• 12:30
  SPEAKER_00: Your lips should be lightly touching.
• 12:33
  SPEAKER_00: You shouldn't see anybody's teeth.
• 12:35
  SPEAKER_00: And you want to notice whether their mouth is open or closed.
• 12:39
  SPEAKER_00: You also want to peek in when they're sleeping, either late at night, early in the morning, or if they fall asleep on the couch and they're catching a quick nap, that would be a great opportunity to look and see what's going on with their face and their mouth.
• 12:53
  SPEAKER_00: Now you're not trying to diagnose anything, you're just noticing some things and taking some data and observations on some things that might be helpful when you talk to your child's healthcare provider about these things.
• 13:07
  SPEAKER_00: So why are they still tired?
• 13:11
  SPEAKER_00: I hear this question a lot too.
• 13:13
  SPEAKER_00: My child sleeps all night.
• 13:15
  SPEAKER_00: They were in bed for like nine or ten hours, but they still seem really tired.
• 13:21
  SPEAKER_00: Or they seem to have dark circles under their eyes.
• 13:25
  SPEAKER_00: It's hard for me to arouse them in the morning or get them out of bed.
• 13:29
  SPEAKER_00: Or they may not be exhausted at all.
• 13:32
  SPEAKER_00: Maybe you've noticed your kiddo bouncing off the walls.
• 13:36
  SPEAKER_00: And this is something I just want to clarify.
• 13:39
  SPEAKER_00: Just because your child's eyes are closed and they're asleep does not mean that they are getting good restorative sleep.
• 13:46
  SPEAKER_00: And that applies to you too.
• 13:49
  SPEAKER_00: Sometimes these things that we're noticing, the snoring, the sleeping with the mouth open, these are all clues that we need to take into account to help us dive deeper and just take a deeper look at what might be going on with this kiddo.
• 14:05
  SPEAKER_00: Now, does this mean every child who snores has an airway issue?
• 14:11
  SPEAKER_00: Nope.
• 14:11
  SPEAKER_00: No, guys, I'm not saying that.
• 14:13
  SPEAKER_00: But I'm also saying we shouldn't ignore it.
• 14:16
  SPEAKER_00: So you are gathering data, okay?
• 14:18
  SPEAKER_00: That's all you're doing.
• 14:20
  SPEAKER_00: I think a lot of parents have been led to believe that snoring is just something that people do.
• 14:26
  SPEAKER_00: And guys, sometimes people snore.
• 14:29
  SPEAKER_00: Like when we have a cold and we're sick and we're congested, yes, we are absolutely going to snore.
• 14:35
  SPEAKER_00: But that is different than habitually snoring every night.
• 14:39
  SPEAKER_00: So any person who is snoring every night, child or adult, we really need to pay attention to that.
• 14:46
  SPEAKER_00: If your child is snoring most nights, that's something that I would encourage you to discuss with your pediatrician or your ENT, because snoring can sometimes, sometimes be associated with sleep-disordered breathing.
• 15:03
  SPEAKER_00: And this can have a big range from mild to more significant obstructive sleep apnea type things.
• 15:10
  SPEAKER_00: So I am not the person who diagnoses sleep apnea that requires another medical evaluation and even a sleep study, but I do want us to recognize signs that might indicate a child that needs further evaluation.
• 15:27
  SPEAKER_00: So, what does that look like, Amanda?
• 15:31
  SPEAKER_00: Like as parents, what are we looking for?
• 15:34
  SPEAKER_00: So here are some things that I ask parents about.
• 15:38
  SPEAKER_00: Okay?
• 15:39
  SPEAKER_00: Does your child snore regularly?
• 15:41
  SPEAKER_00: Are they an agitated sleeper?
• 15:43
  SPEAKER_00: Let's look at their head posture when they're sleeping.
• 15:46
  SPEAKER_00: Is their head tilted way back when they're asleep?
• 15:49
  SPEAKER_00: Does it look uncomfortable?
• 15:51
  SPEAKER_00: Are they sweating a lot in their sleep?
• 15:54
  SPEAKER_00: What about grinding their teeth?
• 15:56
  SPEAKER_00: Are they doing that?
• 15:57
  SPEAKER_00: Are they only doing it at night or during the day?
• 16:00
  SPEAKER_00: Are they hard to wake up in the morning?
• 16:02
  SPEAKER_00: Are they waking up with a dry mouth?
• 16:05
  SPEAKER_00: And are they still having accidents at night beyond the age that we would typically expect for this to happen?
• 16:12
  SPEAKER_00: None of these things individually is going to tell us what's happening.
• 16:17
  SPEAKER_00: But when we start kind of looping them together, this gives us a great reason to start asking a lot more questions.
• 16:27
  SPEAKER_00: And I want to preface all of this by saying: if you ever notice that your child appears to stop breathing during their sleep or they're gasping, I want to encourage you to get prompt medical attention because that is absolutely not normal.
• 16:41
  SPEAKER_00: So we want to get to that kiddo and to see somebody ASAP.
• 16:45
  SPEAKER_00: Another thing that surprises a lot of my parents is how these things can correlate with attention and behavior.
• 16:54
  SPEAKER_00: Absolutely, they can.
• 17:06
  SPEAKER_00: But kids don't always respond to poor sleep the same way that we do.
• 17:12
  SPEAKER_00: Sometimes it may look like that, but sometimes they can be more active, they can be bouncing off the walls, they can also be really irritable and disagreeable.
• 17:24
  SPEAKER_00: And then sometimes they can actually have a hard time engaging and regulating their emotions or even just paying attention.
• 17:34
  SPEAKER_00: So you might hear some things like your child is having trouble focusing, they're really having a hard time sitting still in school.
• 17:44
  SPEAKER_00: Now, I want to be clear, I'm not saying every child that has attention difficulties has a sleep problem.
• 17:51
  SPEAKER_00: I'm also not saying that sleep disordered breathing explains ADHD diagnoses.
• 17:59
  SPEAKER_00: But sleep is something that we should absolutely be asking more questions about, guys.
• 18:06
  SPEAKER_00: Because if that kiddo is not sleeping well, that can absolutely affect how they are functioning during the day, their ability to attend to task, participate, complete activities, regulate their body, and regulate their emotions.
• 18:22
  SPEAKER_00: And these are things that we certainly do not want to overlook.
• 18:27
  SPEAKER_00: So, what can parents do?
• 18:31
  SPEAKER_00: One thing I encourage you to do is take a short video of your child sleeping, especially if if you're noticing the snoring or even like some audible breathing at night.
• 18:43
  SPEAKER_00: Make sure the sound is on, but having a short video of your child sleeping, what their head posture looks like, how they sound, and how their mouth looks, these are can be important things that you're sharing with your pediatrician or your ENT or other provider.
• 18:59
  SPEAKER_00: And we also don't want to overlook sleep environment.
• 19:04
  SPEAKER_00: I don't know about you guys, but I need my room to be dark.
• 19:08
  SPEAKER_00: I have blackout curtains.
• 19:10
  SPEAKER_00: I need my room to be cool.
• 19:12
  SPEAKER_00: I need my sound machine going.
• 19:14
  SPEAKER_00: Like there's just a lot of things that needs to be in place for me to ensure I get a good night's sleep.
• 19:20
  SPEAKER_00: So you want to make sure you're checking on your kiddo's sleep environment.
• 19:24
  SPEAKER_00: Is their room dark?
• 19:26
  SPEAKER_00: Is the temperature comfortable?
• 19:28
  SPEAKER_00: We really want to make sure we're stopping screens 30 minutes to an hour before bedtime.
• 19:34
  SPEAKER_00: And is there anything in the room that could be contributing to allergies or congestion?
• 19:41
  SPEAKER_00: Sometimes we have to look at the detergent that we wash the sheets in.
• 19:45
  SPEAKER_00: Sometimes we have to look at the stuffies that may be in the bed.
• 19:49
  SPEAKER_00: I know they're comforting, but sometimes we need to wash and clean those to make sure there's not allergens there.
• 19:55
  SPEAKER_00: And something else I just want to briefly mention is just be mindful of any plug-ins that you have in your child's room, like the GLADE plug-ins or the ones from Bath and Body Works.
• 20:08
  SPEAKER_00: Make sure they're not in your child's room or either like right outside their room.
• 20:13
  SPEAKER_00: Those can be things that can trigger allergies and congestion.
• 20:18
  SPEAKER_00: So I want to encourage you to take a look at the sleep environment.
• 20:23
  SPEAKER_00: And sometimes we just need to improve the sleep environment to see if that helps our kiddo sleep the best at night.
• 20:32
  SPEAKER_00: Alright, so we've talked a lot about sleeping, breathing, and now we're going to change gears and we're going to talk about oral habits.
• 20:41
  SPEAKER_00: This is something that comes up in my office a lot.
• 20:44
  SPEAKER_00: And so before I start this, I want to say something because my sister told me this.
• 20:50
  SPEAKER_00: She said, Amanda, not everybody understands what an oral habit is.
• 20:54
  SPEAKER_00: So let me talk about that briefly because anybody can have one.
• 20:58
  SPEAKER_00: And so when we're talking at kid talking about kiddos specifically, we're looking at thumb sucking, finger sucking, putting different objects into their mouth, prolonged pacifier use.
• 21:11
  SPEAKER_00: It could be chewing on their shirt or putting the sleeves of their shirt in their mouth and chewing on it.
• 21:17
  SPEAKER_00: They could be biting on their fingernails, they could be sucking on their lip.
• 21:22
  SPEAKER_00: And I've even had a few people sucking on their tongue.
• 21:24
  SPEAKER_00: That's a very real thing.
• 21:26
  SPEAKER_00: And this can happen for adults as well as kiddos.
• 21:29
  SPEAKER_00: Sometimes adults is going to look more like the biting the fingernails or putting like pens and pencils and things in their mouth and chewing on them.
• 21:39
  SPEAKER_00: Now, with some of these oral habits, especially with our littles, sometimes parents get really frustrated because they've tried so many things.
• 21:47
  SPEAKER_00: There's a lot of stuff out there on the market.
• 21:50
  SPEAKER_00: And they've done like a reward or they've bought them a prize.
• 21:56
  SPEAKER_00: They've painted that, they've put that stuff on their thumb.
• 22:00
  SPEAKER_00: and made it taste bad or they bought some kind of splint or something to go over their hand and their arm and they've tried four or five things and really nothing has helped this kiddo break this habit and that can be really frustrating not just for the parents but also for the kiddos.
• 22:20
  SPEAKER_00: Let's talk about why we would have a habit like this in the first place.
• 22:26
  SPEAKER_00: Sucking is completely normal in infancy.
• 22:30
  SPEAKER_00: Babies have that natural need to suck and so it can be very soothing.
• 22:34
  SPEAKER_00: A baby using a pacifier or sucking their thumb isn't something we really need to be concerned about.
• 22:41
  SPEAKER_00: But as these children get older four, five, six, we want to pay attention to how these habits are happening and how long they are continuing for because that's really important.
• 22:56
  SPEAKER_00: And it's also important for people to understand that these different habits can actually serve some different purposes.
• 23:05
  SPEAKER_00: So for some kiddos they're using it for comfort they're using it to self-regulate and to self-soothe okay they could be trying to regulate themselves if they are bored if they're tired if they're overwhelmed those types of emotional things.
• 23:22
  SPEAKER_00: Some kiddos are chewing on things whether that's their clothes or other objects because they are seeking some sensory input okay and there may be some other oral or structural factors that we need to explore.
• 23:38
  SPEAKER_00: I don't want you guys as parents assuming that if your child still has a habit it means there's an airway problem or a tongue tie or something like that.
• 23:50
  SPEAKER_00: That's not necessarily true.
• 23:52
  SPEAKER_00: This is why it's so important for us to take this on a case by case basis and look at that individual child, the history of the habits and other things that might be happening at that time.
• 24:04
  SPEAKER_00: Something that I tell parents quite frequently is if your child is using this habit to kind of comfort themselves we really can't just take that away without finding another way to meet that need.
• 24:19
  SPEAKER_00: Or we're going to have a frustrated child.
• 24:22
  SPEAKER_00: Or that behavior just might shift into something else.
• 24:26
  SPEAKER_00: Maybe they stop sucking their thumb but maybe now they're biting on their nails and putting things in their mouth to chew them.
• 24:34
  SPEAKER_00: This doesn't happen to every child but it is something we absolutely need to consider.
• 24:41
  SPEAKER_00: And so I want us to approach this from the top down habit elimination early is important but I want us to know why we're eliminating the habit and other things we may need to do.
• 24:55
  SPEAKER_00: So I hope that clarifies oral habits and let's just talk about when you as parents may need to be concerned all right so we're looking at frequency like how often are they doing it how long are they doing it for and is it pretty like forceful and intentional so a kid that puts their thumb in their mouth for a few minutes at bedtime and then it falls out is very different than a child who is really like actively sucking on that thumb for several hours throughout the day the longer and the more intense the sucking habit continues the greater we have the potential for some changes with their dentition.
• 25:44
  SPEAKER_00: And that's why I want parents to have conversations with their pediatric dentist about these habits early on.
• 25:52
  SPEAKER_00: We don't have to wait until there's like a major dental problem to start addressing these concerns.
• 25:59
  SPEAKER_00: Here's something I feel strongly about because I actually offer a habit elimination program at my practice.
• 26:09
  SPEAKER_00: The parent that wants the habit gone and the child being ready to stop are two very different things.
• 26:19
  SPEAKER_00: I can't emphasize that enough you as the parent being ready doesn't make the child ready and that's important okay I have a parent who can be on board with quitting this thumbsucking habit.
• 26:36
  SPEAKER_00: They are motivated they are ready to start tomorrow but if that child is not ready or willing to participate this changes everything because habit elimination requires the child to be actively involved in the process.
• 26:54
  SPEAKER_00: And I want you to think about this as an adult that may be trying to stop smoking or chewing tobacco or drinking alcohol.
• 27:03
  SPEAKER_00: I mean a habit is a habit and so the person has to be ready to stop.
• 27:08
  SPEAKER_00: So we have to understand in a very age appropriate way what this child might need and when they might be ready to take ownership of the process because not only does the child need to be ready and motivated timing really does matter for you as a family so if you guys are having like some major things going on in your life like you've recently moved or you're getting ready to move or there's a new baby at home or your child might be going through a really challenging season it might not be the best time to give up the thumb sucking especially if they are relying on that for comfort I want you to eliminate it as soon as possible as soon as your child is ready but you also have to look at the season and the timing for your family.
• 28:01
  SPEAKER_00: Now this doesn't mean that we let the habit go on indefinitely it just means that we have to be a little more thoughtful in how we approach these things.
• 28:11
  SPEAKER_00: I've had several kiddos come into my clinic and successfully complete the habit elimination program.
• 28:18
  SPEAKER_00: I spend a lot of time making sure that the parents understand that the child has to be ready and it has to be the right season.
• 28:26
  SPEAKER_00: I even have a whole questionnaire on my website to make sure that the parent is actually thinking about all the important things before they get ready to move forward with this process because the child has to be ready there's a lot of things we have to put in place and we have to work as a team supporting that child throughout the process of eliminating the habit so could all of these things that we've been talking about could they potentially affect your child's speech or their teeth so let's start connecting some of these pieces together because this is where parents will sometimes look at me and say now wait you're telling me that the bedwetting the snoring the speech sound disorders all of these things are related yes sometimes they can be it depends so we're just going to talk about the mouth itself so if we think about a child who is sucking their thumb for several hours a day or night that thumb is sitting inside the mouth depending on how the child is sucking it's applying pressure to the teeth in the surrounding structures over time that can change how those front teeth line up and for some kids this is what we call an open bite.
• 29:52
  SPEAKER_00: This is when the front teeth don't come together when the child bites down.
• 29:57
  SPEAKER_00: Other kids may develop changes in the positions of their front teeth or the shape of their palate and that same principle applies to other oral habits.
• 30:07
  SPEAKER_00: Although how it affects that child depends on the type of habit and how they're utilizing the habit.
• 30:16
  SPEAKER_00: Now let's bring the tongue back into the conversation.
• 30:21
  SPEAKER_00: When we're at rest we generally want the lips lightly touching and comfortably closed.
• 30:27
  SPEAKER_00: The tongue should be resting up in the top of the mouth and breathing should occur through the nose.
• 30:33
  SPEAKER_00: Okay?
• 30:34
  SPEAKER_00: Sometimes develop patterns where that tongue is resting low in the mouth or it could be resting forward.
• 30:42
  SPEAKER_00: And sometimes that same forward tongue pattern shows up and how these kiddos produce their speech sounds but it can also show up in swallow patterns and I've seen this in adults as well.
• 30:55
  SPEAKER_00: That's where you may hear someone use the term tongue thrust and let's tie in another little caveat here this might mean your child has a lisp sometimes there can be a connection but not every lisp is caused by tongue thrusting and not every child who tongue thrust has a speech sound disorder.
• 31:17
  SPEAKER_00: But if that tongue is thrusting forward it is definitely impacting their front teeth.
• 31:23
  SPEAKER_00: So again we're looking at the whole picture how does this really matter for speech as a speech pathologist I am obviously playing paying very close attention to what that tongue is doing when a child talks.
• 31:37
  SPEAKER_00: Think about the sounds S, s, and Z.
• 31:42
  SPEAKER_00: Z.
• 31:43
  SPEAKER_00: Those sounds require precise tongue placement and airflow.
• 31:48
  SPEAKER_00: When a child is constantly pushing that tongue forward between their front teeth that's probably going to affect how those sounds are produced and that's where you might have a frontal lisp that's going to affect how those sounds are produced.
• 32:04
  SPEAKER_00: Sometimes you might hear a frontal lisp sometimes those sounds may be distorted and sometimes that child could have developed some compensatory patterns with the other structures and muscles of their face that may need to be addressed during the therapy process.
• 32:23
  SPEAKER_00: But guys here's the thing if I'm working with a child on accurate tongue placement for speech and they're also consistently resting their tongue low and their mouth is open I want to understand what's contributing to that whole pattern because I don't want to spend our whole time working on just the speech sound so just one piece of the puzzle while ignoring these other things that are very relevant to what I'm seeing in this kiddo.
• 32:56
  SPEAKER_00: Now let's talk about narrow palettes and tongue ties.
• 33:00
  SPEAKER_00: I'm going through this quickly guys because I'm trying to cover a lot of ground today.
• 33:04
  SPEAKER_00: So I get this question a lot too parents want to know number one does my child have a tongue tie?
• 33:12
  SPEAKER_00: And could it be contributing to their problems producing certain speech sounds or could it be contributing to their open mouth posture and mouth breathing or multiple other things?
• 33:24
  SPEAKER_00: And my answer is that it's going to require an individualized assessment because if you've spent any time listening to anything that I have on social media not every tongue tie needs to be released.
• 33:38
  SPEAKER_00: Just because it's there doesn't mean we need to do anything about it.
• 33:42
  SPEAKER_00: We are looking at how it might potentially impact function.
• 33:48
  SPEAKER_00: So not every child that has these issues has a tongue tie.
• 33:53
  SPEAKER_00: We need to look at structure function breathing oral development and that child's actual symptoms again this is why we reach out and collaborate with dentist orthodontists and ENTs now I have parents ask me about a narrow palate why is my child's palate narrow could this be attributing to their low resting tongue posture and mouth breathing it depends.
• 34:22
  SPEAKER_00: It depends so again this is why we don't need one person trying to do everything this is why we need the right professionals looking at the right pieces and working collaboratively to connect those dots this is a really great time for me to mention that free resource the Root Cause resource library there's three things in the library right now the first one is could these signs be connected this is designed to help parents look at patterns in things like breathing, oral habits and speech.
• 34:57
  SPEAKER_00: There's also within the resource library a better sleep environment checklist so this is going to walk you through some of the things I mentioned earlier very practical things that you can look at in your child's bedroom.
• 35:10
  SPEAKER_00: Both of those are free in the Root Cause resource library which is linked below in the show notes.
• 35:16
  SPEAKER_00: Again these aren't diagnostic tools these are just resources to help you organizing what you're already noticing and then maybe have the information ready so that when you talk to your child's next healthcare provider you can bring these things up because the way the library is set up after you go through the checklist it kind of gives you a review of everything that you checked.
• 35:38
  SPEAKER_00: It has a place there for you to write additional notes and you can just screenshot that if you want to or even print it off and you can use it for yourself and multiple people in your family.
• 35:50
  SPEAKER_00: A lot of parents really have a hard time knowing exactly what to ask how to put the pieces together and how to present this information to their provider and that's kind of my heart behind the resource library.
• 36:03
  SPEAKER_00: So I hope you grab that below in the show notes.
• 36:06
  SPEAKER_00: Let's talk about therapy a tool okay I've really got to talk about this one because social media is so full of products promising to fix just about everything.
• 36:18
  SPEAKER_00: I mean I understand why you're interested in them I see them my husband's even brought a few to me he's got some sleep disordered breathing he's he's got some issues that we're working on here and if somebody tells you that this$25 thing might solve your problem that you've been struggling with for years well of course you're going to be curious.
• 36:38
  SPEAKER_00: I would be too but I just want you to be really cautious how you're spending your hard earned money.
• 36:44
  SPEAKER_00: These tools aren't bad and I'm not saying that I'm saying that they have a place and they can be helpful when they're used appropriately.
• 36:54
  SPEAKER_00: But the tool that you're using has to match the problem.
• 36:58
  SPEAKER_00: And that means we need to understand what we're actually trying to accomplish.
• 37:03
  SPEAKER_00: So if a child is working on eliminating a thumbsucking habit there may be reminders or strategies that help them become more aware of the habit but if that kiddo is not ready to stop or if there are other concerns that have not been addressed simply buying products are probably not going to be good enough.
• 37:23
  SPEAKER_00: And that's the same for the little tools that go in your mouth and you chew them or they're supposed to keep your tongue in a certain place.
• 37:31
  SPEAKER_00: Some children and adults may benefit from you know alternatives to chewing on things but we still need to understand why they're seeking that input and whether that tool is appropriate for their age and their needs.
• 37:46
  SPEAKER_00: And I personally get a lot of questions about the replenish straw and it seems to have its benefits but it's just a tool and it's not going to solve a problem of low-resting tongue posture.
• 38:00
  SPEAKER_00: It's not going to solve the problem of mouth breathing.
• 38:03
  SPEAKER_00: It can help you remember where to keep your tongue but you're not walking around with a straw in your mouth all day right and so we need to do other things to help us.
• 38:13
  SPEAKER_00: Now I want to talk about my favorite thing which is mouth tape.
• 38:18
  SPEAKER_00: I want to address this because it's really become an extremely popular topic online.
• 38:25
  SPEAKER_00: I don't recommend parents taping their child's mouth close to fix mouth breathing or snoring.
• 38:33
  SPEAKER_00: I'm going to say that again please do not tape your child's mouth closed if you're trying to fix mouth breathing or snoring.
• 38:41
  SPEAKER_00: If they're having difficulty breathing through their nose covering their mouth is not going to solve that problem.
• 38:48
  SPEAKER_00: They still have to breathe and if they can only breathe through their mouth then that's how they need to do it.
• 38:54
  SPEAKER_00: We need to figure out why nasal breathing is a problem.
• 38:58
  SPEAKER_00: And if there are concerns about possible sleep disorder breathing those things need to be evaluated medically.
• 39:05
  SPEAKER_00: So please don't assume that because you've seen someone promoting a product online or your neighbor down the street has used it's going to be safe or appropriate for your child.
• 39:17
  SPEAKER_00: And parents I'm talking to you too like please do not tape your mouth shut I've had so many adults come into my office taping their mouth shut.
• 39:27
  SPEAKER_00: We need to fix the underlying issue.
• 39:29
  SPEAKER_00: I think as a society we're we're all getting kind of tired of this band-aid approach.
• 39:34
  SPEAKER_00: Let's just find a provider and help you figure out why we're mouth breathing and why we may not be getting adequate airflow or oxygen through our nose.
• 39:44
  SPEAKER_00: Now this helps us go into the next segment of when do I need to get professional help Amanda?
• 39:51
  SPEAKER_00: This is a really big question.
• 40:03
  SPEAKER_00: They might be affecting that child's function or they're just simply not getting better over time.
• 40:09
  SPEAKER_00: Okay?
• 40:09
  SPEAKER_00: The snoring the mouth breathing the dentist has mentioned some changes with your child's dentition and their bite they are having prolonged issues with certain speech sounds I can't talk about this enough please do not put off speech therapy with your kiddo for two and three years.
• 40:29
  SPEAKER_00: If they are having problems with their speech sounds and you're not seeing improvements in a couple of months please go in and get an evaluation these persistent things are not going to self-correct.
• 40:40
  SPEAKER_00: You're going to need therapy interventions to do that okay now if you've been trying to eliminate an oral habit nothing seems to be working again please talk to a qualified provider sometimes the first right step can be your dentist your pediatric dentist it can be your pediatrician it can be your ENT I love dentist I love our orthodontist and they're amazing.
• 41:06
  SPEAKER_00: And so if you're seeing these things please discuss them with that provider they might not be able to know exactly how to help you but they might can point you in the right direction and you can always see a speech language pathologist as especially one that may have some training in oral facial malofunctional therapy.
• 41:27
  SPEAKER_00: This helps them understand and evaluate the oral function and if you come to my office it helps me determine whether additional referrals might be appropriate for you.
• 41:38
  SPEAKER_00: So a tool is not the same thing as treatment it can support a goal but it's not going to address why that problem's happening and that's really the biggest difference there.
• 41:49
  SPEAKER_00: We want to understand the reason behind what we're seeing.
• 41:53
  SPEAKER_00: We're not just trying to find something that's going to temporarily change that behavior.
• 41:59
  SPEAKER_00: Alright friends so if you've been listening to all of this and now you're thinking okay Amanda I'm noticing 10 different things in my child what am I supposed to do?
• 42:10
  SPEAKER_00: Okay don't panic.
• 42:12
  SPEAKER_00: I don't want anybody to leave this episode today thinking that every open mouth every snore and every oral habit means there's something wrong.
• 42:21
  SPEAKER_00: That is not the point.
• 42:23
  SPEAKER_00: What I want for you is just to be more aware because sometimes we get so incredibly focused on these one or two things that we've been noticing over the past several months we actually forget to look at lots of other things that may be going on.
• 42:40
  SPEAKER_00: Maybe you're frustrated with their thumb sucking and you're concerned about their sleep and these things are completely separate but sometimes there could potentially be a connection there that's worth exploring.
• 42:55
  SPEAKER_00: So you're just going to start noticing patterns what does your child look like breathing during the day how are they sleeping?
• 43:03
  SPEAKER_00: Have you noticed any changes in their teeth or their dentition?
• 43:06
  SPEAKER_00: Do you feel like they have an oral habit that's gone on a little longer than you expected and when you talk to your child's providers please share these observations and concerns with them and you can always ask could these things be connected or is there something else that we should be doing?
• 43:25
  SPEAKER_00: And if you're not getting answers and you're continuing to have concerns it's okay to ask for a referral or to go get a second opinion.
• 43:34
  SPEAKER_00: You are allowed to ask questions and I encourage you to advocate for your child.
• 43:39
  SPEAKER_00: I don't want you to wait until a concern becomes significantly worse before you decide to have that conversation.
• 43:49
  SPEAKER_00: One of the things that I really love most about what I do is being able to collaborate with all of these other amazing providers.
• 43:58
  SPEAKER_00: None of us have the answer Answers.
• 44:00
  SPEAKER_00: No one provider can handle all of these things and answer all of these questions for you.
• 44:06
  SPEAKER_00: But when we bring different professionals together, we can look at that child from different perspectives and treat that child as a whole person, which is what my goal is when I'm working with my clients.
• 44:18
  SPEAKER_00: And then that helps us all make more informed decisions about those next steps based on what that child actually needs.
• 44:27
  SPEAKER_00: And sometimes the answer is absolutely therapy.
• 44:30
  SPEAKER_00: Sometimes we need a medical treatment, and sometimes we just need to monitor it just a little bit longer.
• 44:37
  SPEAKER_00: Sometimes it's simply helping a family just understand what's normal and what might deserve additional attention.
• 44:47
  SPEAKER_00: I'm not trying to put every child or every person in therapy.
• 44:50
  SPEAKER_00: I just want to make sure that we are all looking at the right things.
• 44:55
  SPEAKER_00: Okay?
• 44:56
  SPEAKER_00: So as we are wrapping up today, I want you to remember a few things.
• 45:01
  SPEAKER_00: Your child's body doesn't function in separate little compartments, and neither does yours.
• 45:08
  SPEAKER_00: Breathing, sleeping, eating, swallowing, speech, oral development all involve systems that work together.
• 45:17
  SPEAKER_00: And sometimes what might look like this one isolated issue over here may actually be part of like a real bigger picture.
• 45:26
  SPEAKER_00: And so that's why I encourage you as parents and even grandparents to keep asking questions.
• 45:31
  SPEAKER_00: Not because I want you to sit around and worry about every little thing that your child does.
• 45:36
  SPEAKER_00: I just want you to feel informed and confident so that when you're making decisions about their care, you feel confident in those decisions.
• 45:45
  SPEAKER_00: Now, if today's conversation has you thinking about some of the things that you might be noticing with your own child, please check out the Free Root Cause Resource Library.
• 45:55
  SPEAKER_00: You're going to find three interactive guides that relate directly to everything that we've talked about today.
• 46:02
  SPEAKER_00: The first one, could these signs be connected, helps you look at patterns involving breathing, oral habits, and speech.
• 46:08
  SPEAKER_00: The Better Sleep Environment checklist gives you some practical things to look at and consider when trying to create a healthy sleep environment.
• 46:17
  SPEAKER_00: And the last one is tools versus therapy.
• 46:20
  SPEAKER_00: This is going to help you think through when a tool might be helpful and when it might be time to consider additional professional support.
• 46:27
  SPEAKER_00: They're all free, they're digital, you can access them from your phone.
• 46:31
  SPEAKER_00: There's no more like PDFs to keep up with in your email list.
• 46:35
  SPEAKER_00: You can actually reuse these for different members of your household.
• 46:39
  SPEAKER_00: You can screenshot them, you can print them if you'd like to take them with you to an appointment.
• 46:44
  SPEAKER_00: Again, these are educational resources.
• 46:47
  SPEAKER_00: They are not intended to diagnose, treat, or replace individualized care.
• 46:52
  SPEAKER_00: I just wanted to kind of give you something as a starting point to help you start putting these pieces together.
• 46:58
  SPEAKER_00: And again, I've linked it right below in the show notes.
• 47:01
  SPEAKER_00: Now, if you guys are here in Alabama and you would love to explore whether an evaluation or a therapy might be appropriate for your child, I would love to talk with you at Salt Light Speech and Language Resources.
• 47:14
  SPEAKER_00: We offer in-person services at our office in Vestavia Hills and teletherapy when appropriate.
• 47:21
  SPEAKER_00: You can find our information in the show notes as well.
• 47:25
  SPEAKER_00: Now, before we go, I want to leave you with one final little thought.
• 47:29
  SPEAKER_00: You don't need to know all the answers today, but sometimes asking more questions can lead you in a totally different direction.
• 47:38
  SPEAKER_00: And that's really what Root Cause Conversations is all about.
• 47:42
  SPEAKER_00: I want to thank you guys so much for spending time with me today.
• 47:46
  SPEAKER_00: I hope this conversation gave you some things to think about, and I really hope it helped you connect some dots that you may not have considered before.
• 47:56
  SPEAKER_00: If you know another parent who might benefit from hearing this, please share the episode with them.
• 48:01
  SPEAKER_00: Until next time, keep asking questions, keep looking a little deeper, and I'll see you on the next episode of Root Cause Conversations.
• 48:14
  SPEAKER_00: Thanks for pulling up a seat with us today.
• 48:17
  SPEAKER_00: If this conversation gave you something to think about, make sure you're following the podcast so you don't miss what's coming next.
• 48:25
  SPEAKER_00: And while you're there, take just a second to hit those five stars.
• 48:30
  SPEAKER_00: It really does help more of the right people find these conversations.
• 48:34
  SPEAKER_00: Until next time, keep asking questions and keep connecting those dots.
• 48:39
  SPEAKER_00: And I'll see you guys soon.