August 23, 2023 • 44 mins
Prepare to unravel the mysteries of airway health as we journey into the realm of healthy sleep and jaw development with our distinguished guest, Dr. Shereen Lim, a dentist specializing in this unique field. We’ll shine a light on intriguing topics such as the impact of breastfeeding on muscle development and airway health, and the significance of early intervention. Harnessing Dr. Lim’s expertise, we’ll venture into discussions about common problems like breastfeeding issues, reflux symptoms, swallowing challenges, and speech troubles, and how they’re linked to airway health and tongue ties.
Discover the significant role that tongue positioning plays in neural transmission to the brain, guided by Dr. Lim’s insight. As we continue along this investigative journey, we’ll explore the potential risks associated with overlooking these problems, highlighting the importance of early intervention before they become a lifelong struggle.
But that’s not all, we’ll also be discussing the myomunchee appliance and its role in promoting lip seal and more normal swallowing patterns. These concepts are not just related to speech development, but can also help those grappling with thumb-sucking and posture issues. Also, Dr. Lim will be sharing valuable resources such as her book, “Breathe, Sleep, Thrive” and her professionals-only Facebook group “Airway Health 4 Kids”. Join us for this enlightening episode and gain an in-depth understanding of the significance of airway health and its far-reaching effects on both infants and adults.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:06):
Welcome to the Speech Umbrella,the show that explores simple
but powerful therapy techniquesfor optimal outcomes.
I'm Denise Stratton, apediatric speech-language
pathologist of 30-plus years.
I'm closer to the end of mycareer than the beginning and
along the way I've worked longand hard to become a better
therapist.
Join me as we explore the manytopics that fall under our
umbrellas as SLPs.
(00:27):
I want to make your journeysmoother.
I found the best therapy comesfrom employing simple techniques
with a generous helping ofmindfulness.
Hello, welcome to another SpeechUmbrella podcast.
We are in for a real treattoday.
My guest is Dr Shereen Lim, adentist who specializes in
promoting airway health.
Shereen is a wealth ofinformation, a deep well.
(00:49):
As I was reading her book, Iwas connecting dots all over the
place about my clients.
I'm going to read her bio nowand then we'll jump into the
interview, because I have aboatload of questions.
We're all going to learn somuch today.
Dr Shereen Lim is a Perth-baseddentist with a postgraduate
diploma in dental sleep medicinefrom the University of Western
Australia.
She has been involved in theteam management of snoring and
(01:11):
obstructive sleep apnea for overa decade.
Dr Lim is dedicated topromoting airway health for
infancy as an alternativeapproach to minimize the
development of these problemsand their consequences and, as
the author of the book Breathe,Sleep, Thrive, Discover how
airway health can unlock yourchild's greater health, learning
and potential.
Her work in private practice isrestricted to tongue time
(01:32):
management from infancy toadulthood, early interceptive
orthodontics and myofunctionaltherapy.
Welcome, Shereen.
Thank you so much for joiningme on the speech umbrella.
As I was reading your book, Icouldn't help but think of an
early childhood dentalexperience of mine and how, if
my dentist had known what youknow, maybe I would have got a
palate expander, maybe Iwouldn't have had to have eight
(01:53):
teeth removed in one visit,because my parents lived an hour
from doctors and so had to allbe done at once, and it was kind
of traumatic because theydidn't give me enough gauze and
I was bleeding all over theplace on the way home, anyway.
And now I have these retainersI put in at night, not my
favorite thing, but I thought,wow, what if I didn't have to
wear retainers every night?
(02:13):
Wouldn't that be awesome?
But you know, my outcome wasgood.
I didn't have health or speechor behavioral issues.
I was in speech therapy for R.
I have a bit of an over jet,not bad.
I was orthodontia when I was anadult, but for many kids, you
know, the outcome is not as goodas mine, and they have these
airway issues, and so that'swhat we're going to dive into
today.
I've got some questions that Iwant to ask you on.
(02:35):
Some of them are a little bitmore general, and then we're
going to take a really deep dive.
But let's find out, how did youget started in managing snoring
and obstructive sleep apnea?
Shereen Lim (02:43):
My interest in snoring and obstructive sleep
apnea was prompted by myhusband's snoring and the
frustration of the disturbanceit was creating in my sleep, and
so that's what prompted me tolearn more about dental devices
that could actually be wornovernight to hold the lower jaw
forward and open up the airway.
And so I became one ofAustralia's first dentists to
obtain a qualification in thisarea and become involved in the
(03:05):
team management of adult snoringand obstructive sleep apnea.
And so what I soon realized isthat snoring is not just a noise
.
It can actually create someserious health risk and impact
people's quality of life, andwe're looking at this
craniofacial problem or aproblem of poor jaw development.
I wondered how come we don'tintervene and do orthodontic
(03:26):
interventions and modify jawdevelopment when children are
still growing.
And so in dental school we'retaught you can modify jaw
development through earlyintercept of orthodontic
appliances.
The reality is many of us wereferred to orthodontist, and
the traditional age is not to doanything until age 12.
Watch and wait, like you said,take out teeth down the line and
then straighten them withbraces.
But I became familiar with theresearch to suggest that if we
(03:49):
can widen palates it canactually improve breathing and
sleep.
So I wanted to know how come wedon't do that and I decided I
was gonna learn more about thisas well.
So I did a lot of training inearly intercept of orthodontics
and started to become moreinvolved in that, and I met Dr.
Christian in 2014, pioneer ofobstructive sleep apnea.
Told him that your work hasreally inspired me to learn more
(04:11):
about early intercept oforthodontics and he said if
you're doing palate expansion,you're too late, and I had no
idea what that meant at the time.
But it was rabbit hole oflearning to find out that the
jaw development is verymodifiable by how the muscles
are working in the earliestyears of the life how we suck,
swallow, breathe and chew.
These all influence our jawdevelopment.
(04:33):
And that's how I becameinvolved with promotion of the
mechanical benefits ofbreastfeeding, tongue-tie
release and my functionaltherapy to actually really help
promote good jaw development andgood muscle function.
Denise (04:46):
Let's talk about why breastfeeding develops the
optimal jaw and muscle function,for good airway health, for
speech.
How does that even work?
What are the mechanics ofbreastfeeding versus bottle?
Shereen Lim (04:58):
Yeah so, breastfeeding I mean the first
year of life is one of the mostrapid windows of jaw development
.
So what we're doing in thefirst year of life and how our
muscles are working, it's reallygoing to have a great influence
on our airway development.
And so with breastfeeding it isa more powerful muscle workout
than bottle feeding.
So with breastfeeding it'ssometimes called nature's palate
(05:22):
expander, because for a reallyefficient transfer of milk it
relies upon tongue suction, sothat tongue elevates and it
compresses the very malleablebreast tissue up against the
palate and so it sculpts thatpalate quite broadly and then as
the tongue drops it creates avacuum and that's when milk is
transferred from the breast.
And to get this tongue suctiongoing we need very coordinated
(05:45):
jaw movement.
So we're really stimulatingthat lower jaw back and forth.
Breastfeeding in general willpromote more forward and wide
development of our airways, andso it's really foundational to
develop those muscles well forgood speech, chewing, and
swallowing later on in life.
In contrast, with the bottlefeeding, it doesn't require as
(06:06):
much effort.
We don't rely on tongue suction.
In fact the milk comes out alot more easily and the teat,
it's not as malleable.
Like, so it pushes the tonguedown, it lowers the tongue, so
there's nothing to counteractthe inward pressures of the lips
and cheeks.
And then we get a distortion ofthe palate, so it becomes more
narrow, and so I also thinkbreastfeeding it's really well
(06:29):
designed to suck, swallow andbreathe.
Babies can suck, swallow andbreathe at the same time, in
contrast to bottle feeding wherethey can't regulate the flow
and they often have to pause tobreathe, and sometimes this is
where mouth breathing can begin.
Denise (06:43):
Well, sometimes you hear a baby bottle feeding gasp as
their bottle feeding and younotice that the other day and I
was like, huh, I wonder whatShereen was saying about that.
So, while we're talking aboutbreathing, what are the signs
and symptoms of disturbed sleepbreathing in children?
What should parents look for?
Shereen Lim (07:00):
Well, it's very common for me to ask about a
child's sleep and parents arepretty happy if they don't have
to wake during the night toattend to their child.
Good sleeper.
However, what we really want tosee when children are sleeping
is that they are very still andlook very restful and peaceful.
They aren't making any soundsand they're breathing with their
mouth closed and through theirnose.
(07:22):
So any signs like mouthbreathing, snoring, gasping,
restlessness.
So the frequent tossing andturning and sweating, teeth
grinding, bedwetting, unusualsleep positions like neck hyper
extension to open up the airway,or stomach sleeping, which can
sometimes be a compensation tokeep the tongue from blocking
the throat.
All these things, unexplainedawakening, sometimes that child
(07:45):
coming into bed in the middle ofthe night.
Why are they waking?
We mustn't overlook ourbreathing disturbance.
They're the main symptoms tolook for during the nighttime.
Denise (07:54):
Let's talk a little bit about teeth grinding, because I
wasn't aware of that untilrecently, that teeth grinding
can be a symptom of airwayobstruction or something like
that, or of a tongue tie.
So why would a child grindtheir teeth?
Shereen Lim (08:06):
Teeth grinding is really one of the strongest red
flags that a child may have anunderlying breathing disturbance
, and so it's thought to be aprotective mechanism to help
keep the airway open and protectagainst obstructive sleep apnea
or complete collapses of theairway.
So in children, when there is alimitation of airflow, their
(08:29):
sympathetic nervous systems aremore responsive, and so they
will react with an arousal fromsleep, and what happens is they
recruit the muscles during thegrinding and that helps open up
the airway.
So what that means is they'renot getting the prolonged
collapses of the airway that wesee in obstructive sleep apnea,
but it actually is verydisturbed sleep.
It's a state of constant stressand fight or flight response,
(08:53):
and it doesn't allow children toenter the deep stages of sleep.
So when we have teeth grinding,we must not overlook the
contribution of disturbedbreathing, and we know that
children that have adenoids andtonsils there's been some
research that 65% of them willhave a reduction in teeth
grinding.
There's also some research tosupport widening a palate,
(09:16):
palate expansion, which canimprove nasal airflow.
That can also reduce teethgrinding, and that's something
that I see very commonly in mypractice.
When we do palate expansion,within six weeks there may be an
elimination or reduction inteeth grinding.
But then we also know that ifthe tongue is sitting low inside
the mouth it's more flaccid andmore likely to block or
(09:38):
obstruct the airway, so that canbe implicated as well.
So there could be a variety offactors that contribute to poor
airway and we need to rule outall of them.
Denise (09:50):
So let me see if I understand this correctly.
So the development of the jawin the facial skeleton is the
bony structure that supports agood airway.
Shereen Lim (09:58):
Absolutely.
So, those jaw structures, thepalate is really the floor of
the nose.
When the palate is high andnarrow, we're going to have a
narrow nasal passage.
So we know the research tellsus that when we widen the palate
, even in the range of a fewmillimeters, we're going to get
an exponential improvement innasal airflow.
It's also the space for thetongue.
So when we have a broaderpalate we're going to have more
(10:21):
room for the tongue to sit highand make contact with the palate
.
And so when we have that goodtongue-to-palate seal, it prom
otes nasal breathing -it's impossible to breathe
through the mouth, so it'seasier to breathe through the
nose and then it allows thetongue to suction to the roof of
the mouth.
More space for that to occur.
And then when that tongue issuctioned, we know that it's a
good tone, that this is a tonguethat's going to be less likely
(10:44):
to obstruct the throat duringsleep.
So yes, it is.
The jaw is really out of thefloor of the nasal passage, the
housing for the tongue and theskeletal framework for our
collapsible upper airway orthroat.
Denise (10:56):
So we really need to think of the whole system, not
just the mouth, the whole system.
Now, when you see a high,narrow palate in child, how soon
can you address that aswidening the palate as a dentist
, because sometimes I don't seeit till a child is perhaps, you
know, around 11 or 12 or 10maybe.
Shereen Lim (11:16):
Sure, the traditional age for early
interceptive treatment withpalate expansion is around the
age of seven to eight years.
Usually the idea is to waituntil the first permanent teeth
come through.
However, I see these high archpalates from infancy because I
see a lot of infants in mypractice and I know straight
away that this is a risk factorfor the development of mouth
(11:37):
breathing, for the developmentof snoring, and children with
narrow high arch palates aregoing to be at greater risk of
having glue ear or recurrent earproblems because it affects the
way that they swallow and theydon't get good use station tube
function.
So it's a problem, a functionalproblem when we see these high
arch palates and I don't thinkthat it's necessary to wait
(11:57):
until seven to eight years old.
Children are having problemsand if we can address this risk
factor, I become more and morecomfortable addressing it.
From the age of three and ahalf to four, as long as a child
can sit in the chair, take abunch of photos, we can engage
with them and I think they'regoing to be compliant.
I will look at it if they'rehaving difficulties, Because
sometimes if they're notsleeping well or they're having
(12:19):
behavioral problems and becomingreally difficult for their
parents to manage - it'seggshells at home.
Denise (12:24):
That can be a very effective intervention within
six weeks.
And we talked a little bitearlier about a myo munchie.
Which I have had a couple ofclients use.
I'm a little bit familiar withit.
Describe for our listeners whata myo munchie is and how it's
used and the benefits of it.
Shereen Lim (12:39):
Yeah, a myo munchie is a silicone appliance that
can be placed inside the mouthand I would recommend just
googling what a picture is andthe main benefits when putting
it inside the mouth.
Number one we want children toclose their lips around it.
So it takes a little bit ofeffort to close the lips around
it.
But we're training that lipseal, encouraging and promoting
(13:00):
that lip seal, because if theycan get really good at closing
their lips around it we knowthey're gonna have a more
reliable lip seal during sleep.
The other thing that it does itpromotes more normal swallowing
.
So when it's inside the mouththe tongue cannot thrust forward
, it has to go up and backwardsa more normal swallow.
And it disengages all the cheekmuscles, so the inward
(13:21):
pressures of the lips and cheeks, and so it really promotes more
normal swallowing.
And then when they're reallygood at closing their mouth, we
get them to chew on it.
So it provides a lot offunctional stimulus for those
muscles to chew and to exercisetheir jaw muscles.
So there are a lot of thefactors that we're looking at
and the other thing I think itdoes the feels are very
(13:43):
important sensory need for somechildren as well that want a
mouth, things.
So we put it inside their mouth.
When do I use it?
They have a baby version so itcan be used as early as five to
six months, for which babies doI think it has a value in is
those babies that may have beenbottle fed and had an altered
swallowing from bottle feedingor used a lot of dummies.
(14:04):
Sometimes If the baby has anopen mouth posture and I really
wanna exercise those jaw muscles, I'll use it for those type of
babies or babies that drool,they have their low lying tongue
any of those babies and then itcan be used all the way through
to adulthood.
So nearly everyone that does myfunctional therapy with us.
I like to introduce it because,without really having to do a
(14:25):
lot of exercises, when it'sinside the mouth it's promoting
more normal muscle balance andswallowing.
Denise (14:31):
I had a couple of young clients use it and they both
really did enjoy the sensation.
It's a little bit textured.
Shereen Lim (14:37):
Yeah, it's nice and squishy, lots of little tongs.
You know, we know that themouth is so important.
I think about a third of oursensory input comes from our
mouth.
There's a lot of sensoryreceptors that needs stimulation
, so I do think that it can be avery important piece.
The children that are missingit or they had their mouth
hanging open a lot.
Denise (14:58):
Now, I did say we had some general questions and we
had some deep dive questions andwe're about to go into that.
This stuff is so fascinating.
So I want you to tell us aboutDr Ferrante's research on the
relation between thumbs sucking,neuro transmission, that spot
we call the Avila Ridge, yes,where the tongues should be.
Shereen Lim (15:17):
Yeah, really important work.
Antonio Ferrante he's a dentistand my functional therapist in
Italy.
He's actually published fourtextbooks and I happened to hear
him in 2015 in Los Angeles andit was actually an English
speaking talk, so maybe one ofthe only ones he's done, but I
have heard it five times.
I bought the recording andlistened to it so many times
(15:39):
because I thought it was a verygood presentation.
But basically, what he hastaught is that the 'n' spot when
you say 'n' with the tip ofyour tongue and it shouldn't
touch a teeth that spot in thepalate is richest in sensory
nerve endings and so when thetongue stimulates that spot, it
sends signals to the brain, soit's involved in
neurotransmission and then whathappens is we release at least
(16:01):
four chemicals like dopamine,serotonin,
there's a couple of others,which make us feel calm, relaxed
, and it's involved in ourbalance, and so in the
presentation he did some work tosuggest that with Parkinson's
patients he watched their gaitand they've got a lot of posture
analyzers there - that it couldimprove when that tongue was
hitting the spot.
(16:22):
Now he's also publishedresearch on thumb sucking
children and what he found wasthat when children could put
their tongue on the spot, thatcould also improve their posture
and balance, and so a lot ofthumb sucking children.
We know in my functionaltherapy circles that if they're
ready to give up thumb sucking,it's very predictable to get
(16:44):
them to stop thumb suckingwithin a day with a combination
of strategies, includingteaching their tongue tip where
to sit, so it's a very importantspot in the mouth.
Denise (16:53):
Because then they're getting that sensation or that
feedback that they need, thatthe tongue was filling that role
, but now their tongue isfilling that role.
Yes, yes, that neurotransmission role.
and I have noticed this balancething did just interest me so
much.
There's a connection betweenbalance and where the tongue is
and speech, because I will oftenhave children practice what we
(17:16):
call a neutral resting posture.
So the tongue is up, the teethare gently closed, the lips are
gently closed and I'll have themjust do like what you call a
mountain posing, yoga orsomething like that.
And so many of them, just theycan't even close their mouth and
they're doing that and they'llturn their feet, they'll wiggle
their feet, they're trying toput one foot behind the other.
They don't sometimes reallyhave good balance If they're
trying to stand in that way.
We call that really balancedmountain pose with the feet
(17:37):
parallel to each other.
But when they can do that andwhen they can maintain a neutral
resting posture, I see a hugegain in their speech.
It's just amazing.
It's like something in theirbrain is integrating and you're
like wow.
Shereen Lim (17:52):
I think that spot's very critical.
We even know that there'sresearch to suggest that
children who use a pacifier aregoing to have increased risk of
delayed speech development.
And there's research to suggestyou need a free tongue.
It's involved with perceivingsounds, so there's a sensory
(18:12):
motor component where we needthat tongue up to perceive the
sound.
So that's really important forspeech development.
So there's a lot of reasons whywe want the tongue up.
Even with speech articulation,that's where the tongue belongs.
If the tongue is resting in thebottom of the mouth, it's going
to be a low-tone tongue andwe're going to have more
increased risk of lisping orunclear speech.
(18:32):
But when I get people to puttheir tongue on the spot, when
we train them, a lot of adultsand children will report lots of
various things.
Number one it's easier tobreathe through the nose, they
have less tension in their jaw.
Some people will just reportthey didn't realize how good it
feels to put your tongue on thespot, or more balanced, and some
(18:54):
people may even feel lessheadaches.
I've had children say that aswell.
So it's really importantcritical spot.
I think it's really key that wehave that tongue on the spot.
Denise (19:05):
And when my clients can do that, they are calmer.
Yes, yes, their executivefunction improves.
Shereen Lim (19:11):
Yeah, and I you know a lot of children that have
fidgeting or they're alwayssitting around and their mouth
is moving when they're watchingTV or tongue between their lips.
We just teach them to put theirtongue on the spot.
That's often my first stepbefore I look at doing any
orthodontic treatment, because Idon't want them to be flicking
out expanders or plates.
So I think it's important.
Denise (19:30):
That leads us into talking about tongue ties,
because some children havetrouble putting their tongue on
the spot or keeping their tongueup because they have a tongue
tie.
Now, as a speech therapist, Iknow the problems a tongue tie
causes with speech.
But what do you see as adentist?
What problems do you see atongue tie causing in the
development and from infancy?
App, yeah, okay, great.
Shereen Lim (19:52):
So the main problem with a tongue tie is that it
restricts normal tongueelevation.
So, starting from infancy, themost common problems that we're
going to see are breast feedingchallenges.
So when the tongue can'televate or suction, we're not
going to get efficient transferof milk, and so we may have
perception of low milk supply,may have more shallow latch and
(20:13):
pain, unfeeding, or pulling onand off.
It's very frustrating.
Babies that have short feeds ortire very easily.
So there are common problemswith the breastfeeding.
But even with breastfed andbottle fed babies we may have
problems with reflux, likesymptoms where they're unable to
swallow correctly, with theirtongue going up and their
gulping air, and so babies havethese symptoms of reflux.
(20:36):
They're screaming, arching,stomach distention, vomiting,
very, very gassy, and they maybe put on reflux medications.
But if we are medicating babiesfor reflux, we really need to
make sure that they've got agood latch, whether it's on the
bottle or the breast, and makingsure they're not swallowing air
.
So the next things we might seeare swallowing problems,
children having difficultieswith swallowing and they're
(20:58):
gagging or choking.
There may be more picky eatersbecause they want to eat softer
foods and avoid certain othertypes.
And then the speech problemswhere it might be difficulties
with their speech, speech,articulation, so those type of
problems.
And then the next thing is theteeth grinding.
It's a common thing.
That can be linked, it's a signof disturbed breathing and with
(21:21):
that all the accompanyingincreased risk of behavioral and
learning difficulties.
So those are the type of thingsthat we see.
And then, as we get more intothe adults, the things that I'm
seeing a lot of is, for instance, if you have a tongue tie, you
can still breastfeed, you canstill speak, you can still do a
lot of things, but you may becompensating or using and
(21:42):
recruiting other muscles whichshouldn't be working.
So you may overuse your lipsand cheeks, you may overuse your
jaw muscles and some peopleeven strain and use their neck.
So with the adults I may beseeing more of the chronic neck
tension and they've got thesetrigger points of tight muscles
inside their neck and these mayactually be linked to cervical
(22:05):
genic headaches or referredheadaches.
And so we have a lot of adultsthat come because of their
chronic headaches and if I seethat they're overusing their
neck, it's quite often linkedand we may address the tongue
twister.
But the biggest problem reallyis that the tongue doesn't
develop sufficient tone to restin the roof of the mouth and
when we don't have a well-tonedtongue during sleep is when it
(22:27):
will play out eventually downthe line we're going to have
more risk that the tongue isgoing to cause a base of tongue
is going to cause obstructionand it will disturb the sleep,
so we won't get the fullestquality of sleep possible.
So a lot of implications.
We don't know when it will playout because a lot of people
compensate.
But it's a fact of life that weneed the tongue to work well,
(22:48):
because the genioglossus muscle,which forms the bulk of the
tongue, is the main upper airwaydilator muscle.
It's the main muscle that needsto function well to keep the
throat open during sleep.
Denise (22:58):
So there's a lot of things that can happen with a
tongue tie and not just speech.
Because I have been saying andI have heard well, let's see
what they can do, and I wouldnever say this with an anterior
tongue tie, but a posteriortongue tie is sometimes kind of
difficult to tell.
So you're like well, let's seeif this child can learn to
articulate with what they haveand try for a little bit not too
(23:18):
long.
But we should be looking atthis whole range of symptoms or
things that could occur and notjust speech.
Shereen Lim (23:25):
Yeah, because people can speak perfectly fine
with a tongue tie.
I see a lot of people that haveno problems with their speech,
but because I take video ofevery single child speaking,
what I can see when there is atongue tie is that they're often
making their speech sounds withtheir mouth, their lips and
they're moving too much, orthey're using their jaw to brace
(23:46):
with their jaw, they'reoverusing their jaw or their
neck, and so the ultimateproblem is that that tongue is
not developing good tone, andthat tone is necessary for
palate development as well asgood breathing throughout life.
Dan Stratton (24:00):
We will get back to the interview in just a
moment.
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Now back to the interview.
Denise (25:25):
In your book you talked about tongue ties and postural
issues.
I think that is so fascinating.
Tell us about that.
Shereen Lim (25:32):
Every day I hear new things that you would not
think are connected, so nothingreally surprises me anymore.
But there is a connectivetissue in our body called fascia
, so it covers everything in ourbody, all our muscles and all
our organs.
It's what helps us move in onepiece, and there's a deep-lined
fascia that goes from the tongueall the way to the toes, and so
(25:55):
that's the main fascial line inthe body, and so when we have
any restriction in one area ofthat deep front line, it can
actually affect the motion andthe way that we use other parts
of our body in that same lineall the way down to our toes.
And so what I see with tonguetie release is that when we
(26:17):
release that fascia, we canoften see postural changes in
the body.
When we work closely with manualtherapists like osteopaths or
chiropractors, craniosacraltherapists a really common for
me to hear is babies that seemless tense or tight, or they can
extend their neck better andcope better with tummy time, or
(26:38):
they're just more free and easyto feed on different positions
and then all the way into adultsas well, so we might get less
of those headache and neck achesand people report different
things happening in differentparts of the body down to their
toes.
So I've had quite a lot ofpeople report that inward
turning toes have now becomenormal, or even the toe walking.
(26:59):
So there's a lot to learn andit's very fascinating.
I think even people can breatheeasier when there's more
release of the diaphragm, ifpeople feel like they open up.
So for some adults that have avery significant tongue tie,
it's actually like a literalrelease of them as a person.
They feel unwound.
So yeah, I love listening tothem.
Parents and patients sharethose stories.
Denise (27:23):
That is simply amazing.
I recently referred two clientsto professionals who belong to
the International Association ofTongue Tie Professionals
because they know that they willknow what to do.
I've had the experience of someENT saying that well, it's a
posterior tongue tie, you know,it's not really affecting things
.
But these two children andtheir parents have real concerns
(27:43):
about their eating.
Now they are learning how toarticulate well with the tongue
restricted as it is.
But one child is really reallyunderweight, doesn't like to eat
anything but soft food.
His mom is really concerned andthe other mother is just
beginning to get concerned andshe asked me for referral to an
OT maybe who could help him witheating.
And I'm like you know what?
Let's look at the Tongue Tie.
Let's see if there is a TongueTie.
(28:04):
For myself I can't really tellbecause it, if it is its
posterior, he's able toarticulate well, but it does
look to me like his tongue isnot maybe as free as it could be
.
So I'm like well, they need toeat.
Even if they can speak, theyneed to be well nourished.
So, that's you know.
That's just really interestingto me.
We have to look at the wholechild.
(28:25):
I was a whole child and whilewe're talking about the whole
child, in your book you talkedabout children who have sleep
disturbances and how it affectedtheir gray matter.
In there was a study thattalked about the gray matter in
children who have sleepdisturbances.
Shereen Lim (28:38):
Yeah.
So probably the most compellingof those studies is I think it
was called the ABCD LongitudinalStudy, where they're following
up over 10,000 children over theyears and what they inquired
about is their history ofsnoring, and then they actually
took MRI scans of their brainfor all these children and were
(29:00):
able to correlate that thosechildren who snored had losses
of gray matter compared onaverage to those children that
didn't, and so we don't fullyunderstand the impact or how
it's going to affect eachindividual child, but we know
overall there is somethingdetrimental occurring when a
(29:21):
child snores, so that's not evenobstructive sleep apnea, it's
snoring.
Denise (29:26):
And so we've got, besides speech, we've got
problems, potentially problemswith cognition, potentially
problems with behavior.
You did mention in your bookthat many children are diagnosed
with ADHD.
When actually the trueunderlying problem is sleep
disturbances, airway problems, atongue tie, something like that
.
Shereen Lim (29:44):
Yeah, I think it's important to recognize that
there's very, very compellingresearch a meta analysis paper
which has compiled all thefindings from various studies
that showed us that children whohave obstructive breathing are
going to have a greater risk ofADHD type symptoms and that when
(30:05):
they are treated with removalof adenoids and tonsils there is
a reduction in those ADHDsymptoms.
So it's important when childrenare medicated for these
problems that we don't overlookdisturbed sleep and disturbed
breathing.
And it's not just the adenoidsand tonsils, because the airway
problems are multifactorial.
(30:25):
If there's no response to that,we also need to be looking at
what are the other risk factorsto ensure complete resolution.
So we need to address thepalate and we need to address
poor tongue tone or tongue tiesthat restrict the normal
movement and tone development oftone of the tongue, as well as
ensuring that children closetheir mouth and breathe through
their nose.
Denise (30:46):
I feel like maybe there should be a course for all
pediatricians on this.
Shereen Lim (30:52):
Because they're so busy, like here, the waiting
list is like a year to see apediatrician and they're the
only people that can prescribethe stimulants.
So for me, I think, whilstwe're waiting for that
appointment, let's rule outbreathing disturbance, because
I've done palate expansion forchildren as young as three and a
half and parents who are reallystruggling with their child's
(31:13):
behavior, just really not ableto enjoy their child, and when
they get a better night's sleep,their child can function a bit
better and it's just much moreof a relief for parents.
So I think that we mustn'toverlook it and use
opportunities to spread thisinformation.
Denise (31:31):
And which is exactly why we're having this podcast.
Because we did not know this.
Or maybe, if we knew it yearsago, maybe we forgot it.
Because in your book you alsotalk about our modern lifestyle
affecting the development of ourjaws, our teeth, our face.
So maybe we didn't need to knowthese things a century ago or
before the industrial age.
(31:51):
Maybe these things weren'tproblems.
So talk a little bit about thatabout our modern lifestyle and
how that's affecting us.
Shereen Lim (31:57):
So a lot of people ask is the teeth genetic, narrow
jaws genetic?
But really it's thought to beepigenetic because it's only
been in the last few hundredyears that we've seen a very
rising prevalence of crookedteeth.
And so when we have crookedteeth it's a symptom of poor jaw
development.
And so when we have poor jawdevelopment it means there's an
(32:18):
underlying change in the waythat our muscles are functioning
and providing the stimulus forgood jaw development.
And some of the changes thathave been put forward is number
one a difference in our diet.
We're having more processedfoods that don't require as much
chewing.
So we're cooking our foods andoffering purees to babies, even
(32:38):
the sippy pouches of foods, andwe're not chewing hard foods.
So that's one problem, as wellas breastfeeding.
So previously breastfeeding,most babies were breastfed
before industrialization, forsix months exclusively and up to
three years in complement withtheir solid foods.
So that's no longer occurring.
(32:59):
We're not having as much asbeen introduction of bottles and
pacifiers.
So that's the key change, aswell as the increase in mouth
breathing.
So we're having more allergieswith indoor living and more
pollutants.
So mouth breathing has becomemore prevalent and when we
breathe through our mouth wehave our mouth open, our jaw
muscles become slack.
(33:25):
and so our perception that wehave that every teenager, or
almost every teenager, is goingto have to have braces just a
right a passage is really justeffect of our modern lifestyle.
Yeah, that's right.
If we understand, for instance,when they've brought more
refined diets into newindigenous populations, that
crooked teeth can becomeprevalent within one generation.
(33:46):
So if we kind of understandthat, then we know what we can
do to stimulate the musclesbetter and provide a better
trajectory.
Denise (33:54):
There's one more really fascinating part of your book
that I thought I wish I'd knownthis years ago.
But there is a score, a mellasorry, I say it right.
Mellum and potty score Mellumand potty score yeah, for tonsil
grading.
And of course, as an SLP, I'mnot going to diagnose this kid
needs its tonsils out.
Child needs their tonsils out,necessarily.
(34:16):
But I have looked in somethroats and thought it looks
pretty crowded back there.
But what am I looking at?
What should I tell parents?
If I could just tell them thisis something that you could be
concerned about.
So describe that a little bit.
Shereen Lim (34:28):
Okay, well, it's ideal if people can Google
mellum potty score, because theyhave a really nice
classification with visualdiagrams.
But basically that wassomething developed by an
anesthetist who wanted to beable to relate to their
colleagues how easy will it beto intubate a patient?
How crowded is their throat,the back of their mouth?
And so there's grade one tofour.
(34:49):
One is when you open a mouth,stick the tongue out and you can
kind of see the uvula hangingdown and you can see the back of
the throat.
That's a more open airway.
And the other end of thespectrum is grade four, when you
can't see the uvula.
The tongue is just filling up alot of that space and, you can,
it's just all you can see isthe soft tissue there.
You can't really see the backof the throat.
(35:09):
So that's more crowded.
So we know as we go higher it'sgoing to be more risk of having
disturbed breathing, and usuallythe more crowded it is, it is a
reflection of the jaws notdeveloping properly forward.
With the tonsil grading, whatwe're really looking at is to
see how large are the tonsils inproportion to the throat, and
(35:32):
so we have grade zero to gradefour.
Zero is where they've alreadybeen surgically removed.
You can't see any signs oftonsil enlargement.
And grade four is kissingtonsils where they're meeting in
the middle and generallyspeaking, those grade four
tonsils, they're going to bevery obstructive and affect
breathing.
So grade three and four are themore, if a child is having any
(35:54):
breathing concerns or red flagsof sleep, disturbed breathing
like snoring, they're the onesthat we want to refer to ENT
specialists to check out as well.
Denise (36:03):
So a parent could look at that and look at those
pictures and think, okay, sothis is something I need to
bring up.
Yeah, absolutely, a child whomouth breathes habitually may
develop the perception that theycan't breathe through their
nose.
But that's not really true.
So you talk about that in yourbook a bit about how just nasal
disuse that's right.
Shereen Lim (36:25):
Yeah, so sometimes you know, when children can't
breathe through their nose, it'snot necessarily always an
obstruction.
Yeah, in fact, one of thelargest studies of mouth
breathing children actuallyfound the most common risk
factor associated with mouthbreathing was allergies, not
true obstruction.
It was much greater prevalenceof that compared to things like
(36:46):
enlarged adenoids and tonsilsand deviated symptoms.
And so the thing aboutallergies when children have
allergies, they may be morecongested, and so they may be
prone to having a mouthbreathing habit which actually
makes the nose more congested.
But if we actually use our nose, then it will become clearer to
breathe through our nose, andso we've got to really
(37:07):
differentiate.
Is it nasal disuse, wherethey're not really used to using
their nose and it's morecongested, or is there a true
obstruction?
And so the work of Dr SirushSaki and his team he's an ENT.
He published some work tosuggest that one little thing
that we can try is test out howwell a child can sit with their
mouth closed and breathe throughtheir nose.
(37:30):
So they use micropore tape,just a little bit of breathable
tape on the lips to keep themouth closed.
Or you can also put a paddlepop in between the lips or just
some water inside the mouth andsee how long a child can hold it
for and if they can breathecomfortably through the nose for
three minutes.
The suggestion is don'tnecessarily need to jump into
ENT surgery.
(37:50):
We might want to focus onretraining that habit of nasal
breathing through my functionaltherapy, and so I think it's
really important we do nasalsprays, clear the nose, nasal
hygiene, remove any mucus andthat and see if we can get a
child to breathe through theirnose first, that is a really
good tip.
Denise (38:08):
I've often wondered, as I work on closed mouth breathing
, what is a good benchmark?
How long should they be able todo this?
So I love having that numberbecause I will time you,
sometimes like, hmm, how longcan you go?
And that's good for parents toknow too.
Well, that is a deep dive intoairway obstruction, tongue ties,
(38:30):
all the things that I like togeek out on.
So thank you, Shereen.
I love your depth of knowledgeabout airway health and how it
affects so much down the line,and this book that you wrote is
a book I'm going to keep in mywaiting room and recommend to
every parent who needs it,because with the information in
this book we can intervene inairway issues earlier, we can
stop a cascade of poor outcomesin speech, behavior, cognition,
(38:52):
health, so many things down theline, and also it's just a great
way to retrain all of usprofessionals in this really
critical aspect of airway healthand what we can do at the very
beginning, instead of waiting,as you said, until maybe they're
eight, nine, 10, and now we'reintervening and the pallets
already narrow, the jaw and thefacial structures are already
(39:15):
less pliable than they were.
Habits have been put into placethat are harder to break.
Shereen Lim (39:21):
And we need to establish good sleep in the
earliest years of life, becausethat's when brain development is
the most rapid.
Yeah, so I actually reallyappreciate the opportunity to
speak with you and highlightthis issue amongst your
colleagues because in practice,you know, I am seeing a lot of
those children that are havingon going speech therapy without
any progress, and when it comesto speech, I think that if that
(39:44):
is the case, we really need tobe looking at how the mouth is
structured and how the musclesare working as root causes of
speech concerns.
Denise (39:54):
So I hope it inspires others to kind of look more into
that and we really need to knowa speech therapist what we're
looking at.
What should the jaw look like,what should the palate look like
, what should the muscles looklike, to recognize these things,
to recognize these issues,because we often don't get
taught that in college.
So that's why I so appreciateyour book.
I think we have to learn mostof our profession after we
gradua te.
Shereen Lim (40:15):
Absolutely.
You know, it's always hard forpeople to find the right
providers because not everyonehas received this training.
Most people haven't receivedthis training in their
professional qualificationcourse.
It's looking for those thathave committed to finding those
answers and a lot of the timeit's people looking for answers
for their children that theybecome passionate about this
(40:37):
area.
Denise (40:38):
So where can our listeners find you?
I know you have a book out.
Where can they find the book?
And I don't know if you haveany other resources out there
for them, if you've donepodcasts or things like that.
Shereen Lim (40:48):
Yeah, the book is available on Amazon now.
That's the widest distribution,but that's available through
many online stores.
And in terms of where I'm mostactive, I am most active on
Facebook.
So, Dr Shereen Lim, and if forany healthcare professionals
that are really interested inAirway Health for children, I
have a professionals onlyFacebook group called Airway
(41:08):
Health 4, number four, Kids aswell.
So I share a lot of newresearch.
I think it's really importantthat we have ongoing discussions
about new research betweendifferent professions.
We're all seeing the samechildren.
They have different problems,but many of the time the
underlying problem is poor oralfunction and jaw development
Airway Health 4 Kids.
Denise (41:29):
Number four.
Okay, I love that.
I'm going to look that up onFacebook.
Thank you so much.
I have learned so much, and mylisteners out there, especially
SLPs, you're going to want toget this book and you're going
to want to stand with ahighlighter, like I did, and go
through and put in post-it notesand then when a parent has a
question, you're going to openright up to that and say look
right here, Shereen Lim laid itall out for us and here's the
(41:52):
information you need.
Thank you, Shereen, I enjoyedthis so much.
No, thanks very much for havingme Taa.
I want to thank Dr Lim forreaching out to me and sharing
this information with speechtherapists.
This is so critical for us toknow.
This is one of the things thatfascinated me the most.
When we have a correct oralresting posture, our tongue is
(42:14):
resting up in the upper dentalarch and we know that.
But what I didn't realize isthat area is rich with nerve
endings and when our tongue isresting there, it's sending
information to our brain and ithelps children with balance.
It helps children withself-regulation.
Wow, that is just so cool toknow that, having your tongue in
the correct resting spot ishelping with all of those other
(42:36):
areas of a child's development.
And remember, Dr Lim's book is'Breathe, Sleep, Thrive.
I read this book with ahighlighter in my hand and there
is so much good information forus as SLPs, and for doctors and
for parents.
So be sure and check out herbook Breathe, Sleep, Thrive by
Dr Shereen Lim.
Thank you for joining me underthe speech umbrella today.
I hope you learned something tohelp you in your therapy.
(42:58):
If you did, please share thispodcast with a fellow speech
therapist and leave a five-starreview on Apple, itunes, spotify
or wherever you get yoursubscriptions.
While you are online, come onover to the SpeechUmbrella.
com, where you will findtranscripts, links and my free
resource library.
I also have some other valuablecourses and therapy aids in my
store.
That's all at theSpeechUmbrella.
com.
(43:19):
Let's connect on social media.
I'm DStrattonSLP on Instagramand T he Speech Umbrella on
Facebook and YouTube.
You can also find me on TPP.
Hope to talk to you soon.
Bye.
Dan Stratton (43:32):
Thanks for listening to the SpeechUmbrella.
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com.
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com.
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(43:55):
review on Apple Podcasts andother podcast directories.
Welcome to the Speech Umbrella,the show that explores simple
but powerful therapy techniquesfor optimal outcomes.
I'm Denise Stratton, apediatric speech-language
pathologist of 30-plus years.
I'm closer to the end of mycareer than the beginning and
along the way I've worked longand hard to become a better
therapist.
Join me as we explore the manytopics that fall under our
umbrellas as SLPs.
(00:27):
I want to make your journeysmoother.
I found the best therapy comesfrom employing simple techniques
with a generous helping ofmindfulness.
Hello, welcome to another SpeechUmbrella podcast.
We are in for a real treattoday.
My guest is Dr Shereen Lim, adentist who specializes in
promoting airway health.
Shereen is a wealth ofinformation, a deep well.
(00:49):
As I was reading her book, Iwas connecting dots all over the
place about my clients.
I'm going to read her bio nowand then we'll jump into the
interview, because I have aboatload of questions.
We're all going to learn somuch today.
Dr Shereen Lim is a Perth-baseddentist with a postgraduate
diploma in dental sleep medicinefrom the University of Western
Australia.
She has been involved in theteam management of snoring and
(01:11):
obstructive sleep apnea for overa decade.
Dr Lim is dedicated topromoting airway health for
infancy as an alternativeapproach to minimize the
development of these problemsand their consequences and, as
the author of the book Breathe,Sleep, Thrive, Discover how
airway health can unlock yourchild's greater health, learning
and potential.
Her work in private practice isrestricted to tongue time
(01:32):
management from infancy toadulthood, early interceptive
orthodontics and myofunctionaltherapy.
Welcome, Shereen.
Thank you so much for joiningme on the speech umbrella.
As I was reading your book, Icouldn't help but think of an
early childhood dentalexperience of mine and how, if
my dentist had known what youknow, maybe I would have got a
palate expander, maybe Iwouldn't have had to have eight
(01:53):
teeth removed in one visit,because my parents lived an hour
from doctors and so had to allbe done at once, and it was kind
of traumatic because theydidn't give me enough gauze and
I was bleeding all over theplace on the way home, anyway.
And now I have these retainersI put in at night, not my
favorite thing, but I thought,wow, what if I didn't have to
wear retainers every night?
(02:13):
Wouldn't that be awesome?
But you know, my outcome wasgood.
I didn't have health or speechor behavioral issues.
I was in speech therapy for R.
I have a bit of an over jet,not bad.
I was orthodontia when I was anadult, but for many kids, you
know, the outcome is not as goodas mine, and they have these
airway issues, and so that'swhat we're going to dive into
today.
I've got some questions that Iwant to ask you on.
(02:35):
Some of them are a little bitmore general, and then we're
going to take a really deep dive.
But let's find out, how did youget started in managing snoring
and obstructive sleep apnea?
Shereen Lim (02:43):
My interest in snoring and obstructive sleep
apnea was prompted by myhusband's snoring and the
frustration of the disturbanceit was creating in my sleep, and
so that's what prompted me tolearn more about dental devices
that could actually be wornovernight to hold the lower jaw
forward and open up the airway.
And so I became one ofAustralia's first dentists to
obtain a qualification in thisarea and become involved in the
(03:05):
team management of adult snoringand obstructive sleep apnea.
And so what I soon realized isthat snoring is not just a noise
.
It can actually create someserious health risk and impact
people's quality of life, andwe're looking at this
craniofacial problem or aproblem of poor jaw development.
I wondered how come we don'tintervene and do orthodontic
(03:26):
interventions and modify jawdevelopment when children are
still growing.
And so in dental school we'retaught you can modify jaw
development through earlyintercept of orthodontic
appliances.
The reality is many of us wereferred to orthodontist, and
the traditional age is not to doanything until age 12.
Watch and wait, like you said,take out teeth down the line and
then straighten them withbraces.
But I became familiar with theresearch to suggest that if we
(03:49):
can widen palates it canactually improve breathing and
sleep.
So I wanted to know how come wedon't do that and I decided I
was gonna learn more about thisas well.
So I did a lot of training inearly intercept of orthodontics
and started to become moreinvolved in that, and I met Dr.
Christian in 2014, pioneer ofobstructive sleep apnea.
Told him that your work hasreally inspired me to learn more
(04:11):
about early intercept oforthodontics and he said if
you're doing palate expansion,you're too late, and I had no
idea what that meant at the time.
But it was rabbit hole oflearning to find out that the
jaw development is verymodifiable by how the muscles
are working in the earliestyears of the life how we suck,
swallow, breathe and chew.
These all influence our jawdevelopment.
(04:33):
And that's how I becameinvolved with promotion of the
mechanical benefits ofbreastfeeding, tongue-tie
release and my functionaltherapy to actually really help
promote good jaw development andgood muscle function.
Denise (04:46):
Let's talk about why breastfeeding develops the
optimal jaw and muscle function,for good airway health, for
speech.
How does that even work?
What are the mechanics ofbreastfeeding versus bottle?
Shereen Lim (04:58):
Yeah so, breastfeeding I mean the first
year of life is one of the mostrapid windows of jaw development
.
So what we're doing in thefirst year of life and how our
muscles are working, it's reallygoing to have a great influence
on our airway development.
And so with breastfeeding it isa more powerful muscle workout
than bottle feeding.
So with breastfeeding it'ssometimes called nature's palate
(05:22):
expander, because for a reallyefficient transfer of milk it
relies upon tongue suction, sothat tongue elevates and it
compresses the very malleablebreast tissue up against the
palate and so it sculpts thatpalate quite broadly and then as
the tongue drops it creates avacuum and that's when milk is
transferred from the breast.
And to get this tongue suctiongoing we need very coordinated
(05:45):
jaw movement.
So we're really stimulatingthat lower jaw back and forth.
Breastfeeding in general willpromote more forward and wide
development of our airways, andso it's really foundational to
develop those muscles well forgood speech, chewing, and
swallowing later on in life.
In contrast, with the bottlefeeding, it doesn't require as
(06:06):
much effort.
We don't rely on tongue suction.
In fact the milk comes out alot more easily and the teat,
it's not as malleable.
Like, so it pushes the tonguedown, it lowers the tongue, so
there's nothing to counteractthe inward pressures of the lips
and cheeks.
And then we get a distortion ofthe palate, so it becomes more
narrow, and so I also thinkbreastfeeding it's really well
(06:29):
designed to suck, swallow andbreathe.
Babies can suck, swallow andbreathe at the same time, in
contrast to bottle feeding wherethey can't regulate the flow
and they often have to pause tobreathe, and sometimes this is
where mouth breathing can begin.
Denise (06:43):
Well, sometimes you hear a baby bottle feeding gasp as
their bottle feeding and younotice that the other day and I
was like, huh, I wonder whatShereen was saying about that.
So, while we're talking aboutbreathing, what are the signs
and symptoms of disturbed sleepbreathing in children?
What should parents look for?
Shereen Lim (07:00):
Well, it's very common for me to ask about a
child's sleep and parents arepretty happy if they don't have
to wake during the night toattend to their child.
Good sleeper.
However, what we really want tosee when children are sleeping
is that they are very still andlook very restful and peaceful.
They aren't making any soundsand they're breathing with their
mouth closed and through theirnose.
(07:22):
So any signs like mouthbreathing, snoring, gasping,
restlessness.
So the frequent tossing andturning and sweating, teeth
grinding, bedwetting, unusualsleep positions like neck hyper
extension to open up the airway,or stomach sleeping, which can
sometimes be a compensation tokeep the tongue from blocking
the throat.
All these things, unexplainedawakening, sometimes that child
(07:45):
coming into bed in the middle ofthe night.
Why are they waking?
We mustn't overlook ourbreathing disturbance.
They're the main symptoms tolook for during the nighttime.
Denise (07:54):
Let's talk a little bit about teeth grinding, because I
wasn't aware of that untilrecently, that teeth grinding
can be a symptom of airwayobstruction or something like
that, or of a tongue tie.
So why would a child grindtheir teeth?
Shereen Lim (08:06):
Teeth grinding is really one of the strongest red
flags that a child may have anunderlying breathing disturbance
, and so it's thought to be aprotective mechanism to help
keep the airway open and protectagainst obstructive sleep apnea
or complete collapses of theairway.
So in children, when there is alimitation of airflow, their
(08:29):
sympathetic nervous systems aremore responsive, and so they
will react with an arousal fromsleep, and what happens is they
recruit the muscles during thegrinding and that helps open up
the airway.
So what that means is they'renot getting the prolonged
collapses of the airway that wesee in obstructive sleep apnea,
but it actually is verydisturbed sleep.
It's a state of constant stressand fight or flight response,
(08:53):
and it doesn't allow children toenter the deep stages of sleep.
So when we have teeth grinding,we must not overlook the
contribution of disturbedbreathing, and we know that
children that have adenoids andtonsils there's been some
research that 65% of them willhave a reduction in teeth
grinding.
There's also some research tosupport widening a palate,
(09:16):
palate expansion, which canimprove nasal airflow.
That can also reduce teethgrinding, and that's something
that I see very commonly in mypractice.
When we do palate expansion,within six weeks there may be an
elimination or reduction inteeth grinding.
But then we also know that ifthe tongue is sitting low inside
the mouth it's more flaccid andmore likely to block or
(09:38):
obstruct the airway, so that canbe implicated as well.
So there could be a variety offactors that contribute to poor
airway and we need to rule outall of them.
Denise (09:50):
So let me see if I understand this correctly.
So the development of the jawin the facial skeleton is the
bony structure that supports agood airway.
Shereen Lim (09:58):
Absolutely.
So, those jaw structures, thepalate is really the floor of
the nose.
When the palate is high andnarrow, we're going to have a
narrow nasal passage.
So we know the research tellsus that when we widen the palate
, even in the range of a fewmillimeters, we're going to get
an exponential improvement innasal airflow.
It's also the space for thetongue.
So when we have a broaderpalate we're going to have more
(10:21):
room for the tongue to sit highand make contact with the palate
.
And so when we have that goodtongue-to-palate seal, it prom
otes nasal breathing -it's impossible to breathe
through the mouth, so it'seasier to breathe through the
nose and then it allows thetongue to suction to the roof of
the mouth.
More space for that to occur.
And then when that tongue issuctioned, we know that it's a
good tone, that this is a tonguethat's going to be less likely
(10:44):
to obstruct the throat duringsleep.
So yes, it is.
The jaw is really out of thefloor of the nasal passage, the
housing for the tongue and theskeletal framework for our
collapsible upper airway orthroat.
Denise (10:56):
So we really need to think of the whole system, not
just the mouth, the whole system.
Now, when you see a high,narrow palate in child, how soon
can you address that aswidening the palate as a dentist
, because sometimes I don't seeit till a child is perhaps, you
know, around 11 or 12 or 10maybe.
Shereen Lim (11:16):
Sure, the traditional age for early
interceptive treatment withpalate expansion is around the
age of seven to eight years.
Usually the idea is to waituntil the first permanent teeth
come through.
However, I see these high archpalates from infancy because I
see a lot of infants in mypractice and I know straight
away that this is a risk factorfor the development of mouth
(11:37):
breathing, for the developmentof snoring, and children with
narrow high arch palates aregoing to be at greater risk of
having glue ear or recurrent earproblems because it affects the
way that they swallow and theydon't get good use station tube
function.
So it's a problem, a functionalproblem when we see these high
arch palates and I don't thinkthat it's necessary to wait
(11:57):
until seven to eight years old.
Children are having problemsand if we can address this risk
factor, I become more and morecomfortable addressing it.
From the age of three and ahalf to four, as long as a child
can sit in the chair, take abunch of photos, we can engage
with them and I think they'regoing to be compliant.
I will look at it if they'rehaving difficulties, Because
sometimes if they're notsleeping well or they're having
(12:19):
behavioral problems and becomingreally difficult for their
parents to manage - it'seggshells at home.
Denise (12:24):
That can be a very effective intervention within
six weeks.
And we talked a little bitearlier about a myo munchie.
Which I have had a couple ofclients use.
I'm a little bit familiar withit.
Describe for our listeners whata myo munchie is and how it's
used and the benefits of it.
Shereen Lim (12:39):
Yeah, a myo munchie is a silicone appliance that
can be placed inside the mouthand I would recommend just
googling what a picture is andthe main benefits when putting
it inside the mouth.
Number one we want children toclose their lips around it.
So it takes a little bit ofeffort to close the lips around
it.
But we're training that lipseal, encouraging and promoting
(13:00):
that lip seal, because if theycan get really good at closing
their lips around it we knowthey're gonna have a more
reliable lip seal during sleep.
The other thing that it does itpromotes more normal swallowing
.
So when it's inside the mouththe tongue cannot thrust forward
, it has to go up and backwardsa more normal swallow.
And it disengages all the cheekmuscles, so the inward
(13:21):
pressures of the lips and cheeks, and so it really promotes more
normal swallowing.
And then when they're reallygood at closing their mouth, we
get them to chew on it.
So it provides a lot offunctional stimulus for those
muscles to chew and to exercisetheir jaw muscles.
So there are a lot of thefactors that we're looking at
and the other thing I think itdoes the feels are very
(13:43):
important sensory need for somechildren as well that want a
mouth, things.
So we put it inside their mouth.
When do I use it?
They have a baby version so itcan be used as early as five to
six months, for which babies doI think it has a value in is
those babies that may have beenbottle fed and had an altered
swallowing from bottle feedingor used a lot of dummies.
(14:04):
Sometimes If the baby has anopen mouth posture and I really
wanna exercise those jaw muscles, I'll use it for those type of
babies or babies that drool,they have their low lying tongue
any of those babies and then itcan be used all the way through
to adulthood.
So nearly everyone that does myfunctional therapy with us.
I like to introduce it because,without really having to do a
(14:25):
lot of exercises, when it'sinside the mouth it's promoting
more normal muscle balance andswallowing.
Denise (14:31):
I had a couple of young clients use it and they both
really did enjoy the sensation.
It's a little bit textured.
Shereen Lim (14:37):
Yeah, it's nice and squishy, lots of little tongs.
You know, we know that themouth is so important.
I think about a third of oursensory input comes from our
mouth.
There's a lot of sensoryreceptors that needs stimulation
, so I do think that it can be avery important piece.
The children that are missingit or they had their mouth
hanging open a lot.
Denise (14:58):
Now, I did say we had some general questions and we
had some deep dive questions andwe're about to go into that.
This stuff is so fascinating.
So I want you to tell us aboutDr Ferrante's research on the
relation between thumbs sucking,neuro transmission, that spot
we call the Avila Ridge, yes,where the tongues should be.
Shereen Lim (15:17):
Yeah, really important work.
Antonio Ferrante he's a dentistand my functional therapist in
Italy.
He's actually published fourtextbooks and I happened to hear
him in 2015 in Los Angeles andit was actually an English
speaking talk, so maybe one ofthe only ones he's done, but I
have heard it five times.
I bought the recording andlistened to it so many times
(15:39):
because I thought it was a verygood presentation.
But basically, what he hastaught is that the 'n' spot when
you say 'n' with the tip ofyour tongue and it shouldn't
touch a teeth that spot in thepalate is richest in sensory
nerve endings and so when thetongue stimulates that spot, it
sends signals to the brain, soit's involved in
neurotransmission and then whathappens is we release at least
(16:01):
four chemicals like dopamine,serotonin,
there's a couple of others,which make us feel calm, relaxed
, and it's involved in ourbalance, and so in the
presentation he did some work tosuggest that with Parkinson's
patients he watched their gaitand they've got a lot of posture
analyzers there - that it couldimprove when that tongue was
hitting the spot.
(16:22):
Now he's also publishedresearch on thumb sucking
children and what he found wasthat when children could put
their tongue on the spot, thatcould also improve their posture
and balance, and so a lot ofthumb sucking children.
We know in my functionaltherapy circles that if they're
ready to give up thumb sucking,it's very predictable to get
(16:44):
them to stop thumb suckingwithin a day with a combination
of strategies, includingteaching their tongue tip where
to sit, so it's a very importantspot in the mouth.
Denise (16:53):
Because then they're getting that sensation or that
feedback that they need, thatthe tongue was filling that role
, but now their tongue isfilling that role.
Yes, yes, that neurotransmission role.
and I have noticed this balancething did just interest me so
much.
There's a connection betweenbalance and where the tongue is
and speech, because I will oftenhave children practice what we
(17:16):
call a neutral resting posture.
So the tongue is up, the teethare gently closed, the lips are
gently closed and I'll have themjust do like what you call a
mountain posing, yoga orsomething like that.
And so many of them, just theycan't even close their mouth and
they're doing that and they'llturn their feet, they'll wiggle
their feet, they're trying toput one foot behind the other.
They don't sometimes reallyhave good balance If they're
trying to stand in that way.
We call that really balancedmountain pose with the feet
(17:37):
parallel to each other.
But when they can do that andwhen they can maintain a neutral
resting posture, I see a hugegain in their speech.
It's just amazing.
It's like something in theirbrain is integrating and you're
like wow.
Shereen Lim (17:52):
I think that spot's very critical.
We even know that there'sresearch to suggest that
children who use a pacifier aregoing to have increased risk of
delayed speech development.
And there's research to suggestyou need a free tongue.
It's involved with perceivingsounds, so there's a sensory
(18:12):
motor component where we needthat tongue up to perceive the
sound.
So that's really important forspeech development.
So there's a lot of reasons whywe want the tongue up.
Even with speech articulation,that's where the tongue belongs.
If the tongue is resting in thebottom of the mouth, it's going
to be a low-tone tongue andwe're going to have more
increased risk of lisping orunclear speech.
(18:32):
But when I get people to puttheir tongue on the spot, when
we train them, a lot of adultsand children will report lots of
various things.
Number one it's easier tobreathe through the nose, they
have less tension in their jaw.
Some people will just reportthey didn't realize how good it
feels to put your tongue on thespot, or more balanced, and some
(18:54):
people may even feel lessheadaches.
I've had children say that aswell.
So it's really importantcritical spot.
I think it's really key that wehave that tongue on the spot.
Denise (19:05):
And when my clients can do that, they are calmer.
Yes, yes, their executivefunction improves.
Shereen Lim (19:11):
Yeah, and I you know a lot of children that have
fidgeting or they're alwayssitting around and their mouth
is moving when they're watchingTV or tongue between their lips.
We just teach them to put theirtongue on the spot.
That's often my first stepbefore I look at doing any
orthodontic treatment, because Idon't want them to be flicking
out expanders or plates.
So I think it's important.
Denise (19:30):
That leads us into talking about tongue ties,
because some children havetrouble putting their tongue on
the spot or keeping their tongueup because they have a tongue
tie.
Now, as a speech therapist, Iknow the problems a tongue tie
causes with speech.
But what do you see as adentist?
What problems do you see atongue tie causing in the
development and from infancy?
App, yeah, okay, great.
Shereen Lim (19:52):
So the main problem with a tongue tie is that it
restricts normal tongueelevation.
So, starting from infancy, themost common problems that we're
going to see are breast feedingchallenges.
So when the tongue can'televate or suction, we're not
going to get efficient transferof milk, and so we may have
perception of low milk supply,may have more shallow latch and
(20:13):
pain, unfeeding, or pulling onand off.
It's very frustrating.
Babies that have short feeds ortire very easily.
So there are common problemswith the breastfeeding.
But even with breastfed andbottle fed babies we may have
problems with reflux, likesymptoms where they're unable to
swallow correctly, with theirtongue going up and their
gulping air, and so babies havethese symptoms of reflux.
(20:36):
They're screaming, arching,stomach distention, vomiting,
very, very gassy, and they maybe put on reflux medications.
But if we are medicating babiesfor reflux, we really need to
make sure that they've got agood latch, whether it's on the
bottle or the breast, and makingsure they're not swallowing air
.
So the next things we might seeare swallowing problems,
children having difficultieswith swallowing and they're
(20:58):
gagging or choking.
There may be more picky eatersbecause they want to eat softer
foods and avoid certain othertypes.
And then the speech problemswhere it might be difficulties
with their speech, speech,articulation, so those type of
problems.
And then the next thing is theteeth grinding.
It's a common thing.
That can be linked, it's a signof disturbed breathing and with
(21:21):
that all the accompanyingincreased risk of behavioral and
learning difficulties.
So those are the type of thingsthat we see.
And then, as we get more intothe adults, the things that I'm
seeing a lot of is, for instance, if you have a tongue tie, you
can still breastfeed, you canstill speak, you can still do a
lot of things, but you may becompensating or using and
(21:42):
recruiting other muscles whichshouldn't be working.
So you may overuse your lipsand cheeks, you may overuse your
jaw muscles and some peopleeven strain and use their neck.
So with the adults I may beseeing more of the chronic neck
tension and they've got thesetrigger points of tight muscles
inside their neck and these mayactually be linked to cervical
(22:05):
genic headaches or referredheadaches.
And so we have a lot of adultsthat come because of their
chronic headaches and if I seethat they're overusing their
neck, it's quite often linkedand we may address the tongue
twister.
But the biggest problem reallyis that the tongue doesn't
develop sufficient tone to restin the roof of the mouth and
when we don't have a well-tonedtongue during sleep is when it
(22:27):
will play out eventually downthe line we're going to have
more risk that the tongue isgoing to cause a base of tongue
is going to cause obstructionand it will disturb the sleep,
so we won't get the fullestquality of sleep possible.
So a lot of implications.
We don't know when it will playout because a lot of people
compensate.
But it's a fact of life that weneed the tongue to work well,
(22:48):
because the genioglossus muscle,which forms the bulk of the
tongue, is the main upper airwaydilator muscle.
It's the main muscle that needsto function well to keep the
throat open during sleep.
Denise (22:58):
So there's a lot of things that can happen with a
tongue tie and not just speech.
Because I have been saying andI have heard well, let's see
what they can do, and I wouldnever say this with an anterior
tongue tie, but a posteriortongue tie is sometimes kind of
difficult to tell.
So you're like well, let's seeif this child can learn to
articulate with what they haveand try for a little bit not too
(23:18):
long.
But we should be looking atthis whole range of symptoms or
things that could occur and notjust speech.
Shereen Lim (23:25):
Yeah, because people can speak perfectly fine
with a tongue tie.
I see a lot of people that haveno problems with their speech,
but because I take video ofevery single child speaking,
what I can see when there is atongue tie is that they're often
making their speech sounds withtheir mouth, their lips and
they're moving too much, orthey're using their jaw to brace
(23:46):
with their jaw, they'reoverusing their jaw or their
neck, and so the ultimateproblem is that that tongue is
not developing good tone, andthat tone is necessary for
palate development as well asgood breathing throughout life.
Dan Stratton (24:00):
We will get back to the interview in just a
moment.
We want to take a moment towelcome you to the 2023-24
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Now back to the interview.
Denise (25:25):
In your book you talked about tongue ties and postural
issues.
I think that is so fascinating.
Tell us about that.
Shereen Lim (25:32):
Every day I hear new things that you would not
think are connected, so nothingreally surprises me anymore.
But there is a connectivetissue in our body called fascia
, so it covers everything in ourbody, all our muscles and all
our organs.
It's what helps us move in onepiece, and there's a deep-lined
fascia that goes from the tongueall the way to the toes, and so
(25:55):
that's the main fascial line inthe body, and so when we have
any restriction in one area ofthat deep front line, it can
actually affect the motion andthe way that we use other parts
of our body in that same lineall the way down to our toes.
And so what I see with tonguetie release is that when we
(26:17):
release that fascia, we canoften see postural changes in
the body.
When we work closely with manualtherapists like osteopaths or
chiropractors, craniosacraltherapists a really common for
me to hear is babies that seemless tense or tight, or they can
extend their neck better andcope better with tummy time, or
(26:38):
they're just more free and easyto feed on different positions
and then all the way into adultsas well, so we might get less
of those headache and neck achesand people report different
things happening in differentparts of the body down to their
toes.
So I've had quite a lot ofpeople report that inward
turning toes have now becomenormal, or even the toe walking.
(26:59):
So there's a lot to learn andit's very fascinating.
I think even people can breatheeasier when there's more
release of the diaphragm, ifpeople feel like they open up.
So for some adults that have avery significant tongue tie,
it's actually like a literalrelease of them as a person.
They feel unwound.
So yeah, I love listening tothem.
Parents and patients sharethose stories.
Denise (27:23):
That is simply amazing.
I recently referred two clientsto professionals who belong to
the International Association ofTongue Tie Professionals
because they know that they willknow what to do.
I've had the experience of someENT saying that well, it's a
posterior tongue tie, you know,it's not really affecting things
.
But these two children andtheir parents have real concerns
(27:43):
about their eating.
Now they are learning how toarticulate well with the tongue
restricted as it is.
But one child is really reallyunderweight, doesn't like to eat
anything but soft food.
His mom is really concerned andthe other mother is just
beginning to get concerned andshe asked me for referral to an
OT maybe who could help him witheating.
And I'm like you know what?
Let's look at the Tongue Tie.
Let's see if there is a TongueTie.
(28:04):
For myself I can't really tellbecause it, if it is its
posterior, he's able toarticulate well, but it does
look to me like his tongue isnot maybe as free as it could be
.
So I'm like well, they need toeat.
Even if they can speak, theyneed to be well nourished.
So, that's you know.
That's just really interestingto me.
We have to look at the wholechild.
(28:25):
I was a whole child and whilewe're talking about the whole
child, in your book you talkedabout children who have sleep
disturbances and how it affectedtheir gray matter.
In there was a study thattalked about the gray matter in
children who have sleepdisturbances.
Shereen Lim (28:38):
Yeah.
So probably the most compellingof those studies is I think it
was called the ABCD LongitudinalStudy, where they're following
up over 10,000 children over theyears and what they inquired
about is their history ofsnoring, and then they actually
took MRI scans of their brainfor all these children and were
(29:00):
able to correlate that thosechildren who snored had losses
of gray matter compared onaverage to those children that
didn't, and so we don't fullyunderstand the impact or how
it's going to affect eachindividual child, but we know
overall there is somethingdetrimental occurring when a
(29:21):
child snores, so that's not evenobstructive sleep apnea, it's
snoring.
Denise (29:26):
And so we've got, besides speech, we've got
problems, potentially problemswith cognition, potentially
problems with behavior.
You did mention in your bookthat many children are diagnosed
with ADHD.
When actually the trueunderlying problem is sleep
disturbances, airway problems, atongue tie, something like that
.
Shereen Lim (29:44):
Yeah, I think it's important to recognize that
there's very, very compellingresearch a meta analysis paper
which has compiled all thefindings from various studies
that showed us that children whohave obstructive breathing are
going to have a greater risk ofADHD type symptoms and that when
(30:05):
they are treated with removalof adenoids and tonsils there is
a reduction in those ADHDsymptoms.
So it's important when childrenare medicated for these
problems that we don't overlookdisturbed sleep and disturbed
breathing.
And it's not just the adenoidsand tonsils, because the airway
problems are multifactorial.
(30:25):
If there's no response to that,we also need to be looking at
what are the other risk factorsto ensure complete resolution.
So we need to address thepalate and we need to address
poor tongue tone or tongue tiesthat restrict the normal
movement and tone development oftone of the tongue, as well as
ensuring that children closetheir mouth and breathe through
their nose.
Denise (30:46):
I feel like maybe there should be a course for all
pediatricians on this.
Shereen Lim (30:52):
Because they're so busy, like here, the waiting
list is like a year to see apediatrician and they're the
only people that can prescribethe stimulants.
So for me, I think, whilstwe're waiting for that
appointment, let's rule outbreathing disturbance, because
I've done palate expansion forchildren as young as three and a
half and parents who are reallystruggling with their child's
(31:13):
behavior, just really not ableto enjoy their child, and when
they get a better night's sleep,their child can function a bit
better and it's just much moreof a relief for parents.
So I think that we mustn'toverlook it and use
opportunities to spread thisinformation.
Denise (31:31):
And which is exactly why we're having this podcast.
Because we did not know this.
Or maybe, if we knew it yearsago, maybe we forgot it.
Because in your book you alsotalk about our modern lifestyle
affecting the development of ourjaws, our teeth, our face.
So maybe we didn't need to knowthese things a century ago or
before the industrial age.
(31:51):
Maybe these things weren'tproblems.
So talk a little bit about thatabout our modern lifestyle and
how that's affecting us.
Shereen Lim (31:57):
So a lot of people ask is the teeth genetic, narrow
jaws genetic?
But really it's thought to beepigenetic because it's only
been in the last few hundredyears that we've seen a very
rising prevalence of crookedteeth.
And so when we have crookedteeth it's a symptom of poor jaw
development.
And so when we have poor jawdevelopment it means there's an
(32:18):
underlying change in the waythat our muscles are functioning
and providing the stimulus forgood jaw development.
And some of the changes thathave been put forward is number
one a difference in our diet.
We're having more processedfoods that don't require as much
chewing.
So we're cooking our foods andoffering purees to babies, even
(32:38):
the sippy pouches of foods, andwe're not chewing hard foods.
So that's one problem, as wellas breastfeeding.
So previously breastfeeding,most babies were breastfed
before industrialization, forsix months exclusively and up to
three years in complement withtheir solid foods.
So that's no longer occurring.
(32:59):
We're not having as much asbeen introduction of bottles and
pacifiers.
So that's the key change, aswell as the increase in mouth
breathing.
So we're having more allergieswith indoor living and more
pollutants.
So mouth breathing has becomemore prevalent and when we
breathe through our mouth wehave our mouth open, our jaw
muscles become slack.
(33:25):
and so our perception that wehave that every teenager, or
almost every teenager, is goingto have to have braces just a
right a passage is really justeffect of our modern lifestyle.
Yeah, that's right.
If we understand, for instance,when they've brought more
refined diets into newindigenous populations, that
crooked teeth can becomeprevalent within one generation.
(33:46):
So if we kind of understandthat, then we know what we can
do to stimulate the musclesbetter and provide a better
trajectory.
Denise (33:54):
There's one more really fascinating part of your book
that I thought I wish I'd knownthis years ago.
But there is a score, a mellasorry, I say it right.
Mellum and potty score Mellumand potty score yeah, for tonsil
grading.
And of course, as an SLP, I'mnot going to diagnose this kid
needs its tonsils out.
Child needs their tonsils out,necessarily.
(34:16):
But I have looked in somethroats and thought it looks
pretty crowded back there.
But what am I looking at?
What should I tell parents?
If I could just tell them thisis something that you could be
concerned about.
So describe that a little bit.
Shereen Lim (34:28):
Okay, well, it's ideal if people can Google
mellum potty score, because theyhave a really nice
classification with visualdiagrams.
But basically that wassomething developed by an
anesthetist who wanted to beable to relate to their
colleagues how easy will it beto intubate a patient?
How crowded is their throat,the back of their mouth?
And so there's grade one tofour.
(34:49):
One is when you open a mouth,stick the tongue out and you can
kind of see the uvula hangingdown and you can see the back of
the throat.
That's a more open airway.
And the other end of thespectrum is grade four, when you
can't see the uvula.
The tongue is just filling up alot of that space and, you can,
it's just all you can see isthe soft tissue there.
You can't really see the backof the throat.
(35:09):
So that's more crowded.
So we know as we go higher it'sgoing to be more risk of having
disturbed breathing, and usuallythe more crowded it is, it is a
reflection of the jaws notdeveloping properly forward.
With the tonsil grading, whatwe're really looking at is to
see how large are the tonsils inproportion to the throat, and
(35:32):
so we have grade zero to gradefour.
Zero is where they've alreadybeen surgically removed.
You can't see any signs oftonsil enlargement.
And grade four is kissingtonsils where they're meeting in
the middle and generallyspeaking, those grade four
tonsils, they're going to bevery obstructive and affect
breathing.
So grade three and four are themore, if a child is having any
(35:54):
breathing concerns or red flagsof sleep, disturbed breathing
like snoring, they're the onesthat we want to refer to ENT
specialists to check out as well.
Denise (36:03):
So a parent could look at that and look at those
pictures and think, okay, sothis is something I need to
bring up.
Yeah, absolutely, a child whomouth breathes habitually may
develop the perception that theycan't breathe through their
nose.
But that's not really true.
So you talk about that in yourbook a bit about how just nasal
disuse that's right.
Shereen Lim (36:25):
Yeah, so sometimes you know, when children can't
breathe through their nose, it'snot necessarily always an
obstruction.
Yeah, in fact, one of thelargest studies of mouth
breathing children actuallyfound the most common risk
factor associated with mouthbreathing was allergies, not
true obstruction.
It was much greater prevalenceof that compared to things like
(36:46):
enlarged adenoids and tonsilsand deviated symptoms.
And so the thing aboutallergies when children have
allergies, they may be morecongested, and so they may be
prone to having a mouthbreathing habit which actually
makes the nose more congested.
But if we actually use our nose, then it will become clearer to
breathe through our nose, andso we've got to really
(37:07):
differentiate.
Is it nasal disuse, wherethey're not really used to using
their nose and it's morecongested, or is there a true
obstruction?
And so the work of Dr SirushSaki and his team he's an ENT.
He published some work tosuggest that one little thing
that we can try is test out howwell a child can sit with their
mouth closed and breathe throughtheir nose.
(37:30):
So they use micropore tape,just a little bit of breathable
tape on the lips to keep themouth closed.
Or you can also put a paddlepop in between the lips or just
some water inside the mouth andsee how long a child can hold it
for and if they can breathecomfortably through the nose for
three minutes.
The suggestion is don'tnecessarily need to jump into
ENT surgery.
(37:50):
We might want to focus onretraining that habit of nasal
breathing through my functionaltherapy, and so I think it's
really important we do nasalsprays, clear the nose, nasal
hygiene, remove any mucus andthat and see if we can get a
child to breathe through theirnose first, that is a really
good tip.
Denise (38:08):
I've often wondered, as I work on closed mouth breathing
, what is a good benchmark?
How long should they be able todo this?
So I love having that numberbecause I will time you,
sometimes like, hmm, how longcan you go?
And that's good for parents toknow too.
Well, that is a deep dive intoairway obstruction, tongue ties,
(38:30):
all the things that I like togeek out on.
So thank you, Shereen.
I love your depth of knowledgeabout airway health and how it
affects so much down the line,and this book that you wrote is
a book I'm going to keep in mywaiting room and recommend to
every parent who needs it,because with the information in
this book we can intervene inairway issues earlier, we can
stop a cascade of poor outcomesin speech, behavior, cognition,
(38:52):
health, so many things down theline, and also it's just a great
way to retrain all of usprofessionals in this really
critical aspect of airway healthand what we can do at the very
beginning, instead of waiting,as you said, until maybe they're
eight, nine, 10, and now we'reintervening and the pallets
already narrow, the jaw and thefacial structures are already
(39:15):
less pliable than they were.
Habits have been put into placethat are harder to break.
Shereen Lim (39:21):
And we need to establish good sleep in the
earliest years of life, becausethat's when brain development is
the most rapid.
Yeah, so I actually reallyappreciate the opportunity to
speak with you and highlightthis issue amongst your
colleagues because in practice,you know, I am seeing a lot of
those children that are havingon going speech therapy without
any progress, and when it comesto speech, I think that if that
(39:44):
is the case, we really need tobe looking at how the mouth is
structured and how the musclesare working as root causes of
speech concerns.
Denise (39:54):
So I hope it inspires others to kind of look more into
that and we really need to knowa speech therapist what we're
looking at.
What should the jaw look like,what should the palate look like
, what should the muscles looklike, to recognize these things,
to recognize these issues,because we often don't get
taught that in college.
So that's why I so appreciateyour book.
I think we have to learn mostof our profession after we
gradua te.
Shereen Lim (40:15):
Absolutely.
You know, it's always hard forpeople to find the right
providers because not everyonehas received this training.
Most people haven't receivedthis training in their
professional qualificationcourse.
It's looking for those thathave committed to finding those
answers and a lot of the timeit's people looking for answers
for their children that theybecome passionate about this
(40:37):
area.
Denise (40:38):
So where can our listeners find you?
I know you have a book out.
Where can they find the book?
And I don't know if you haveany other resources out there
for them, if you've donepodcasts or things like that.
Shereen Lim (40:48):
Yeah, the book is available on Amazon now.
That's the widest distribution,but that's available through
many online stores.
And in terms of where I'm mostactive, I am most active on
Facebook.
So, Dr Shereen Lim, and if forany healthcare professionals
that are really interested inAirway Health for children, I
have a professionals onlyFacebook group called Airway
(41:08):
Health 4, number four, Kids aswell.
So I share a lot of newresearch.
I think it's really importantthat we have ongoing discussions
about new research betweendifferent professions.
We're all seeing the samechildren.
They have different problems,but many of the time the
underlying problem is poor oralfunction and jaw development
Airway Health 4 Kids.
Denise (41:29):
Number four.
Okay, I love that.
I'm going to look that up onFacebook.
Thank you so much.
I have learned so much, and mylisteners out there, especially
SLPs, you're going to want toget this book and you're going
to want to stand with ahighlighter, like I did, and go
through and put in post-it notesand then when a parent has a
question, you're going to openright up to that and say look
right here, Shereen Lim laid itall out for us and here's the
(41:52):
information you need.
Thank you, Shereen, I enjoyedthis so much.
No, thanks very much for havingme Taa.
I want to thank Dr Lim forreaching out to me and sharing
this information with speechtherapists.
This is so critical for us toknow.
This is one of the things thatfascinated me the most.
When we have a correct oralresting posture, our tongue is
(42:14):
resting up in the upper dentalarch and we know that.
But what I didn't realize isthat area is rich with nerve
endings and when our tongue isresting there, it's sending
information to our brain and ithelps children with balance.
It helps children withself-regulation.
Wow, that is just so cool toknow that, having your tongue in
the correct resting spot ishelping with all of those other
(42:36):
areas of a child's development.
And remember, Dr Lim's book is'Breathe, Sleep, Thrive.
I read this book with ahighlighter in my hand and there
is so much good information forus as SLPs, and for doctors and
for parents.
So be sure and check out herbook Breathe, Sleep, Thrive by
Dr Shereen Lim.
Thank you for joining me underthe speech umbrella today.
I hope you learned something tohelp you in your therapy.
(42:58):
If you did, please share thispodcast with a fellow speech
therapist and leave a five-starreview on Apple, itunes, spotify
or wherever you get yoursubscriptions.
While you are online, come onover to the SpeechUmbrella.
com, where you will findtranscripts, links and my free
resource library.
I also have some other valuablecourses and therapy aids in my
store.
That's all at theSpeechUmbrella.
com.
(43:19):
Let's connect on social media.
I'm DStrattonSLP on Instagramand T he Speech Umbrella on
Facebook and YouTube.
You can also find me on TPP.
Hope to talk to you soon.
Bye.
Dan Stratton (43:32):
Thanks for listening to the SpeechUmbrella.
We invite you to sign up forthe free resource library at
thespeech umbrella.
com.
You'll get access to some ofDenise's best tracking tools,
mindfulness activities and othergreat resources to take your
therapy to the next level.
All this is for free atthespeech umbrella.
com.
If you've enjoyed this podcast,subscribe and please leave us a
(43:55):
review on Apple Podcasts andother podcast directories.
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