Hand-In-Hand Speech Pathology

21/03/2025

Prematurity and high narrow palates

It is well known that premature infants are at greater risk of developing obstructive Sleep Disturbed Breathing (SDB). These sleep disorders are well linked to increased risk of developmental, neurocognitive and behavioural problems in children.

We also know that narrow high palates are a risk factor for SDB.

Last year, a research study of 244 premature infants exploring the links between high arch palates, the development of SDB and developmental outcomes at 2 years, was published by Huang et al. in the journal Sleep Medicine.

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What were the findings?

62% of pre-term babies had a high narrow palate at birth, compared to 10% of the control group (infants born 37-40 weeks).

The high palate persisted during the two year follow up period.

At the end of two years, 79% of the premature infant group had Obstructive Sleep Apnoea (OSA) compared to 10% of the control group.

Within the subgroup of premature infants with narrow high palate, the incidence of OSA was 84.7%.

Neurodevelopmental outcomes were assessed at 6, 12, 18 and 24 months using Bayley Scales of Infant Development and the Denver Developmental Screening Tests (DDT).

There was a greater proportion of children with developmental delay in the premature infant group at every stage. Within the premature infant group, there was a significantly greater proportion of children with developmental delay in the narrow high palate group compared to the normal palate group.

Overall, the data supports that high narrow palate is an important risk factor in the development of abnormal breathing.

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Why is there a link with prematurity and high palate?

The last three months of pregnancy are critical for the fetus to train normal reflexes and prepare for the functions of sucking, swallowing, chewing and nasal breathing.

Prematurity interrupts this training time, leading to incomplete muscle development. This includes the tongue, which needs to function correctly to stimulate the midpalate suture and properly develop the palate structure.

The palate is the floor of the nose. When it is high and narrow, the nasal passages are narrowed and there is increased resistance to nasal breathing. It promotes nasal disuse and the development of mouth breathing over time. Mouth breathing is also associated with poor stimulation of palate development. The cycle of dysfunction and poor structural development is perpetuated.

The palate is also an important part of the skeletal framework that supports our collapsible tube of airway muscles. A narrow palate offers reduced support. The upper airway is more prone to collapse during sleep when its muscles (including the tongue) are more relaxed.

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As a dentist involved in with managing adult OSA, I see the narrow high palate in many of my patients. I often find it despairing to listen to the impacts it has had on people’s health, mood and quality of life and wish the problem had been intervened earlier.

I believe normalizing both orofacial muscle functions and palate structures as early in life as possible is a very worthwhile goal.

Of great interest to me is that the same group of researchers has previously shared data demonstrating that myofunctional therapy exercises to stimulate more normal oral function helps normalise palate development and breathing over time. (Huang et al. 2012)

They excluded a group of children who were having myofunctional therapy from the premature infant group in the 2019 published study for this reason.

I have a special interest and am closely following the research in this area. I hope to learn more approaches with interdisciplinary colleagues to help this high-risk group in the future.

I also hope to see more focus on prevention as early as conception – and specifically through addressing maternal sleep disturbed breathing, a known risk factor in pre-term births.

28/03/2024

P A E D I A T R I C F E E D I N G 👶🍏🥙

Did you know speech pathologists can diagnose and treat feeding issues? Some of my training includes SOS Approach to Feeding and an oral-motor feeding course with (and subsequent mentoring by) Diane Barr. I've also found my training and background in oromyofunctional therapy helpful in approaching feeding issues, especially when there has been a history of airway dysfunction.

I am excited about my upcoming participation in feeding guru Carly Veness' Paediatric Feeding Foundations Program. It will further develop my skills in being able to assist children with feeding issues, including babies and toddlers. I'm also keen to learn about the responsive feeding approach, which helps develop skills and confidence in eating, within a safe and nurturing environment for the struggling eater.

Build your feeding therapy confidence in the Paediatric Feeding Foundations Program 2024

02/12/2023

Poetry and singing for babies!

New research reveals that infants primarily learn language through rhythm rather than individual sounds, challenging traditional theories. The study emphasizes the importance of rhythmic speech patterns, like nursery rhymes, in early language development.

27/05/2023

Great infographic showing optimal tongue resting posture.

Tongue tie, however, is only 1 reason for low tongue posture. Low tongue posture may also be caused by chronic nasal obstruction (or past history of this), high, narrow palate (meaning the tongue does not fit into the palate) and low tone muscles, or a combination of these. Going through each of these issues consecutively, the person may need ENT, dental/orthodontic and/or myofunctional assessment/intervention to address their particular issue.

How do you keep good oral rest posture when you are sleeping 😴

When you have tongue range of motion, function and space ……….👅

➡️ the tongue makes a negative suction cup effect to seal itself to the roof of the mouth.

➡️ negative suction cup effect prevents the tongue from collapsing backwards.

30/01/2023

When I was recently getting a dental splint to treat my TMJ dysfunction, my holistic dentist mentioned that they were starting to make "performance splints" - splints for the mouth to enhance performance (athletic/cognitive/etc). When I just mentioned it to my son he said, "so is it like teeth doping"? 😆

It is no wonder that many people I see with neurological issues also have difficulties with chewing, moving their jaw during speech, swallowing and tongue resting posture.

Dentists must consider that alterations in the occlusal pattern during mastication can lead to changes in the activation of different brain regions related to memory, learning, anticipatory pain, and anxiety. This suggests that mastication maintains the integrity of certain brain areas and that it m...

02/11/2022

Thank you to Dr. Rosalba Courtney DO, PhD for sharing her expertise in breathing. She has an insatiable appetite to learn, a questioning mind and a commitment to evidence based practice. I had the privilege of learning alongside her during my first orofacial myology course in 2017, and I went on to complete her 2 part training course in Integrative Breathing Therapy in 2017 and 2018. Please check out her website - such a treasure trove of information. I am rewatching some of her talks from the "VIDEOS" page.

Dr Lewis Ehrlich discussing Breathing with Rosalba Courtney In this wide ranging conversation, Dr Lewis Ehrlich and Rosalba cover the nose and upper airway, nitric oxide, functional and dysfunctional breathing, the diaphragm, paradoxical breathing and much more…. Details All articles, All videos, ...

25/08/2022

16/07/2022

Tongue tie release – should my child have this done under GA at the time of ENT surgery?

Having a tongue tie release whilst a child is under for other surgery like removal of adenoids and tonsils or the insertion of grommets can seem an attractive option.

But I don’t always think this option is the best for every single child.

This is because I’ve seen frequent cases where a release has been rushed through to the time of GA and there is a lot of scar tissue, the tongue is still restricted, and a child still needs further release. This scarring makes it not as easy a release, as without it.

Some of the factors that I consider when answering this question are:

👅 One of the keys to minimising scarring and reattachment is for the tongue to be moving well whilst the area is healing. This happens best when a child has had some pre-hab therapy in the form of oromotor, feeding or myofunctional therapy. Has the child been adequately prepared? Or will they be able to do better prehab therapy once airway obstruction is removed? Will they be better able to do post-op tongue exercises to minimise reattachment when they are not sore and recovering from other surgery?

👅 What is the child’s temperament? How anxious will they be? As parents, it’s natural to feel apprehensive about them having a surgery in the chair. It’s best not to share your thoughts with them and discuss them directly with us. We’re experienced treating many children in the chair from age 4 years with good co-operation and are pretty good at predicting who will cope well.

👅 How thorough will the release be with the ENT surgeon? Personally, if my child was having a release under GA, I wouldn’t want anything less than a technique including stitches, used by ENT colleague Dr Soroush Zaghi. Refer to this link for surgical photos - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437727/. Since I’m not familiar with anyone local using this approach, with an older child that can sit in the chair, I tend to prefer full control of the release to achieve the best functional outcome in combination with therapy.

👅 In select cases, there may be benefit in getting the most severely restrictive anterior tongue ties released sooner to help facilitate better therapy, even knowing they may need a subsequent release later.

👅 If a child is too young to sit in the chair and follow instructions, a release under GA could be a good interim option when there are significant functional concerns related to reduced tongue mobility.

To make the most fully informed decision on what is right for you child, it is best to have an individualised assessment, and a second opinion from your ENT surgeon.

05/07/2022

TAKING NEW REFERRALS IN TAREE!

I am new to Taree, but not to Speech Pathology! I have nearly 20 years of experience and 10 years in private practice. I am registered with NDIS and Medicare and can work with all ages.

Please call to make an appointment: 0402 097 005.

Adult and paediatric speech pathology services located in Taree, NSW. Special interest in orofacial