Austin Pediatric Speech & Language

10/10/2022

09/27/2022

👅TONGUE TIES👅​​​​​​​​
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Tongue ties occur when the thin tissue under baby's tongue restricts movement of the tongue​​​​​​​​
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👅The small membrane on the bottom of the tongue connects all the way down to the big toe! This is why babies struggling with oral restrictions often present with tension​​​​​​​​
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👅 If you suspect your child has a tongue tie - we recommend contacting a lactation consultant first to asses whether there is a true tongue tie that could need a revision by a pediatric dentist ​​​​​​​​
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👅 Infants with tongue ties are not able to latch as deeply, could have problems creating negative pressure to draw milk out, or are not using tongue correctly to breast feed​​​​​​​​
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👅 Chiropractic care cannot make tongue ties disappear but it can help decrease restriction and tension throughout the body​​​​​​​​
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👅Getting chiropractic care after tongue tie revisions is essential to support healing, remove body tension, and promote proper biomechanics

09/18/2022

09/02/2022

I'm frequently asked "When will I notice difference after today's tongue tie release?" The answer I give is "I don't know". Why do I give that answer?

I answer like this not to be intentionally vague - the reality is that there are too many factors that play into predicting timing of success. These include (in no particular order):
1) Thoroughness of the surgical release
2) Appropriate pre- and post-procedural therapy
3) Prevention of reattachment
4) Addressing any muscular tension
5) Milk supply
6) Age of infant at the time of procedure
etc etc etc (literally an endless list of possibilities - this list isn't comprehensive)

In general, what I've experienced is what this graph shows (and this graph shows fake data just for illustration purposes). From day to day or week to week, there are ups and downs, but the overall trend is an upward one. Do some babies/moms improve immediately? Absolutely. Do some babies/moms never improve? Absolutely. But in general, most dyads gradually improve.

I say this to not let you get dejected if things aren't immediately better or if you notice temporary setbacks. Keep working with your team and things usually work out if the major factors are appropriately addressed.

08/17/2022

https://www.instagram.com/reel/ChU3tQPsaJP/?igshid=YmMyMTA2M2Y=

JORDYN 🥑 SPEECH + FEEDING MOM shared a post on Instagram: "⚠️ Are you surprised at some of these milestones? Fine motor skills for eating are actually LATER than most people think. They are really complex motor movements, so they take time to learn! 👋 Hi, we are Jordyn and Katie, two feedi...

08/16/2022

The Two Kinds of Tongue Tie Releases

There are only two kinds of tongue tie releases: complete releases and incomplete releases. A complete release is one where the primary bound muscle under the tongue (called the genioglossus) is released from any restriction overlying it. This results in a diamond-shaped wound that is flush to the tissue on either side of it as the genioglossus has fallen back under the tongue.

Anything short of that release is an incomplete release. This includes:
1) a simple snip of a visible band
2) a simple lasering of a visible band
3) releasing the visible band and opening a small wound under the tongue
4) releasing the visible band and opening a small diamond-shaped wound, but that wound still sits on a shelf of muscle underneath

Whether it’s a 10% release, 50% release, or 95% release - it’s incomplete. As long as the genioglossus is held by some abnormal tissue, symptoms can persist. That being said, I’ve written before that I don’t think every single tongue always needs a 100% release (there are 5 randomized, controlled studies that show that partial release can help latching and ni**le pain). But if you are a parent of a baby who’s been released and you’re not noticing improvement in symptoms, there’s a chance that the tie was never fully released OR it was released but enough reattachment has occurred to re-bind the genioglossus.

08/10/2022

I am often asked, "when should I see a doctor for my/my child's tongue-tie?"

First, let's talk about WHO to see if you have a concern. I recommend you start with a feeding therapist if your child is under 4 years of age. Over 4 years you can seek out an orofacial myofunctional therapist.

If you choose to go straight to the doctor, I recommend a dentist, oral surgeon or ENT who is trained in tethered oral tissues (TOTs; this includes tongue tie, lip ties, buccal ties).

Most pediatricians and general doctors are NOT TRAINED in functional assessment of TOTs. If yours is, consider them a unicorn!

So what's the tipping point for needing an evaluation?

Babies: struggles with breast feeding, bottle feeding, transition to solids, open cup or straw drinking, quiet breathing in a relaxed state, sleep, tummy time (and more)

Toddlers & older kids: picky eating (beyond a few months which can be typical in toddler stage), selective eating (cutting foods out, limited number of foods), speech delays or hard to understand speech, issues attending/behavior (concerns of ADHD?), postural concerns

Adults: same issues as the toddler/older kids but now they've snowballed into chronic neck or back pain, worsened postural issues, chronic headaches or migraines, TMJ/D or facial pain, waking tired and/or daytime sleepiness

And for any of the above groups, if sleep is a struggle, the mouth is open at rest or while sleeping, you can HEAR breathing (it should always be quiet), snoring, restless sleeping...and MORE...

Then you know it's time to make a self-referral. And I highly recommend starting with an oral sensorimotor feeding evaluation with an SLP or OT trained in TOTs and Myo under age 4...and an orofacial myologist for 4 year olds through adults! They can help you make sense of your symptoms and determine if additional referrals are necessary.

Need a referral? Check out pediatricfeedingtherapist.com or DM me for a referral!

Note: These lists are NOT exhaustive, they are just some of the most common symptom's shared by patients at various ages of the lifespan.

08/08/2022

Oral Posture in an Infant

If you say the phrase “tongue thrust”, those of us who have heard it will think about the impact it has on speech issues and on orthodontic success/failure.

I’ll do my best to give you all a brief tutorial on tongue posture. First and foremost, it’s important to understand that there are no good peer-reviewed studies linking tongue tie and tongue thrust. It’s becoming more common for speech pathologists (essentially those trained in myofunctional therapy/orofacial myology) to understand the connection between the two (pun intended). A tongue’s normal resting position is up and forward within the oral cavity with the lips closed. This allows a person to breathe comfortably through the nose, which is the more efficient way to breathe (the nose warms and humidifies air, making oxygen exchange easier). The ideal resting position for the tongue is against the palate, behind the central incisors.

In the setting of tongue tie, especially during breastfeeding, the most important movement that is impeded is UP towards the palate (not OUT like most people think). A person can have completely normal protrusion of the tongue out of the mouth and still be tongue tied. Remember what I’ve said previously about a person’s health timeline - if a baby is tied then it makes sense that the tie will affect that child as they get older. Tongue thrust in the setting of tongue tie is not an unexpected consequence of untreated ties.

I’m going to personify a tongue for the purposes of illustration: If I’m a tongue, I desperately want to go up in the oral cavity. I can see the palatal sweet spot and i want to reach reach reach it. But the tie is keeping me down. That sweet spot isn’t just straight up though - it’s up and ahead of me just a bit. In my efforts to reach up, I’m also reaching forward. In the setting of tongue tie, however, my up movement doesn’t work. My forward movement may still be functioning, so the net effect is that I move forward. Voila - tongue thrust.

Believe it or not, we can see this in infants too. Look at the picture attached here. This baby’s normal resting posture is to have the lips parted with the tongue forward. I’m not talking about mouth posture when the baby has a cold or congestion - I’m talking about everyday tendencies. When I see a mouth like this in an infant, I immediately think 2 things: 1) that baby probably has a tongue tie; and 2) that baby may also have significant nasal congestion (this could be from a high palate, enlarged adenoids, or both). Keeping in mind that the majority of babies I evaluate are tongue tied (it’s a self-selecting group after all), I’d estimate that about 25% of the infants I evaluate have this sort of oral posture. This is the infant version of tongue thrust. And if they’re doing this as infants, I’ll guarantee you that they’ll do this as they get older. It can result in speech difficulties and orthodontic problems like overjet or an anterior open bite. And it’s much harder to treat as the child gets older (in my opinion, the tongue release must happen with myofunctional therapy).

08/08/2022

08/08/2022

08/08/2022

08/06/2022