“Is my child’s speech typical?!”

Maybe you’ve been sitting on a sinking feeling that your kiddo should be saying more words than she is.

Maybe you’re concerned that she should be understood more easily than she is.

Maybe you’re questioning the “funny thing her mouth does” when she’s playing, eating, talking, or drinking.

Navigating concerns and questions on your own can be nothing short of confusing and worrisome. Differentiating between what’s “just normal” and what’s atypical is especially tough in today’s society. We have an app at our fingertips ready to feed our anxious minds with the comparison game. Your child’s growth and development is certainly not immune to being up for debate against the pictures you see, comments you hear, and same-aged kids you encounter in public.

Because Dr. Google is only helpful in increasing those worries you may have, this is where a professional opinion can come in handy. At the end of the day, listening to your “gut” is never a bad idea. An evaluation of speech and language function can be beneficial for many reasons, even if the only result is peace of mind for you as a parent.

Language and speech dysfunction can manifest as early as infancy, and our research shows us that early intervention is always the best path to take. While speech-language pathologists wear many hats, the one we’ll highlight today is the obvious one: that of assessing and treating speech and language disorders.

Outside of the well-known “flags” your child may exhibit (such as not saying more than a few words by about 1.5 years old or not understanding what others say, for example), some lesser known signs may also warrant an assessment:

• Difficult to understand starting around 2 years old

• Hoarse, scratchy, or raspy voice

• Sounds “congested” or “nasaly” while talking

• “Mumbles” while talking

• Drools, creates “spit bubbles,” or sounds slushy while talking

• Tongue protrudes forward between teeth while talking

• Sounds “under water” while talking

• Appears to be straining while talking

• Check out our website for a more exhaustive list of symptoms.

While a list of symptoms can be helpful, determining whether or not your child’s speech is typical is much more of a dynamic process than checking boxes.

Here at BodyWorks, we are well-versed in assessing and treating various manifestations of speech dysfunction, including limited speech intelligibility, motor planning difficulties, delayed language, articulation errors, phonological disorders, voice or resonance disorders, and speech impacted by orofacial myofunctional disorders. We’re only scratching the surface here, and we’ll leave the “other side” of speech therapy (i.e., feeding, swallowing, and more) for another post!

We would love to answer your questions, help provide peace of mind, and offer a comprehensive look at your concerns.

Why We're Different

Ever felt like you’re just a number? Especially if it involves your medical care? 

Yeah, us too. 

Ever felt like you’ve run in circles to 800 and counting professionals to find a solution? 

Yeah, us too.

Ever felt like your problems are being solved with “bandaid” solutions? 

Yeah, us too. 

Ever felt like you’ve been doing the same thing over and over just to get the same results? Or even worse, no results? 

Yeah, us too. 

Ever felt like you just aren’t being heard? 

Yeah, us too. 

. . .

We hear you. 

We want to help - the right way. By digging to the root of the issue and creating a plan that results in results. 

Our approach involves team-based care. At our multidisciplinary therapy clinic, we focus on improving your ability to breathe, sleep, eat, speak, digest, and feel better. Regardless of age - 2 days old to 99 years old - we can help you! 

Battles are fought best alongside each other. Whether your battle is…

• Suffering from poor sleep, snoring, or waking frequently during the night

• Breathing through your mouth instead of your nose during day or nighttime hours

• Battling chronic headaches and/or jaw pain

• Fighting a toddler who won’t eat anything other than chicken nuggets and French fries

• Struggling with an infant that is a poor feeder or sleeper

• Having a difficult time understanding your child’s speech

• Or a plethora of other issues that you can check out here: https://bodyworksbetter.net/who-we-help

… we want to help. And show you how all of these symptoms and more might just be related!

Mouth Breathing: Catching Flies No More

Ashley Larson, PT, C/NDT

Airplane rides are now the worst for me.

I inevitably sit next to the person who sleeps with their mouth wide open. A few weeks ago, I thought it was going to be different as this beautiful high school girl was sitting next to me. Within 15 minutes, she drifted off to sleep, of course... with her mouth wide open.

We all know this person. This has become so common that no one even gives mouth breathing a second thought.  

The only thing we HAVE to do in life is breathe, right?  I often say to my patients, “the nose is for breathing and the mouth is for eating and talking - never the two should be confused.” Let’s face it, breathing is the most important thing we do throughout the day, and we all take it for granted...  until we have a cold and cannot breathe through our nose. We then prepare ourselves for a poor night’s sleep and a cloudy head or short temper the next day. Well, what happens if this type of breathing pattern is our norm?

Seriously, what’s the big deal if someone sleeps with their mouth open or chronically keeps their mouth open during the day?  

The answer is: it’s a BIG deal! It can be quite dangerous to your health. Yet, many health care providers are often inundated with simply treating the immediate issue at hand. Mouth breathing can be overlooked. So, I’ve decided to play my part and connect some dots for you. Let me explain some of the common consequences of mouth breathing.

Sleep Problems

This is a big one and deserves it’s own spotlight (stay tuned).  Bottom line: mouth breathing is very much linked with sleep impairments for people of all ages.  Sleep experts now recognize that poor sleep increases our risk of chronic disease. Chew on that for a second.

Sleep is the reason I dove down this rabbit hole. I saw my dad on CPAP at an early age, and I have watched my younger 2 kiddos struggle with sleep issues. An important study found that mouth breathing and snoring in kids as young as 6 months can lead to a significantly increased risk of behavioral and social problems by the age of seven.  Kids are not little adults; as such, they behave differently when sleepy. Adults usually are tired and groggy, whereas kids tend to overcompensate and speed up. People can be moody, emotionally explosive, and/or aggressive when sleepy. Many prominent researchers believe that a sleep disorder should be ruled out before an ADHD diagnosis is made. Hmmm… food for thought!

Poor Posture

Are you constantly telling your kids to “sit up straight?” Maybe you yourself slouch a little more than you would like? Question… what does your mouth look like? Mouth breathing and forward head posture go together like peanut butter and jelly. Mouth breathing forces the head to bend forward and the neck to extend to help the flow of air through the oral cavity.  Over time, this leads to significant muscle fatigue, poor recruitment of the diaphragm for breathing, neck pain, tension in the temporomandibular joint area, tension headaches, and the list goes on.

Unattractive Features

Ever heard: “Wow, he looks tired,” or “I’m losing my jawline!”? Mouth breathing can change jaw development and the look of your face. There is actually a name for this: “Adenoid Facies” or “Long Face Syndrome.” Faces lengthen, the jaw becomes less defined, teeth become crooked, and often kids and adults that chronically mouth breathe present with a “gummy smile” and dark circles under their eyes. Mouth breathers often have dry, chapped lips.

Not to mention… research has shown that an open lip resting posture leads others to gain the impression of the person “not being very bright.” Just take a look at actors in movies, and you will see what I’m talking about. Best example: Jim Carrey in the movie “Dumb and Dumber”... enough said!

Dental Misalignment

This could be a post of its own, but let's just take one example. Mouth breathing has been shown to significantly change dental alignment. You know those people who wore braces and had perfectly aligned teeth, and then one day their teeth “moved?” Sure you do. Why, do you ask? Stay with me… an awesome orthodontist will tell you this. The tongue is a group of incredibly strong muscles. And muscle trumps bone any day and twice on Tuesday. When a person breathes through their mouth, their tongue isn’t in the right position at rest, or when they swallow. Thus, if you “fix” the teeth but haven’t fixed the reason why the teeth are impaired or moving in the first place, you may notice rather quickly that the teeth go right back to where they were.

Poor Athletic Performance

Much has been said about this in recent years - very exciting! Recent studies show that athletes perform better when nasal breathing is utilized. In summary, it has everything to do with oxygen and carbon dioxide utilization. Mouth breathing adversely affects respiratory biomechanics and exercise capacity. Mouth breathing also limits a person’s ability to utilize the diaphragm effectively. AND, it limits the ability for the person to place the tongue in its correct resting posture, which has recently been shown to improve isokinetic knee performance in strength testing.

Smacking While Eating

Generally, noisy eaters are mouth breathers. We all know “that” person we hate to sit across from at dinner because they chew like a cow and smack throughout dinner. As it turns out, often these people are simply attempting to figure out how to breathe and chew food at the same time.

Bad Breath

Mouth breathers have increased bacteria accumulation, which can lead to bad breath. Maybe we should tell our kids to shut their trap instead of brush their teeth?!

Gum Disease

Mouth breathers typically have a dry mouth with reduced salivary production. This can allow bacteria to perpetuate. Long term gum disease has been linked to some serious stuff, including heart disease, stroke, and even dementia. Yet another reason to learn how to close your trap!

Allergies and Sinus Issues

A LOT more is to be said regarding this issue than what this simple post can cover; but, if your mouth is open, the palate and nasal passages narrow over time. This contributes to sinus issues, increased nasal obstruction, and inability of the body to combat allergies. Simply stated, if you don’t use your nose, you lose it!

Asthma

Mouth breathing increases asthmatic complications and decreases lung function. Asthma symptoms can be significantly decreased if the sufferer learns how to breathe through their nose and not through their mouth. I have seen this to be true with so many patients who no longer need their asthma action plans or inhalers..

The bottom line is that often times, we are not even aware of our breathing - and we certainly don’t realize that we are doing it well, or perhaps not so well.

Check out our attached list of symptoms associated with mouth breathing. Do any of these signs or symptoms ring true for you?

Is there a way to change mouth breathing habits?  

Well, certainly I wouldn’t write a blog of doom without offering a solution!  

If you are experiencing any of the symptoms above, or simply want to learn strategies to improve the above issues, contact our office for a physical therapy evaluation!

Together, we can begin to help each other breathe better, exercise better, eat better, and sleep better so that we may all the the best versions of ourselves!

Nothing will change if nothing changes.

---

References

1. Barocas, R., & Karoly, P. (1972). Effects of Physical Appearance on Social Responsiveness. Psychological Reports,31(2), 495-500. doi:10.2466/pr0.1972.31.2.495

2. Guilleminault, Christian, and Shannon S. Sullivan. "Towards Restoration of Continuous Nasal Breathing as the Ultimate Treatment Goal in Pediatric Obstructive Sleep Apnea." Enliven: Pediatrics and Neonatal Biology 01.01 (2014): n. pag. Print.

3. Hallani, Mervat, John R. Wheatley, and Terence C. Amis. "Enforced Mouth Breathing Decreases Lung Function in Mild Asthmatics." Respirology 13.4 (2008): 553-58. Print.

4. Izuhara, Y., H. Matsumoto, T. Nagasaki, Y. Kanemitsu, K. Murase, I. Ito, T. Oguma, S. Muro, K. Asai, Y. Tabara, K. Takahashi, K. Bessho, A. Sekine, S. Kosugi, R. Yamada, T. Nakayama, F. Matsuda, A. Niimi, K. Chin, and M. Mishima. "Mouth Breathing, Another Risk Factor for Asthma: The Nagahama Study." Allergy 71.7 (2016): 1031-036. Print.

5. Jefferson, Yosh. "Mouth Breathing: Adverse Effects on Facial Growth, Health, Academics, and Behavior." General Dentistry: Growth and Development (2009): 18-25. Print.

6. Kukwa, W., C. Guilleminault, M. Tomaszewska, A. Kukwa, E. Migacz, and A. Krzeski. "Prevalence of Upper Respiratory Tract Infections in Habitually Snoring and Mouth Breathing Children." Sleep Medicine 40 (2017): n. pag. Print.

7. Lee, Seo-Young, Christian Guilleminault, Hsiao-Yean Chiu, and Shannon S. Sullivan. "Mouth Breathing, “nasal Disuse,” and Pediatric Sleep-disordered Breathing." Sleep and Breathing 19.4 (2015): 1257-264. Print.

8. Okuro, R. T., Morcillo, A. M., Ribeiro, M., Sakano, E., Conti, P., & Ribeiro, J. D. (2011). “Mouth breathing and forward head posture: Effects on respiratory biomechanics and exercise capacity in children.” Jornal Brasileiro de Pneumologia, 37(4). http://dx.doi.org/10.1590/S1806-37132011000400009

9. Purwanegara, Miesje Karmiati, and Bambang Sutrisna. "Mouth Breathing, Head Posture, and Prevalence of Adenoid Facies in Patients with Upper Respiratory Tract Obstruction." Journal of Dentistry Indonesia 25.1 (2018): n. pag. Print.

10. Torre, Carlos, and Christian Guilleminault. "Establishment of Nasal Breathing Should Be the Ultimate Goal to Secure Adequate Craniofacial and Airway Development in Children." Jornal De Pediatria 94.2 (2018): 101-03. Print.
    
    
    
    
    

A Different Perspective

OK, so I am trying out this blog thing.  For those of you who know me, you know that this is my definition of torture. In school, I was the one with red circles and lines through EVERYTHING. Somehow, I made it through many, many years of school and now practice as a physical therapist in Baton Rouge, Louisiana.  Six months ago, when one of my adult patients told me that I should write a blog, I literally laughed out loud.  And well, here I am putting myself out there.

WHO am I? I am a wife and mother to three “typically” developing, constantly growing boys. I am a physical therapist and an orofacial myofunctional therapist (we’ll get to that part later).  My family, probably much like yours, never stops moving. I’m certain I spend more time at various ballparks than at my home.  We eat dinner together between 8- 9 pm. We fall into bed at night, and at 6 am, start all over again.  It’s nothing short of a happy life that, within the last two years, has collided with my professional life as a therapist.  This is where the story begins.

Let me begin with my 10-year-old.  At birth, I noticed that he was another boy and oh, he was tongue-tied.  We had it “fixed” when he was 2 days old, and he breast fed without issues.  He was the happy baby who always had a bib on because he drooled, but thank goodness grew out of it for the most part.  The dental hygienist told me to get my bank account ready because he would need lots of work to fix his teeth.  Last summer, following the beginning of my son’s orthodontic work, I noticed that he didn’t want to read out loud with me or his brothers anymore because he was nervous he would drool.  He grinds his teeth at night, always has, but it was worse- so much so that it would wake up his brothers at night.  I began noticing that his mouth was open while he chewed his food- ALL- THE- TIME.  It was out of desperation that I started connecting the dots.

Then there’s my 12-year-old… loyal and observant of everything.  A firecracker that broke the mold upon delivery.  He was a terrible breast feeder.  An extremely “colicky” and fussy baby (though no one could ever tell me why).  He has NEVER been a sound sleeper.  NEVER. I cannot even begin to tell you how many different therapies and natural medicines we have tried to improve his quality of sleep.  He used to hum and rock himself to sleep!  I was told it was a sensory or attention-related behavior, and that he would grow out of it.  He sighs a lot and has trouble breathing when he runs, yet loves to exercise.  I was also told that his sighs were just a tic.  He has always taken an extremely long amount of time to eat.  He has two speeds in everything that he does:  off and fast.  I’m quite certain his teachers would say that he has attention issues.  My husband and I would certainly agree. Often, he can be found in his bed attempting to nap, especially toward the end of the week.  Yet, he never seems rested.  I often wondered … there has to be a correlation between his sleep and his daytime temperament, right?

Finally, my 13-year-old…last summer my husband (who is also a physical therapist) and I noticed that his posture was REALLY becoming an issue.  His head sat more forward than it should and sitting up at the dinner table was suddenly a constant battle.  He frequently complained of headaches.  We were just getting started with the orthodontic evaluation process and I was told that he had a “small airway.”  WTH? I didn’t know a lot, but I knew that the size of his airway was kind of an important thing and my sweet orthodontist was telling me that my 13-year-old had a narrow one.  

As a mom, hearing this and realizing that all three of my kids were having issues at the same time made me want to cry “uncle.”  We escaped to the beach where I typically catch up on all the new best sellers.  Not that year.  I read, researched, and soaked up everything I could about the relationship between weak posture, breathing, asthma, ADHD, sleep, teeth grinding, and tongue restrictions.  

I wanted to start with “fixing” my youngest child first, so I Skyped with Sarah Hornsby, a Myofunctional Therapist out of Portland, Oregon for his evaluation.  She explained  myofunctional therapy to me in terms I could really understand.  She said, “myofunctional therapy is essentially like physical therapy for the mouth”.  It is therapy used to eliminate faulty habits and correct imbalances in the face and tongue muscles which help train the tongue to rest properly in the mouth, eliminate mouth breathing and correct faulty head/neck posture. I chuckled and put out the disclaimer that I was a physical therapist.  Her response was “Well, you should get trained”.  So I did.  

I spent 15 months flying to courses across the country.  I returned from these courses with not only a few extra pounds, but a ton of knowledge and a grateful heart.  I know that I am doing EXACTLY what I was put here to do.  I know that my own kids’ “issues” are now very typical and very treatable.   I also started to think about the kiddos that I treat as a physical therapist, and their parents, their grandparents, and how this type of therapy could have a profound effect on their lifestyles.  I now have the ability to provide a treatment plan to teach my friend some exercises that will let her eat chips with me without jaw pain, and stop snoring so she can sleep in the same bedroom as her husband.

I never dreamed that my work as a pediatric physical therapist would lead me to where I am today.  Many years ago, I took my first course with Mary Massery, a breathing guru and honestly one of the most talented and well researched PT’s I have ever met.  That course is titled “If you Can’t Breathe, You Can’t Function.”  I would just add, if you can’t breathe, you can’t sleep and you certainly won’t function!  The good news is, we can change this.  We MUST change this.  

We, as a society, for many reasons, are not sleeping well and breathing well.  Our mouths are not being used the way they were intended to anymore.  We eat quicker, easier, and softer foods to accommodate our lifestyles.  We are more rushed, more anxious and less rested.  We are worried about the way we look, but don’t have time to “fix” the issues.  We just want to make it “look” like we have it together-- like everyone else.  We put braces on our teeth to make them pretty and straight, but don’t fix the underlying issue that made the teeth look like that in the first place.  We give a kid an inhaler, tell them to use it when they exercise, but we don’t take time to work on why they are not breathing well in the first place.  We put earplugs in our ears at night or sleep in another room because our loved one snores or grinds their teeth, yet we don’t fix the problem.  We all know someone who has a CPAP machine at their bedside.  The sad thing is that we have learned to accept these issues because they are “normal” and because everyone appears to perpetuate a very similar story in our circle of friends.  

This blog is simply to begin to talk about my family’s story and, in large part, my own story.  This is my life.  I’m certainly not saying that I know everything about breathing, sleeping, jaw dysfunction or ankyloglossia.  I pray that I never know it all.  I’m also not saying that I now have perfect children.  The honest reality is that I thought I could be my boys’ physical therapist, and well, not so much.  They do not recognize my wisdom or expertise in any areas other than cooking and laundry. And really, to them, I am not exactly enlightened.   I am Mom, not a PT with a lot of certifications behind my name or years of experience under my belt.  Just Mom.  And that’s certainly good enough.  I have been lucky enough to find another therapist for my boys.  We have a plan and are getting there!  

My hope is that someone other than my immediate family will read this blog.  If I am able to fix one infant, one child, one athlete, one husband, or one mama by writing this blog, then it will all be worth it.  Click here to find some of the “red flags” that I ask about in a physical therapy evaluation.  If two or more of the items on my checklist apply to you or your kiddos, email me or call me at (225) 366-8016.  Similar to a shoulder that needs some therapy at some point, your mouth does too.  Let’s get your mouth working with you, not against you, to improve your breathing, sleeping, and overall health.

Acknowledgements:

First and above all, thank you to my family and friends for their unbelievable support and encouragement.  You believe in me when I don’t believe in myself and you let me grovel when I miss a baseball game, family day, date night, or wine time. I have the best Team around.

Thank you Sarah Hornsby, RDH, for starting me down this rabbit hole and beginning me on my journey to help my boys.

Thank you Mary Massery, PT, DPT, DSc, for giving me an amazing foundation regarding breathing and postural support.  I want to be you when I grow up!

Thanks also go to Michelle Emmanuel, OTR/L, and TummyTime Method Founder, for reaffirming my clinical skills and validating that what I’m seeing in the clinic is correct… and for giving a name to it!  I also want to thank you for not only welcoming me into a community where sadly few PT’s exist, but for your immense social media networking.  Because of you and Linda D’ Onofrio there are not many people that should still feel like they are on an island.

Thanks to the entire AOMT team for not only beginning my education in the field of Myofunctional Therapy, but also providing me with a talented group of colleagues that will remain lifetime friends.  

And finally, a thank you must go to my dear friend and colleague, Courtney Gonsoulin, CCC-SLP.   Oh, the places you will go!  After 17 years of working together, we still think it’s fun to problem-solve the hardest patient of the day.  You have built an amazing team at Speech and Feeding Specialists of Louisiana that I’m grateful to be part of.   I never want to do a day of work or raise kids without you.  

Best,