23 - Tongue Ties, Feeding Struggles, and the Power of Myofunctional Therapy (Guest: Brittany Hageman from Coastal Myofunctional Speech Therapy)

In this eye-opening episode of Doula Talk, Doula Deb sits down with Brittany Hageman, a speech-language pathologist and certified orofacial myologist who specializes in myofunctional and oral motor therapy from infancy through adulthood. With over a decade of clinical experience—and personal experience navigating tongue ties with both her children and herself—Brittany brings deep insight, clinical expertise, and heartfelt empathy to a conversation that every parent needs to hear.

They explore the often-overlooked topic of Tethered Oral Tissues (TOTs) and their far-reaching impact on feeding, sleep, speech development, oral facial growth, and even pelvic floor health. From red flags in newborns (hello, clicking during feeds, reflux, and lip blisters!) to misunderstood speech delays and tongue thrusts in older kids, Brittany breaks down what’s normal, what’s not, and what to do if something feels off.

She also shares her personal healing journey following an adult tongue tie release—and the astonishing improvements she experienced in everything from posture to snoring to pelvic floor strength. You’ll learn why pre- and post-release therapy is crucial for successful outcomes, how to recognize the signs of oral dysfunction, and why proper tongue posture is about more than just feeding—it’s foundational to lifelong health.

Whether you're currently in the thick of feeding challenges or you’ve got a curious toddler with speech quirks you can’t quite place, this episode offers the clarity, support, and expert insight you didn’t know you needed.

🎧 Tune in now and get ready to look at tongue ties in a whole new way.

Brittany Hageman - https://coastalmyofunctionalspeechtherapy.com/about/ 

Find a Qualified Orofacial Myopathy Provider near you: https://orofacialmyology.com/training/

Chapters

• 0:40 Understanding Tongue Ties and Their Impact
• 7:14 Personal Experiences with Tongue Ties
• 13:43 The Role of Myofunctional Therapy
• 20:54 Collaborative Care for Tongue Tie Treatment
• 22:25 The Importance of Awareness and Education
• 27:02 Identifying Tethered Tissue in Infants
• 29:54 Feeding Difficulties and Their Impact
• 33:23 Oral-Facial Development and Structural Issues
• 36:54 The Role of Myofunctional Therapy
• 40:16 Recognizing Red Flags in Children
• 53:44 Guidance for Parents Seeking Help
• 59:50 Resources and Support for Families
• 1:01:47 Understanding Oral Function and Its Impact
• 1:03:19 Resources for Parents on Myofunctional Therapy

Transcript

Deb (00:40)

Hey, welcome back to Doula Talk. Today we're going to dive into a topic that might not be every new parent's radar, but it should be. We're talking about tongue ties, oral function, and how something as small as a tiny piece of tissue under the tongue can have a big ripple effect on feeding, speech, and even sleep. And to help us break it all down, I've got a fantastic guest with me today, Brittany. She is an experienced speech therapist, a myofunctional therapist, and has a deep passion for

helping babies, kids, and even adults navigate tethered oral tissues and oral motor challenges. So she's also been through all of it herself. She got her own tongue tie released as an adult and seeing the impact in everything from her speech to her posture. So we're going to cover what myofunctional therapy is. That's a mouthful. Why tongue posture matters, because it does and how ties

can impact everything from feeding struggles in babies to speech challenges in older kids. Brittany is full of knowledge and real-life experience and I know this is going to be such an eye-opening conversation for many of you. So let's just get into it. Brittany, thank you for coming and welcome to the podcast. Thank you so much for having me. Yeah. So why don't you just tell me about yourself and how you got into this and then we'll jump

into all the other things? Sure, sure. So I am a speech therapist. I have been a speech therapist since 2011. And I've done a variety of things, such as birth to three. I've worked at a hospital. I did nursing home. I've worked in the school district. And then I've also done teletherapy with kids in California.

I experienced the effects of a tongue tie with my first. We actually had the tongue tie clipped by a provider and it was done with scissors, but the provider only released the anterior or the front part of the tongue tie. And initially it gave some relief with breastfeeding and helped at least with, you know, reducing my episodes.

of mastitis and cracked bleeding nipples. But so I didn't even think anything of it. I just thought, OK, I think we're done. We're moving on from this. And so later on, I flew down to L.A. for an ASHA conference, which is a national speech therapy conference, and they cover a variety of topics. And there was a feeding therapist there who talked about posterior tongue ties.

And I realized that I didn't understand until then that there is a back portion of a tongue tie. And so sometimes you don't release the full tether of that tissue unless the provider is knowledgeable with how to release a posterior tongue tie. So at the time, my oldest son, was...

older, he was about two and a half. And he had all of the red flags that she talked about. He had sensory processing issues. He had a very high palate. He had a really difficult time saying his L sounds. And he also would spit out food, like randomly spit out food. A gag, maybe. Exactly. A gag. And then, you know, at the time we were still breastfeeding.

And so that was going fine. So I didn't think anything of it until she talked about the posterior tongue tie. Another issue he was having was mouth breathing and it was really impacting his oral health, his dental health.

He had like eight cavities on the top.

And he wasn't able to actually lick his food after he would chew. He couldn't lick. To clear out your gums and... Exactly. Even though he had an excellent diet, you know, everything was organic. No sugar. Whole foods. I mean, it was... Right. You know, I flossed every day, brushed. I did all the things. Totally. Yeah. All the things You're like, what the heck? Yeah. All that work.

know, kids don't like sometimes to brush their teeth, we did it made it happen. And for him to have that many cavities, I just felt so much guilt. Like, how could I, how could this happen? And then I realized it wasn't my fault. No. You know. I think a lot of people have that.

you know, disappointment in themselves of like, what the heck, I'm doing all the things. Yeah. And so, you know, it's one of those things where I just felt like, OK, there is a root cause and

It isn't always a simple answer. And so my mama gut was like, dig deeper. You know, I heard the posterior tongue tie. I was like, okay, I need to dig deeper. And so I ended up becoming a myofunctual therapist and I realized the impact of the posterior tongue tie. So I had his tongue tie released this time by a pediatric dentist and it was done by a laser. Okay.

Ever since he had his revision, because he had the full release done, he no longer struggled with any cavities after that. That's so crazy. I mean, was like huge. Wow.

for him. So, and then also his sensory processing issues, it decreased. I mean, it's not 100 % gone, but he's able to manage it. And it seems like he was able to, integrate a lot of sensory input. Yeah.

Yeah, and so we worked on that. He also started making his L sounds. He started having more variety of foods that he would eat. He was sleeping better. I mean, it just was like a different kid. A different toddler. that all was how old was he when? So he was two. so fast forward to my second son, who I was like, all right, I now know.

Right. About... The more you know, you do better, the more you know. Yes. So I was very intrigued by the research that was coming out how folic acid is actually... There is a correlation of folic acid in synthetic B vitamins in all of our supplements and food, bread, cereal. And so I was very mindful.

about

what I took and so I ended up taking a whole food and it was basically a natural form of B vitamins folate. So I did that and then I had a little experiment. I was like, alright, I'm going to try to eliminate all of the environmental factors to see if that impacts ties.

This is the longest experiment I felt like. But I basically lived a non-toxic lifestyle, everything natural.

pretty much crunchy mama. That's a big commitment. Huge. That's huge. I was like, okay, you're to give yourself the best chance. right. So now I'm on the edge of my seat. What happened? So I ended up opting for a home birth and I was like, all right, we're going to have no intervention at all and no offense or no, no, against intervention. Like it was, you know, yep. And it was great for my first, like I had,

everything at the hospital it was great but this is a kind of an experiment I was like I want to see if there's a different result

I had a it's interesting because my pregnancy was actually more relaxed with my second So I was working on the stress level working on my sleep working on a lot of different things. I Ended up having my second son and he had worse ties Than my first Exactly so

sure that there was benefits to all of that. Sure. Other than driving yourself crazy. And I just tell mamas, I'm like, it is not your fault. Yeah. Because there is a genetic piece. I will say that. And I do think that that actually was a stronger piece in this situation because ties are common in my family. And so I think that that could be a cause. And so I was able to kind of

Well, in that genetic mashup, I mean, we can just have different blends of genes for each kid. it's like, you never know what you're going to get. never know. I've had clients where the first one had no ties, second one has severe ties and vice versa. The first one would have terrible ties. They're already gung ho with that second and then they're fine. Breastfeeding perfectly, no issues, no restrictions. Yes, functional. So that's been an interesting experience.

because every baby is different, every tie is different, know, every pregnancy is different. And so I feel like it depends on the type of tie, how thick it is, where is it attached. So the membrane, you know, it's kind of like a sailboat, right? So you have the front part and then the back part. And sometimes you can't see the tie unless you know how to look for it with the baby.

it. Get your fingers underneath and it's not something that just a parent would even know how to do. It's like you go to a specialist who can actually functionally check and make sure that there's, if there's restriction in the back or not. Exactly. yeah. pediatrician typically does not have training in that. Yeah unless they specifically sought that training, it's just not as in depth.

And mean, there's in the, is the frustrating thing for a lot of parents. And for me as a parent too, is that there are so many different providers that say different things. Like they're not all on the same page and you'll, you'll go to different people and have different opinions. It's a very polarized topic. Yes. Especially right now. Yes. Every guest I've had talk about tongue ties, I ask about the New York Times article. yes.

They're like, God. Well, the thing is, you know, with that, it's interesting because it's you can't you have to look at the whole picture and there's a lot of things that I think that they didn't really look at. And so, you know, cherry picking situations isn't really a very good picture of what's happening. Exactly. Yeah. And so many different factors that go into the restrictions and severities and and all of that. Exactly. And who do you go to?

Who you go to for the release, how they do the release, what was the tool used, what therapy was given before and after. I mean, there's a lot of things that could impact positive or negative, the outcomes. Yeah, absolutely. Okay. So where do you come in with the tongue tie? like you had all these experiences and you're like that sent me down the path of my myofunctional therapy. And how does that tie in and how you're helping?

families. Yes, so after that I decided to just well first of all I read the book Tongue Tied by Dr. Baxter and so that book really opened my eyes again and it kind of validated everything that I was seeing.

I really like his checklist. He has a checklist for symptoms and red flags for babies, kids, and adults. And so I went through that, checked all the boxes, and as I was doing that, I realized that I have a tie. And so I thought, I need to further my education. So I ended up becoming certified with the NeoHealth Services program, the Myofunctional Therapy program, and became a qualified oral

facial myologist. that's fancy. was great. I loved Sandra Holtzman. She is an amazing speech therapist and she kind of was like one of the founders basically of myofunctional therapy from a speech pathologist perspective. I felt like that's kind of, that was my last step to feel like, okay, I have now the knowledge.

to help families. So it was a course, I took the course, I learned how to do the myomanual that goes through phases one, two, and three. And phases one works on strengthening and helping the muscles of the oral facial muscles of the lips, the tongue, the jaw to be strong and to function.

And then phase two works on the swallowing. And phase three is integration into lifestyle. And so, yeah, it was great. I took a test and then I had to do a project where I took a client through all phases. And then the board kind of goes over that project and then you can become a qualified facial myologist. So. That's amazing.

Tell us how that connects to the restriction and why somebody would need that when they have a tie. Yes. Okay. So basically what happens is it's almost like, I love how Dr. Baxter in that book talked about how, you know, a tie is almost like shoelaces that are tied together, you know, with tennis shoes, right? And you can technically run a marathon with your shoelaces tied.

Would have to train even harder like your muscles would be sore. It wouldn't be very fast But you could do it. Yeah, it just would be hard. Yeah so my I like that analogy because that's kind of what happens is after the release is done the shoelaces are released and you're it's free, right? The tongue is free. The lip is free. There's a lip tie and Those structures can move the the structures in the range of motion can move

freely how they're supposed to. And basically what I like to say is if that person had their shoe laces untied and then all of sudden someone says, now go run a marathon, that person might need a little bit of training of how do I use this new range of motion? Right? Like they'd be like, you know, kind of tripping or feeling like, I'm like, there's too much freedom. Right.

They haven't used any of those muscles before because they haven't had the range of motion. I've seen so many babies after they get released for the next 24 or 48 hours, they do this really funny thing with their tongue where it's like a totally different entity, but they have no idea what to do with it. And bottle and breastfeeding is a little rough for a little bit. Trying to figure it out, how to use it. Exactly. So the importance of doing therapy beforehand and specifically oral motor,

Therapy so a lot of people think myofunctual therapy is you know something for babies But really it's for for and up and so oral motor and feeding therapy That is more for the toddlers and for babies because with myofunctual therapy There's there's more intention and they have to actually actively participate in those exercises versus oral motor therapy and feeding therapy

therapy.

Some people like to say mini-myo, but really it's passive. Passive stretches, passive exercises. When they're toddlers, there's more participation and it's more play-based. So there's kind of different ways of doing it.

And it's super helpful because you can actually strengthen both of them, oral motor therapy and myofunctional therapy if they're older kids and adults. It's so important to do before the phrenectomy or a release because you're strengthening the muscles around the ties so that once it's released, those, you know, the lips, the tongue, the jaw, everything will

be to function properly and you'll have a quicker healing outcome, you'll have better outcomes and the structures and the muscles will be strong and so then once you have the range of motion then you can work on compensations, you can work on helping the patterns and the dysfunction. I think parents who I've seen have

the surgery right away without any kind of therapy before or after, it's not as good outcomes. And they expect the surgery to be like an instant fix. And sometimes it's a pretty instant, but from my experience, I see these families just struggling afterward and they have some regret sometimes that they don't have that support of a feeding therapist. And the exercise, knowing what to do to how to support them and strengthen. Exactly. And I mean,

I always tell parents that I like to train parents how to do those exercises because they're with baby. They're with the baby all the time. you know, it's not going to be effective if I was only person doing them. And I want to empower families. I want to help them to know this is how I can care for my baby and prepare the muscles, the tissue, and a lot of the fascia can be really tight.

under the tongue too. And so some of the body work that's involved with getting baby ready for a release, it's huge. I mean, I know I've talked to pediatric dentists who said, yep, know who is doing that. Like I can tell. The pre-work, right? Exactly. Yeah. And sometimes you don't have time. They're so severe. They're three days old and you're like, wow, we have to get this done. But sometimes running straight to the release is not enough.

Yes, and I always like to say it's an it's an individualized thing I mean, there's some situations where baby needs to eat Yeah, I mean figure out how to get this food. Yeah, and baby can't so I mean I always encourage parents at least get one or two sessions in before if you can Yeah Okay, and also working collaboratively with a team is so important. I'm so passionate about it because you know, we can't be

perfect and experts at everything. No. No. We sometimes think we can. Right? And there's a lot of pressure. Yes. Yeah. You know, it's, I took craniosacral therapy training and I do provide that for babies before I do work in their mouth. But I still recommend going to a craniosacral therapist who the session is solely focused on that. Yeah. You know, and I think, you know, chiropractors are important to get

the alignment, think, you know, going to see PT, OT, another speech therapist, think working collaboratively together, working with lactation consultants, even doulas. I mean, the whole team, the whole birth and postpartum team should really be involved. The pediatric dentists or ENTs, mean, whoever is involved needs to be communicating with all the providers so that everybody's on the same page. Yeah.

very overwhelming for parents. It is. for different things. like working together is super important. Definitely. Yeah. Okay. So why should parents care about this? Yes. Well, so tongue ties, I like to call them tots. So tethered oral tissues. That could be buckle ties. the, you know, it's the tissue that connects the cheeks to the gums. The lip tie upper, you can have an upper lip tie.

for the upper lip or the bottom because actually when I had mine done I had both upper and lower Wow labial you know tight for any for any lumps yeah I was crazy posterior yep Nanterior, posterior okay great it was the whole thing

what did it feel like when you got it done, like throughout your whole body? Yes. Okay. So, I actually ended up flying out to Alabama and I saw Dr. Baxter and because at the time I'm like, well, everybody's releasing babies. I didn't actually know anyone at the time who were doing adults. I mean, I know some now.

But anyway, he was great, but I was laying there. And I actually did my own my own myself. I did my own my own function therapy. It's conflict of interest. Totally. I was like, yeah. So it was great. I mean, it was so funny. Like my husband and I just in the mirror like, hey, look what I'm doing. Moving the time because it really isn't just sticking your tongue in and out.

Or

left and right like there's so many other things involved with this, you know the tongue suctioning up to the palate suction and hold For proper, you like I didn't learn that until my son was like eight or nine and I was like My tongue is never at the top of my mouth ever interesting very like a year or two. I was like, where's my tongue? Retrain it. Yeah, and it took a while, but now it's comfortable. Yes Yeah, it was I mean

So when I actually ended up, I was super excited about it and I was so what he did, he just numbed it with, you know, lidocaine and as I had the other doctors that were training under him video it for me. cool. Yeah, it was interesting and the laser is so fast. It's about 30 seconds for the tongue and about it took about 10 seconds for the lip.

For adults, it's a little bit more involved because usually with adults they'll do sutures. I mean, it's just usually with adults. It's deeper. It's thicker. to have to give you some structure. Yes, with babies, they don't do that usually.

Yeah, and you know, I didn't even feel it. It was so fast. And basically, as I was laying there, and he said, okay, suction and hold. So suction my tongue up to the roof of the mouth, like you're gonna do a tongue click, but then hold.

And I had to hold that position for two minutes as he was suturing. wow. Right? But before he did the release, he said, suction and hold. And right when he released the posterior tongue tie, I just felt this like almost like a popper release of my entire facial. I mean, all my face muscles, my neck, clavicle area, everything. just felt like it opened up.

And I felt like, whoa, this is crazy. And then he said, OK, now pull your tongue all the way back to the soft palate and see how far you can go. I could actually. moly. Yeah, I could get that. I could feel my soft palate. And then he's like, OK, swallow. And then when I swallowed, it was so easy to swallow.

thought this is how- What? Who knew? It was supposed to be this easy. Yes, I didn't know how it was supposed to feel. Interesting. And my whole life I struggled with an overbite. I had a gap between my two front teeth from the lip tie. And then I also had a really high palate and I snored. I had really bad TMJ pain and TMD, clenching, the tori. And so I didn't, and then not to mention pelvic floor.

issues. yeah. Right? And so I had all these issues that were from the tie and when it was released like I'm telling you almost all of it is gone. Wow. Like. Okay you're convinced of me I need to go get it?

Know I you know and so when that New York Times article came out it's sad to me because I It has changed my life for the better doing it and my boys too It's just you have to have the resources to understand. What are the right steps? You know, what's the right way of going about it? What provider is best for your child? Right, and so I feel like that really is the difference With with my experience

Oh man, I need to get it done. bad. Okay, so if you are a parent and your baby is having, what are the signs that you would be like, we need to investigate a tethered tissue? Yes. So yeah, kind of going back to, you know, why a should care too. It does impact babies feeding, sleep, oral facial development. You know, it can really impact

the

way that baby transfers milk. So you'll notice, okay, like baby will be taking a long time at the bottle or a breast and baby might be popping on and off. Clicking. Clicking. Pain. Pain. Yep, for mom, cracked nipples and actually compressed nipples. Sometimes you'll see like, you know, blebs and sometimes even, you know, that compression stripe. And then you'll also see, you know,

with a shallow latch, maybe the lip will curl in. Lip blisters. Lip blisters. they're their lips to clamp on and hold on for dear life. Yes. For babies. Totally. Sometimes weight, you know, say weight loss, tension in the neck and is actually a sign and head turning preference because everything's connected. Right. Right. And then for the jaw, what you'll see too is chomping at the bottle or breast and like a chewing.

Right, yeah. And so basically what's happening is, you know, baby is not able to disassociate the tongue movements from the jaw movement.

And so baby's using jaw, the jaw, the lower jaw, the mandible to compensate and pull the milk out. And so you want the tongue to freely move separate from the jaw so that it can create that wave like motion during the swallow. get the milk to eject. Yep. Rather than chomp, chomp, chomp. Exactly. And if the palate is so high, because I mean, tongue ties happen at like seven weeks gestation. Wow. So this this happens so early.

early in the womb that it is one of those things where baby's been practicing the whole time. Strengthening muscles in a way that it's not optimal. Yeah, exactly. I mean, swallowing and sucking, all of that is practice before even birth. And so if baby's compensating and not able to have that tongue meet the palate, that palate is going to be very high so that you're going to hear that clicking, which is the tongue not...

losing suction so it can't get to the palate, the roof of the mouth. And then baby will swallow air, so you'll have gassiness, fussy, reflux.

Decrease sleep so baby will wake up every hour starving. Yes. Yes. I get the milk efficiently Exactly working really really hard. Yeah, and then sometimes it'll be an issue of coordination So, you know, baby won't be able to suck swallow breathing and coordinate the suck swallow breathe properly during feeding It is it is absolutely you'll also see if it's an older baby they'll have a

hard time transitioning to solids, they'll have a gag, very sensitive gag It's normal for babies to have a gag. It's just, it's supposed to recede and go back. Eventually. Yeah. Yeah. The more desensitization, right? With the tongue on the top and like really getting it to come back and recede once they're doing solids. if you can't reach the palate, it's not going to desensitize, right? Right. Exactly. And so there, there you'll see, okay, babies will have aversions to textures, certain

textures that will touch or get sticky on and stick on the palette, right? It would make baby gag. And then you also see a vertical chewing pattern versus a rotary chewing pattern in the older child. That's another sign that, you know, there's kind of a compensation. Yep.

So then those red, I mean we just had all those red flags for those dysfunctions. are those the type of parents that come to you? Yes, you know usually parents are like, like my baby I just feel like the tongue is always low or the mouth is always open, feeding difficulties, you know if it's an older child or toddler the speech development might be delayed and there could be other factors involved with that. Of course. Of course, but you know

I always like to look at the root cause. so, yeah. if they're not breastfeeding, what would you say to those parents who...

the babies have a tethered tissue and they're like, well, I'll just, I just want breastfeed and I'm okay with that. What would you say? Yes, I would say that dysfunction that a baby will have, you'll see it on the bottle as well. it's so interesting because what will happen is baby will have a tongue thrust and you'll see that bottle kind of come out and it's hard to keep that bottle in. They'll just put

it out. And so with that, it's more of an anterior swallowing pattern. Which is a problem. That's a problem. Yeah. mean, it can affect future dental, you know, the bite and the alignment, right? So as baby's developing, it can create issues and underdevelopment of the oral facial muscles and the jaw. So you'll see a jaw that's more receded or moved back. You'll see more of a forward

head posture, you might see a more elongated long face. And then eventually they'll have kind of dark circles. That's another sign. And then sleep issues. Now with a high palate, that can actually cause a lot of airway issues because the palate or the roof of the mouth is actually up where the floor of the nasal cavity is. So it's invading that area. Exactly.

hard to breathe. I mean it totally. And you know breathing an airway trumps everything. So if you go into your baby or child's room at night and look where their tongue is. You know kind of pull down on their chin. Where's their tongue? Is it up? Is the mouth down? And where should it be? It should be up top. Yeah and sometimes even if their mouth is closed but sometimes they will kind of

Look up extend or to the side, right? Yep So they're trying to make more space for their airway. So extending the neck exactly And so even if if if baby is only being fed by a bottle

there's going to be structural, like there's gonna be an impact with the oral facial development and the strength of the muscles of the tongue and of the lips and of the cheeks and the shape of the face and the palate and the jaw. So all of it will impact the child. You just might not see the impact until later. Yeah. Yeah. Until later, until you're introducing foods and they gag on everything that's thicker than.

baby food. Yes. Consistency. And I will say the aftercare is so much easier if you do it as a baby versus an older toddler or child even or an adult. I mean the longer the compensatory strategies are there and the dysfunction of the breathing pattern, you know, if it's open mouth breathing versus nasal breathing through the breathing through the nose, if it's, you know, the more dysfunction with the

oral tongue posture, so if it's a low resting tongue posture. And also with the development of speech and swallowing too. So all of that, you know, it'll be impacted whether it's impacted now or later, you know, and every kid is different. So I'm not saying, every single tie should be released, but I am saying if there's dysfunction, then yes, it's easier to have babies have that release done versus

me as an adult. Yes, support. get that function up because it's really not about what it looks like. maybe we can stick their tongue out. It's fine. I've had plenty of tongue type babies that can do that. Exactly. still can't take a bottle or...

Take the best. It's hard. It's hard because you know a lot of people are like well my baby can stick the tongue out or my child can stick the tongue out but that really is interesting because the issue is the middle part of the tongue and the back part of the tongue not going up. So you want the tongue to go up, out, left, right and then you also want it to have this kind of a wave motion and a suction up to the palate so you have to have that middle

movement and range of motion in order to build strength and and It's crazy because there's eight muscles in the tongue. Yeah, like it's not just one muscle Yeah, all of the you know all of the I have a program that I use for my toddlers. That's more of a feeding It's called tiny tongue tips program by Simon Says Speech Yeah, and so I use that for them and then I use for forward up the myomannual. Okay, and so

Because of the eight muscles, all of the programs that I use, every single exercise, whether it's for babies or toddlers or kids or adults, all of the exercises are targeting a specific muscle.

specific muscle group in the tongue. So, and then also the lips and the cheeks and the, you know, and the function of the chewing. And then also we work on, so at rest tongue posture, which is up to the palate, nasal breathing, you know, working on the swallowing pattern. So when we swallow, we want our tongue to go up, right? The tip of the tongue goes up to the right behind the two front teeth, which is the alveolar ridge.

in myofunctional therapy, call it the spot. So the tongue goes to the spot. then, the tongue has to make this slight suction and then a wave that that food up and back, right, for swallowing. And that's the oral phase of the swallow. And that's what we're targeting. And then we also, want to work on chewing patterns.

And when later on with older kids and adults, we want a rotary chewing pattern and we want the tongue to be able to not only pick the food up from the left side or right side, depending on which side you take a bite from, we want the tongue to go on both sides. So you want to chew evenly on the right and the left because sometimes you'll see like someone will only chew on the right side and they'll have more development of the muscles of the mass that are

let's say, of their chewing, and all the muscles for chewing, and ultimately the jawbone, right? Yeah, totally. And so that's why you'll see kind of asymmetry. You'll see part of someone's face and when a child, and you'll see this even with babies too, is if they open their mouth, you'll see jaw deviation, or sometimes it'll go to one side. You might see like, okay, there's asymmetry even of the face, the eyes and... And the nose maybe. Nose. Yeah.

So I mean just the whole oral facial development is impacted by ties and so Yeah, I mean I think that

With swallowing, know, we have to actually move the bolus which is bolus just means the food particles that are mixed with saliva makes a ball and so our tongue has to do that and to do that we have to use Like right left up down Just all the range of motion that the tongue needs to have in order to make a cohesive ball of food to swallow And what I see a lot with kids that come in my office

is that they will have bits and pieces of food scattered all over in their mouth, all across their tongue, all in the sulci or the space where the cheek pockets. And so, I had one that actually would cough or choke that can have dangerous consequences. Yeah, I mean, if that food goes into the lungs and causes that aspiration,

that could cause aspiration pneumonia. And so there's a lot of feeding issues that could come from it. when I see a baby or I have a free console and I talk to a mom, whether they have a baby or a child or it's another adult, I listen for red flags. So I kind of wanted to talk about the red flags a little bit. So for infants, I'll just kind of tell you the red flags.

and list them. So you'll see restless sleep, open mouth breathing, low resting tongue posture, snoring, high palate, pinched nipples, shallow latch, clicking, gas, long feeds, uncoordinated suck, loss of bottle or pacifier, tight neck and lip blisters, lip curls in, weight loss, feeding issues, reduced tongue and lip and jaw range of motion and fussiness. And with kids and adults,

you'll hear like some speech errors, so S sounds that or sometimes the L's or the T's that are produced with the tongue going up and then also palatal sounds. like think of how you produce the SH sound like shh. You know your tongue has to go up to the palate. And if it's tethered down, it can't really do it. Now a lot of kids can compensate and and they could have speech therapy, which is a little bit different than myo. they overlap. Okay.

So, myo focuses on the, correcting the dysfunction of the tongue and working on rehabbing the muscles. It's almost like PT for the tongue, right? And the lips and the jaw. So, it's basically building strength of those oral facial muscles and also fixing the patterns for breathing, swallowing, at rest tongue posture, right? And for sleep. And then, traditional speech therapy works

that articulation or how the speech sounds are made so it's a little bit different because you're looking at you know language or communication and swallowing or feeding but it's not necessarily looking at it from

the pattern perspective of like, I'm gonna fix this dysfunctional pattern. it's like the foundation. It is the foundation. Okay. And what I see too is that sometimes, mean, I've had...

A high schooler come to me that, you know, he was working on his Rs for years and he's in high school. Nobody looked under his tongue. And so come to find out he had a tongue that had a heart shape at the end. It was tethered all the way to the tip.

Like very severe. No one caught it. No one looked under his tongue. And so literally he, you know, did the rehab, did the mile, had the release and literally within a month he was able to say the R sound clearly. Wow. So it's like, if you're just kind of up against a wall of we're at a dead end, therapy isn't working. all the therapy you can when there's something structurally wrong. There's a barrier. could practice all you want, but you can't do it.

Right, exactly. I mean, you know, I'm all for taking a, you know, looking at other alternative ways to treat something. But if there's just a structural barrier or an airway issue that you need to address first.

you won't really have a successful outcome necessarily that you're looking for if you don't treat and remove those barriers first. Right, yeah. Good, okay, so we have red flags and we talked a little bit about breathing.

So the red flags for breathing would be the snoring snoring side posture like trying to get that open airway, right? So snoring, sometimes there's apnea sleep apnea even in children You know, you'll see that Some signs would be Incontinence or bedwetting that can be one. We had that with my son He we did not realize that that was part of part of the issue is the mouth breathing

breathing

and the airway issue. And he probably doesn't want me to share, but bedwetting was a problem and he literally couldn't help it. And then once we took care of all of that.

Almost instantly. Isn't that amazing? Almost instantly, yeah. That's so amazing. the interesting thing is that it's connected by fascia, right? The tongue is connected to the pelvic floor by fascia, which is kind of the covering that you'll see around muscle or nerve. And it's very thin and it should move. But sometimes there's like a kink or something in that fascia to where you'll

If the tongue is tight, then the pelvic floor can be tight or you can have the opposite. Right. So it's interesting. in the pelvic floor. Perfect.

Deb (45:23)

Okay, so you mentioned after care, that can mean a bunch of different things. So why don't you tell us what that looks like for you and your patients? Sure, sure. So once the tight tethered oral tissue is released, then you'll see almost like a diamond shape and it'll be a little bit pink red. And what will happen, and personally, since I had it done, it felt kind of like canker sores under my tongue. That's kind of how it felt.

for a couple days. And then once day two was done, day three was so much better. And after that, the stretches after, it wasn't that bad. And so what parents will have to do is they will, like for example, if they had a tongue tie and lip tie, you'll have to stretch that wound, usually four lifts, four times a day for four weeks. And the tongue heals within three weeks, but I always like to say four weeks,

because everybody is a little bit different with how they heal and the lip will usually heal within two weeks. a misconception is, it's growing back. Well, sometimes that can happen if the stretching isn't done properly because the body wants to reattach. it wants to heal. Close the wound, which this is like the only time where you don't want a wound to close too fast because

because

then it'll just reattach and then you'll be right back to square one. not, possibly, you might have to then deal with scar tissue and you don't want to do that. So, it's really important to be all on board, all in. I tell parents, set your phone alarm and just try to make sure you get four times a day, morning, afternoon.

dinner time, before bed, but you don't want too long of a stretch at night. And so you'll have to basically lift that tongue in and up four times. And so my best friend always says to people, you have to stretch the tongue.

as high and as much with range of motion as you want your baby or child to have after you're done with this healing process. So the amount you're stretching and lifting that tongue is the range of motion that person will have.

So that's huge. Like if you think about it like that, if you're like, I need my baby to have full range of motion, you're going to have to stretch that wound so that that diamond elongates and becomes, you could see that whole wound. So a tip I always have is use a headlamp like for camping. Because you want to be able to see what you're doing. You want to see the whole wound when you lift up the tongue. That's how you know you're doing it right. Is that you see the whole...

diamond elongate, right? And then with the lip, you just pull out and up four times, and then you can do some rolling pin exercises and stretches. But those are really, really important to do. And I always say focus on those first for at least two weeks and then add in oral motor exercises. I mean, you could be doing suck training exercises and oral motor exercises throughout this whole time, but then add in the more

all of them at the two week mark to continue two more weeks past that. So I always say, you you can do them, but just continue. Really important to focus the initial part of aftercare on stretch, stretch, stretch those wounds. And that's what's gonna help it to heal from within up.

superficially and actually Dr. Gehry, he's a ENT in Portland, he has some great videos on his website. He really does. I mean like amazing with a puppet. Yeah his aftercare videos are amazing. Yes. see exactly what it's going to look like on different ages. Exactly and so you'll see like a little bit after a whitish film sometimes it's yellowish. Which sometimes will freak people out. I know you're like. Because it looks infected. Yeah you're like

It does, but it's not it's like okay. It's just normal tissue. And you know usually with the tongue tie releases my experiences with the laser is that there's really it doesn't have a ton of bleeding which that's the benefit of the laser in my opinion versus scissors. Although I know there's providers that use scissors and they know what they're doing with it. So I'm not saying that I'm just saying from my personal experience. It cauterizes as they go. so it's minimizes.

Like I've never seen an infection ever so yeah, and then you could put breast milk under it I mean, I'm not saying this is not medical advice I just think that's what I did right and you know breastfeeding or skin to skin. That's so important, too That's so calming for babies and just to help you know Regulate and just heal and and that skin to skin. It's it's a pain relief in itself Yeah, so yeah, that's huge for parents to do and then

Following

up with therapy after that's really important. Yeah. To get the healing right, but also strengthen the muscles, Yes. And I always like to look like a week after at how the healing and how everything is going and progressing. And sometimes, you know, we might change a little bit or change some things. And it's really important because it's one thing if you watch a video, you have to know what you're getting yourself into because it's a commitment. Yes. But it's worth it. It's totally.

worth it and I would do it again in a heartbeat. Like for my kids I've seen huge results with them and you know with myself too so it's one of those things. long-term benefits. Totally long-term. For temporary problem. Yes and even if you're like crying as you're doing the stretches because you're like I like innately as a mom do you don't want to hurt your baby and

Just know that like, yeah, it's a bummer. Like babies don't like you in their mouth under their tongue. They just don't. it's an owie. Yeah. Right? And it's kind of like, okay, that initial part gets better as babies used to you in. And that's another thing of, you know, doing stretches and care beforehand is baby will get used to you being in the mouth. Right. Under the tongue. So I always tell parents stretching the frenulum before the

The surgery is so important for the lip and the tongue and the buckle ties. Stretch those as much as you can and that gets baby prepared for you to do the aftercare. And you need train too. Yes. Feeling comfortable going in their mouth. Confident. Yeah. And like you said, they can do them while they're skin to skin. One parent holds and the other one.

Yeah, I mean my favorite way is usually I'll have like baby's head is kind of in between my legs and then Feet are faced out and so maybe one parent can hold baby's arms and you know talk and cuddle and then you have the headlamp and maybe grab some gloves I always feel like gloves helped me for some reason as a parent. Yeah Just because I felt even though you could totally wash your hands. That's your baby. You could

do

it. But I felt like it was easier for me to get up under there. Sometimes babies will chomp down and so you want to kind of go from the side, under the tongue, lift up and you know do it that way because sometimes when the head is is back and they're facing away from you, you could actually get up under it better. And so that's what I would always recommend too.

Deb (53:26)

So we're going to bring it all together. What would your advice be for parents if they listen to this and they're like, man, my kid or I am having these issues. Like what do we do? Yes. Help them out of freeze. Yes. Well, I would just encourage.

encourage you to just take a deep breath and be like, all right, I have done my best. This is something that I did not cause. I feel like that is a huge one. And also there's a lot of frustration. So addressing the frustrations and validating parents is so huge because it's frustrating when your baby is frustrated to eat and whether it's breastfeeding or a bottle, it's frustrating when you have all these symptoms.

symptoms that are impacting your daily life and you're wanting to bond and you're wanting to have them have the most optimal development. So I would definitely validate that frustration. The next step would be to find an oral facial myologist to take a look and do an assessment. And that assessment is going to look at function. So function with the structures and how they move, the strength. actually for the older, like

Toddlers and up I have measuring tools that I measure the range of motion in the strength with so I can have objective data To measure to say okay. This is within normal limits, and this is not So looking at the just the strength the range of motion of how the struck oral facial structures work and function and then also looking at speech development looking at language development and how Swallowing is impacted so that's for that but for

babies.

I look at how are they feeding, so I assess the patterns and compensations and how the structures are working. And I work closely with lactation and chiropractic and pediatric dentists and all those providers, craniosacral therapists, to assess feeding with an infant and how that's impacting function.

So looking for that team. So the first step would be you can have an assessment with pediatric dentists or you can come to someone like me who can do that and then I would refer you to pediatric dentist who would do the release. And so it's kind of like that's the step. You can either go straight to the release provider and then they would send you for body work and therapy or you can come to me and then go to them.

It

kind of works who specialize, right? Exactly. Yeah. And I mean, I just encourage you to, you can even go no matter where you're at in the country and you could go to the oral facial myology website and find providers in your area. Great. That are qualified oral facial myologists. Well, I will throw that link in the show. Yes, that'd be good. Yes. And then also Dr. Baxter has a website of providers that

He has trained across the country. And then there's other great providers that I work with. So depending on insurance. And we were very lucky in the area to have really great support people in the Pacific Northwest. Yes. And if you don't, like let's say a parent chooses not to release, I completely support parents no matter what either way. Because there's different situations, you know? Sometimes it's not necessary, right? Right. I've had some families, they go do the therapy and then

and that's all they really needed. They didn't have to go down that route. But then they always think like, if we run into more problems as a toddler, as you know, speech.

they may want to relook at that. Yes, definitely. Yeah. I mean, I think to just even doing some of the retraining of the tongue, see how that goes, you know. And I mean, it depends on the situation and if there's, you know, other factors involved, there could be things that are contra-intigrating, you know, or comorbidities that you just have to work through first before doing a release. But typically, I like

to parents like one or two times before a release and then once they have the release I like to follow up with them one or two times after. And you know some babies if they have like extreme ties and oral versions there might be a little bit more therapy after working on the retraining and and working on suck training and and feeding therapy afterwards but you know it depends yeah and then for the adults or kids you know they

Going through the phases one through three is really important after two. So Exactly, it's connected. So Tell us about how people pay for it Yes, that can be an issue Actually, the interesting thing is is that as a myofunctual therapist and speech therapist I'm able to bill medical codes Okay, and so if they go to a dentist and have myofunctual therapy through a dentist

dental office, they have to build the dental insurance. And another thing is a dental hygienist, they cannot work on swallowing. Like it's out of their Yeah, so if there's a tongue thrust anterior swallowing pattern, then you really do need a speech therapist to do that. And you know, as far as the swallowing disorder part and the oral phase part of the swallow.

But for me, I provide super bills for parents and then sometimes they can call their medical insurance companies and they can actually get reimbursed if they have out of network coverage. And then another thing that I've had parents have success with is that they can call their insurance companies and the medical insurance provider will sometimes provide an out of network exception letter because there's really not a lot of oral facial myologist and speech there.

is in the area. Okay. So they can actually get out of network coverage if ahead of time. Yes. If it's indicated. So it's worth checking in. It's worth checking out. Yeah. Okay. Well, that's great. Are there any final thoughts you want to tell parents and also how do they get a hold of you? If they're in the area and they

needs help. Yes, I just encourage you to do some research. You know, I'm happy to provide a consult for free if parents just are wanting information, if they want resources, if they're like, I don't know, is this an issue or is this normal? You know, they could totally call me, they could go to my website and see. But I'm happy to talk to anyone if they need support. I definitely want to support people. But yeah, you can go to my website is

www.coastalmyofunctionalspeechtherapy.com and we'll put that in the show notes. That'd be great. And you can contact me there to schedule an appointment and I have an office space in Port Richard, Washington, but I'm licensed in Washington and California so I can see anybody in Washington and California even virtually through teletherapy. I've actually had some California

patients and they are great and I just send them an evaluation packet to their house and the therapy tools to their house and then I coach them. Great! So there's options. That's awesome. Especially if you can't find someone in your area. Yes. That's a really great option. Perfect! Well thank you so much for coming and we'll put everything in the show notes for you guys and if you have a question for Brittany I'll put her email on there as well.

And we'll just wrap up here. Yes, thank you so much. Thank you.

Deb (1:01:47)

Britney.

That was so enlightening and an eye-opening conversation. I'm so glad that you guys were here to be part of this conversation. I think so many parents are going to walk away from this episode realizing just how much the tongue and oral function impact everything from feeding to sleep to speech development and beyond that. I love how passionate Brittany was about educating families and making sure that they have the support they need, whether it's for their baby.

their toddler or even themselves.

It's so reassuring that therapy and treatment options exist to help improve function and long-term health.

For the parents who want to learn more, I will go ahead and drop Brittany's contact information on how to contact her for a free consult and also a link to the database she mentioned to find a myofunctional therapist in your area. I am so thankful that she came to share her knowledge with us and personal experiences.

And for everyone listening, if today's episode got you thinking or you have more questions about tongue ties, oral development, or myofunctional therapy, please feel free to reach out to Brittany or send me a message and I will connect you. I love hearing your thoughts and making sure that we bring in guests who answer the questions that you actually have. I already invited her to come back. So if you do have specific questions,

we will add those to the list a more focused conversation around the topics that you really want to hear. And as always, thank you for tuning in to Doula Talk. If you found this episode helpful, don't forget to subscribe and leave a review. It really helps more parents find this kind of support that they really need. All right, until next time, take care.

Get some rest if you can and I'll be back here soon.