June 23, 2024 • 56 mins
My guest today is Occupational Therapist, Natalie "Nat" Udwin. Nat is an infant development, airway and reflexive feeding specialist. Most people know them on Instagram as "Nat The Baby OT".
Nat has a B.A. in Studio Art from Whitman College and a M.S. in Occupational Therapy from Milligan College and has been an OT for 12 years. They have specialized in infant development for 7 years now.
Nat, alongside some incredible mentors and colleagues, has spent the past 7 years mastering their understanding of infant development to not only become an infant development specialist, but to create what is now the foundation of Áha OT - a holistic airway focused approach to therapy - for children of all ages.
You can find out more about Nat at ahaotcollab.podia.com or on Instagram at nat_thebabyot.
Show Notes:
- The First 1,000 Days: A Crucial Time for Mothers and Children, by Roger Thurow
- The TummyTime! Method with Michelle Emanuel
- Campfire Chats with Nat
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi everyone, and welcome to another video.
(00:29):
Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First Foundation.
I'm your host, Rebecca St. James.
My guest today is occupational therapist Natalie Udwin.
NET is an infant development, airway and reflexive feeding specialist who is known to most people by the name of NET, the baby OT.
(00:52):
NET has a BA in studio art from Whitman College and a master's in occupational therapy from Milligan College and has been an OT for 12 years and specialized in infant development for seven years.
Sometime around 2015, NET's eyes were open to the world of reflexive integration, which completely transformed their practice.
(01:15):
Finally, NET was seeing skills were sticking and carrying over to other aspects of daily life that just weren't happening before for their patients.
It was the foundational approach to therapy that NET had been trying to figure out for years.
During their investigation, NET quickly learned about the importance of human connection and emotional regulation in early infancy,
(01:38):
as well as the developmental importance of strong breathing and oral motor skills to support a lifetime of healthy growth.
It was now all starting to make sense.
The next step was to start working with infants and put all of this new knowledge to the test.
NET, alongside some incredible mentors and colleagues, has spent the past seven years mastering their understanding of infant development
(02:04):
to not only become an infant development specialist, but to create what is now the foundation of the AOT,
which is a holistic, airway-focused approach to therapy for children of all ages.
You can find out more about NET on Instagram at nat-the-baby-OT.
(02:25):
And now, let's jump into my interview with today's guest, Natalie Goodwin.
All right, perfect. Great. Thank you for joining us today. I really appreciate it, Natalie.
You're welcome.
Thanks. All right, well then, let's just jump right in, because one of the things that I have found in hosting this podcast
is a lot of the people that I talk to have had their own airway journey or something that put them on this path.
(02:50):
So how did you end up in your particular field?
So it wasn't personal, actually, for me at all.
And most people call me Nat. I'm fine with Natalie, too, but most people call me Nat. That's kind of...
Nat, it is.
Cool. So let's see. My airway journey was not personal.
I've been a pediatric OT about 13 years now, and mine was because I kept wanting to go backwards in airway, essentially, as the source.
(03:22):
And so is the foundation of everything we do. And so I'll explain that.
So basically, I always knew I wanted to work with kids. I wanted to work some kind of medical field and art.
And I couldn't figure out how to meld the two. And OT, via a lot of trial and error, I discovered OT, and it was the perfect profession for me.
But after a few years of building obstacle courses and messy play and all that stuff, I was getting stuck with my kids.
(03:49):
I felt like I got to a point where I couldn't make things stick anymore. And I was asking a lot of questions and doing a lot of reading, and I couldn't crack the code.
And I worked with a student, actually, from a local university who had been from California, long story short, had worked in a clinic there and said, hey, have you checked this kids reflexes?
And I said, what are you talking about? And so she said, oh, let me explain it to you.
(04:13):
So she gave me a little handout from her old clinic that she worked at. And within a week, I was devouring as much information as I could get my hands on.
And so primitive reflexes, reflex integration, what does that mean? What does it mean when they're not integrated, all that stuff?
Because in grad school, we just learned about how to check for reflexes in an infant, like the zero to 12 month range.
And then if they're not there, you just check they're not there. Like that's it. That's just right.
(04:38):
It's basically for a standardized assessment. And that's it. They don't talk about it as it affects the developmental trajectory at all.
And so that was a huge eye opener for me. And so that became kind of my obsession.
There weren't classes that were teaching this at the time. This was seven, eight years ago, maybe there really wasn't much out there.
(05:03):
In terms of, you know, easily accessible information. So I read all the books that were out there on primitive reflexes, all the articles that I could find.
And I started to notice the patterns.
And it really is just a pattern of movement that you're looking for and you're looking for these patterns in kids, you're looking at what they should look like, what they shouldn't look like, where are you noticing these inconsistencies or really just these patterns of movement and how they're affecting their everyday function.
(05:32):
But then I came to realize after a few years of getting good at that, that everything I was working on with these kids from like a kind of home programming, just all the things that they needed to work on were things that skills that they should have picked up in infancy.
And I needed to know more. I needed to know why. Why were all of these kids at six, seven, eight, nine, 10, coming to me with issues that should have been resolved or dealt with when they were six months old or three months old.
(06:01):
I didn't understand why.
What kind of issues were you looking at?
So, so for example, I was basically in terms of integrating reflexes, all of those should integrate pretty much most of them should integrate by the first 12 months of life.
And it happens if we naturally progress through all of the movements that our body was meant to do, we're supposed to turn our head side to side, we're supposed to look up and down, we're supposed to be able to track through a full range of motion with our eyes, we're supposed to be able to crawl.
(06:29):
We're supposed to be able to and we're supposed to do all that typically, you know, on all fours, that kind of thing. And so what I was having to do with all of my older kids, really all of my kids was get them back on their belly.
We were having to go back and tell me time and skills that should have been acquired then. And so what happens then is that's where we develop eye movements. Like that's really where our eyes start to separate from our body.
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Not physically, I mean we start to independently have our torso and we strengthen our eyes. We also work on convergence, which is watching something as it comes closer to your face and divergence and all of those skills and then we get that when we crawl but if we crawl kind of sideways or asymmetrical, that doesn't work well.
And so all of these skills that these kids, what I was having to work on, that I was seeing in these older kids were really skills that should have been sharpened in that first, you know, really six months of life, six, eight months a year.
(07:31):
And so I was having to go back and work in this kind of developmental phases first year with everybody. And I still do, but I needed to understand why I still was like what, what is happening to our kids.
And yes, there's the back to sleep campaign which as you know, you know it puts baby sleep around their backs thanks to SIDS risk all those things so that's definitely a huge limiting factor when it comes to movement and opportunities for movement with our children so that plays a little bit of a role in it.
(08:03):
And so I essentially went and I took the tummy time method class by Michelle Emmanuel. That was my first intro to infant development and it really opened my eyes to things that was was available at the time and so from there, it was a jumping off point for me because I took a lot of different classes I took
(08:25):
tons of classes on tongue ties and jaw stability and jaw movement and breathing and airway and I took my functional therapy classes I took everything I could possibly afford at the time.
And you know over the last, and that was about seven years ago which when I really started to dive into infant specific work. And that's when I really started to understand the connection between feeding skills.
(08:53):
So there's, so I didn't want to be a feeding therapist feeding therapy was not interesting to me at all in the least sensory based feeding didn't appeal to me. But I, but what I learned very quickly was that feeding is a, it requires a whole lot of coordination infant feeding, especially, and
that's where we can start to see some of this coordination breakdown. And obviously with feeding comes sucks while we'll breathe sucks while it sucks while a breeze so breathing is a huge component of that.
(09:25):
And that's where I realized that in order to understand this well I had to understand what was happening with these babies when they were eating, and where were things breaking down where were these kids taking what I called developmental detours.
And why. So, yeah, I accidentally became an infant feeding specialist.
(09:51):
Totally not what I set out to do or become when I first became an OT but it makes all my big kids make sense.
If I understand the early few months of development and what these babies are struggling with and then what happens when they should be using these reflexes the way that nature intended but what gets in the way.
(10:17):
And why these babies are struggling so much and then why they take these shortcuts and why they don't crawl and you know why they just jump up to to walking.
It just made it all make so much sense. And so that's, that's kind of my journey so I basically just kept going backwards.
I kept rewinding and rewinding and rewinding to where to a to a level that at least I understand it right. So, could I go even further probably like cranial nerves or something that I'm starting to understand a lot more about now, but certainly haven't mastered yet.
(10:50):
And again, that's another layer of understanding for me that I'm, I'm slowly adding into my daily practice but I say the last probably four or five years has really been me just practicing. I've taken courses here and there.
But it's been a lot of practice and a lot of trial and a lot of error and a lot of me recognizing patterns. And I've added some breathing courses there too which has been also another layer for me to understand more about what I was seeing and why these things made sense to me like I could inherently see the
(11:22):
patterns, but I needed to understand why why these work for these babies why they didn't work for these babies etc.
And so, yeah, so this is where you know when I first started working with babies I started working with a team I was in Nashville, Tennessee at the time and I started working with a team of local, IBCLC there and couple of the dentist and then I started developing, you know, my, my colleagues
(11:46):
I was like my airway focused colleagues I would say about the time it wasn't even really airway it was more like tongue tie focused, because it wasn't really the thing that was looked at yet although we knew that that was coming it was more but that's been relatively new.
Yeah, we were called tie savvy clinicians I guess is the way that that was sort of referred to her if I was looking for people to join my team or to kind of vet them when I was, you know, meeting them for lunch or whatever. I wanted to know more about that so there was my
(12:16):
therapist in Nashville who was starting a practice then and she was, you know, diving into that world of airway health and development as well and so it was starting it was fledgling, but it was all very new nobody knew how to talk about it.
And so, you know, that's where I started so I built that team and then I opened my other practice in Atlanta when I moved here about three years ago now, and then slowly built a team here to have by now I guess three years ago it really was more of an airway focused field, or
(12:50):
people starting to call themselves that, and I think that's still how I like to refer to my practice, depending on who I'm talking to and who actually understands what that means.
Because that airway piece is crucial so I mean I'm kind of jumping all over the place now but I do work with babies still primarily but I also have a caseload of older kids to an older right now I think my oldest is seven sometimes I see teenagers but not often.
(13:19):
Yeah, but you know and a lot of them, some are referred to me from airway focused practitioners, because they need they've recognized a need some sensory based needs or some postural based needs and it is part of an airway journey that they're on whether it's
expansion tongue tie release etc. But a lot of them are just referred because they're clumsy they're having behavioral challenges at school it kind of your more typical OT referrals, even right if I get a referral for a kid who needs help with their handwriting.
(13:52):
99% of the time there's also an airway component to really. Yes.
Because when we don't feed well and when we breathe well as an infant, we skip motor milestones or we avoid hard things, babies are really good at compensating with their shoulders and their torso.
(14:14):
So we get all these 10s babies 10s toddlers kids that skip crawling when we skip crawling we don't develop the muscles in our hand. Therefore, fine motor skills are affected. Sometimes it's just it's that simple, but it is all connected it's wild.
And so, yeah, it's really fascinating.
I would never I don't think in all the podcasts I've done.
(14:37):
I've heard handwriting maybe maybe somebody did say it and I apologize if I missed it but
it's just so huge that yeah just never would have occurred to me that there's something else to watch out for.
And again, it's not handwriting handwriting is not it is not a causation there is a correlation right. Yes, because we're avoiding movement patterns that
(15:01):
were challenging from the very beginning and at the beginning airway was a dictator airway is king always as you know I breathing.
Yeah, is the one thing that I mean, no matter what we have to breathe and so a human being will find a way to breathe and almost always it'll affect their posture.
It'll affect their posture because they are going to tilt their head right.
They're going to go back and they're going to arch while they're sleeping or they're going to tilt their head when they're walking right and so that's going to affect the way that they use their muscles the the way that those reflexes will or won't
(15:35):
affect their body and it's going to affect their coordination and everything trickles down from there.
So, it's really fascinating so that's what I love to do is kind of trace it backwards. And so, over the years I've started to ask.
I've essentially been working on more detailed questionnaires for parents when kids start with me so I have my own airway questionnaire now which is pulled from a lot of different resources but I found that, no matter what even if
(16:02):
it's coming to me for airway concerns parents one need to understand that I'm going to look at that. I need to look at how their kid choose I need to look at how they swallow I need to look at how they breathe.
That's so important because if their child breathing all the work that I'm doing with them, you know, once a week or the work that they're doing at home, it's not going to stick.
They're not restorative sleep. Never mind, you know, the, I mean, the open mouth posture during the day all that stuff in terms of craniofacial development it's all being affected but it's a multifactorial approach so.
(16:34):
Sure. And then, for me there's so much and what you said that I want to go back to so you're just got to bear with me.
I think I'll pause there so feel free to rewind.
Yeah, here we go. One of the first things that you said that I really just want to validate is because I personally think it's so important and we're hearing this a lot and people we we talked to you formed a team.
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Yes, it's not a silo when you're looking at a child you need this team because it really is a lot of and I just want to applaud that because that's that's massive and that's one of the biggest things we advocate for as too many of our partners.
And I think that's huge. And it's because of people like you that we are starting to see that happen across the US. So I think that's that's fantastic and parents listening.
(17:22):
That's something to look for, because you want to give your child this overall comprehensive help and support system.
So I think that's massive.
One of the other things that I think is interesting is you remember exactly how you worded it, you just rewind, you keep rewinding. You know, we hear this a lot. You know, it's also people are like, what's the root cause.
(17:45):
So I find that very interesting that your instincts where we'll just keep rewinding, keep rewinding until you find something that made sense to work with me in these kids. I think that's, that's pretty cool.
Thanks. Yeah, I mean, I just, again, if it's not working for me, then I need to figure out what works right so essentially being able to address the.
(18:06):
Yeah, I mean if we can address the root cause like if we can address the chewing and address the posture stuff we can address their tongue tongue position in their mouth we can address their open mouth posture their breathing skills, then we can start to change that kids overall
gross motor posture the way they hold themselves it up in a chair, all that stuff.
And we can build the strength that we need to then integrate those reflexes to then do all the things that they couldn't first do when they came to me as a as a toddler or however old they are so yeah, it's basically just a function of pool.
(18:39):
I mean, you can band aid things to a certain extent like there's so many courses out there that teach reflex integration but they don't actually really go into why they don't go in why these reflexes aren't integrating and so much of it has to do with that function or dysfunction and that first even
honestly three months of life.
So, yeah, I mean, and that's good row, but we see.
(19:01):
Well, yeah, we can see it now and you do. Yeah, and I think it's interesting to that you mentioned band aid because there's a lot of that and again this is no knocked anybody.
I swear I say this every podcast you don't know what you don't know this goes for parents it also applies to clinicians weren't taught this in medical school, but just giving them a pill and sending them on their way this is not the way to treat things like you said, let's rewind
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and I think we're starting to see that more and more just kind of across the board from your allied health professionals and clinicians. It's a new way of thinking, or I guess maybe it's an old way of thinking that we're going back to.
Yeah, I mean it's also daunting right and so a lot of therapists and you probably were going to ask me this but therapists when I'm talking to colleagues and they're asking how did I get into this field or how do I bring up this subject with with my patients.
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They're not here for airway focused therapy right I mean they do and I'm going to look at it but like how do I say oh by the way also your child has a very narrow palette and we need months of, you know, therapy or we need something else right we have to bring
another practitioner as we have to make this a team approach like this isn't just me. It's a lot more complicated than that how do I. Yeah, how do you approach that without completely flipping out a parent because as a parent I know my first reaction be.
(20:23):
Yeah, right like I was in here for that and so I always colleagues like it's a dance. It's a dance because you have to you have to get to know your families first and know what's their bandwidth. Right like and not dump this on a patient, you know, or a family like day one, unless
something's glaringly obvious and I feel like okay I'm willing to risk my relationship with them because this kid's health isn't jeopardy, then go send them to the NT I'm going to send them somewhere if I think they're, you know, obviously that always comes first but it's not something
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that comes up quickly I plant the seed I say I'm going to look at all of these things because it's connected.
And you know the nice thing is, I give them very detailed intake paperwork so my work asks a lot about early infancy, you know and if they they're bringing me a five year old like it makes parents think like well why are why is not asking me these questions right
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So it opens a door for me to say okay this is where I'm seeing these connections here, and I might not talk specifically about airway stuff but I might ask them or detailed questions about breastfeeding difficulties, you know what was happening there, why did they need a nipple shield
why were they on bottles for so long was that something that they intended or was that a choice that they had to make because breastfeeding failed it no judgment just you know right you just need to know sure what happened, where were the challenges.
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And so and I've given them an airway questionnaire, I want to know all about their sleep habits and so I've already planted a seed that I'm looking at this is important. And so even if I don't talk about it for a few weeks.
I'm going to bring it back up once I write their evaluation and I've, I've written up the significance of my findings in their report.
And then we'll let that parent sit on that. And then we discuss it afterwards and say okay so I think that in a referral to an airway focus practitioner. Here's the name of the people that I recommend.
(22:16):
When you're ready to talk about it. I'm here for you, basically, and some parents will ask right away like ooh I want to talk about this more. We've been noticing that I you know I don't like that my child snores.
I thought that maybe that was a red flag but my pediatrician brushed it off that kind of thing because I hear that a lot.
You know and it's sort of just, I give them information I open the door. I'm approachable I keep dropping nuggets and hints depending on what I'm seeing throughout my sessions and what I feel is relevant for that child and then we just kind of we approach it when it's time I guess
(22:52):
to meet them where they are right. Definitely have to meet them where they are and you have to respect that it is a journey like it's not something that we can just go to the ENT get our tonsils and adenoids removed and then we're done which is a lot of parents believe.
Most parents come to me and say my child snores and even before and if I bring up this happens to me often actually they go get they go to the ENT they circumvent my team.
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They go to who they're comfortable with or who their friends have referred them to, because this is what they know other people have done. They get their child's tonsils and adenoids removed because it's a quick fix for them.
Right.
Things get better for a month or two or three. The snoring stops, and then it comes back. It always comes back.
And that's where we have a very gentle I told you so moment. And we sit down and they say okay so I'm noticing these things again I think it's time that I make an appointment with your airway focused dentist usually that's how it goes.
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And that's okay. They had to do what they felt.
Exactly was right for their child.
Right and what was comfortable for them and what was within their financial means to because that's a huge one this can be a very expensive journey.
And there's no shame in that there's just recognizing where they are what they're ready to hear and me serving as that resource for them and I'm kind of like the quarterback when it comes to a lot of this stuff.
(24:11):
Yeah.
And we read that a lot too from from other occupational therapists myofunctional therapists it's you you're kind of the the.
I like the quarterback analogy but you're you're this pivotal piece because you can shoot in directions. Yeah and you're and you're connecting everyone together.
Yeah we're really triaging like and just because it really is the parents that you know we're that usually the practitioner that they have a strong relationship with because they're seeing us weekly or on a very regular basis.
(24:41):
We get to know their families we get to know their child and they trust us they should right yeah yeah my face they do.
And so they're the ones that say okay you're the one like I'm going to go to you with my questions you know and so they they'll hopefully I am that sounding word for them and can steer them in the right direction.
And you know but then this I started talking about this because you brought up about band aids.
(25:07):
And it's also like sometimes we just have to do what we need to do to get through this stage or phase of life.
You know even if I'm not working with a child anymore but they've you know they're on anxiety meds or they're on ADHD meds because and we know there's a sleep disorder problem of all of this but right now we are medicating the problem because this is how it's showing up and this is
(25:32):
what we're doing with no judgment like that's what we're doing I'm meeting them where they are we're working with the skills that we have right now and they have the resources and the information to do something about it later and and I trust
they're ready when they're ready and often I do have families that will email me a year later and say hey can you give me the name of that dentist again I think we're ready to do something and that's cool that's fine like yeah this is a it is a journey it is not as a journey easily fixed and quickly fix and even when
(26:02):
parents go and get like an airway scan or an airway focused evaluation sometimes they don't do anything with that either for months because they're not ready to but they've got the information and when they're ready they will hopefully so
exactly yeah and you know I'm glad you said it because there is no judgment right and parents take the guilt off because we're all doing the very best we can we all know that right and it is it's not as being all woo woo let's grab a trendy work but it is a journey that's
(26:31):
really important takeaway and everyone's journey is different and you've got to do as a parent what you think is right for your child as well as like you mentioned what's within your bandwidth as far as time goes emotionally financially you know do the best you can
yeah and I love that you're meeting them where they are and that's huge and you also mentioned tummy time yeah which I'll make sure I put a link to that episode because we did speak with Michelle Emmanuel is a great episode for anyone that hasn't heard it as well as a link to the first 1000 days fantastic
(27:06):
and I hope for parents to read even if your child is older you know I have old children still fascinating to read it and reflect back again not for parent guilt but you kind of become aware of missed opportunities or oh wait that didn't occur let me see it you know let's as you said rewind
(27:28):
I haven't seen any of the fallout of the patterns or the repercussions because of it. Yeah a lot of time. Yeah a lot of times parents when I'm asking them questions you know about patterns that I think that this child is likely falling into I'll say hey like, you know, how long do they
wear a bib for like oh yeah we went through three bibs a day until they were like 18 month old and I'll you know and then they're like is that a thing was that a thing that's a definitely a thing right like that's a thing and that's one of those things that like parents so much of this is normalized, you know thumb sucking
(28:00):
like thumbs up sucking to the age of two all the you know thumb sucking a pacifier use you know prolonged everything in terms of oral habits. Again it's normalized but is it it's indicative of difficulties are dysfunction because it's common it's not actually normal
it's not what should be normal. That's where you know sometimes a lot of times I am the person the first one to point things out like hey that's maybe something we should dive into or at least all of these you know by themselves aren't necessarily problems but they are indicative of patterns that you know are these clusters of behaviors or tendencies for this child to do that are indicative of things that maybe we need to look at a little bit further so yeah
(28:49):
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(29:16):
you're listening to airway first with today's guests occupational therapist Natalie Eudwin
you can find out more about the children's airway first foundation and our mission to fix before six on our website at children's airway first dot org
the calf website offers tons of great resources for both parents and medical professionals
(29:38):
visit our parents portal clinicians corner resource center and video library to see for yourself
we also encourage parents to join the airway huddle our facebook support group which was created for parents of children with airway and sleep related issues
you can access the airway huddle support group at facebook dot com backslash groups backslash airway huddle
(30:02):
as a reminder this podcast and the opinions expressed here are not a medical diagnosis if you suspect your child might have an airway issue contact your pediatric airway dentist or pediatrician
and now let's jump back into today's episode
(30:42):
and so you touched on a little bit and I kind of want to go back to it because you know and previous shows we've talked a little bit about primitive reflex and tummy time so yeah I'll definitely put links for anybody that missed those but we haven't talked much about sensory integration therapy
okay
so just kind of lay it out for parents you know what is it exactly what does that look like
(31:07):
okay um it's a really good question so I mean
OTS look at eight senses right so we have our five basic senses I mean and really not just OTS but developmental professionals are usually neurological professionals
we have a sense so we have our five basic senses which is you know the normal ones taste smell touch site
(31:30):
and then there's three others so there's your sense of your vestibular sense
your sense of movement we get a lot of information from our inner ear and our eyes
there's your sense of proprioception which is where you are in space so
your joints give you that information has a lot to do with gravity and pressure
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and then there's what's called interoception which is your inner sense like are you hungry are you thirsty are you nauseous do you need to go to the bathroom like that one basically
that is really hard for kids when the other ones break down but basically we've got this sensory system and that's what tells us how to do things right so it is our information receptors right so
(32:19):
we are always taking in information from our environment and in computations and well some of them are reflexive and a lot more of them are reflexive when we're babies
and we are responding somehow right so you talk to me I'm answering right but as an infant we have these reflexes that work with our it's called our sensory motor system it's it's our senses and our movement and how it all works together so
(32:44):
and it happens in our brainstem so our sensory system is so important because it starts to develop in utero especially our sense of touch and our movement and our
proprioceptive system those three senses happen more so in utero than any others those are the most fully formed and our sense of touch is our very first one
(33:08):
and it's it's our skin gives us that information but our skin is also our largest organ right them when kids are born premature or when we have some kind of birth trauma those senses are disrupted somehow
(33:29):
and that is a huge those have everything to do with the way we feed and the way that we coordinate our movements later on in life and so our job as a tease is to figure out where did this start to break down, you know and we have to base it
on these behaviors that we're seeing with kids and then work it all backwards and try to figure out what we need to do to give them what kind of information do we need to provide that person's body with to be able to then meet their sensory needs, you know and a lot of
(34:07):
people assume in a lot of the ways that sensory processing is presented there's like over responsive and under responsive and people don't understand that you can easily be both, you know, our sensory systems are very volatile they change all day
and it's just like I explained to parents like if you're driving in traffic and it's bumper to bumper and you've got kids screaming in the back seat and the, you know the radio's on and all of a sudden your kids get way louder, and then the song comes on and it's an X, it's an exceptionally loud song
(34:44):
and you've hit sensory overload, whereas if you weren't in bumper to bumper traffic and you were driving down a beautiful country road the windows were open, none of that might have bothered you right so like staying input different capabilities to process it right and so
as OTs our job is to figure out kind of what that kid's threshold is what are they missing, how does that inform what they're able to do and what they're not able to do but so much of it has to do with our feeding skills as an infant to
(35:17):
feeding again sucking, swallowing, breathing all of that coordination is it has to work well for us to then get to the next level right for us to be able to do what you need to do and so if it doesn't work well if there's a breakdown somewhere
then everything else will be affected the sensory systems happen, inform so much of the rest of our development later on in life, especially that first eight years like we are sensory sponges.
(35:48):
After that we're still taking in a lot of sensory information but a lot of our ability to process that has already been not solidified because we are neuro plastic but the first eight years of the work is there.
Is this why you see volunteers come in and hold the preemies they always have people in your volunteer to come hold the newbies the preemies is this why I mean this is that sensory thing is that
(36:16):
sure there's a huge component I mean touches touch the sense of touch is responsible for our sense of emotional security right so kids that have are excessively clingy have separation anxiety.
They have a really integrated sense of touch. And so they're extra sensitive sometimes or sometimes they need more so those are kids that are often clawing at their parents a lot they like to scratch or touch their faces.
(36:46):
They liked with their hands up their shirts they are very.
They are very sensitive to the way that they bond with their caregivers which is a bad thing to an extent right, but sometimes it goes to the end degree, and those children have a hard time separating from their parents, and sometimes there is a birth trauma or there is you
(37:08):
know, they were premature there was a kind of developmental component in utero, or during the birth process that happened to cause that but sometimes we don't know.
Sometimes kids, everything looks typical on paper they had a perfectly normal birth.
And, you know, everything went well so to speak, but they're still wired a little bit differently sometimes they need more input than your average kid and sometimes they need less or they're just more easily set off by certain things.
(37:36):
So, I like to explain that to parents I like to teach them about their child's nervous system, particularly so they can understand what they need. What does that look like because some parents are not.
They can't read their children as well and that there's no fault to them like that's just not what they're good at right and they might have their own sensory needs, which is huge.
(38:00):
So, a lot of parents are easily set off, especially during that early infancy that fourth trimester by certain things that can be.
They learn a lot about their sensory needs during that period of life, but they don't know how to get their needs met they don't know how to adapt their environment they don't know how to do because they're in survival mode right right.
(38:25):
So, learning about their own sensory processing abilities or needs or habits etc, as well as their child's can help them to.
So a lot of it is education, but I mean the sensory piece informs the movement piece, which kind of they go hand in hand we can't do one without the other so.
(38:46):
Yeah, and that totally makes sense basis of that really.
So, when you're assessing a patient and you're putting together a program for them for them and I know it's different right every child's different every family is different.
What is that just kind of at a high level just so parents get a good understanding who may not have worked with anyone like you before. What is that process look like.
(39:09):
So let's talk different ages I guess because I mean okay yeah let's talk.
Wow, let's talk with the difference first yeah.
Okay, so infants. Let's say a baby, I don't know, three months old comes to me and they're having feeding difficulties.
The last thing I look at in my evaluation is their mouth, even though that's the thing that their parents want help with because I'm going to look at their body first.
(39:33):
I want to look at all the systems that have been affected I want to look at. I want to make sure everything that is should be there is there.
And what I mean is I'm looking at reflexes first I'm looking I'm touching their feet I'm looking at their backs I'm looking for tension I'm looking for symmetry.
So I'm, I'm watching but I'm moving the baby I'm handling them a little bit. And then I'm at three months old I'm going to see okay can they can they look both ways with their eyes can they turn their head side to side well.
(40:02):
If one side's more difficult than the other, we have to work on these things that's part of that's going to affect their feeding skills.
And from the very beginning, when a baby baby walks in when a parent walks in with it into my office, I'm watching and listening for how they breathe from the very beginning.
So usually they're sitting across from me on my sofa, and getting a history from them and I'm watching that baby.
(40:26):
And I'm, I'm watching the way that they're positioned or postured in their hand I'm watching their chest rise and fall I'm, I'm watching the color of their skin if it's changing I'm listening, which part of breathing is listening.
You know and sometimes I'll pause the parent and say hey, do they always sound like that. And the parent will say.
Yeah, I guess they do but I've never really noticed like that's just what they sound like like, you know and then I explain okay we shouldn't really be hearing that all the time but.
(40:53):
So there's I'm looking at all of that first looking at the whole big picture first and how it's all been affected.
And then maybe on their left on their right sides on their tummy. And I want to make sure can they move through that whole range of motion that they were intended or that they should be doing around three months old and if not I'm going to give, we're going to practice and we're going to move that baby
(41:17):
different movements some of its assisted with me and I have the parents demonstrate and practice with me in my office as well. I work virtually a lot too so the parents are then hands on with the infants all the time.
And I want to make sure that they're seeing what I'm seeing and they're feeling what I'm feeling. And then I'm going to make them a home program so I'm going to give them, I don't know, or five six little movements activities, things to do with their baby different
(41:44):
ways to move them to encourage more natural movement patterns and usually a lot of strength building.
And so, and then I'll assess their oral function. I'll see what their suck is like. And, you know, can they suck do they have a phasic bite what is their rooting reflex like I'm looking at all of these things.
And then the last thing I'm looking at our oral structures. I'm looking for tethered oral tissues I'm looking at their palate shape. And I'm, I'm feeling around basically but that's the very last piece of the puzzle, because I want to see what they can do first.
(42:18):
I don't want to be biased by what I'm seeing.
Right.
And that makes sense. Yeah, parents often come in and they've seen other professionals too and I'll say look I don't want to see that about right now.
I want to make my own observations and you know I don't want to cloud my judgment with that and so. Yeah, so that's kind of what an initial session would look like.
It's, I call it a developmental feeding evaluation because it truly does look at all the systems I'm looking at reflexes eyes breathing, I mean and virtually to parents often ask, you know how do you do that on the computer.
(42:51):
I'm looking for patterns, and it's not that hard. And if I know I've learned over the years, what questions to ask. And usually those are really really helpful and how to get the right information out of parents to but it's it's a lot of observation skills as well.
And so, yeah, and then, you know, follow up sessions with infants is a lot of piggybacking I wait a couple weeks till I see them again and we're going to build on the skills that now we've acquired and what happens next. And so it's, it's a lot of a lot of gross motor skill
(43:22):
building, because I work outside in so we're working on the big supporting missiles first.
The neck the shoulders, you know we're working on breathing skills in different positions.
And then we're also working on our motor skills as we're ready to do them.
And how would this different than from let's say, let's jump a little bit like four or five year old but maybe comes to you. Okay, so that's a really good question so for like my older kiddos I mean I'm, you know, obviously I'm not moving them right so they're
(43:57):
they're they're reactive it's a sweaty session. But I'm, you know, once I figure once, once they trust me and I trust them and we have a little bit of a rapport.
Let's say a screening is when I screen a kid to see okay what's going on I'm going to look at their reflexes I'm going to, I'm going to get them on all fours I'm going to see what happens when they turn their head different ways.
(44:18):
And it's hard to check this takes maybe, maybe three to five minutes max. It looks like we're crawling. It looks like we're, I mean it's really very and then we stand up we do some stuff with our arms we turn our head side to side we hold our arms it's not very difficult.
We pretend to be certain animals, and I'm saying it looks more like play doesn't it looks totally like play. Yeah, and we, you know, I'm just directing it at this point.
(44:43):
And I'm going to always look at their eyes so I muscles function that is a huge component as well because eyes direct head movement. Initially, most of my kids really all of my older kids have some kind of eye muscle weakness.
And that's not because they were born that way necessarily it's because they never used that full range of motion. They maybe only turn their head well to the left and then they turned it partially to the right.
(45:10):
That was good for them and they figured out how to roll they didn't need to do that and those muscles remained weak on that right side. Oftentimes there's a, there's a pretty significant difference between one eye versus the other.
And a lot of them struggle with convergence so bringing eyes together here which has a lot to do with bilateral coordination, the use of both sides of our brain and midline function so sucking breathing all that happens here in the center.
(45:38):
And if we can't do things here with both eyes. We get tired really quickly and we avoid stuff we tend to use one side more than the other.
And so eyes are a huge part of my screen as well. And eye muscles also can really show up when we have a lot of visual fatigue, especially for older kids.
As they start doing kind of more academic or sit down tasks at school or play groups.
(46:02):
And they can show up as behavioral issues as well because now stuff's hard. And so sitting and look at a book or sitting and looking at a coloring page for more than, you know, 10 seconds like they're done they're out of there.
Right.
But then I'm also looking at their posture I'm looking at their core strength I'm looking at their shoulder and neck strength because those are things that should have.
And so if they had that solid foundation as an infant, we should also still see that as a four or five year old but usually they can't do a chin tuck when they're laying on their back and their heads hanging off the edge of the thing we have some serious weakness there, but they've compensated with momentum.
(46:38):
So they just move really fast and they can sit still they can sit still because if they sit still they fall over.
So with those kiddos. Yeah, so I'm looking at gross motor skills I'm looking at reflexes. The sensory stuff is a bit more nuanced, sometimes I'll give them a questionnaire to tease stuff out to know what questions I need to ask a front.
(47:01):
But I'll often do a little chewing swallowing assessment will go and have a snack basically again just looks like we're having a snack but I'm watching.
And sometimes I'm filming so I can go back and look at it later. And that tells me a lot about their ability to breathe to, because if we can't they'll make that face when they swallow right.
(47:23):
Yeah, watch how they swallow I watch how they're chewing. I'm listening. And then we'll also do stuff where we get their heart rate up right so I'll have them run in my office will have them jump I'll have them do animal walks things where you know I shouldn't hear them panting at the beginning and maybe
I'll have them do but I want to see are they mouth breathing are they nose breathing. You know I'm looking at all that, while I am assessing other things to breathing is one of those it's always there it's always underlying everything but I guess I've gotten good at noticing
(47:53):
when things don't sound right and when things don't look right.
And often for most of those kids I'll usually get to a point where I asked the parents if it's okay if I lift their shirt up to, and I at least want to see, you know, below their nipples right I want to see the rib cage I want to see what's happening.
And I get them, you know, laying on their back and then sometimes I get them on their back over a yoga ball or over a peanut ball. I want to see are you watching their diaphragm at that point.
(48:18):
I'm watching their diaphragm I'm looking for their ribs or do their rib cages wing out is are they asymmetrical a lot of times there's an asymmetry there.
And I'm oftentimes seeing some abdominal separation there too so.
So, it's all just part of the package right like none of it is super worrisome or like a red flag in and of itself but it tells me a story. And so I'm always trying to figure out okay like, why is this kid having trouble sitting like this why is this kid having trouble holding
(48:52):
their utensil. You know, why do they bear down so hard on a crayon what. Why can't they hold a quadruped like an all fours position for longer than 10 seconds without falling over, you'd be surprised, it's really a struggle in all four.
Really. Yes, really. Wow, your legs they fall over they're silly all the things like it's really difficult for kids especially if crawling was difficult as a baby.
(49:17):
So that would make sense yeah yeah I like you. I think it was something when we were emailing back and forth and you mentioned, you know, part of what you just connect the dots.
Yeah, I mean, I think for me.
As an OTA realized like, you know, it doesn't matter what I do in my sessions. If what I'm doing doesn't make sense to the parents or the caregivers there. So, it's all about education and explanation and really, I have to illustrate.
(49:48):
They need to be able to see what I'm seeing like yes I can look at, I can see it, you know, in two seconds and I can make these assessments and I can understand okay, oh yeah that's that shouldn't look like that or that shouldn't be there that's dysfunctional but if the parent doesn't
understand what I'm seeing, then the buy-in isn't as good first of all. And they're not going to understand why I've asked their kid to, you know, do bare walks at home, like why is this important as opposed to like okay I said do it but I want them to understand
(50:21):
what we're trying to get out of the task.
Because they need to understand, like it's just the more understanding there is the more comprehension the more everybody's on board truly. I was gonna say the more compliance right. Yeah, the more compliant as a parent then you're going to okay I can make this one we're going to go do the bare
walks let's do it. Well, and what's really cool is you know I'll get a, well it works both ways so I have infants in my office and they oftentimes have toddler siblings or older siblings, and the parents as I'm explaining things the parents are going, do you see three year olds.
(50:55):
Can I bring my three year old have some questions is that okay if I ask and I love them to ask because that means they're connecting the dots. And that's their frame of reference. They might this is kid number two and so they only have kid number one to compare it to and maybe they also had a bit of a shaky foundation
as well so their, their sense of normal, or typical isn't the same as mine right and so I need to go. What they're, yeah I mean where are they starting from, how do they understand this and what's normal to them but then also works both ways when I have you know maybe the three
(51:26):
years in here, and somebody, you know, a friend of a friend referred them to me to bring their three year old in because they were having difficulty chewing, or they were too rough on the playground or something, and then suddenly they say, Oh, you know so they might have an infant at home as well.
And now they're thinking, Oh, I, I, maybe we need to bring that child in for not to evaluate because these things, you know as I'm explaining okay these things should have happened early on did they crawl well did they you know they struggle with nursing etc.
(51:56):
Got a nursing infant at home the parents starts to connect the dots and think, Oh yeah maybe we need to look further into this. I love it.
And then I get the parents that ask questions about themselves to. But again, that's really important because it's not like we can just look at this in a bubble I want them to understand how this is affecting everybody.
I'm changing their plans and it's really helpful.
(52:18):
And that's fascinating. And not passing me and it's fantastic because they're definitely on board they're open to learn and now you have a collaboration not just with your medical allies but now you have a collaboration with parents.
And I love it when they're like, Oh, I'm going to go explain this I need I need my husband to talk to you.
Yeah, I love that when they get the whole family on board and everybody's on their own airway issues and oftentimes they do they go.
(52:43):
They run in families. Yeah and the parent but the parents then go get their own evaluations and that makes me happy because truly they're they're seeing the value right in my work, not just my work it's not about me.
It's about the value in what we're doing right and right.
And this is important from a longevity standpoint. Truly, sure. Yeah, it's going to impact their health span and their life and which is amazing.
And it's one of those things that I don't care how old you are.
(53:07):
Once you see it, you can you can you can't and see it.
I have stood in line with my children and I get this like, please don't please don't.
I know I see that child. Please don't.
All right. All day long.
Yeah, because now they're tiny little advocates like running amok with their friends, your mouth be there. Oh, you blah, blah, blah.
You know, so but once you see it, you can take ownership of it and you can share with other people and you can save more people.
(53:34):
So yeah, just be the resource to steer people in the right direction when they're ready.
Yeah, for sure. Exactly when they're ready. I love that so much.
Well, I cannot thank you enough for being on here and typically at the end and we've covered so much.
So I'm going to put you on the spot net at the end of an episode. I always turn it back over to my guest to let you have final thought for our parents.
(53:59):
Okay. Yes, definitely.
Definitely on the spot.
Final thought just I guess trust your gut as a parent don't be afraid to ask for help.
And, you know, even like I'm on Instagram a lot lately and I love that parents, you know, the don't be afraid to reach out to professionals and ask them questions.
We're all just, you know, on our own journey to and truly here to learn with you all and I think that, you know, and if it's a question where you feel like, okay, maybe this is something, you know, this is a very involved question.
(54:33):
I'm going to say maybe we need to book a console or maybe you need to ask this person because this isn't in my wheelhouse etc. But we'll at least refer you to the professional that can give you the best answer but don't be afraid to ask, ask the questions.
And the earlier you deal with this stuff the better truly because the longer you wait more habits you have to undo so but at the same time in the other regard, we can still deal with this later on as well.
(54:57):
So never too late.
And when we can do it in phases if it seems overwhelming, you know, and bite off a little bit at a time that's okay too. We can make really long term plans so.
That's awesome.
Well, thank you so much for coming on today I really appreciate it.
Thanks again to today's guest, Natalie Udwin for joining us on the show, and to each of you for listening.
(55:21):
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(55:51):
Today's episode was written and directed by Rebecca St. James, video editing and promotion by Ryan Drawn, and guest outreach by Kristi Bocheevian.
And finally, thanks to all the parents and medical professionals out there that are working hard to help make the lives of kids around the globe just a little bit better.
Take care, stay safe, and happy breathing everyone.
Hi everyone, and welcome to another video.
(00:29):
Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First Foundation.
I'm your host, Rebecca St. James.
My guest today is occupational therapist Natalie Udwin.
NET is an infant development, airway and reflexive feeding specialist who is known to most people by the name of NET, the baby OT.
(00:52):
NET has a BA in studio art from Whitman College and a master's in occupational therapy from Milligan College and has been an OT for 12 years and specialized in infant development for seven years.
Sometime around 2015, NET's eyes were open to the world of reflexive integration, which completely transformed their practice.
(01:15):
Finally, NET was seeing skills were sticking and carrying over to other aspects of daily life that just weren't happening before for their patients.
It was the foundational approach to therapy that NET had been trying to figure out for years.
During their investigation, NET quickly learned about the importance of human connection and emotional regulation in early infancy,
(01:38):
as well as the developmental importance of strong breathing and oral motor skills to support a lifetime of healthy growth.
It was now all starting to make sense.
The next step was to start working with infants and put all of this new knowledge to the test.
NET, alongside some incredible mentors and colleagues, has spent the past seven years mastering their understanding of infant development
(02:04):
to not only become an infant development specialist, but to create what is now the foundation of the AOT,
which is a holistic, airway-focused approach to therapy for children of all ages.
You can find out more about NET on Instagram at nat-the-baby-OT.
(02:25):
And now, let's jump into my interview with today's guest, Natalie Goodwin.
All right, perfect. Great. Thank you for joining us today. I really appreciate it, Natalie.
You're welcome.
Thanks. All right, well then, let's just jump right in, because one of the things that I have found in hosting this podcast
is a lot of the people that I talk to have had their own airway journey or something that put them on this path.
(02:50):
So how did you end up in your particular field?
So it wasn't personal, actually, for me at all.
And most people call me Nat. I'm fine with Natalie, too, but most people call me Nat. That's kind of...
Nat, it is.
Cool. So let's see. My airway journey was not personal.
I've been a pediatric OT about 13 years now, and mine was because I kept wanting to go backwards in airway, essentially, as the source.
(03:22):
And so is the foundation of everything we do. And so I'll explain that.
So basically, I always knew I wanted to work with kids. I wanted to work some kind of medical field and art.
And I couldn't figure out how to meld the two. And OT, via a lot of trial and error, I discovered OT, and it was the perfect profession for me.
But after a few years of building obstacle courses and messy play and all that stuff, I was getting stuck with my kids.
(03:49):
I felt like I got to a point where I couldn't make things stick anymore. And I was asking a lot of questions and doing a lot of reading, and I couldn't crack the code.
And I worked with a student, actually, from a local university who had been from California, long story short, had worked in a clinic there and said, hey, have you checked this kids reflexes?
And I said, what are you talking about? And so she said, oh, let me explain it to you.
(04:13):
So she gave me a little handout from her old clinic that she worked at. And within a week, I was devouring as much information as I could get my hands on.
And so primitive reflexes, reflex integration, what does that mean? What does it mean when they're not integrated, all that stuff?
Because in grad school, we just learned about how to check for reflexes in an infant, like the zero to 12 month range.
And then if they're not there, you just check they're not there. Like that's it. That's just right.
(04:38):
It's basically for a standardized assessment. And that's it. They don't talk about it as it affects the developmental trajectory at all.
And so that was a huge eye opener for me. And so that became kind of my obsession.
There weren't classes that were teaching this at the time. This was seven, eight years ago, maybe there really wasn't much out there.
(05:03):
In terms of, you know, easily accessible information. So I read all the books that were out there on primitive reflexes, all the articles that I could find.
And I started to notice the patterns.
And it really is just a pattern of movement that you're looking for and you're looking for these patterns in kids, you're looking at what they should look like, what they shouldn't look like, where are you noticing these inconsistencies or really just these patterns of movement and how they're affecting their everyday function.
(05:32):
But then I came to realize after a few years of getting good at that, that everything I was working on with these kids from like a kind of home programming, just all the things that they needed to work on were things that skills that they should have picked up in infancy.
And I needed to know more. I needed to know why. Why were all of these kids at six, seven, eight, nine, 10, coming to me with issues that should have been resolved or dealt with when they were six months old or three months old.
(06:01):
I didn't understand why.
What kind of issues were you looking at?
So, so for example, I was basically in terms of integrating reflexes, all of those should integrate pretty much most of them should integrate by the first 12 months of life.
And it happens if we naturally progress through all of the movements that our body was meant to do, we're supposed to turn our head side to side, we're supposed to look up and down, we're supposed to be able to track through a full range of motion with our eyes, we're supposed to be able to crawl.
(06:29):
We're supposed to be able to and we're supposed to do all that typically, you know, on all fours, that kind of thing. And so what I was having to do with all of my older kids, really all of my kids was get them back on their belly.
We were having to go back and tell me time and skills that should have been acquired then. And so what happens then is that's where we develop eye movements. Like that's really where our eyes start to separate from our body.
(06:54):
Not physically, I mean we start to independently have our torso and we strengthen our eyes. We also work on convergence, which is watching something as it comes closer to your face and divergence and all of those skills and then we get that when we crawl but if we crawl kind of sideways or asymmetrical, that doesn't work well.
And so all of these skills that these kids, what I was having to work on, that I was seeing in these older kids were really skills that should have been sharpened in that first, you know, really six months of life, six, eight months a year.
(07:31):
And so I was having to go back and work in this kind of developmental phases first year with everybody. And I still do, but I needed to understand why I still was like what, what is happening to our kids.
And yes, there's the back to sleep campaign which as you know, you know it puts baby sleep around their backs thanks to SIDS risk all those things so that's definitely a huge limiting factor when it comes to movement and opportunities for movement with our children so that plays a little bit of a role in it.
(08:03):
And so I essentially went and I took the tummy time method class by Michelle Emmanuel. That was my first intro to infant development and it really opened my eyes to things that was was available at the time and so from there, it was a jumping off point for me because I took a lot of different classes I took
(08:25):
tons of classes on tongue ties and jaw stability and jaw movement and breathing and airway and I took my functional therapy classes I took everything I could possibly afford at the time.
And you know over the last, and that was about seven years ago which when I really started to dive into infant specific work. And that's when I really started to understand the connection between feeding skills.
(08:53):
So there's, so I didn't want to be a feeding therapist feeding therapy was not interesting to me at all in the least sensory based feeding didn't appeal to me. But I, but what I learned very quickly was that feeding is a, it requires a whole lot of coordination infant feeding, especially, and
that's where we can start to see some of this coordination breakdown. And obviously with feeding comes sucks while we'll breathe sucks while it sucks while a breeze so breathing is a huge component of that.
(09:25):
And that's where I realized that in order to understand this well I had to understand what was happening with these babies when they were eating, and where were things breaking down where were these kids taking what I called developmental detours.
And why. So, yeah, I accidentally became an infant feeding specialist.
(09:51):
Totally not what I set out to do or become when I first became an OT but it makes all my big kids make sense.
If I understand the early few months of development and what these babies are struggling with and then what happens when they should be using these reflexes the way that nature intended but what gets in the way.
(10:17):
And why these babies are struggling so much and then why they take these shortcuts and why they don't crawl and you know why they just jump up to to walking.
It just made it all make so much sense. And so that's, that's kind of my journey so I basically just kept going backwards.
I kept rewinding and rewinding and rewinding to where to a to a level that at least I understand it right. So, could I go even further probably like cranial nerves or something that I'm starting to understand a lot more about now, but certainly haven't mastered yet.
(10:50):
And again, that's another layer of understanding for me that I'm, I'm slowly adding into my daily practice but I say the last probably four or five years has really been me just practicing. I've taken courses here and there.
But it's been a lot of practice and a lot of trial and a lot of error and a lot of me recognizing patterns. And I've added some breathing courses there too which has been also another layer for me to understand more about what I was seeing and why these things made sense to me like I could inherently see the
(11:22):
patterns, but I needed to understand why why these work for these babies why they didn't work for these babies etc.
And so, yeah, so this is where you know when I first started working with babies I started working with a team I was in Nashville, Tennessee at the time and I started working with a team of local, IBCLC there and couple of the dentist and then I started developing, you know, my, my colleagues
(11:46):
I was like my airway focused colleagues I would say about the time it wasn't even really airway it was more like tongue tie focused, because it wasn't really the thing that was looked at yet although we knew that that was coming it was more but that's been relatively new.
Yeah, we were called tie savvy clinicians I guess is the way that that was sort of referred to her if I was looking for people to join my team or to kind of vet them when I was, you know, meeting them for lunch or whatever. I wanted to know more about that so there was my
(12:16):
therapist in Nashville who was starting a practice then and she was, you know, diving into that world of airway health and development as well and so it was starting it was fledgling, but it was all very new nobody knew how to talk about it.
And so, you know, that's where I started so I built that team and then I opened my other practice in Atlanta when I moved here about three years ago now, and then slowly built a team here to have by now I guess three years ago it really was more of an airway focused field, or
(12:50):
people starting to call themselves that, and I think that's still how I like to refer to my practice, depending on who I'm talking to and who actually understands what that means.
Because that airway piece is crucial so I mean I'm kind of jumping all over the place now but I do work with babies still primarily but I also have a caseload of older kids to an older right now I think my oldest is seven sometimes I see teenagers but not often.
(13:19):
Yeah, but you know and a lot of them, some are referred to me from airway focused practitioners, because they need they've recognized a need some sensory based needs or some postural based needs and it is part of an airway journey that they're on whether it's
expansion tongue tie release etc. But a lot of them are just referred because they're clumsy they're having behavioral challenges at school it kind of your more typical OT referrals, even right if I get a referral for a kid who needs help with their handwriting.
(13:52):
99% of the time there's also an airway component to really. Yes.
Because when we don't feed well and when we breathe well as an infant, we skip motor milestones or we avoid hard things, babies are really good at compensating with their shoulders and their torso.
(14:14):
So we get all these 10s babies 10s toddlers kids that skip crawling when we skip crawling we don't develop the muscles in our hand. Therefore, fine motor skills are affected. Sometimes it's just it's that simple, but it is all connected it's wild.
And so, yeah, it's really fascinating.
I would never I don't think in all the podcasts I've done.
(14:37):
I've heard handwriting maybe maybe somebody did say it and I apologize if I missed it but
it's just so huge that yeah just never would have occurred to me that there's something else to watch out for.
And again, it's not handwriting handwriting is not it is not a causation there is a correlation right. Yes, because we're avoiding movement patterns that
(15:01):
were challenging from the very beginning and at the beginning airway was a dictator airway is king always as you know I breathing.
Yeah, is the one thing that I mean, no matter what we have to breathe and so a human being will find a way to breathe and almost always it'll affect their posture.
It'll affect their posture because they are going to tilt their head right.
They're going to go back and they're going to arch while they're sleeping or they're going to tilt their head when they're walking right and so that's going to affect the way that they use their muscles the the way that those reflexes will or won't
(15:35):
affect their body and it's going to affect their coordination and everything trickles down from there.
So, it's really fascinating so that's what I love to do is kind of trace it backwards. And so, over the years I've started to ask.
I've essentially been working on more detailed questionnaires for parents when kids start with me so I have my own airway questionnaire now which is pulled from a lot of different resources but I found that, no matter what even if
(16:02):
it's coming to me for airway concerns parents one need to understand that I'm going to look at that. I need to look at how their kid choose I need to look at how they swallow I need to look at how they breathe.
That's so important because if their child breathing all the work that I'm doing with them, you know, once a week or the work that they're doing at home, it's not going to stick.
They're not restorative sleep. Never mind, you know, the, I mean, the open mouth posture during the day all that stuff in terms of craniofacial development it's all being affected but it's a multifactorial approach so.
(16:34):
Sure. And then, for me there's so much and what you said that I want to go back to so you're just got to bear with me.
I think I'll pause there so feel free to rewind.
Yeah, here we go. One of the first things that you said that I really just want to validate is because I personally think it's so important and we're hearing this a lot and people we we talked to you formed a team.
(16:56):
Yes, it's not a silo when you're looking at a child you need this team because it really is a lot of and I just want to applaud that because that's that's massive and that's one of the biggest things we advocate for as too many of our partners.
And I think that's huge. And it's because of people like you that we are starting to see that happen across the US. So I think that's that's fantastic and parents listening.
(17:22):
That's something to look for, because you want to give your child this overall comprehensive help and support system.
So I think that's massive.
One of the other things that I think is interesting is you remember exactly how you worded it, you just rewind, you keep rewinding. You know, we hear this a lot. You know, it's also people are like, what's the root cause.
(17:45):
So I find that very interesting that your instincts where we'll just keep rewinding, keep rewinding until you find something that made sense to work with me in these kids. I think that's, that's pretty cool.
Thanks. Yeah, I mean, I just, again, if it's not working for me, then I need to figure out what works right so essentially being able to address the.
(18:06):
Yeah, I mean if we can address the root cause like if we can address the chewing and address the posture stuff we can address their tongue tongue position in their mouth we can address their open mouth posture their breathing skills, then we can start to change that kids overall
gross motor posture the way they hold themselves it up in a chair, all that stuff.
And we can build the strength that we need to then integrate those reflexes to then do all the things that they couldn't first do when they came to me as a as a toddler or however old they are so yeah, it's basically just a function of pool.
(18:39):
I mean, you can band aid things to a certain extent like there's so many courses out there that teach reflex integration but they don't actually really go into why they don't go in why these reflexes aren't integrating and so much of it has to do with that function or dysfunction and that first even
honestly three months of life.
So, yeah, I mean, and that's good row, but we see.
(19:01):
Well, yeah, we can see it now and you do. Yeah, and I think it's interesting to that you mentioned band aid because there's a lot of that and again this is no knocked anybody.
I swear I say this every podcast you don't know what you don't know this goes for parents it also applies to clinicians weren't taught this in medical school, but just giving them a pill and sending them on their way this is not the way to treat things like you said, let's rewind
(19:26):
and I think we're starting to see that more and more just kind of across the board from your allied health professionals and clinicians. It's a new way of thinking, or I guess maybe it's an old way of thinking that we're going back to.
Yeah, I mean it's also daunting right and so a lot of therapists and you probably were going to ask me this but therapists when I'm talking to colleagues and they're asking how did I get into this field or how do I bring up this subject with with my patients.
(19:53):
They're not here for airway focused therapy right I mean they do and I'm going to look at it but like how do I say oh by the way also your child has a very narrow palette and we need months of, you know, therapy or we need something else right we have to bring
another practitioner as we have to make this a team approach like this isn't just me. It's a lot more complicated than that how do I. Yeah, how do you approach that without completely flipping out a parent because as a parent I know my first reaction be.
(20:23):
Yeah, right like I was in here for that and so I always colleagues like it's a dance. It's a dance because you have to you have to get to know your families first and know what's their bandwidth. Right like and not dump this on a patient, you know, or a family like day one, unless
something's glaringly obvious and I feel like okay I'm willing to risk my relationship with them because this kid's health isn't jeopardy, then go send them to the NT I'm going to send them somewhere if I think they're, you know, obviously that always comes first but it's not something
(20:55):
that comes up quickly I plant the seed I say I'm going to look at all of these things because it's connected.
And you know the nice thing is, I give them very detailed intake paperwork so my work asks a lot about early infancy, you know and if they they're bringing me a five year old like it makes parents think like well why are why is not asking me these questions right
(21:18):
So it opens a door for me to say okay this is where I'm seeing these connections here, and I might not talk specifically about airway stuff but I might ask them or detailed questions about breastfeeding difficulties, you know what was happening there, why did they need a nipple shield
why were they on bottles for so long was that something that they intended or was that a choice that they had to make because breastfeeding failed it no judgment just you know right you just need to know sure what happened, where were the challenges.
(21:45):
And so and I've given them an airway questionnaire, I want to know all about their sleep habits and so I've already planted a seed that I'm looking at this is important. And so even if I don't talk about it for a few weeks.
I'm going to bring it back up once I write their evaluation and I've, I've written up the significance of my findings in their report.
And then we'll let that parent sit on that. And then we discuss it afterwards and say okay so I think that in a referral to an airway focus practitioner. Here's the name of the people that I recommend.
(22:16):
When you're ready to talk about it. I'm here for you, basically, and some parents will ask right away like ooh I want to talk about this more. We've been noticing that I you know I don't like that my child snores.
I thought that maybe that was a red flag but my pediatrician brushed it off that kind of thing because I hear that a lot.
You know and it's sort of just, I give them information I open the door. I'm approachable I keep dropping nuggets and hints depending on what I'm seeing throughout my sessions and what I feel is relevant for that child and then we just kind of we approach it when it's time I guess
(22:52):
to meet them where they are right. Definitely have to meet them where they are and you have to respect that it is a journey like it's not something that we can just go to the ENT get our tonsils and adenoids removed and then we're done which is a lot of parents believe.
Most parents come to me and say my child snores and even before and if I bring up this happens to me often actually they go get they go to the ENT they circumvent my team.
(23:14):
They go to who they're comfortable with or who their friends have referred them to, because this is what they know other people have done. They get their child's tonsils and adenoids removed because it's a quick fix for them.
Right.
Things get better for a month or two or three. The snoring stops, and then it comes back. It always comes back.
And that's where we have a very gentle I told you so moment. And we sit down and they say okay so I'm noticing these things again I think it's time that I make an appointment with your airway focused dentist usually that's how it goes.
(23:46):
And that's okay. They had to do what they felt.
Exactly was right for their child.
Right and what was comfortable for them and what was within their financial means to because that's a huge one this can be a very expensive journey.
And there's no shame in that there's just recognizing where they are what they're ready to hear and me serving as that resource for them and I'm kind of like the quarterback when it comes to a lot of this stuff.
(24:11):
Yeah.
And we read that a lot too from from other occupational therapists myofunctional therapists it's you you're kind of the the.
I like the quarterback analogy but you're you're this pivotal piece because you can shoot in directions. Yeah and you're and you're connecting everyone together.
Yeah we're really triaging like and just because it really is the parents that you know we're that usually the practitioner that they have a strong relationship with because they're seeing us weekly or on a very regular basis.
(24:41):
We get to know their families we get to know their child and they trust us they should right yeah yeah my face they do.
And so they're the ones that say okay you're the one like I'm going to go to you with my questions you know and so they they'll hopefully I am that sounding word for them and can steer them in the right direction.
And you know but then this I started talking about this because you brought up about band aids.
(25:07):
And it's also like sometimes we just have to do what we need to do to get through this stage or phase of life.
You know even if I'm not working with a child anymore but they've you know they're on anxiety meds or they're on ADHD meds because and we know there's a sleep disorder problem of all of this but right now we are medicating the problem because this is how it's showing up and this is
(25:32):
what we're doing with no judgment like that's what we're doing I'm meeting them where they are we're working with the skills that we have right now and they have the resources and the information to do something about it later and and I trust
they're ready when they're ready and often I do have families that will email me a year later and say hey can you give me the name of that dentist again I think we're ready to do something and that's cool that's fine like yeah this is a it is a journey it is not as a journey easily fixed and quickly fix and even when
(26:02):
parents go and get like an airway scan or an airway focused evaluation sometimes they don't do anything with that either for months because they're not ready to but they've got the information and when they're ready they will hopefully so
exactly yeah and you know I'm glad you said it because there is no judgment right and parents take the guilt off because we're all doing the very best we can we all know that right and it is it's not as being all woo woo let's grab a trendy work but it is a journey that's
(26:31):
really important takeaway and everyone's journey is different and you've got to do as a parent what you think is right for your child as well as like you mentioned what's within your bandwidth as far as time goes emotionally financially you know do the best you can
yeah and I love that you're meeting them where they are and that's huge and you also mentioned tummy time yeah which I'll make sure I put a link to that episode because we did speak with Michelle Emmanuel is a great episode for anyone that hasn't heard it as well as a link to the first 1000 days fantastic
(27:06):
and I hope for parents to read even if your child is older you know I have old children still fascinating to read it and reflect back again not for parent guilt but you kind of become aware of missed opportunities or oh wait that didn't occur let me see it you know let's as you said rewind
(27:28):
I haven't seen any of the fallout of the patterns or the repercussions because of it. Yeah a lot of time. Yeah a lot of times parents when I'm asking them questions you know about patterns that I think that this child is likely falling into I'll say hey like, you know, how long do they
wear a bib for like oh yeah we went through three bibs a day until they were like 18 month old and I'll you know and then they're like is that a thing was that a thing that's a definitely a thing right like that's a thing and that's one of those things that like parents so much of this is normalized, you know thumb sucking
(28:00):
like thumbs up sucking to the age of two all the you know thumb sucking a pacifier use you know prolonged everything in terms of oral habits. Again it's normalized but is it it's indicative of difficulties are dysfunction because it's common it's not actually normal
it's not what should be normal. That's where you know sometimes a lot of times I am the person the first one to point things out like hey that's maybe something we should dive into or at least all of these you know by themselves aren't necessarily problems but they are indicative of patterns that you know are these clusters of behaviors or tendencies for this child to do that are indicative of things that maybe we need to look at a little bit further so yeah
(28:49):
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(29:16):
you're listening to airway first with today's guests occupational therapist Natalie Eudwin
you can find out more about the children's airway first foundation and our mission to fix before six on our website at children's airway first dot org
the calf website offers tons of great resources for both parents and medical professionals
(29:38):
visit our parents portal clinicians corner resource center and video library to see for yourself
we also encourage parents to join the airway huddle our facebook support group which was created for parents of children with airway and sleep related issues
you can access the airway huddle support group at facebook dot com backslash groups backslash airway huddle
(30:02):
as a reminder this podcast and the opinions expressed here are not a medical diagnosis if you suspect your child might have an airway issue contact your pediatric airway dentist or pediatrician
and now let's jump back into today's episode
(30:42):
and so you touched on a little bit and I kind of want to go back to it because you know and previous shows we've talked a little bit about primitive reflex and tummy time so yeah I'll definitely put links for anybody that missed those but we haven't talked much about sensory integration therapy
okay
so just kind of lay it out for parents you know what is it exactly what does that look like
(31:07):
okay um it's a really good question so I mean
OTS look at eight senses right so we have our five basic senses I mean and really not just OTS but developmental professionals are usually neurological professionals
we have a sense so we have our five basic senses which is you know the normal ones taste smell touch site
(31:30):
and then there's three others so there's your sense of your vestibular sense
your sense of movement we get a lot of information from our inner ear and our eyes
there's your sense of proprioception which is where you are in space so
your joints give you that information has a lot to do with gravity and pressure
(31:55):
and then there's what's called interoception which is your inner sense like are you hungry are you thirsty are you nauseous do you need to go to the bathroom like that one basically
that is really hard for kids when the other ones break down but basically we've got this sensory system and that's what tells us how to do things right so it is our information receptors right so
(32:19):
we are always taking in information from our environment and in computations and well some of them are reflexive and a lot more of them are reflexive when we're babies
and we are responding somehow right so you talk to me I'm answering right but as an infant we have these reflexes that work with our it's called our sensory motor system it's it's our senses and our movement and how it all works together so
(32:44):
and it happens in our brainstem so our sensory system is so important because it starts to develop in utero especially our sense of touch and our movement and our
proprioceptive system those three senses happen more so in utero than any others those are the most fully formed and our sense of touch is our very first one
(33:08):
and it's it's our skin gives us that information but our skin is also our largest organ right them when kids are born premature or when we have some kind of birth trauma those senses are disrupted somehow
(33:29):
and that is a huge those have everything to do with the way we feed and the way that we coordinate our movements later on in life and so our job as a tease is to figure out where did this start to break down, you know and we have to base it
on these behaviors that we're seeing with kids and then work it all backwards and try to figure out what we need to do to give them what kind of information do we need to provide that person's body with to be able to then meet their sensory needs, you know and a lot of
(34:07):
people assume in a lot of the ways that sensory processing is presented there's like over responsive and under responsive and people don't understand that you can easily be both, you know, our sensory systems are very volatile they change all day
and it's just like I explained to parents like if you're driving in traffic and it's bumper to bumper and you've got kids screaming in the back seat and the, you know the radio's on and all of a sudden your kids get way louder, and then the song comes on and it's an X, it's an exceptionally loud song
(34:44):
and you've hit sensory overload, whereas if you weren't in bumper to bumper traffic and you were driving down a beautiful country road the windows were open, none of that might have bothered you right so like staying input different capabilities to process it right and so
as OTs our job is to figure out kind of what that kid's threshold is what are they missing, how does that inform what they're able to do and what they're not able to do but so much of it has to do with our feeding skills as an infant to
(35:17):
feeding again sucking, swallowing, breathing all of that coordination is it has to work well for us to then get to the next level right for us to be able to do what you need to do and so if it doesn't work well if there's a breakdown somewhere
then everything else will be affected the sensory systems happen, inform so much of the rest of our development later on in life, especially that first eight years like we are sensory sponges.
(35:48):
After that we're still taking in a lot of sensory information but a lot of our ability to process that has already been not solidified because we are neuro plastic but the first eight years of the work is there.
Is this why you see volunteers come in and hold the preemies they always have people in your volunteer to come hold the newbies the preemies is this why I mean this is that sensory thing is that
(36:16):
sure there's a huge component I mean touches touch the sense of touch is responsible for our sense of emotional security right so kids that have are excessively clingy have separation anxiety.
They have a really integrated sense of touch. And so they're extra sensitive sometimes or sometimes they need more so those are kids that are often clawing at their parents a lot they like to scratch or touch their faces.
(36:46):
They liked with their hands up their shirts they are very.
They are very sensitive to the way that they bond with their caregivers which is a bad thing to an extent right, but sometimes it goes to the end degree, and those children have a hard time separating from their parents, and sometimes there is a birth trauma or there is you
(37:08):
know, they were premature there was a kind of developmental component in utero, or during the birth process that happened to cause that but sometimes we don't know.
Sometimes kids, everything looks typical on paper they had a perfectly normal birth.
And, you know, everything went well so to speak, but they're still wired a little bit differently sometimes they need more input than your average kid and sometimes they need less or they're just more easily set off by certain things.
(37:36):
So, I like to explain that to parents I like to teach them about their child's nervous system, particularly so they can understand what they need. What does that look like because some parents are not.
They can't read their children as well and that there's no fault to them like that's just not what they're good at right and they might have their own sensory needs, which is huge.
(38:00):
So, a lot of parents are easily set off, especially during that early infancy that fourth trimester by certain things that can be.
They learn a lot about their sensory needs during that period of life, but they don't know how to get their needs met they don't know how to adapt their environment they don't know how to do because they're in survival mode right right.
(38:25):
So, learning about their own sensory processing abilities or needs or habits etc, as well as their child's can help them to.
So a lot of it is education, but I mean the sensory piece informs the movement piece, which kind of they go hand in hand we can't do one without the other so.
(38:46):
Yeah, and that totally makes sense basis of that really.
So, when you're assessing a patient and you're putting together a program for them for them and I know it's different right every child's different every family is different.
What is that just kind of at a high level just so parents get a good understanding who may not have worked with anyone like you before. What is that process look like.
(39:09):
So let's talk different ages I guess because I mean okay yeah let's talk.
Wow, let's talk with the difference first yeah.
Okay, so infants. Let's say a baby, I don't know, three months old comes to me and they're having feeding difficulties.
The last thing I look at in my evaluation is their mouth, even though that's the thing that their parents want help with because I'm going to look at their body first.
(39:33):
I want to look at all the systems that have been affected I want to look at. I want to make sure everything that is should be there is there.
And what I mean is I'm looking at reflexes first I'm looking I'm touching their feet I'm looking at their backs I'm looking for tension I'm looking for symmetry.
So I'm, I'm watching but I'm moving the baby I'm handling them a little bit. And then I'm at three months old I'm going to see okay can they can they look both ways with their eyes can they turn their head side to side well.
(40:02):
If one side's more difficult than the other, we have to work on these things that's part of that's going to affect their feeding skills.
And from the very beginning, when a baby baby walks in when a parent walks in with it into my office, I'm watching and listening for how they breathe from the very beginning.
So usually they're sitting across from me on my sofa, and getting a history from them and I'm watching that baby.
(40:26):
And I'm, I'm watching the way that they're positioned or postured in their hand I'm watching their chest rise and fall I'm, I'm watching the color of their skin if it's changing I'm listening, which part of breathing is listening.
You know and sometimes I'll pause the parent and say hey, do they always sound like that. And the parent will say.
Yeah, I guess they do but I've never really noticed like that's just what they sound like like, you know and then I explain okay we shouldn't really be hearing that all the time but.
(40:53):
So there's I'm looking at all of that first looking at the whole big picture first and how it's all been affected.
And then maybe on their left on their right sides on their tummy. And I want to make sure can they move through that whole range of motion that they were intended or that they should be doing around three months old and if not I'm going to give, we're going to practice and we're going to move that baby
(41:17):
different movements some of its assisted with me and I have the parents demonstrate and practice with me in my office as well. I work virtually a lot too so the parents are then hands on with the infants all the time.
And I want to make sure that they're seeing what I'm seeing and they're feeling what I'm feeling. And then I'm going to make them a home program so I'm going to give them, I don't know, or five six little movements activities, things to do with their baby different
(41:44):
ways to move them to encourage more natural movement patterns and usually a lot of strength building.
And so, and then I'll assess their oral function. I'll see what their suck is like. And, you know, can they suck do they have a phasic bite what is their rooting reflex like I'm looking at all of these things.
And then the last thing I'm looking at our oral structures. I'm looking for tethered oral tissues I'm looking at their palate shape. And I'm, I'm feeling around basically but that's the very last piece of the puzzle, because I want to see what they can do first.
(42:18):
I don't want to be biased by what I'm seeing.
Right.
And that makes sense. Yeah, parents often come in and they've seen other professionals too and I'll say look I don't want to see that about right now.
I want to make my own observations and you know I don't want to cloud my judgment with that and so. Yeah, so that's kind of what an initial session would look like.
It's, I call it a developmental feeding evaluation because it truly does look at all the systems I'm looking at reflexes eyes breathing, I mean and virtually to parents often ask, you know how do you do that on the computer.
(42:51):
I'm looking for patterns, and it's not that hard. And if I know I've learned over the years, what questions to ask. And usually those are really really helpful and how to get the right information out of parents to but it's it's a lot of observation skills as well.
And so, yeah, and then, you know, follow up sessions with infants is a lot of piggybacking I wait a couple weeks till I see them again and we're going to build on the skills that now we've acquired and what happens next. And so it's, it's a lot of a lot of gross motor skill
(43:22):
building, because I work outside in so we're working on the big supporting missiles first.
The neck the shoulders, you know we're working on breathing skills in different positions.
And then we're also working on our motor skills as we're ready to do them.
And how would this different than from let's say, let's jump a little bit like four or five year old but maybe comes to you. Okay, so that's a really good question so for like my older kiddos I mean I'm, you know, obviously I'm not moving them right so they're
(43:57):
they're they're reactive it's a sweaty session. But I'm, you know, once I figure once, once they trust me and I trust them and we have a little bit of a rapport.
Let's say a screening is when I screen a kid to see okay what's going on I'm going to look at their reflexes I'm going to, I'm going to get them on all fours I'm going to see what happens when they turn their head different ways.
(44:18):
And it's hard to check this takes maybe, maybe three to five minutes max. It looks like we're crawling. It looks like we're, I mean it's really very and then we stand up we do some stuff with our arms we turn our head side to side we hold our arms it's not very difficult.
We pretend to be certain animals, and I'm saying it looks more like play doesn't it looks totally like play. Yeah, and we, you know, I'm just directing it at this point.
(44:43):
And I'm going to always look at their eyes so I muscles function that is a huge component as well because eyes direct head movement. Initially, most of my kids really all of my older kids have some kind of eye muscle weakness.
And that's not because they were born that way necessarily it's because they never used that full range of motion. They maybe only turn their head well to the left and then they turned it partially to the right.
(45:10):
That was good for them and they figured out how to roll they didn't need to do that and those muscles remained weak on that right side. Oftentimes there's a, there's a pretty significant difference between one eye versus the other.
And a lot of them struggle with convergence so bringing eyes together here which has a lot to do with bilateral coordination, the use of both sides of our brain and midline function so sucking breathing all that happens here in the center.
(45:38):
And if we can't do things here with both eyes. We get tired really quickly and we avoid stuff we tend to use one side more than the other.
And so eyes are a huge part of my screen as well. And eye muscles also can really show up when we have a lot of visual fatigue, especially for older kids.
As they start doing kind of more academic or sit down tasks at school or play groups.
(46:02):
And they can show up as behavioral issues as well because now stuff's hard. And so sitting and look at a book or sitting and looking at a coloring page for more than, you know, 10 seconds like they're done they're out of there.
Right.
But then I'm also looking at their posture I'm looking at their core strength I'm looking at their shoulder and neck strength because those are things that should have.
And so if they had that solid foundation as an infant, we should also still see that as a four or five year old but usually they can't do a chin tuck when they're laying on their back and their heads hanging off the edge of the thing we have some serious weakness there, but they've compensated with momentum.
(46:38):
So they just move really fast and they can sit still they can sit still because if they sit still they fall over.
So with those kiddos. Yeah, so I'm looking at gross motor skills I'm looking at reflexes. The sensory stuff is a bit more nuanced, sometimes I'll give them a questionnaire to tease stuff out to know what questions I need to ask a front.
(47:01):
But I'll often do a little chewing swallowing assessment will go and have a snack basically again just looks like we're having a snack but I'm watching.
And sometimes I'm filming so I can go back and look at it later. And that tells me a lot about their ability to breathe to, because if we can't they'll make that face when they swallow right.
(47:23):
Yeah, watch how they swallow I watch how they're chewing. I'm listening. And then we'll also do stuff where we get their heart rate up right so I'll have them run in my office will have them jump I'll have them do animal walks things where you know I shouldn't hear them panting at the beginning and maybe
I'll have them do but I want to see are they mouth breathing are they nose breathing. You know I'm looking at all that, while I am assessing other things to breathing is one of those it's always there it's always underlying everything but I guess I've gotten good at noticing
(47:53):
when things don't sound right and when things don't look right.
And often for most of those kids I'll usually get to a point where I asked the parents if it's okay if I lift their shirt up to, and I at least want to see, you know, below their nipples right I want to see the rib cage I want to see what's happening.
And I get them, you know, laying on their back and then sometimes I get them on their back over a yoga ball or over a peanut ball. I want to see are you watching their diaphragm at that point.
(48:18):
I'm watching their diaphragm I'm looking for their ribs or do their rib cages wing out is are they asymmetrical a lot of times there's an asymmetry there.
And I'm oftentimes seeing some abdominal separation there too so.
So, it's all just part of the package right like none of it is super worrisome or like a red flag in and of itself but it tells me a story. And so I'm always trying to figure out okay like, why is this kid having trouble sitting like this why is this kid having trouble holding
(48:52):
their utensil. You know, why do they bear down so hard on a crayon what. Why can't they hold a quadruped like an all fours position for longer than 10 seconds without falling over, you'd be surprised, it's really a struggle in all four.
Really. Yes, really. Wow, your legs they fall over they're silly all the things like it's really difficult for kids especially if crawling was difficult as a baby.
(49:17):
So that would make sense yeah yeah I like you. I think it was something when we were emailing back and forth and you mentioned, you know, part of what you just connect the dots.
Yeah, I mean, I think for me.
As an OTA realized like, you know, it doesn't matter what I do in my sessions. If what I'm doing doesn't make sense to the parents or the caregivers there. So, it's all about education and explanation and really, I have to illustrate.
(49:48):
They need to be able to see what I'm seeing like yes I can look at, I can see it, you know, in two seconds and I can make these assessments and I can understand okay, oh yeah that's that shouldn't look like that or that shouldn't be there that's dysfunctional but if the parent doesn't
understand what I'm seeing, then the buy-in isn't as good first of all. And they're not going to understand why I've asked their kid to, you know, do bare walks at home, like why is this important as opposed to like okay I said do it but I want them to understand
(50:21):
what we're trying to get out of the task.
Because they need to understand, like it's just the more understanding there is the more comprehension the more everybody's on board truly. I was gonna say the more compliance right. Yeah, the more compliant as a parent then you're going to okay I can make this one we're going to go do the bare
walks let's do it. Well, and what's really cool is you know I'll get a, well it works both ways so I have infants in my office and they oftentimes have toddler siblings or older siblings, and the parents as I'm explaining things the parents are going, do you see three year olds.
(50:55):
Can I bring my three year old have some questions is that okay if I ask and I love them to ask because that means they're connecting the dots. And that's their frame of reference. They might this is kid number two and so they only have kid number one to compare it to and maybe they also had a bit of a shaky foundation
as well so their, their sense of normal, or typical isn't the same as mine right and so I need to go. What they're, yeah I mean where are they starting from, how do they understand this and what's normal to them but then also works both ways when I have you know maybe the three
(51:26):
years in here, and somebody, you know, a friend of a friend referred them to me to bring their three year old in because they were having difficulty chewing, or they were too rough on the playground or something, and then suddenly they say, Oh, you know so they might have an infant at home as well.
And now they're thinking, Oh, I, I, maybe we need to bring that child in for not to evaluate because these things, you know as I'm explaining okay these things should have happened early on did they crawl well did they you know they struggle with nursing etc.
(51:56):
Got a nursing infant at home the parents starts to connect the dots and think, Oh yeah maybe we need to look further into this. I love it.
And then I get the parents that ask questions about themselves to. But again, that's really important because it's not like we can just look at this in a bubble I want them to understand how this is affecting everybody.
I'm changing their plans and it's really helpful.
(52:18):
And that's fascinating. And not passing me and it's fantastic because they're definitely on board they're open to learn and now you have a collaboration not just with your medical allies but now you have a collaboration with parents.
And I love it when they're like, Oh, I'm going to go explain this I need I need my husband to talk to you.
Yeah, I love that when they get the whole family on board and everybody's on their own airway issues and oftentimes they do they go.
(52:43):
They run in families. Yeah and the parent but the parents then go get their own evaluations and that makes me happy because truly they're they're seeing the value right in my work, not just my work it's not about me.
It's about the value in what we're doing right and right.
And this is important from a longevity standpoint. Truly, sure. Yeah, it's going to impact their health span and their life and which is amazing.
And it's one of those things that I don't care how old you are.
(53:07):
Once you see it, you can you can you can't and see it.
I have stood in line with my children and I get this like, please don't please don't.
I know I see that child. Please don't.
All right. All day long.
Yeah, because now they're tiny little advocates like running amok with their friends, your mouth be there. Oh, you blah, blah, blah.
You know, so but once you see it, you can take ownership of it and you can share with other people and you can save more people.
(53:34):
So yeah, just be the resource to steer people in the right direction when they're ready.
Yeah, for sure. Exactly when they're ready. I love that so much.
Well, I cannot thank you enough for being on here and typically at the end and we've covered so much.
So I'm going to put you on the spot net at the end of an episode. I always turn it back over to my guest to let you have final thought for our parents.
(53:59):
Okay. Yes, definitely.
Definitely on the spot.
Final thought just I guess trust your gut as a parent don't be afraid to ask for help.
And, you know, even like I'm on Instagram a lot lately and I love that parents, you know, the don't be afraid to reach out to professionals and ask them questions.
We're all just, you know, on our own journey to and truly here to learn with you all and I think that, you know, and if it's a question where you feel like, okay, maybe this is something, you know, this is a very involved question.
(54:33):
I'm going to say maybe we need to book a console or maybe you need to ask this person because this isn't in my wheelhouse etc. But we'll at least refer you to the professional that can give you the best answer but don't be afraid to ask, ask the questions.
And the earlier you deal with this stuff the better truly because the longer you wait more habits you have to undo so but at the same time in the other regard, we can still deal with this later on as well.
(54:57):
So never too late.
And when we can do it in phases if it seems overwhelming, you know, and bite off a little bit at a time that's okay too. We can make really long term plans so.
That's awesome.
Well, thank you so much for coming on today I really appreciate it.
Thanks again to today's guest, Natalie Udwin for joining us on the show, and to each of you for listening.
(55:21):
Please stay connected with Children's Airway First Foundation by following us on Instagram, Facebook, X, LinkedIn, and YouTube.
Don't forget to subscribe to the Airway First podcast on your favorite podcasting platform so you won't miss an upcoming episode.
If you'd like to be a guest or have an idea for an upcoming show, shoot us a note via the contact page on our website or send us an email directly at infoatchildrensairwayfirst.org.
(55:51):
Today's episode was written and directed by Rebecca St. James, video editing and promotion by Ryan Drawn, and guest outreach by Kristi Bocheevian.
And finally, thanks to all the parents and medical professionals out there that are working hard to help make the lives of kids around the globe just a little bit better.
Take care, stay safe, and happy breathing everyone.
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