January 24, 2025 • 59 mins
Our guest today is Claire Duque, a Myofunctional Therapist & Occupational Therapist. Before being trained in myofunctional therapy, Claire served the adult population as an occupational therapist. Having a child with airway issues ignited her passion for this space and her desire to help kids and their futures.
Claire believes that sleep and breathing are the cornerstones of health for a child. Claire is particularly passionate about early intervention and the role orofacial dysfunction plays in a child's behavior, sensory system, health, immunity, allergies, and cognitive development. Treatment includes comprehensive assessment and evaluation, muscle training and exercises, and retraining in breathing, nasal breathing, tongue posture, and tongue thrust.
You can read Claire’s full story in her own words in a guest blog she did with CAFF here: Link to Claire's Blog Post.
Show Notes:
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi everyone, and welcome to another episode of The
(00:29):
Welcome Back to Airway First, the podcast from the Children's Airway First Foundation.
I'm your host, Rebecca St. James. In today's episode, our parent liaison,
Christy Bojinkian, will be chatting with Claire Duke, a myofunctional therapist and
occupational therapist. Before receiving her training in myofunctional therapy,
(00:49):
Claire served the adult population as an occupational therapist. Having a child with
an airway issue ignited her passion in this space and her desire to help kids in their futures.
Claire believes that sleep and breathing are the cornerstones of health for any child,
and she is particularly passionate about early intervention and the role that oral facial
(01:12):
dysfunction plays in a child's behavior, sensory system, health, immunity, allergies,
and cognitive development. If you want to hear more about Claire in her own words and her story
with herself and her daughter in their airway journey, you can check out our blog, Our Airway
Journey with Sleep Disordered Breathing, Mystery to Passion, on our website.
(01:34):
And now, let's jump into the interview with Christy and today's guest, Claire Duke.
So welcome, Claire. Thank you so much for joining us today. So kind of before we get into it,
before you got into your airway journey, can you tell me about your practice as an occupational
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therapist? Yeah, sure. So I've worked 13 years with adults who have mental health diagnoses,
and mostly that's people with psychotic illnesses. So it's get to friendly us,
get to affected disorder, bipolar disorder, and voice people that hear voices. And, you know,
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it was teaching a lot of everyday living skills sort of stuff. So the practical day-to-day stuff
that we all take for granted, some of these people were in homes for much of their life or in jail
for much of their life. So it was just about retraining some of those life skills. So that's
sort of what I was doing prior to, you know, over the last little, probably year and a half,
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when life took a rather large turn. And I'm still doing some of that mental health adult work. So
that's that's certainly an area that I still very much love. But for, I've ventured elsewhere
because for a very long time, our son was a mystery to many specialists out there. He wasn't a very
(03:16):
well-child. He had, you know, what I can see now is lots of red flags for airway. He had things
like he was late bedwetter, he was irritable, we couldn't figure out why he still yawned quite a
lot. He'd have troubles sitting. He would be on prednisone quite a lot to try to control his
(03:42):
asthma. He had some sensory issues as well, which we, you know, we weren't trying to figure out,
does he have sensory processing disorder? Does he have ADHD? He had a lot of these kind of,
kind of issues. Teachers were reporting that he was having some meltdowns at school, wasn't quite
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coping at school. Also had some oral ticks. So some unusual, you know, behaviors with his,
with his mouth or making kind of vocal sounds, shoulder shrugging, these sorts of things,
which is quite an interesting area. And frequent wakeups as well. So he, looking back now, you
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know, I can see there's lots of things there that kind of scream, this is an airway child,
he needs some help with his sleep and his breathing. But back then he was really a mystery to, we
had seven specialists in, in a year period. I remember it was two sleep doctors, two ENTs,
we had two, we had sorry, two pediatricians and an allergist. So at least seven different
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specialists. So what kind of, who did you go see first and what kind of spurred you to get?
It would have been the pediatrician first, I'd say. Any centers for a sleep study, which was,
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you know, ended up being helpful in the long run, but it's, it's didn't show that there was any major
concerns with our sun sleep. Yeah, which, which I know now can happen. And I really,
we were starting on the right direction, but not all the way there. Yeah, that's right. And I,
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a little side note, you know, I don't want a parent, I think parents, if you are getting a
sleep study, that's amazing and parents really should, but don't let that be the be all and end
all of your journey of trying to figure out what's wrong with your child. Because, you know,
a little side note, I guess, story about what happened to us was, he had the sleep study. And,
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you know, I've got it here. So I'm not sure if you can see these. This is his CO2 numbers,
you probably can't see that. But anyways, there, the numbers such as like 49, 52, 48,
47, 47. So Charles CO2 is meant to be around 35. But there's one in there where the machine was
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off. And so it was a zero and it skewed the whole score. Right. So, so the clues were there.
But because of the way some sleep studies are read, you know, this then presented as a child
that didn't have any issues with CO2. So it wasn't until later down the track that I asked for the
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raw data and had a look at it myself, that I could see there was, there was gaps there. So sleep
studies are amazing to help create a picture of what's going on. But they're certainly not the
real end all, you know, to figure out what's going on. Definitely. Yeah. And we will have a
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upcoming episode doing like a tour of a sleep lab too. So parents can get a little familiar. And
then yeah, of course, definitely, who is interpreting the data is going to make a big
difference too. Yes. Yes. And then I can sleep study because I went to see another sleep doctor
because he was yawning all the time. You know, he was just in that mild, mild range of sleep apnea.
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And what I know now is that even though a child might present as having mild symptoms, it certainly
doesn't correlate to how that plays out in their life and and how they're, even if it's only a
couple of wake ups per hour, that's going to majorly affect every system in life. So, you know,
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also if it's just a mild sleep apnea to take that quite seriously as well. Definitely. Yeah.
Okay. Seeing the specialists and stuff. Yeah, how did you kind of get into the airway world?
And where did you first hear about it? Start going down with rabbit holes? Yeah. Yeah. So we had a
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couple of a couple of golden nugget clues, I call them. And the first one was our second ENT. He
said, let's get his adenoid out. Let's reduce his turbinates in his nose, which is our six filtration
system in our nose. And that really helped that really helped. You know, we thought, oh, he's less
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irritable. He's yawning less. He's growing now. You know, this is done great. Our child's thriving
now, not just surviving. And we also, the second kind of golden nugget clue, I would say was that
we got his allergies under control using a, it's great exposure to spray put under their tongue.
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It's like a three year course. And it just gets that child used to their allergens for our kid.
It's dust mites and animals. And that really helped as well. So these are two clues along the way
that let us know that this was kind of an airway issue. But it wasn't resolving everything. He was
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still having a lot of these symptoms, still having the oral ticks and sensory staff, ADHD symptoms,
irritable, all this sort of thing. So he was, this was between three and a half and five and a half.
And we thought, okay, this is, we'll take this. This is pretty good. And then symptoms started to
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come back a little bit. The dark circles up the eyes. And a lot of the other symptoms that I mentioned
started to return. And we just couldn't figure it out. And he really was a mystery to all these
specialists. They were checking him for autoimmune disease or diabetes, parasites, all these sorts
of treatments that kind of weren't working. And, you know, looking back now, they all had the best
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of intention, all these specialists, they, they wanted to help and they were trying to help, but
they weren't kind of looking at the full picture of what was going on. And like you say on your
podcast, no, you don't, you don't know what you don't know. But I, you know, looking back, I thank
them for their help along the way to help us try to figure it out. Our world really cracked open
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a year and a half ago, I'd say it was, it was April 2023 when, when life really changed for us.
I saw a video from Dr. Mary Ali, who is an occupational therapist and an oryfacial myofunctional
therapist. So oryfacial, you know, mouth and face, myofunctional, how the muscles work, and
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therapist. And my jaw dropped to the ground. She was describing what we were going through. She was
describing an airway child. She was describing a sleep-disorted child. I remember just sitting on
the floor of his bedroom and watching this video and wow, this was, this was like, this was the
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aunt, you know, this had to be the aunt's. What you've been looking for? Yeah, that's right. It was,
it was like, it was just this absolute pull to look into this. And I watched it again, the
next day, it was 30 minutes and the next day. And was just, you know, thinking, I need to really
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investigate this. So steps after that was I took some free zooms, some free zoom calls. So with Dr.
Mark Levi and his team who are our leaders in the pack here in Australia for, for airway and sleep
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to sort of breathing stuff for kids. And, you know, as a parent, I would definitely recommend doing
that, taking those free zoom calls, trying to learn as much as we can. Instagram is also a really
great resource for learning. There's so much going on there. There's so many passionate people
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on there. And yeah, sharing their wisdom, including you. Yeah, that's right. And the funny thing along
the way is you learn so many of these passionate people are parents of kids that have airway issues.
Or they've got airway issues themselves, which as we know is a huge percentage of the population.
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Yeah. And now they're trying to get the word out there. And I feel like it's slowly,
you know, it's slowly coming out. So, so after this, we got our child in an expander,
which is, you know, there's a few pieces to our puzzle and having his adenoids and terminates out,
it's a big thing that helped having the immunotherapy, which is the graded exposure under
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the tongue for allergies really helped. nasal sprays along the way really helped. But
the one of the biggest things was a pallid expander for us.
And, you know, I could talk all day about this process, how it went and how it tolerated it well.
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We were seeing results. We were seeing good outcomes within a month of active expansion.
So as scary as it sounds having a bulky thing in your kids mouth to parents, I would say,
give it a go. Give it a go. So I wrote down some measures when he got to him. So when he got his
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pallid expander in, I thought, I just want to measure this. I want to write down what we're
having issues with and recheck it because I don't want to be putting this time energy,
our emotional resources, everything into a treatment that may or may not work.
So he was five and a half. So that was 15 months ago, 14 months ago.
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I had to prep him for the expander.
That was the hard part. Getting him in the chair. Getting him in the chair was the hard part
because he was a sensory kid. He didn't like things, creams, band-aids, haircuts. He didn't like
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socks with no seams, socks with seams, pants with seams, all these sorts of things.
That's all resolved now, I'm happy to say. But we had to just try to bribe him.
That sounds, yeah, it is what it is. Yeah, big reward. Exactly. We had to say,
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do you want the biggest lego from the shop? He kicked the seat the whole way there. It was
really terrible. I took my hubby. But when he saw it, he was like, oh, okay. We made it red,
which is a little snippet, a little side note against parents. He thought was amazing because
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it looked like blood. So he could open his mouth and get that and scared. My mouth bleeding.
I'm gonna show my friends. So highly recommend choosing the color again. Yeah.
Goal factor. Getting it in the mouth was easy. He sat up and was like, oh, it's right here.
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And then he quite liked it. I don't know. Maybe it was all the attention he got. Maybe it was the
the video games that he was allowed to play afterwards.
Lots of ice cream for the next few days, all those sorts of tricks to do what you have to do
with a parent. Right. Yeah. Making a great experience. Yeah. Anything to get it in. Because
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I tell you what, within it was less, it was, we had it in there for two weeks before they started
actively turn it. So it was really two weeks after actively expanding him that we started to see
these symptoms of a child that could breathe. And it was, some of it was quite
physical as well. You know, he used to sleep in hyperextension. So his neck out mouth open.
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This photos I've got on my Instagram of that so parents can visually see what that looks like.
But so we got it in June. And these measures I've got here. September I did measures again.
So about four months later. And here's bedwetting. So in June, it was about once a week. In September,
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from June, he'd only wet the bed once. His ability to sit went from 10 minutes in June to 40 minutes
in September. Yorns on our drive to school, which is a 20 minute trip in June before expander was
about eight year olds in that 20 minutes in September, it was two year olds needing prednisone.
So he needed prednisone about every two to three months prior to six Panda.
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He hasn't needed it since. So that's 15 months of not, I'm no. Has he had asthma, terrible asthma?
Yes, a lot less, a lot less. We've only needed his puffers. There's been no oral steroids needed,
which is a huge, huge change. He's able to. So as of September, he was able to tolerate baths.
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He was able to tolerate band-aids, seams in pants in socks didn't worry him anymore. He's
he's to have a rash around his mouth pretty much monthly. That was totally resolved as of September
and we haven't seen that back since. His school report cards, because it's nice to, you know,
as a parent, you can see these things, but it's also nice to get that objective
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measure from somebody else in his school. What? They are quite different. They're really different.
You know, they they noted in that teachers big change from last term.
So it's not just it's nice to get that it's refirming to be like, okay, not just us that
are noticing these. His tics, his oral tics, whilst they're still there occasionally,
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they're not constantly rotating now. They come up when he has a cold. So he's had a cold this week.
And so we've had a little bit more of some unusual mouth noises. He was just he used to wake up 930
every night, maybe wake, wake up again about 1230. That totally resolves. He'll sleep through the
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night now. His irritability was a hard one to measure, but that definitely went down. He's a
really happy child now. Shiness at the park, you know, all these kind of all these sort of
measures that are that you can capture because their numbers were really reaffirming that we're
on the right path. Yeah. So is he still an expansion now or he is? Yeah, he's still an
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expansion now. So we're not we're not at the end of our journey. After this, you know, we've got to
start working on the muscles of his mouth and get those to to work properly. Because at the moment
he's got the expandar in so getting that that top that tongue up to that top palate is not really
happening for him. So it is still blocking his airway sometimes at night. His tongue is still
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and he's got quite a small pharyngeal that's the back throat kind of area. So we're we're still
got a way to go. But he's he's definitely an improved child and just happier and less sick,
much less sick, way, way less. He's still an athlete here. So he still takes longer to get
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better and those sorts of things. But you know, he's he's a lot a lot, lot better. So I guess
after we started to see all these measures, I was like, this is I need to do this. This is
this is amazing. This everyone needs to know about this. And I remember having and I still have all
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this passion for it. So I rang I just tried to connect myself with some people out there in
this space. And one of the people I rang was Dr. Mark Levi, who's a craniophacial sleep
and airway guru. And I just said a cold called him out of nowhere and just said,
I've got all this passion. I don't know where to put it. I don't know what to do with it.
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I'm just ringing people. And he was kind enough to match that passion, I guess, you know, he's a
very passionate fellow. And yeah, and has let me go into his office and work with an amazing OMT,
our facial myofunctional therapist, Robin Ann, who is there and look in all these little mouths and
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start really learning, you know, start talking to the parents that are there. Start learning how
all the the face works and muscles and the lip, her important lip seal is and tongue up and, and I went on
to do my functional therapy course and become qualified in that. And it was just interesting
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hearing from other parents, you know, there's a heap of children that are seen in that office.
And the parents are just saying the same, the same things. Their kids are finding school easier,
bedwennings going, ADHD symptoms are getting less. And it's the same story being told. And that is
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really reaffirming that it's not just us. This is this is out there. This is helping kids. This is
helping parents. There's not one parent that I've spoken to in that office, or in my own private
practice now, that is not seeing good results from looking into this airway space with their child.
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Yeah. So let's talk a little bit more about how, yeah, your career has shifted kind of into the airway.
Yeah, yeah, sure. So I just started to really look into airway and sleep for kids and for adults. And
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I guess that I started to look at my adult mental health people that I was working with as well.
And I can see, you know, now when I go and do therapy with them and work with them, I'm asking
more questions. I'm seeing them with kind of airway eyes now, I guess, and I'm able to see all these
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overbites, unobytes, misalignments, asking them about their sleep. And so many adults with mental
health diagnoses have, you know, have airway and sleep issues. So it's definitely made me rethink a
little bit about what I do. And I know mental health is absolutely multifactorial, you know,
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you've got childhood experiences, you've got your environment, you've got your things that happen to
you, you've got addictions, you've got your inner resilience, all that sort of thing that make it a
very complicated area. But I just, I just kind of wandered out now and I think back to a man that
died by suicide a year ago. And again, looking at his funeral book with airway eyes, I could see
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these photos of this lovely, beautiful man. And he had gummy smile and he had the really long
changed kind of skull of what's happening to us now as a human species, you know, we're not
just wide with all this airway now, getting longer and narrower and affecting our airway. And I could
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see all these things, all these sort of red flag visible signs with him, you know, crooked teeth.
And I asked somebody in a kind of delicate way that knew him well about his sleep and yes, he had ADHD
as a child. He didn't sleep very well, he spoke about that often and all these other kind of things and it
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just, it just makes me think, you know, wouldn't the trajectory of some of these people's lives have
gone a different way had they have got the help they needed when they were children with their sleep,
with their breathing. It may not have made any difference, but now it's just in the back of my
thought, in the back of my mind, I'm really shifting my focus to let's go in early, let's get early
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intervention into these people and try to make a change. So I'm slowly shifting from adult mental
health into kids airway, because when you see can't unsee it, and when you've lived it and see the
benefits, and hearing stories from parents that are also seeing the benefits, it's, you know, you can't
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kind of, you can't look away now.
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You can find out more about the Children's Airway First Foundation and our mission to fix before six on
our website at children'sairwayfirst.org. The CAF website offers tons of great resources for both
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parents and medical professionals. 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.com backslashgroups backslashairwayhuddle.
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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.
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And I think, you know, I love, I love that you guys have that fix before six. I think that's such a great, such
a great motto because as an OTE, you know, so much learning consolidation goes on before six in the
child's brain. So many neural pathways are being laid down. That's when they're meeting or not
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meeting some of their social milestones or they're just general milestones. And you want them to be, you
want a child to be using their energy on, you know, their cognition and figuring out their executive
functioning sort of things. So like memory and sequencing and putting their energy towards all of
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these learning kind of aspects of their life and then your pathways instead of just trying to breathe and
survive.
Right. Not just getting by.
Yeah, that's right. And also before six, they're so malleable, you know, they're so, you can really make
changes in that time. It's 80% of their craniofacial growth is done by the age five or six or something
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like that. So yeah, that's during that time. Yeah. Yeah. So that's a time to really get in there. And the
other thing about that is that if they are using the muscles of their face incorrectly, you know, not
swallowing correctly or mouth breathing or tongues on the bottom of their palate, or as it should be at
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the top, if you're trying to work with a child that is say four or five on those, those muscle related
functions, it's so much easier than trying to work with a child who is 10 or 12, who's had 10 or 12 years
worth of habits of muscles. So the key really is in that first six years, you know, that's when a lot of the
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magic will happen. So I love your your fix before six. I think that's brilliant.
Yes. Yes.
Yeah.
Yeah. Yeah.
And it really resonates. It does resonate with a lot of parents when you start talking to them out there about
these, these things because a lot of them are a lot of these things they can see, you know, you start
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talking about crooked teeth, pallets not being big enough, they can visually see that, oh, my child does have
crooked teeth, they've got shark teeth. You know, you can talk about dark circles and why that happens. And
they can visually see that you can talk about a child, hyper extended at night, so trying to get breath in or
fakes or bedwetting. These are, these are the and when you talk to parents, it kind of makes sense, you know,
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when you start learning about it, and you look at skulls, you can go on and Google, you know, skulls from
500 years ago, a thousand years ago. And they've visually we can see with our own eyes, they look different.
They're longer, they're more narrow. All this beautiful airway arches is is is here's my head here. Oh yeah.
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You know, all this is just smaller and what that does and when you describe it to parents as well.
Parents are clever. This stuff makes sense when you talk about the, the pallet, the top pallet.
You know, mandible maxilla. When you talk about that, being smaller, of course, it connects the roof of your
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mouth is the floor of your nose. Parents understand that when you talk about it. So of course you're going to have, it's the same bone.
So if that area is narrow and not wide, you know, and high arched, then of course the nasal passages are going to be
more narrow. You've got a kid with allergies out there, like so many people in Australia have allergies.
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The same amount of swelling on an airway, sorry on a nasal passage that's wide is going to affect that child a lot less than that same amount of
swelling on a passage where it is narrow. It makes sense. This stuff actually makes sense when you read about it.
Yeah, it's just, yeah, it just makes sense. Yeah, you don't need any fancy degrees to understand.
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That's right. Yeah, when you start learning about it, it's like, well, how did we not see this before? How did we not?
And I love this Dr. Sherene Alim's book, but I'm not sure if.
Oh, yes. Yes, I love that image. Yeah.
Yeah, that's the, that's the floor of the top jaw and so is this. But this is showing a, which a lot of kids have and my kid had it that narrow, high arch and this is, you know, space up here.
(34:04):
I'm not sure this is a video podcast.
Yeah, okay.
Okay, cool. And this is an airway, you know, at the top of a palette. So your top jaw that is nice and wide there. And to seal that, that's the top of the nose there.
So it makes sense when you actually look at it as well.
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And you can open your own.
Oh, do you want that oxygen for your kid? Yes.
Yeah. Yeah. So this, this, you know, like I said, parents are clever. It all makes sense. Of course, if you're not sleeping well, your immune system's not going to work as well.
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If you're not able to go into those deep sleep stages where a lot of that restorative work happens, then you're going to, you know, not function as well either.
And I think it's really a sleep disorder breathing and airway issues, I think are really interesting in a lot of ways.
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And they actually affect so many systems out there in the body that they're really, and again, it makes sense when you start delving into it.
But my hope for the future is that a lot of these big organizations out there that are dealing with different systems of the body start to shine a bit more of a spotlight onto that early intervention kids sleep airway.
(35:38):
And for example, you know, cardiac health, if you think of, and I know a lot of specialists know sleep apnea, you know, there's, there's a link between poor cardiac outcomes and sleep apnea.
But it's just, you know, you get higher blood pressure, you get the loosening of your cardiac fibres, all this sort of stuff.
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And a lot of these things you can find you can fix in a child, and that will impact the outcomes of that adult.
It's the same with the same with ADHD, you know, if you've got a child and again this makes sense when you think about it.
If you've got a child that is chronically under slept, so they're not going through all their sleep stages that they need to the light sleep stages and the deeper sleep stages.
(36:32):
And if they're not going into those then their body is going to flip into their nervous system is going to flip into a sympathetic nervous system state.
Right. And that what that looks like in a child is that hyperactivity that fight or flight, they're in a fight or flight they're not, they're not worried about their other systems you know they're executive functioning their cognitive abilities their social abilities their physical growth abilities
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their bodies just trying to survive, you know, keep them alive.
So ideally when a child sleeps they will consolidate that's when they do their learning consolidation.
And they make sense of the world. So they think, okay, yep, I've gone to sleep. This is an ideal child that sleeps well.
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I'm integrating all the learning that I've done today. I am putting it all the building blocks together. Yep, that makes sense. Building that neural pathway. Yep, making sense of the world and then they get the next bit of learning you know the next day or the next couple of days then they go to sleep where their
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brains are 10 times more active at night than during the day. And they lay that learning down. Okay, that makes sense. Yep, that goes there and all of a sudden you're building this beautiful brick wall. I like to think of it of a world that makes sense a sensory system that makes
sense a nervous system that makes sense. And that child is able to to really thrive.
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If you have a child that is starting to drop down into their sleep stages to do that, integrating that learning that consolidating all that stuff.
And then the soft tissues that the mouth start to relax because they're going down into their sleep stages.
They have to wake up because they have to breathe of course they go out they go to the lights lighter stages again. And then they try again to go through their, you know through their sleep cycles we need a number of years per night to be able to be a healthy functioning
(38:41):
human.
And then they try again, and the same thing happens you know it's all too small so when the muscles relax, it blocks and then of course their body is trying to survive so it wakes them up.
And they never get down into where they have to do that integration consolidation neural pathway stuff.
(39:03):
Whilst I am certain that ADHD exists without sleep disorder breathing as well.
Certainly for our child. That was the cause of his ADHD symptoms.
And now that we've got him a lot better air at night and better sleep.
(39:25):
You know they've they've resolved those symptoms so I think I think for a lot of these big organizations out there.
It would be just amazing if if some of the focus was shifted to this area because it's really.
It's really prevalent and even even mental health you know as a mental health OT.
(39:49):
I think if your if your system is on for so many years if you're in that chronic sympathetic nervous system state where you're you're on your inside or flight.
You know that you measure the quarter zone levels.
In a person that has sleep disorder breathing and they're high and that that can equal a person that has anxiety then because of course if you're constantly feeling like you're in danger.
(40:15):
You know that doesn't build well for your mental health as an adult.
Yeah, you'll just burn burn right out. Yeah.
So it all really it all really makes a lot of sense.
And it's the same thing.
Well having worked with people for years on their sensory issues and sensory processing disorders and things like that.
(40:46):
Yes, you can make a lot of difference with sensory interventions and finding out what that person needs.
But now there's no way I'd be working on sensory processing disorder with a kid or an adult without looking at their way.
Because they're not sleeping well and they're not breathing well then their body doesn't have the capacity to be able to interpret their senses properly.
(41:11):
So you really want to go.
You know you want to look at I know you guys talk about root cause a lot.
And you really want to shift your focus to there and I love more ot's out there to be screaming for sleep disorder breathing.
Yeah, I love that too. Yeah.
(41:33):
And EPs and ENTs and yeah wouldn't it be great because then you don't have to be an expert in this area but you can refer on if you're doing a screen up.
Yeah, just got a screen.
Yeah.
Yes, no one's expecting somebody to be a professional to be all over every part of a human body because it's impossible.
(41:58):
But if a kid or an adult has these issues if you're working on other systems in their body and ignoring our way in sleep, you're really missing a great opportunity to be able to help them.
And yeah, like how much is of course yeah, multifactorial but how much is other stuff going to stick without that foundation.
(42:25):
Gotta have. Gotta have the breathe. Yeah.
Yeah, exactly right. And and one of my going back to things that make sense you know one of my favorite quotes by Steven Lynn, Steven Lynn, his Australia is a holistic dentist is
I'm going to get them on the podcast. Come on.
Oh awesome. Yeah.
(42:47):
Hey, Sam, I've got it written down here because I didn't want to misquote him kids today are three to four generations deep into a health condition that's accelerating.
So I think that makes sense to me and I think kids that are born now are in this really interesting and frustrating time where you know compared to many years ago compared to generations before they they're a lot now a lot smaller a lot
(43:15):
more pushed in a lot thinner. So they're not getting asleep and airway.
Sorry, they're not getting the airway space that they used to.
But though the people that or the medical field that needs to help them with this smaller airway that they have, because they're born in this generation is not quite here.
(43:37):
So that evidence was it's out there. It's not mainstream now. It's not like you're going to walk into your pediatrician and they're going to all of a sudden start screening this other time out there that do. Yes, absolutely.
But in general, your mainstream GPs, ENTs, pediatricians, medical field is not going to screen the whole airway and by that I mean not just your not just the adenoids, terminates and tonsils but look at the home the mouth as a whole look at the tongue does it fit where it needs to fit.
(44:19):
Is there a tongue tie.
Look at the nasal passages look at the posture of the child look at the.
You know the lungs as well so as you as a lot of people in this space know it's all very siloed still people are not airway as a whole.
(44:43):
And so I just I feel sorry for these kids and I know I'm hoping by the next generation that this means that this information has made it to mainstream help.
So we can kind of meet somewhere in the middle you know kids are getting small arm.
And this information is.
Yeah, and it's.
Yeah.
(45:05):
So it's it's certainly on its way it just hasn't hit the ground, I guess so it's an interesting space for these kids to live in at the moment.
Yeah, yeah.
And yeah generations deep so hopefully we can get the ball rolling, but I mean I think it's rolling but yeah.
Yeah, yeah.
(45:27):
I'm excited for the future.
Yes, yes, we're doing it we're moving we're moving the needle. Yes.
Yes, you can take me back a little bit in when you were kind of assembling your kind of airway team for your son.
Like how did you find providers and then how did you kind of, you know, know they were the one so to speak.
(45:56):
I feel like I see a lot of parents getting really caught up, you know, they don't know who to trust they don't look for etc.
Yeah, for sure.
Connecting for so there's 15 minute free zooms that's really helpful.
Yeah, they helped give me some ideas and then I went straight for an airway focused orthodontist.
(46:23):
And I just simply Googled that, you know, and then I had a look at their websites, and I made sure that on the website there's there's orthodontist or dentist I was looking at we're talking about.
Anyway, pallet science, jaws, sleep.
So there's some of the keywords that I wanted to read.
(46:46):
And, and for parents, you know, if you're not sure, maybe ask reception before you go in before you waste your time.
And, and just ask, you know, is are you guys looking in our way are you looking at pallets are you looking at jaws.
(47:09):
And the second thing would be so good place to start I'd say is an anti to check out obstructions.
And you know, there's something to be said about whether or not you get obstructions out to but for us it was super helpful you got a way out, you know, have these have the adenoids tonsils actually lost their immune function because they're so chronically inflamed now that they're just an
(47:34):
obstruction, instead of actually being part of the immune system.
So that's a, you know, a personal choice as per family.
But so you want to get somebody like an ENT that's going to check out for actual obstructions and search for an a way also nontist or dentist that's what I did.
(47:58):
And also look at a myofunctional therapist I hadn't heard of that before, you know, before coming across that video from Dr. Mary Ely I had no idea what that was I am now one, which is quite funny.
But so they can help you check out is there a tongue tie, you know, is there some muscle function issues going on with your child.
(48:25):
And they're three really good places to start.
So how I decided was just the wording that people used where they were they talking about airway where they're talking about sleep where they're talking about pallet tongue or this sort of stuff and not just talking about straightening teeth.
So I was really looking for keywords that's what helped me decide who to use.
(48:51):
And where they listening as well so you know where they're listening to my concerns.
Where they using measurements that's another big one.
So you want to make sure that whoever's treating your child is having some sort of baseline measurements.
(49:12):
And, you know, able to look at relook at that again in three months time and see if if there's been any been in the changes.
And, and just someone that's, yeah, like I said really listening to what your concerns are as a parent.
But they're three really good places to start. It doesn't make up the whole team.
You know, unfortunately, yeah, it's a very complicated system.
(49:38):
Yeah, yeah. And I do love having the myofunctional therapist a lot of times, you know, they can be great with referrals or who you know, need to go see the next.
Yeah, because I understand the whole system. You know, it's not just about your ad noise.
It's not just about your nose or your, your breathing. It's about all of it.
(50:00):
And, and the thing about that is as well, you can't have, you can't just have one specialist looking after an airway child, unfortunately.
You can have a child with as much expansion as you like.
But if they've got a tongue tie that's holding that tongue down, they're still going to have issues.
(50:21):
You know, you can go and get your, you can have the muscles of your tongue working beautifully. And you can have that tongue up. But if you don't have, if you, a kid still got crazy allergies, and they can't physically breathe through their nose.
Then you know, you know, you know, better off as well. So you can have your ad noids taken out and have all this beautiful airway at the back.
(50:46):
And again, if you've got allergies that are not addressed in your nose, it's just not going to work.
You can, again, you can have a tongue that's super strong. But if you haven't got the actual space in that top jaw for that time to go to go out where it needs to go, then you know better off either a little bit better off.
(51:09):
So you really need, unfortunately, it is a complicated kind of area. It's called, you know, the craniofacial respiratory complex.
And I, it is complex.
So just just for parents to know that it's so worth it. It's so worth it.
(51:31):
Even if I don't want it to overwhelm parents, I think, Oh my gosh, I'm going to need, you know, E and T and my functional therapist, a chiropractor to help with that.
Or waking up the cranial nerves that have been asleep or getting that posture right or all these fabulous things that body worker or chiropractor can do.
(51:53):
You know, an orthodontist or an airway dentist.
So yes, it sounds like a lot of people that are going to become your army as an airway parent.
But it's so worth it. It's so beyond worth it because all these other issues that you may be having with your child and putting your energy and your emotional resources into trying to fix these one by one or deal with them.
(52:18):
Boom, go straight to the potential root cause and then resolve themselves, you know, the shyness at the park that our kid used to have is resolved issues at school, resolved immunity, working on it.
Yeah, allergy is pretty much resolved. Sensor issues resolved. Like, we're not at the end of our journey yet. Absolutely. But far out. I cannot express enough to parents that it's worth a look in.
(52:56):
And I say on my Instagram all the time, just really in or out. It's worth, it's worth focusing some attention to, to it. Just really in or really out.
Yeah, yeah. Yeah, definitely.
I liked what you had said when I talked last time too about like, you know, maybe your son's case might be more extreme than others, but yeah, for, for other kids too, even if it's just a little bit less, you know, sleep and breathing like, you know, wanting them to reach their full potential.
(53:33):
So, yeah, definitely worth a rule in or out.
Yeah, absolutely. And if you can, you know, maybe your kid is not is thriving.
But they've just got those few little things.
You know, they could be, they could be extra thriving, I guess, or just, or just having to put in less work within themselves because kids are really good at compensating and trying to deal with the load, you know, the lot that they have.
(54:06):
So if you can relieve them of some of that burden, if they are being affected by airway or sleep issues, then why not.
They might start to thrive in all these other ways that you just never thought was possible.
So yeah, it's definitely worth a look in or a look out, you know, really in or all out.
And I think, I think another, you know, another suggestion for parents would be to
(54:33):
get a second or third opinion. And I guess kind of like a something I want to really relate to parents is get a second or third opinion.
If you're not happy with, if you don't feel heard, if you're not, if your guts telling you that a specialist is not understanding your issues.
So a second or third opinion, you know, I wish that we had got a few more opinions, even though we had seven specialists in a year, we, we eventually found our people, our people that could help us.
(55:07):
So don't be scared to keep looking.
And yeah, and just also for the parents out there that have got these goods outcomes.
Keep talking. The kids in the next generation need you to keep talking about.
And parents really, I know parents are driving this, a lot of this airway information getting out there.
(55:33):
Because we've lived it, we've seen it, and, and also these, you know, these amazingly passionate people like you guys.
And all these other sort of specialists out there, or airway people out there are trying to get the information out in any way they can.
But there's, there's parents out there too. And I really, you know, I employ you to keep talking about it, keep sharing your stories.
(56:00):
And I meet many of you in Dr. Montlivier's office and hear these amazing outcomes. So keep telling other parents about it, because the generations to come need us.
They really do. I love that.
Yeah, so we'll definitely link your Instagram and everything in the show notes. So parents can connect with you as well.
(56:28):
At the end of the podcast. I know you've already dropped a lot of encouragement and advice to parents, but is there any final thoughts you'd want to leave them with or also to the clinician side as well.
Um, so my parents, yeah, I just, the parents again keep talking about it you had some good outcomes keep chatting, get your second and third opinions and clinicians.
(56:54):
I would say for occupational therapists, which I am, come on over. This is this is exciting. This isn't it. This is a, this is a domain that can be ours. Sleep is something that OTS cover.
It's a really exciting area. You know, you can get to the root cause of issues with a lot of kids with that sensory stuff with ADHD stuff with the physical stuff, immunity stuff, all that.
(57:21):
You can really make a difference. So, you know, always happy to connect with OTS out there. This can be part of our toolbox.
If you're not totally comfortable, you know, if you're really happy in whatever you're doing as an OT already, then I would, I would suggest maybe just getting an airway screener.
(57:43):
You can find them out there. If you just look for them, I've got one as well on my Instagram, just a screener child for airway issues and then refer on, you refer on someone that can help with that.
And you're going to see if that is an issue for the child, you're going to see some really beautiful outcomes in your therapy if we can work on those issues with that child.
(58:07):
Yeah, definitely. Awesome. Well, thank you so much, Claire. It was so great to have you on.
You're so welcome and thank you guys for everything you do.
You can stay connected with the Children's Airway First Foundation by following us on Instagram, Facebook, X, LinkedIn and YouTube.
(58:28):
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 contacts page on our website, or send us an email directly at infoatchildrensairwayfirst.org.
(58:49):
Today's episode was written and directed by Rebecca St. James, video editing and promotion by Ryan Dran and guest outreach by Christy Bochinkian.
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.
(59:39):
.
Hi everyone, and welcome to another episode of The
(00:29):
Welcome Back to Airway First, the podcast from the Children's Airway First Foundation.
I'm your host, Rebecca St. James. In today's episode, our parent liaison,
Christy Bojinkian, will be chatting with Claire Duke, a myofunctional therapist and
occupational therapist. Before receiving her training in myofunctional therapy,
(00:49):
Claire served the adult population as an occupational therapist. Having a child with
an airway issue ignited her passion in this space and her desire to help kids in their futures.
Claire believes that sleep and breathing are the cornerstones of health for any child,
and she is particularly passionate about early intervention and the role that oral facial
(01:12):
dysfunction plays in a child's behavior, sensory system, health, immunity, allergies,
and cognitive development. If you want to hear more about Claire in her own words and her story
with herself and her daughter in their airway journey, you can check out our blog, Our Airway
Journey with Sleep Disordered Breathing, Mystery to Passion, on our website.
(01:34):
And now, let's jump into the interview with Christy and today's guest, Claire Duke.
So welcome, Claire. Thank you so much for joining us today. So kind of before we get into it,
before you got into your airway journey, can you tell me about your practice as an occupational
(01:56):
therapist? Yeah, sure. So I've worked 13 years with adults who have mental health diagnoses,
and mostly that's people with psychotic illnesses. So it's get to friendly us,
get to affected disorder, bipolar disorder, and voice people that hear voices. And, you know,
(02:21):
it was teaching a lot of everyday living skills sort of stuff. So the practical day-to-day stuff
that we all take for granted, some of these people were in homes for much of their life or in jail
for much of their life. So it was just about retraining some of those life skills. So that's
sort of what I was doing prior to, you know, over the last little, probably year and a half,
(02:45):
when life took a rather large turn. And I'm still doing some of that mental health adult work. So
that's that's certainly an area that I still very much love. But for, I've ventured elsewhere
because for a very long time, our son was a mystery to many specialists out there. He wasn't a very
(03:16):
well-child. He had, you know, what I can see now is lots of red flags for airway. He had things
like he was late bedwetter, he was irritable, we couldn't figure out why he still yawned quite a
lot. He'd have troubles sitting. He would be on prednisone quite a lot to try to control his
(03:42):
asthma. He had some sensory issues as well, which we, you know, we weren't trying to figure out,
does he have sensory processing disorder? Does he have ADHD? He had a lot of these kind of,
kind of issues. Teachers were reporting that he was having some meltdowns at school, wasn't quite
(04:03):
coping at school. Also had some oral ticks. So some unusual, you know, behaviors with his,
with his mouth or making kind of vocal sounds, shoulder shrugging, these sorts of things,
which is quite an interesting area. And frequent wakeups as well. So he, looking back now, you
(04:24):
know, I can see there's lots of things there that kind of scream, this is an airway child,
he needs some help with his sleep and his breathing. But back then he was really a mystery to, we
had seven specialists in, in a year period. I remember it was two sleep doctors, two ENTs,
we had two, we had sorry, two pediatricians and an allergist. So at least seven different
(04:51):
specialists. So what kind of, who did you go see first and what kind of spurred you to get?
It would have been the pediatrician first, I'd say. Any centers for a sleep study, which was,
(05:12):
you know, ended up being helpful in the long run, but it's, it's didn't show that there was any major
concerns with our sun sleep. Yeah, which, which I know now can happen. And I really,
we were starting on the right direction, but not all the way there. Yeah, that's right. And I,
(05:38):
a little side note, you know, I don't want a parent, I think parents, if you are getting a
sleep study, that's amazing and parents really should, but don't let that be the be all and end
all of your journey of trying to figure out what's wrong with your child. Because, you know,
a little side note, I guess, story about what happened to us was, he had the sleep study. And,
(06:03):
you know, I've got it here. So I'm not sure if you can see these. This is his CO2 numbers,
you probably can't see that. But anyways, there, the numbers such as like 49, 52, 48,
47, 47. So Charles CO2 is meant to be around 35. But there's one in there where the machine was
(06:24):
off. And so it was a zero and it skewed the whole score. Right. So, so the clues were there.
But because of the way some sleep studies are read, you know, this then presented as a child
that didn't have any issues with CO2. So it wasn't until later down the track that I asked for the
(06:46):
raw data and had a look at it myself, that I could see there was, there was gaps there. So sleep
studies are amazing to help create a picture of what's going on. But they're certainly not the
real end all, you know, to figure out what's going on. Definitely. Yeah. And we will have a
(07:08):
upcoming episode doing like a tour of a sleep lab too. So parents can get a little familiar. And
then yeah, of course, definitely, who is interpreting the data is going to make a big
difference too. Yes. Yes. And then I can sleep study because I went to see another sleep doctor
because he was yawning all the time. You know, he was just in that mild, mild range of sleep apnea.
(07:35):
And what I know now is that even though a child might present as having mild symptoms, it certainly
doesn't correlate to how that plays out in their life and and how they're, even if it's only a
couple of wake ups per hour, that's going to majorly affect every system in life. So, you know,
(07:57):
also if it's just a mild sleep apnea to take that quite seriously as well. Definitely. Yeah.
Okay. Seeing the specialists and stuff. Yeah, how did you kind of get into the airway world?
And where did you first hear about it? Start going down with rabbit holes? Yeah. Yeah. So we had a
(08:23):
couple of a couple of golden nugget clues, I call them. And the first one was our second ENT. He
said, let's get his adenoid out. Let's reduce his turbinates in his nose, which is our six filtration
system in our nose. And that really helped that really helped. You know, we thought, oh, he's less
(08:45):
irritable. He's yawning less. He's growing now. You know, this is done great. Our child's thriving
now, not just surviving. And we also, the second kind of golden nugget clue, I would say was that
we got his allergies under control using a, it's great exposure to spray put under their tongue.
(09:09):
It's like a three year course. And it just gets that child used to their allergens for our kid.
It's dust mites and animals. And that really helped as well. So these are two clues along the way
that let us know that this was kind of an airway issue. But it wasn't resolving everything. He was
(09:29):
still having a lot of these symptoms, still having the oral ticks and sensory staff, ADHD symptoms,
irritable, all this sort of thing. So he was, this was between three and a half and five and a half.
And we thought, okay, this is, we'll take this. This is pretty good. And then symptoms started to
(09:53):
come back a little bit. The dark circles up the eyes. And a lot of the other symptoms that I mentioned
started to return. And we just couldn't figure it out. And he really was a mystery to all these
specialists. They were checking him for autoimmune disease or diabetes, parasites, all these sorts
of treatments that kind of weren't working. And, you know, looking back now, they all had the best
(10:20):
of intention, all these specialists, they, they wanted to help and they were trying to help, but
they weren't kind of looking at the full picture of what was going on. And like you say on your
podcast, no, you don't, you don't know what you don't know. But I, you know, looking back, I thank
them for their help along the way to help us try to figure it out. Our world really cracked open
(10:45):
a year and a half ago, I'd say it was, it was April 2023 when, when life really changed for us.
I saw a video from Dr. Mary Ali, who is an occupational therapist and an oryfacial myofunctional
therapist. So oryfacial, you know, mouth and face, myofunctional, how the muscles work, and
(11:11):
therapist. And my jaw dropped to the ground. She was describing what we were going through. She was
describing an airway child. She was describing a sleep-disorted child. I remember just sitting on
the floor of his bedroom and watching this video and wow, this was, this was like, this was the
(11:35):
aunt, you know, this had to be the aunt's. What you've been looking for? Yeah, that's right. It was,
it was like, it was just this absolute pull to look into this. And I watched it again, the
next day, it was 30 minutes and the next day. And was just, you know, thinking, I need to really
(11:58):
investigate this. So steps after that was I took some free zooms, some free zoom calls. So with Dr.
Mark Levi and his team who are our leaders in the pack here in Australia for, for airway and sleep
(12:23):
to sort of breathing stuff for kids. And, you know, as a parent, I would definitely recommend doing
that, taking those free zoom calls, trying to learn as much as we can. Instagram is also a really
great resource for learning. There's so much going on there. There's so many passionate people
(12:53):
on there. And yeah, sharing their wisdom, including you. Yeah, that's right. And the funny thing along
the way is you learn so many of these passionate people are parents of kids that have airway issues.
Or they've got airway issues themselves, which as we know is a huge percentage of the population.
(13:17):
Yeah. And now they're trying to get the word out there. And I feel like it's slowly,
you know, it's slowly coming out. So, so after this, we got our child in an expander,
which is, you know, there's a few pieces to our puzzle and having his adenoids and terminates out,
it's a big thing that helped having the immunotherapy, which is the graded exposure under
(13:42):
the tongue for allergies really helped. nasal sprays along the way really helped. But
the one of the biggest things was a pallid expander for us.
And, you know, I could talk all day about this process, how it went and how it tolerated it well.
(14:06):
We were seeing results. We were seeing good outcomes within a month of active expansion.
So as scary as it sounds having a bulky thing in your kids mouth to parents, I would say,
give it a go. Give it a go. So I wrote down some measures when he got to him. So when he got his
(14:32):
pallid expander in, I thought, I just want to measure this. I want to write down what we're
having issues with and recheck it because I don't want to be putting this time energy,
our emotional resources, everything into a treatment that may or may not work.
So he was five and a half. So that was 15 months ago, 14 months ago.
(15:00):
I had to prep him for the expander.
That was the hard part. Getting him in the chair. Getting him in the chair was the hard part
because he was a sensory kid. He didn't like things, creams, band-aids, haircuts. He didn't like
(15:23):
socks with no seams, socks with seams, pants with seams, all these sorts of things.
That's all resolved now, I'm happy to say. But we had to just try to bribe him.
That sounds, yeah, it is what it is. Yeah, big reward. Exactly. We had to say,
(15:49):
do you want the biggest lego from the shop? He kicked the seat the whole way there. It was
really terrible. I took my hubby. But when he saw it, he was like, oh, okay. We made it red,
which is a little snippet, a little side note against parents. He thought was amazing because
(16:11):
it looked like blood. So he could open his mouth and get that and scared. My mouth bleeding.
I'm gonna show my friends. So highly recommend choosing the color again. Yeah.
Goal factor. Getting it in the mouth was easy. He sat up and was like, oh, it's right here.
(16:33):
And then he quite liked it. I don't know. Maybe it was all the attention he got. Maybe it was the
the video games that he was allowed to play afterwards.
Lots of ice cream for the next few days, all those sorts of tricks to do what you have to do
with a parent. Right. Yeah. Making a great experience. Yeah. Anything to get it in. Because
(17:00):
I tell you what, within it was less, it was, we had it in there for two weeks before they started
actively turn it. So it was really two weeks after actively expanding him that we started to see
these symptoms of a child that could breathe. And it was, some of it was quite
physical as well. You know, he used to sleep in hyperextension. So his neck out mouth open.
(17:24):
This photos I've got on my Instagram of that so parents can visually see what that looks like.
But so we got it in June. And these measures I've got here. September I did measures again.
So about four months later. And here's bedwetting. So in June, it was about once a week. In September,
(17:47):
from June, he'd only wet the bed once. His ability to sit went from 10 minutes in June to 40 minutes
in September. Yorns on our drive to school, which is a 20 minute trip in June before expander was
about eight year olds in that 20 minutes in September, it was two year olds needing prednisone.
So he needed prednisone about every two to three months prior to six Panda.
(18:12):
He hasn't needed it since. So that's 15 months of not, I'm no. Has he had asthma, terrible asthma?
Yes, a lot less, a lot less. We've only needed his puffers. There's been no oral steroids needed,
which is a huge, huge change. He's able to. So as of September, he was able to tolerate baths.
(18:36):
He was able to tolerate band-aids, seams in pants in socks didn't worry him anymore. He's
he's to have a rash around his mouth pretty much monthly. That was totally resolved as of September
and we haven't seen that back since. His school report cards, because it's nice to, you know,
as a parent, you can see these things, but it's also nice to get that objective
(19:01):
measure from somebody else in his school. What? They are quite different. They're really different.
You know, they they noted in that teachers big change from last term.
So it's not just it's nice to get that it's refirming to be like, okay, not just us that
are noticing these. His tics, his oral tics, whilst they're still there occasionally,
(19:27):
they're not constantly rotating now. They come up when he has a cold. So he's had a cold this week.
And so we've had a little bit more of some unusual mouth noises. He was just he used to wake up 930
every night, maybe wake, wake up again about 1230. That totally resolves. He'll sleep through the
(19:48):
night now. His irritability was a hard one to measure, but that definitely went down. He's a
really happy child now. Shiness at the park, you know, all these kind of all these sort of
measures that are that you can capture because their numbers were really reaffirming that we're
on the right path. Yeah. So is he still an expansion now or he is? Yeah, he's still an
(20:17):
expansion now. So we're not we're not at the end of our journey. After this, you know, we've got to
start working on the muscles of his mouth and get those to to work properly. Because at the moment
he's got the expandar in so getting that that top that tongue up to that top palate is not really
happening for him. So it is still blocking his airway sometimes at night. His tongue is still
(20:41):
and he's got quite a small pharyngeal that's the back throat kind of area. So we're we're still
got a way to go. But he's he's definitely an improved child and just happier and less sick,
much less sick, way, way less. He's still an athlete here. So he still takes longer to get
(21:02):
better and those sorts of things. But you know, he's he's a lot a lot, lot better. So I guess
after we started to see all these measures, I was like, this is I need to do this. This is
this is amazing. This everyone needs to know about this. And I remember having and I still have all
(21:24):
this passion for it. So I rang I just tried to connect myself with some people out there in
this space. And one of the people I rang was Dr. Mark Levi, who's a craniophacial sleep
and airway guru. And I just said a cold called him out of nowhere and just said,
I've got all this passion. I don't know where to put it. I don't know what to do with it.
(21:48):
I'm just ringing people. And he was kind enough to match that passion, I guess, you know, he's a
very passionate fellow. And yeah, and has let me go into his office and work with an amazing OMT,
our facial myofunctional therapist, Robin Ann, who is there and look in all these little mouths and
(22:14):
start really learning, you know, start talking to the parents that are there. Start learning how
all the the face works and muscles and the lip, her important lip seal is and tongue up and, and I went on
to do my functional therapy course and become qualified in that. And it was just interesting
(22:36):
hearing from other parents, you know, there's a heap of children that are seen in that office.
And the parents are just saying the same, the same things. Their kids are finding school easier,
bedwennings going, ADHD symptoms are getting less. And it's the same story being told. And that is
(23:00):
really reaffirming that it's not just us. This is this is out there. This is helping kids. This is
helping parents. There's not one parent that I've spoken to in that office, or in my own private
practice now, that is not seeing good results from looking into this airway space with their child.
(23:21):
Yeah. So let's talk a little bit more about how, yeah, your career has shifted kind of into the airway.
Yeah, yeah, sure. So I just started to really look into airway and sleep for kids and for adults. And
(23:44):
I guess that I started to look at my adult mental health people that I was working with as well.
And I can see, you know, now when I go and do therapy with them and work with them, I'm asking
more questions. I'm seeing them with kind of airway eyes now, I guess, and I'm able to see all these
(24:10):
overbites, unobytes, misalignments, asking them about their sleep. And so many adults with mental
health diagnoses have, you know, have airway and sleep issues. So it's definitely made me rethink a
little bit about what I do. And I know mental health is absolutely multifactorial, you know,
(24:36):
you've got childhood experiences, you've got your environment, you've got your things that happen to
you, you've got addictions, you've got your inner resilience, all that sort of thing that make it a
very complicated area. But I just, I just kind of wandered out now and I think back to a man that
died by suicide a year ago. And again, looking at his funeral book with airway eyes, I could see
(25:06):
these photos of this lovely, beautiful man. And he had gummy smile and he had the really long
changed kind of skull of what's happening to us now as a human species, you know, we're not
just wide with all this airway now, getting longer and narrower and affecting our airway. And I could
(25:33):
see all these things, all these sort of red flag visible signs with him, you know, crooked teeth.
And I asked somebody in a kind of delicate way that knew him well about his sleep and yes, he had ADHD
as a child. He didn't sleep very well, he spoke about that often and all these other kind of things and it
(25:54):
just, it just makes me think, you know, wouldn't the trajectory of some of these people's lives have
gone a different way had they have got the help they needed when they were children with their sleep,
with their breathing. It may not have made any difference, but now it's just in the back of my
thought, in the back of my mind, I'm really shifting my focus to let's go in early, let's get early
(26:17):
intervention into these people and try to make a change. So I'm slowly shifting from adult mental
health into kids airway, because when you see can't unsee it, and when you've lived it and see the
benefits, and hearing stories from parents that are also seeing the benefits, it's, you know, you can't
(26:42):
kind of, you can't look away now.
(27:12):
You can find out more about the Children's Airway First Foundation and our mission to fix before six on
our website at children'sairwayfirst.org. The CAF website offers tons of great resources for both
(27:33):
parents and medical professionals. 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.com backslashgroups backslashairwayhuddle.
(28:00):
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.
(28:41):
And I think, you know, I love, I love that you guys have that fix before six. I think that's such a great, such
a great motto because as an OTE, you know, so much learning consolidation goes on before six in the
child's brain. So many neural pathways are being laid down. That's when they're meeting or not
(29:06):
meeting some of their social milestones or they're just general milestones. And you want them to be, you
want a child to be using their energy on, you know, their cognition and figuring out their executive
functioning sort of things. So like memory and sequencing and putting their energy towards all of
(29:31):
these learning kind of aspects of their life and then your pathways instead of just trying to breathe and
survive.
Right. Not just getting by.
Yeah, that's right. And also before six, they're so malleable, you know, they're so, you can really make
changes in that time. It's 80% of their craniofacial growth is done by the age five or six or something
(29:58):
like that. So yeah, that's during that time. Yeah. Yeah. So that's a time to really get in there. And the
other thing about that is that if they are using the muscles of their face incorrectly, you know, not
swallowing correctly or mouth breathing or tongues on the bottom of their palate, or as it should be at
(30:24):
the top, if you're trying to work with a child that is say four or five on those, those muscle related
functions, it's so much easier than trying to work with a child who is 10 or 12, who's had 10 or 12 years
worth of habits of muscles. So the key really is in that first six years, you know, that's when a lot of the
(30:55):
magic will happen. So I love your your fix before six. I think that's brilliant.
Yes. Yes.
Yeah.
Yeah. Yeah.
And it really resonates. It does resonate with a lot of parents when you start talking to them out there about
these, these things because a lot of them are a lot of these things they can see, you know, you start
(31:23):
talking about crooked teeth, pallets not being big enough, they can visually see that, oh, my child does have
crooked teeth, they've got shark teeth. You know, you can talk about dark circles and why that happens. And
they can visually see that you can talk about a child, hyper extended at night, so trying to get breath in or
fakes or bedwetting. These are, these are the and when you talk to parents, it kind of makes sense, you know,
(31:50):
when you start learning about it, and you look at skulls, you can go on and Google, you know, skulls from
500 years ago, a thousand years ago. And they've visually we can see with our own eyes, they look different.
They're longer, they're more narrow. All this beautiful airway arches is is is here's my head here. Oh yeah.
(32:14):
You know, all this is just smaller and what that does and when you describe it to parents as well.
Parents are clever. This stuff makes sense when you talk about the, the pallet, the top pallet.
You know, mandible maxilla. When you talk about that, being smaller, of course, it connects the roof of your
(32:37):
mouth is the floor of your nose. Parents understand that when you talk about it. So of course you're going to have, it's the same bone.
So if that area is narrow and not wide, you know, and high arched, then of course the nasal passages are going to be
more narrow. You've got a kid with allergies out there, like so many people in Australia have allergies.
(33:06):
The same amount of swelling on an airway, sorry on a nasal passage that's wide is going to affect that child a lot less than that same amount of
swelling on a passage where it is narrow. It makes sense. This stuff actually makes sense when you read about it.
Yeah, it's just, yeah, it just makes sense. Yeah, you don't need any fancy degrees to understand.
(33:31):
That's right. Yeah, when you start learning about it, it's like, well, how did we not see this before? How did we not?
And I love this Dr. Sherene Alim's book, but I'm not sure if.
Oh, yes. Yes, I love that image. Yeah.
Yeah, that's the, that's the floor of the top jaw and so is this. But this is showing a, which a lot of kids have and my kid had it that narrow, high arch and this is, you know, space up here.
(34:04):
I'm not sure this is a video podcast.
Yeah, okay.
Okay, cool. And this is an airway, you know, at the top of a palette. So your top jaw that is nice and wide there. And to seal that, that's the top of the nose there.
So it makes sense when you actually look at it as well.
(34:26):
And you can open your own.
Oh, do you want that oxygen for your kid? Yes.
Yeah. Yeah. So this, this, you know, like I said, parents are clever. It all makes sense. Of course, if you're not sleeping well, your immune system's not going to work as well.
(34:47):
If you're not able to go into those deep sleep stages where a lot of that restorative work happens, then you're going to, you know, not function as well either.
And I think it's really a sleep disorder breathing and airway issues, I think are really interesting in a lot of ways.
(35:10):
And they actually affect so many systems out there in the body that they're really, and again, it makes sense when you start delving into it.
But my hope for the future is that a lot of these big organizations out there that are dealing with different systems of the body start to shine a bit more of a spotlight onto that early intervention kids sleep airway.
(35:38):
And for example, you know, cardiac health, if you think of, and I know a lot of specialists know sleep apnea, you know, there's, there's a link between poor cardiac outcomes and sleep apnea.
But it's just, you know, you get higher blood pressure, you get the loosening of your cardiac fibres, all this sort of stuff.
(36:04):
And a lot of these things you can find you can fix in a child, and that will impact the outcomes of that adult.
It's the same with the same with ADHD, you know, if you've got a child and again this makes sense when you think about it.
If you've got a child that is chronically under slept, so they're not going through all their sleep stages that they need to the light sleep stages and the deeper sleep stages.
(36:32):
And if they're not going into those then their body is going to flip into their nervous system is going to flip into a sympathetic nervous system state.
Right. And that what that looks like in a child is that hyperactivity that fight or flight, they're in a fight or flight they're not, they're not worried about their other systems you know they're executive functioning their cognitive abilities their social abilities their physical growth abilities
(37:00):
their bodies just trying to survive, you know, keep them alive.
So ideally when a child sleeps they will consolidate that's when they do their learning consolidation.
And they make sense of the world. So they think, okay, yep, I've gone to sleep. This is an ideal child that sleeps well.
(37:22):
I'm integrating all the learning that I've done today. I am putting it all the building blocks together. Yep, that makes sense. Building that neural pathway. Yep, making sense of the world and then they get the next bit of learning you know the next day or the next couple of days then they go to sleep where their
(37:43):
brains are 10 times more active at night than during the day. And they lay that learning down. Okay, that makes sense. Yep, that goes there and all of a sudden you're building this beautiful brick wall. I like to think of it of a world that makes sense a sensory system that makes
sense a nervous system that makes sense. And that child is able to to really thrive.
(38:08):
If you have a child that is starting to drop down into their sleep stages to do that, integrating that learning that consolidating all that stuff.
And then the soft tissues that the mouth start to relax because they're going down into their sleep stages.
They have to wake up because they have to breathe of course they go out they go to the lights lighter stages again. And then they try again to go through their, you know through their sleep cycles we need a number of years per night to be able to be a healthy functioning
(38:41):
human.
And then they try again, and the same thing happens you know it's all too small so when the muscles relax, it blocks and then of course their body is trying to survive so it wakes them up.
And they never get down into where they have to do that integration consolidation neural pathway stuff.
(39:03):
Whilst I am certain that ADHD exists without sleep disorder breathing as well.
Certainly for our child. That was the cause of his ADHD symptoms.
And now that we've got him a lot better air at night and better sleep.
(39:25):
You know they've they've resolved those symptoms so I think I think for a lot of these big organizations out there.
It would be just amazing if if some of the focus was shifted to this area because it's really.
It's really prevalent and even even mental health you know as a mental health OT.
(39:49):
I think if your if your system is on for so many years if you're in that chronic sympathetic nervous system state where you're you're on your inside or flight.
You know that you measure the quarter zone levels.
In a person that has sleep disorder breathing and they're high and that that can equal a person that has anxiety then because of course if you're constantly feeling like you're in danger.
(40:15):
You know that doesn't build well for your mental health as an adult.
Yeah, you'll just burn burn right out. Yeah.
So it all really it all really makes a lot of sense.
And it's the same thing.
Well having worked with people for years on their sensory issues and sensory processing disorders and things like that.
(40:46):
Yes, you can make a lot of difference with sensory interventions and finding out what that person needs.
But now there's no way I'd be working on sensory processing disorder with a kid or an adult without looking at their way.
Because they're not sleeping well and they're not breathing well then their body doesn't have the capacity to be able to interpret their senses properly.
(41:11):
So you really want to go.
You know you want to look at I know you guys talk about root cause a lot.
And you really want to shift your focus to there and I love more ot's out there to be screaming for sleep disorder breathing.
Yeah, I love that too. Yeah.
(41:33):
And EPs and ENTs and yeah wouldn't it be great because then you don't have to be an expert in this area but you can refer on if you're doing a screen up.
Yeah, just got a screen.
Yeah.
Yes, no one's expecting somebody to be a professional to be all over every part of a human body because it's impossible.
(41:58):
But if a kid or an adult has these issues if you're working on other systems in their body and ignoring our way in sleep, you're really missing a great opportunity to be able to help them.
And yeah, like how much is of course yeah, multifactorial but how much is other stuff going to stick without that foundation.
(42:25):
Gotta have. Gotta have the breathe. Yeah.
Yeah, exactly right. And and one of my going back to things that make sense you know one of my favorite quotes by Steven Lynn, Steven Lynn, his Australia is a holistic dentist is
I'm going to get them on the podcast. Come on.
Oh awesome. Yeah.
(42:47):
Hey, Sam, I've got it written down here because I didn't want to misquote him kids today are three to four generations deep into a health condition that's accelerating.
So I think that makes sense to me and I think kids that are born now are in this really interesting and frustrating time where you know compared to many years ago compared to generations before they they're a lot now a lot smaller a lot
(43:15):
more pushed in a lot thinner. So they're not getting asleep and airway.
Sorry, they're not getting the airway space that they used to.
But though the people that or the medical field that needs to help them with this smaller airway that they have, because they're born in this generation is not quite here.
(43:37):
So that evidence was it's out there. It's not mainstream now. It's not like you're going to walk into your pediatrician and they're going to all of a sudden start screening this other time out there that do. Yes, absolutely.
But in general, your mainstream GPs, ENTs, pediatricians, medical field is not going to screen the whole airway and by that I mean not just your not just the adenoids, terminates and tonsils but look at the home the mouth as a whole look at the tongue does it fit where it needs to fit.
(44:19):
Is there a tongue tie.
Look at the nasal passages look at the posture of the child look at the.
You know the lungs as well so as you as a lot of people in this space know it's all very siloed still people are not airway as a whole.
(44:43):
And so I just I feel sorry for these kids and I know I'm hoping by the next generation that this means that this information has made it to mainstream help.
So we can kind of meet somewhere in the middle you know kids are getting small arm.
And this information is.
Yeah, and it's.
Yeah.
(45:05):
So it's it's certainly on its way it just hasn't hit the ground, I guess so it's an interesting space for these kids to live in at the moment.
Yeah, yeah.
And yeah generations deep so hopefully we can get the ball rolling, but I mean I think it's rolling but yeah.
Yeah, yeah.
(45:27):
I'm excited for the future.
Yes, yes, we're doing it we're moving we're moving the needle. Yes.
Yes, you can take me back a little bit in when you were kind of assembling your kind of airway team for your son.
Like how did you find providers and then how did you kind of, you know, know they were the one so to speak.
(45:56):
I feel like I see a lot of parents getting really caught up, you know, they don't know who to trust they don't look for etc.
Yeah, for sure.
Connecting for so there's 15 minute free zooms that's really helpful.
Yeah, they helped give me some ideas and then I went straight for an airway focused orthodontist.
(46:23):
And I just simply Googled that, you know, and then I had a look at their websites, and I made sure that on the website there's there's orthodontist or dentist I was looking at we're talking about.
Anyway, pallet science, jaws, sleep.
So there's some of the keywords that I wanted to read.
(46:46):
And, and for parents, you know, if you're not sure, maybe ask reception before you go in before you waste your time.
And, and just ask, you know, is are you guys looking in our way are you looking at pallets are you looking at jaws.
(47:09):
And the second thing would be so good place to start I'd say is an anti to check out obstructions.
And you know, there's something to be said about whether or not you get obstructions out to but for us it was super helpful you got a way out, you know, have these have the adenoids tonsils actually lost their immune function because they're so chronically inflamed now that they're just an
(47:34):
obstruction, instead of actually being part of the immune system.
So that's a, you know, a personal choice as per family.
But so you want to get somebody like an ENT that's going to check out for actual obstructions and search for an a way also nontist or dentist that's what I did.
(47:58):
And also look at a myofunctional therapist I hadn't heard of that before, you know, before coming across that video from Dr. Mary Ely I had no idea what that was I am now one, which is quite funny.
But so they can help you check out is there a tongue tie, you know, is there some muscle function issues going on with your child.
(48:25):
And they're three really good places to start.
So how I decided was just the wording that people used where they were they talking about airway where they're talking about sleep where they're talking about pallet tongue or this sort of stuff and not just talking about straightening teeth.
So I was really looking for keywords that's what helped me decide who to use.
(48:51):
And where they listening as well so you know where they're listening to my concerns.
Where they using measurements that's another big one.
So you want to make sure that whoever's treating your child is having some sort of baseline measurements.
(49:12):
And, you know, able to look at relook at that again in three months time and see if if there's been any been in the changes.
And, and just someone that's, yeah, like I said really listening to what your concerns are as a parent.
But they're three really good places to start. It doesn't make up the whole team.
You know, unfortunately, yeah, it's a very complicated system.
(49:38):
Yeah, yeah. And I do love having the myofunctional therapist a lot of times, you know, they can be great with referrals or who you know, need to go see the next.
Yeah, because I understand the whole system. You know, it's not just about your ad noise.
It's not just about your nose or your, your breathing. It's about all of it.
(50:00):
And, and the thing about that is as well, you can't have, you can't just have one specialist looking after an airway child, unfortunately.
You can have a child with as much expansion as you like.
But if they've got a tongue tie that's holding that tongue down, they're still going to have issues.
(50:21):
You know, you can go and get your, you can have the muscles of your tongue working beautifully. And you can have that tongue up. But if you don't have, if you, a kid still got crazy allergies, and they can't physically breathe through their nose.
Then you know, you know, you know, better off as well. So you can have your ad noids taken out and have all this beautiful airway at the back.
(50:46):
And again, if you've got allergies that are not addressed in your nose, it's just not going to work.
You can, again, you can have a tongue that's super strong. But if you haven't got the actual space in that top jaw for that time to go to go out where it needs to go, then you know better off either a little bit better off.
(51:09):
So you really need, unfortunately, it is a complicated kind of area. It's called, you know, the craniofacial respiratory complex.
And I, it is complex.
So just just for parents to know that it's so worth it. It's so worth it.
(51:31):
Even if I don't want it to overwhelm parents, I think, Oh my gosh, I'm going to need, you know, E and T and my functional therapist, a chiropractor to help with that.
Or waking up the cranial nerves that have been asleep or getting that posture right or all these fabulous things that body worker or chiropractor can do.
(51:53):
You know, an orthodontist or an airway dentist.
So yes, it sounds like a lot of people that are going to become your army as an airway parent.
But it's so worth it. It's so beyond worth it because all these other issues that you may be having with your child and putting your energy and your emotional resources into trying to fix these one by one or deal with them.
(52:18):
Boom, go straight to the potential root cause and then resolve themselves, you know, the shyness at the park that our kid used to have is resolved issues at school, resolved immunity, working on it.
Yeah, allergy is pretty much resolved. Sensor issues resolved. Like, we're not at the end of our journey yet. Absolutely. But far out. I cannot express enough to parents that it's worth a look in.
(52:56):
And I say on my Instagram all the time, just really in or out. It's worth, it's worth focusing some attention to, to it. Just really in or really out.
Yeah, yeah. Yeah, definitely.
I liked what you had said when I talked last time too about like, you know, maybe your son's case might be more extreme than others, but yeah, for, for other kids too, even if it's just a little bit less, you know, sleep and breathing like, you know, wanting them to reach their full potential.
(53:33):
So, yeah, definitely worth a rule in or out.
Yeah, absolutely. And if you can, you know, maybe your kid is not is thriving.
But they've just got those few little things.
You know, they could be, they could be extra thriving, I guess, or just, or just having to put in less work within themselves because kids are really good at compensating and trying to deal with the load, you know, the lot that they have.
(54:06):
So if you can relieve them of some of that burden, if they are being affected by airway or sleep issues, then why not.
They might start to thrive in all these other ways that you just never thought was possible.
So yeah, it's definitely worth a look in or a look out, you know, really in or all out.
And I think, I think another, you know, another suggestion for parents would be to
(54:33):
get a second or third opinion. And I guess kind of like a something I want to really relate to parents is get a second or third opinion.
If you're not happy with, if you don't feel heard, if you're not, if your guts telling you that a specialist is not understanding your issues.
So a second or third opinion, you know, I wish that we had got a few more opinions, even though we had seven specialists in a year, we, we eventually found our people, our people that could help us.
(55:07):
So don't be scared to keep looking.
And yeah, and just also for the parents out there that have got these goods outcomes.
Keep talking. The kids in the next generation need you to keep talking about.
And parents really, I know parents are driving this, a lot of this airway information getting out there.
(55:33):
Because we've lived it, we've seen it, and, and also these, you know, these amazingly passionate people like you guys.
And all these other sort of specialists out there, or airway people out there are trying to get the information out in any way they can.
But there's, there's parents out there too. And I really, you know, I employ you to keep talking about it, keep sharing your stories.
(56:00):
And I meet many of you in Dr. Montlivier's office and hear these amazing outcomes. So keep telling other parents about it, because the generations to come need us.
They really do. I love that.
Yeah, so we'll definitely link your Instagram and everything in the show notes. So parents can connect with you as well.
(56:28):
At the end of the podcast. I know you've already dropped a lot of encouragement and advice to parents, but is there any final thoughts you'd want to leave them with or also to the clinician side as well.
Um, so my parents, yeah, I just, the parents again keep talking about it you had some good outcomes keep chatting, get your second and third opinions and clinicians.
(56:54):
I would say for occupational therapists, which I am, come on over. This is this is exciting. This isn't it. This is a, this is a domain that can be ours. Sleep is something that OTS cover.
It's a really exciting area. You know, you can get to the root cause of issues with a lot of kids with that sensory stuff with ADHD stuff with the physical stuff, immunity stuff, all that.
(57:21):
You can really make a difference. So, you know, always happy to connect with OTS out there. This can be part of our toolbox.
If you're not totally comfortable, you know, if you're really happy in whatever you're doing as an OT already, then I would, I would suggest maybe just getting an airway screener.
(57:43):
You can find them out there. If you just look for them, I've got one as well on my Instagram, just a screener child for airway issues and then refer on, you refer on someone that can help with that.
And you're going to see if that is an issue for the child, you're going to see some really beautiful outcomes in your therapy if we can work on those issues with that child.
(58:07):
Yeah, definitely. Awesome. Well, thank you so much, Claire. It was so great to have you on.
You're so welcome and thank you guys for everything you do.
You can stay connected with the Children's Airway First Foundation by following us on Instagram, Facebook, X, LinkedIn and YouTube.
(58:28):
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 contacts page on our website, or send us an email directly at infoatchildrensairwayfirst.org.
(58:49):
Today's episode was written and directed by Rebecca St. James, video editing and promotion by Ryan Dran and guest outreach by Christy Bochinkian.
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.
(59:39):
.
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