Oral Restrictions and Sensory Regulation


189 - Oral restrictions and sensory regulation - 9:5:21, 9.04 PM

00:00:01    Alyssa 

You're listening to Voices of Your Village. This is episode 189. I got to hang out with Michelle Emanual to chat about oral restrictions and sensory regulation. This was something that was coming up in our village asking about how lip ties or tongue ties might play into sensory regulations, right? Started to do a deep dive and found Michelle and was like, whoa, I ended up diving real deep. She is a wealth of knowledge. And I hung out with her before, Sagey was even born. I was pregnant when we recorded this episode and was just blown away by how, you know, we know everything is connected, but and everything really is connected. And this episode was super fun. I learned a bunch, and I hope that it's helpful for you, there's a lot more discussion now about oral restrictions than there has been in the past and more diagnosis of this and support around it. And it is really interesting to me how much it plays into the nervous system and our sensory reg. So without further ado, let dive in. 


00:01:21    Alyssa 

Welcome to Voices of Your Village, a place where parents, caregivers, teachers and experts come to support one another on this wild ride of raising tiny humans. We combined decades of experience with the latest research to create the modern parenting village. Let's dive into honest conversation about real parenting challenges, so it doesn't have to be this hard. I'm your host, Alyssa Blask Campbell. 



00:01:51    Alyssa 

Hey everyone, welcome back to Voices of Your Village. Today we're going to talk about oral restrictions and their impact on overall sensory regulation. We talked about the sensory systems a lot over at Seed. Ya'll know, I'm obsessed with OT's. They're some of my favorite humans to chat with and get nerdy with. And today I get to do that again. Today I get to hang out with Michelle Emanuel. Hi, Michelle. 


00:02:15    Michelle 

Hi, I'm so glad to be here. Thank you Alyssa for having me. 


00:02:19    Alyssa 

Totally. I'm excited to get to know you and to get nerdy with you. 


00:02:22    Michelle 

I like to get nerdy! 


00:02:24    Alyssa 

Me too. Can you share with our village a bit about who you are and like your background kind of what brings you into this work? 


00:02:32    Michelle 

Oh yeah, I'd love to. I started out knowing I wanted to be an occupational therapist before I even went to college, and it was a journey to get there. It took me five and a half years to get a baccalaureate degree. But I did. And I was really intent. You have to have a very high marks right to get into OT school. So I was already a big achiever, and I knew I wanted to work with children, it was always really clear to me. And so I got into OT school, and my first job was in Pediatric Rehab. And I learned a lot about out the nervous system and how the brain works in the spinal cord. And I was amazed at some of the recovery in the progress, and then I was dismayed by the lack of it sometimes, Etc. And and what it meant to learn to cope with the new reality and mourn the loss of something and embrace something new. But in the back of my mind, I always knew I wanted to work with babies. And so I then began, you know, seeking out places that I could learn. I did some Acute Care Pediatrics. And then I worked, I got a job at Cincinnati Children's Hospital medical center, And I worked there for 17 and a half years, half of that was in the NICU and the CCU and PICU. So all the Intensive cares, But mainly the NICU. And then NICU follow up, and I worked in a lot of different clinics that I work with amazing people. But I learned a lot there. And so I ended up going into full-time Private Practice about five years ago, and just specifically focusing on the pre crawling baby and the sensory systems and nervous system regulation and co-regulation and movement and making sure that babies have movement prolific environments so that there aren't inhibition to their motor systems developing, because this pre crawling period is so unique. And I've got my microscope on it, you know, and I, that's where I focus. And I mentor professionals who want to also focus on this. We've got a bunch of people now who, you know, are out there and very resource with the minutiae, because some people were glossing over this period, sometimes, especially with the tummy time. And anyway, so that's how I did that. And along the way, I was raising three of my own beautiful children and learning what it was like in reality, taking care of children and what it was like to be a therapist recommending stuff. And and that reality. So I was always having some of what of a balance there, because parenting is tough. And it's a process where, you know, there's a lot of change and it even, you know, for me, who I'm kind of a sensory person, I think, all pediatric OTS, are former sensory kids. Okay. And what that was like for me to have to, you know, learn a whole new way of regulating myself around being a mother. And the now here I am. You know, my youngest is getting ready to turn 18. We have OTS who specifically focus on that now, I would have loved to have worked with an OT, you know, at that time. So I think that's really neat. Well, anyway, more about how I got here, I'm very passionate. And I love working with babies who are tummy  time haters, because really, they're just telling us what they need help with, because all the babies deserve to be comfortable in all positions of their body. There's no reason why we put a baby on their belly if they don't like it, that we need to investigate further and find out what's going on, because there's nothing inherently painful or uncomfortable, it might be challenging or difficult, or something that we need to make, adapt to make it easier. But we want babies to be able to be in all positions comfortably. And so now I feel really blessed. I work, you know, I have a private practice here in Cincinnati. I'm as busy as I want to be. And I also have, you know, a little. I have a little fun on social media, and I like trying to help get the word out. What can parents do at home? What's easy? What's helpful in the realm of helping relationships and social emotional interactional development? So for me, it's not just about the physicality, but as an OT, I think you understand too from emotional. But yeah, for sure. 


00:06:54    Alyssa 

That's awesome. And I, one of my favorite things about OTs is that you're awesome detectives like always, going into the why. And and that's how my brain works. I am not like a surface human. I want to know like what's really going on below the surface here? But what is this behavior communicating, etcetera? What are you really letting me know that you need more support with? And OTS are so good at that. I think that's something I really gravitate toward with y'all. So I'm grateful for that. And it's it's also, I think, the cornerstone for everything like our nervous system regulation affects how we move through the day. It affects how we feel. It affects how we show up in all spaces. And it's, I think, at like the key to getting down to that why, and what's going on within the nervous system before we can move up the ladder to what else is happening? And we talked about this. I made it up, but I called the triangle of growth. And really looking at sensory regulation is at the base of the triangle for me that we can't move to emotional regulation or language and communication until we have really looked at sensory regulation and supported kiddos there. So everything you just said, I would just like, yep. Yep, I'm here for all of this. Really, one thing that I want to learn more about here, And what I'm excited to dive in specifically on today is around oral restrictions. I want to learn more about like how this connects to other systems and structures in the body and kind of what we're looking at and seeing here feel like it's a topic. I'm hearing more and more about in The Early Childhood world, and just want to learn more about. So can we start off with like, what are oral restrictions? What does that even mean? If that's a new term for somebody? 


00:08:47    Michelle 

Yeah, it's a great question. Basically, we can call it a tongue tie. But the reason why we switched sort of to oral restrictions is because there's now also lip ties. And there's also buccal ties which, our buccal is the space in the cheek BUCCAL. And so we actually have seven natural frenna. It's two on our lips and one on our tongue, and then two upper and two lower and they're natural. These are supposed to be there. These structures and what they're there for is stabilizing the soft tissue to the bone. So how they develop in utero is going to be reflected and how they feel at Birth. It's how they've practiced. So if an area that they were using a lot, and here we go, If we do have oral restrictions, we're calling them tongue ties that is going all the way back, just and you know, to the embryology to when they were eight weeks, Nine weeks, 10 weeks 11 weeks, these very early places, It's the transition from embryo to fetus is in all this oral stuff. And the tongue is supposed to be separating from the floor of the mouth. And the tissues are supposed to develop in these ways that are open. And anyway, so that doesn't happen a lot. Now it can it's exacerbated by them practicing compensatory strategies. So if they can't move the tongue, or they can't move the lip, they can't move the jaw. The jaw is a big piece of it too how we move our jaws. Then as the body grows and gets bigger, The tissue does doesn't necessarily grow and get elastic. It kind of grows and gets tight. And that's making it may be a little simplistic. But that's basically what happens. So this is, you know, tongue-tied has been around for a long long time. It's been documented there for a long time that you know that this has been there, but people want to know, why does it seem like it's so much more now? I think that's the problem, you know, one it dipped down when breastfeeding went down a little bit, because bottle-feeding can mask ties and oral dysfunction. Now here we got to talk about, if we have a tie, it's not like, oh, there's this one little piece in the body that isn't working, and if we just released everything's going to work right. It's all integrated into the myofascial structures, which means the muscles too and how movement happens. So it's a little bit more complex than just releasing the tie, even when there is a tongue tie. 


00:11:34    Alyssa 

All right. Oh my gosh, my wheels are turning. Okay. So first of all, like, that's so rad to like dive into I didn't realize it went back all the way to from like embryonic stage. And it makes total sense to me that then, like, as the tiny human would grow, that it would get tighter that makes total sense to me. 


00:11:53    Michelle 

Now It depends on the baby though, if they're high level of movement And there's not a lot of restrictions, and perhaps it doesn't have as much of an effect, right? 


00:12:03    Alyssa 



00:12:03    Michelle 

And for some babies, it's going to be significant like they get in one position. They don't move around a lot. 


00:12:10    Alyssa 

Got it because, almost like they have that restriction, They almost can't move around a lot. It's too tight. That makes sense. So when we're looking at, you know, if you said you wouldn't just like, release a tie, you would want to be doing this work, kind of beyond in with as a systems whole approach. What do you mean by that? Like, what else would it look like? Why? I guess what I'm confused about is like, if you release the tie, why wouldn't that make everything else kind of relax? 


00:12:39    Michelle 

Well, it does. And there are different degrees and varying degrees of it. And I'm an occupational therapist and an oral motor professional, and the body worker and the neural developmental specialist. So I'm one part of the team. So I'm it's not up to me like what exactly happens, it's working collaboratively with and release provider, who would be a doctor or a nurse practitioner, or someone who has the surgical ability to release the tie and do the diagnosing and a lactation consultant who would bring in and help with a whole host of things that are needed, because, you know, sometimes babies, that's the thing. Sometimes there's a lot of feeding signals that there are things going on. And sometimes there aren't. There's no guarantee. There's so much variability and uniqueness to ties that I call it the Slippery Noodle. But it depends like for some babies, It's compromised, and it's made things a little bit more chaotic, okay or more asymmetric, like some babies who have a very small jaw, like or a recessed jaw. Sometimes the tie itself is so short and thick in there, so much muscle or dysfunction that they're all kind of woven in together, And in order for us to adequately, because the only thing that the medical provider releases is the white connective tissue facia part, they do not cut into the muscle at all. And so when those tissues have been a little bit more, you know, dissociated, or you can tell that there's less muscle dysfunction that can be done. But we would. that's what we call optimal timing of release. So it kind of depends on the severity. It depends. There's so much. This is why we really need to get babies, you know, assessed individually and recommendations made based on individuals. 


00:14:41    Michelle 

Yeah, totally. I mean, there's so much, I think, in the postpartum period, especially here in the states that we are lacking, that we aren't supportive within. And I think a lot of it, Yeah, I even saw in teaching infants and toddlers. So especially in my infant room so much that was like a wait-and-see approach. And you know, when you've seen hundreds of thousands of infants right, You start to notice like at it. One Kiddo just came to my mind to at four months. I was like, there's something that's off, and I couldn't, I had the privilege of having access to an OT to be able to consult with. And we went through all these things. And long story short, This kiddo ended up at age two qualifying for services for OT, but nobody would do the eval under 6 months. He wouldn't. He couldn't qualify under six months. That's because it wasn't severe enough. Just drives me bonkers. I think there are so many things in that early infancy stage that we don't have enough support on. 


00:15:43    Michelle 

Well and now you know that's why I focus on these pre crawling babies and their families, because there is so much to know and focus on. And if we do put the emphasis here with the village, then it makes everything else later. So much easier. Now we're not going to make perfect people, because we don't even want to do that. We want people to be who they are. We don't want them to have barriers and obstacles and restrictions to who they are going to express themselves fully. And everybody's going to be a little different. And everybody should be different. But we don't want we want everyone to be optimized.  


00:16:20    Alyssa 

Totally not to have those roadblocks. So how might oral restrictions like impact the overall central nervous system regulation? 


00:16:30    Michelle 



00:16:31    Alyssa 

That's a big question question.


00:16:34    Alyssa 

That is a big question. I think we should like have a different time, or we go deep on that, because I need to go a little shallow. Otherwise we will open up so much that it will get off track. But it totally, Yeah, well it's an inside/outside job. Okay. On the one hand, we've got the nervous system, which is busy developing a body and a nervous system and a motor system, which is really quite sophisticated, actually, and that, I call it the gestational playground right now, when the fetus is in the womb. This is not a waiting period to be born. This is a movement, It should be filled with movement. The baby really doesn't slow down movement till right now, you should really be feeling your baby slowing down, but not too much, Right? 


00:17:25    Alyssa 

Yeah. So, just for folks who are listening at the time of this recording, I'm 37 weeks pregnant. 


00:17:31    Michelle 

Oh yes, wonderful. but the baby's doing things in there, so they should be really moving around and still actually rotating and flipping and moving and pushing and extending and using the feet on the uterine wall and developing their foot bracing regulation. They should be turning their head side to side and vigorously working on their hands and their fingers and the cord probably. 


00:17:58    Alyssa 

Yeah, for sure, don't you worry all thats for sure happening, especially around like four thirty in the morning. 


00:18:04    Michelle 

You've gotta 4:30 in the morning baby! I love that. 


00:18:09    Alyssa 

Yeah, but so, how then does this, you know, I'm so jazzed you're diving into really like what the nervous system is I think it's something that, yeah, a lot of folks don't understand like the vastness of the nervous system, and how much it does affect all of the things. And I think this can play into the wait and see, is like, oh, let's just wait and see if this develops. And this is, I think, what you're about to go into is why I'm not not a fan of wait and see. 


00:18:36    Michelle 

Yeah, wait and see makes me so woo. Not happy, Because why? Because we know that we don't just get handed our developmental skills because we change a week and age. We have to move through them and work through them and have them elicited and have optimal sensory input for the optimal motor output. And it's gonna be a little different between babies. But we have to do the thing to get the thing. So we really need to move a lot and practice a lot. And we have some barriers to that, especially even after birth, but before birth. And that's what we're talking about right now is that we're all restrictions which binds the tongue down to one degree or another, right? But this gestational playground is when they're practicing, and they're developing at the same time because they're practice even breathing movements you know? And all the muscles are breathing. They're just breathing, kind of like in and out. And there's, they have lung fluid. Okay, it's just a little bit different than amniotic fluid. There's kind of a meeting of them. They meet somewhere in the airway, but they're practicing breathing. And we know that if babies don't practice these breathing movements, they don't develop their lungs. So we, it's this function. And this practice is all really important for right after they come into the extra uterine environment. But they've got lots of reflexes already in there. Okay? And there's reflexes to be born. So the mother has reflexes for birth, and the baby has reflexes for birth, and we would like to have that unfold. There's and one of the things that gets in the way of that natural unfolding are tethered oral tissues or oral restrictions, because the tongue I call it the epicenter of development. It's like for a baby. Your tongue should be the most well developed, sophisticated thing you've got. Besides sleeping, bonding and snuggling and looking cute. Your primary occupation is feeding using your tongue to create suction and your jaw movements And swallowing in order to develop the airways and craniofacial respiratory development. And also, there's a lot of this going on, and our brain wants to be really efficient. So it will get better at the things we practice and not learn about the new things until we, you know, entice it sometimes. So that's why these habits get really ingrained. And so its first latch and practicing, breathing and getting used to gravity. And then they might think that this certain way they've got a feeding is the way to do it and continue doing it. Okay. And that's where, and then it's really hard to get them to use more optimal movements, especially when we have certain barriers, which leads us to having inadequate experiences at tummy time. Big problem, too. 


00:21:51    Alyssa 

Yeah. Okay. So what I'm hearing here is like that when essentially all these things lead to another thing, right? Like I've said here before that, like, I don't actually care at what point your kid crawls or walks, because I want them to hit a milestone. I want to know when they crawl or walk so that I know if there's any barrier in their way, because if it is, it'll affect other things along the way, right? It's not just like, oh, well, you know, everybody walks at some point if they, you know, have that motor ability, but rather that like, oh, if it's not happening, why and what else might get in its way? And that's what I'm hearing from you here is that if we are seeing that, there's like a restriction, that that would restrict other things. And then we would have this, like under the surface kind of restrictions across the board, whether it's movement restrictions outside of feeding or tongue, or lip ties that we'll see it affect other areas of motor development, which is bout sensory development is that, is that, did I get that right? 


00:22:56    Michelle 

Yes, and connecting that back with how the nervous system is reflecting and ties those kind of compensatory strategies in the way that the tissues are aligned or not. It makes some reflexes hypersensitive, some hypo sensitive, and it makes some digestive tracts really have some dysfunction like lots of reflux, or gastric motility, or all different types. And then airway like squeakiness, congestion, noisy breathing. So there's a lot of different things about the tongue being the most sophisticated organ is going to dictate how the autonomic nervous system had that really primal part of us. That was, we're babies, It feels it's going to be directly related to tongue function and what the tongue is doing that make sense tongue restrictions actually pull the tongue down low and compress the airway a little bit. And they but they do also is not allowed to tell me to go up to the palette, where it needs to be fully suctioned when they're sleeping a hundred percent of the time. And then also there when they're not using it, you know, when they're awake, just at rest. 


00:24:12    Alyssa 

That makes total sense to me. So, really, like what we could see is that something starting with an oral restriction could potentially lead to like other, maybe even like motor delays, things like that. Could those be connected there? 


00:24:29    Michelle 

Yeah, but not to get too worried, or like scared about that, more than just, you know, know that the tongue needs to move the most. 


00:24:38    Alyssa 

Totally. I'm yeah, not in like a fear-based, like "if your kid has a tongue tie then this is gonna be the case." But I what I'm hearing is it like it really does connect to all these other systems or and can affect them. Yes, That's that's so interesting to me. Is revision always the answer? 


00:24:59    Michelle 

If a baby has a restriction, and they have, they don't have the range of motion in their tongue that everybody needs to do the proper development. It needs to be released. Okay, but the timing is always going to be the question. So yes, if somebody has a restriction or a tie, they need to be released. But when is the question is best for them, you know. So, like the babies that are identified in the hospital. Then yes, we need to let, you know, go ahead with that. But we also need to tell families that that may not meet all the needs that they need to follow up with lactation therapy or bodywork support. And it's really important to locate your lactation resources in the community, okay, and people who know how to work with infant feeding in general too. 


00:25:55    Alyssa 

What does this look like if it wasn't diagnosed in the hospital? What if it's something that like, you know, maybe you're a few weeks in, and you are seeing feeding challenges or something like that, and you end up with a diagnosis a little bit later. What would that look like at that point? Is it still something that you would say, like, yeah, we are still going to revise, or how does that change the course of treatment? 


00:26:18    Michelle 

Well, yes. And that actually happens a lot because, and that's okay. But we do need the kind of funnel these babies into people who do are knowledgeable and able to identify properly and to assess the baby for readiness of release. 


00:26:37    Alyssa 

Will you tell me what that means? Readiness of release? 


00:26:40    Michelle 

Well, it means, are they ready to get the tongue released? And I when you say revised, revision means they've already had one and this is their second one. Well, in for some babies it will be if they were, if they had a little snip, that's what they call it sometimes in the hospital. And you go for another release, which that would be technically be a revision. Either You could say release for everything if you want, but it's You know, there are circumstances where it's caused so much dysfunction in the nervous system, or with the movement system that or that it's embedded still in the in the muscle. And it's not enough, you know, its own tissue. 


00:27:24    Alyssa 



00:27:24    Michelle 

 Or the jaw is really small. And sometimes we need a little bit of growth, Otherwise we can't fully release it. 


00:27:30    Alyssa 

Got it. Okay. 


00:27:31    Michelle 

And we need to like weigh, because it's an intense process going through tongue tie release. It's totally doable. And this is also why we want to work with babies. Did you know? Sometimes they need to build a little bit of resiliency. Some babies are having a lot of dysregulation, and we don't want to just overload them with the procedure when they don't have the capability to use the range of motion in the first place, right? So that's why it needs to be timed really well. And it needs to be done on an individual basis. I cannot stress this enough like anything, I would say today, you know, even globally, it's still needs to be looked at and individualized this timing thing. And it's not like we wait a long, long time. These babies, I mean we're talking about days to a week to maybe a couple weeks, three, it depends on what's going on. 


00:28:25    Alyssa 

Who would be able to best like assess the timing portion of that like what I guess, who would you seek out for support for nailing that part down? 


00:28:35    Michelle 

That's a great question, because it's a multidisciplinary team. It could be composed of OT occupational therapy, Physical Therapy, speech therapy, Chiropractic osteopathy, I don’t want to forget anyone. But it can be people who are specialty trained. And I think that's more important than their exact discipline. You do want to be working with people who have a license to touch or a license to do what they do, or certification, because this is a very sensitive issue working in and around a baby's mouth it's a Sacred Space. 


00:29:14    Alyssa 



00:29:14    Michelle 

Babies have loads and loads and loads and brain rent is being paid to the mouth, and we can mess this up. That's all I want to say. If we do procedures that are ill-timed because the brain is learning through experience and is developing through experience, and we don't want babies having negative experiences and going through procedures where it's too intense for them at that time. Now, we also do want to go as fast as we can, because we want to get it as early as possible. But that doesn't always mean right away. 


00:29:49    Alyssa 



00:29:49    Michelle 

But anyway, so it can be anybody of that discipline. And I would really just kind of seek out like, who's the knowledgeable people who've done trainings, Etc. Because the whole optimal time in your release was like a concept I just put out there because I was seeing suboptimal outcomes. I was seeing babies who I thought. Wow, just really it's not just I just had a gut feeling. And this was many years ago. And have I put it into words. I started using the word optimal timing just to start thinking about it, because we used to just identify release. If I release and that's just not it doesn't. It doesn't help. It doesn't work anymore, because there's too many co-morbidities or things that go along with having the tongue-tie like really posture problems, Breathing dysfunction, recessed jaws, smaller jaws, really 


00:30:38    Michelle

a lot of tension or nervous system dysregulation, difficulty, calming, difficulty sleeping. 


00:30:46    Alyssa

Yeah, that makes sense to me. So what I would that would that was interesting, because I have thousand percent before 5 minutes ago in this conversation would have fallen into the category of like, oh, my kid has a lip tie or a tongue-tie. Yeah, let's do the release. And like it would not have known that there is a certain. And I think so for so many of us the like go-to person, or the person who we might be seeing, or that might be covered by Insurance, Etc. Is that pediatrician or nurse practitioner? And I noticed that when you were saying, when you were talking about the optimal, those people weren't people you mentioned there. 


00:31:26    Michelle

Yeah. And I also forgot to mention lactation, because there's a lot of lactation consultants who have also done the same thing, we all need to say that we've taken a specially-trained I didn't want to forget anyone, but that's a good point. There are some pediatricians who have really excelled at this, and some just don't. And as matter of fact, the story that is now being really talked about with pediatricians. And I love the criticism of the tongue tie release world that they're giving. But they're saying now it's trendy, and I don't believe in that. And don't do this because the posterior tie isn't a thing. I welcome all of that criticism. That's why I'm saying what they're seeing these bad outcomes or whatever, or inconsequential outcomes or subpar outcomes. They're not impressed or whatever. I'm just speaking from the pediatricians mind, is this lack of optimal timing.


00:32:16    Alyssa

Okay, That makes total sense to me.


00:32:18    Michelle

Rushing every baby to a release just because they, I'm getting excited, You know... 


00:32:23    Michelle

You're excited as welcome here!


00:32:26    Michelle

because they got identified. And we really need to be more sophisticated than that, and use these intellectual like mindful decisions and taking a lot of different factors into helping the family understand that because all of them 


00:32:40    Speaker 1

is I work with, or a large majority of them understand after they've had the education, and they've understood the whole process, and they can see the changes happening. The other thing is, we're not going to send them home just to fail and flop around. That's what therapies for. That's what bodywork is for. That's what these interventions are for lactation support. We need to make sure we need to preserve the milk supply was like, what do we need to get the baby release of the mommy can make that doesn't always equal out. If a release always solved that problem. I would be the first one to say, just send them because that's easy. It would be let's do it, but it doesn't do it. And so I'm not always. Now there are some babies to do. You hear the miracle, you know, my baby got released, and it changed everything. Well there. There is a group of babies like that, but they had milder symptoms to begin with, and they had less associated compensations. Yeah, that may had less associated things going on less symptomatology, right? The tongue is going to send symptoms all through the whole body, because the tongue, again at these centers, the middle of development, and it's going to spread all over the body. All the way down to the toes. And many people are into facia these days. And they understand what facia is and the tongue is connected to the toes. 


00:34:00    Alyssa

That that was really helpful to hear, because the I have definitely heard the narrative of like, oh, we did it, and it didn't work or whatever.


00:34:09    Michelle

That's because they were sent before they were ready, and they weren't in a place to be able to assimilate that. I dont know why everybody understands this for adults Like, okay, I need this kind of surgery like you would understand, like certain people need a little bit more prep work, and other people need a little bit less. We can see that in babies as well. It's really kind of obvious, Once we've got our microscope on it and looking at it, or even the rehab after that, 


00:34:35    Alyssa

Like, if you had surgery, then you would likely see a PT to do rehab after whatever, that like, and so that makes total sense as you're bringing like the full Village into this that it wouldn't just be the release, Its then what do you do after what else are we doing around that release to support this tiny human?


00:34:55    Michelle

And I don't want families to get overwhelmed by thinking, Oh, my gosh, how am I going to work with all of these people? I know. So that's why I developed the tummy time method, you know, a little marketing here, because it's too, so that families could do Tummy Time therapy tummy time at home. So it minimizes the need for all the therapeutic intervention. It doesn't decrease. I mean, it doesn't take it away, You just minimize it. You like you only have to do so many sessions, and change happens quickly, what we do at home matters. And so it's really powerful therapy you do for free at your house. And then you take your baby in for a little adjustments, or a little bit of micro might, you know, right changing things, tweaking things a little bit here and there, because babies we need to also, even though their symbiotic with the birth parent, they we need to see them also as unique human beings. And they have, there's a whole normal biological imperative and neural developmental sequence that happens. We watch The humans as mammals. And, you know, we want that to be able to happen easily. And feeding happens to be the number one indicator of how well that's going movement wise. 


00:36:12    Alyssa

Yeah, No, that makes total sense to me. And I think that I guess I'm wondering, hey, we had a Facebook like comment at one point on this where somebody was like, oh, well, my kid had a tongue or lip tie, and we didn't do anything. And now they're two and a half, and things are fine, and they're eating fine, and they're whatever. And I would like to touch on that of like, what, what can we see down the road? If we don't do revisions or releases earlier? That might not be the glaring like, oh, you know, it might not be like some big thing that we see, but that we might not even know, Oh, these are connected. Does that make sense?


00:36:55    Michelle

 Yeah. Well, first of all, It's I hear that a lot like we didn't do tummy time, and my kids fine. And this and that one, And I really can appreciate that you don't, that the parent doesn't have any overt concerns about that. But saying someone is fine is, you know, relative to what, a parent, or a therapists eye, to the norm, to the bell curve, to what we have expectations? Because what we want to do is really be proud of our babies for how prolific like they can move, rather than how still and quiet they can be right, or infants have a rapid sequence of development in six months, they really need to go from basically whoa, you know, heads all tipped over, and they, you really don't have much of a voluntary control at all to having voluntary control and integrating the reflexes and kind of there it is. And they're going from that to getting in a crawling position. Now, crawling could be anywhere from six to nine months. Really, there's a lot of spongy variability there, but it's a short period of time to get your postural control. And we want babies to be able to do that with ease and grace. And when babies can problem solve in their bodies and feel the ease and freedom of movement and not have inhibitions, This helps them learn better. This helps them connect better. This helps them process their sensory. You want to talk about a baby who can do well with their sensory processing is how that they feel inside their body about movement? 


00:38:30    Alyssa

Yeah, Yeah, totally. And it for me, is one of those things where, you know, you mentioned, like optimizing development earlier, and that for me, that's what I want for all humans is that you feel the best you can in your body and in your environment. And again, it's not that like you hit this milestone, and we're just checking that off as like, wow, you hit this milestone, But instead, like really optimizing this kiddos life, the ability to move through the world, and I have seen it as a teacher and how it can affect their ability to enter into a social group or play in a certain space, or really filter information sensory stimuli, Like there are so many different ways that I think these things come into play, that don't necessarily seem like oh A to B. And so we can. It can be hard to see how we might see these effects down the road. But also, I've said, like, I'm not a Band-Aid person like, tell me more, You know why? And for me, that's really like. I want to release any roadblocks. 


00:39:33    Michelle

You want to know something really trippy. It's there's a posture connection to social, emotional interactional skills And posture means that babies have to go from being physiologically flexed, and they have to come out. And when they birth is our first really big extension. And we extend our bodies, and we need to spend the first 14 16 18 20 weeks extending up into gravity and being able to use these experiences. And we're not getting as much of that as we need to. Okay. We really need to develop our posture. And that is so inner digitated with our sensory processing and also our social emotional interactional skills. And I agree with you so much, because to me, it's the nuances of development. And I hate box checking. Okay, I did check so many boxes working at a children's hospital. I've checked him off, But guess what? It's the nuances It's the experience is the embodiment. It's the baby's felt sense. This whole, this new sense that's coming into everyone's awareness. Thankfully, through even just an occupational therapist has brought our awareness to it is interoception events of our insides, right? You've heard that. And for babies, that's a lot of that is from their gut. What? And that sensation is coming up from the vagus nerve, right? This is really big. And definitely the tongue is part of the digestive system. So anything that's disrupting tongue function, range of motion and endurance, rest posture is going to have an effect all the way down. Yeah, that's so fascinating to me. 


00:41:22    Alyssa

Okay, Michelle, I feel like I could get nerdy with you for so long. I love this so much. If folks were like, okay, I'm curious about my baby now, and I'm wondering if, like, they wanted to have them checked out, or have them assessed by someone who is trained in this. Where would you, essentially, what would you look up? Where would you suggest that they start to look that up in a world where, like, if you just type anything into Google, you're going to feel overwhelmed like where would a parent start? 


00:41:53    Michelle

Well, that's a great question I would start with if they're into social media, you could get on your usually there's a state or a geographic location tongue-tie support group. 


00:42:06    Alyssa

Hmm. Okay. 


00:42:08    Michelle

Now that can be intense to be involved in those and those groups that can be, I recommend them with moderation, but reaching out to local lactation resources and asking the question, you know, do you have knowledge and experience working with oral restrictions? And that person will tell you yes, or they'll send you or know, or send. They should send you and say, well, if you don't, can you tell me someone who does. It's calling the local pediatric occupational therapy speech therapy clinics. And especially if you find someone and this is kind of the secret is someone in private practice. That's somebody who's come out of an institution. Now, I'm not saying that there aren't really great therapist working in institutions. Hello? Y'all out there. Yes, there are. But the people who have come out of Institutions like myself were in private practice. We don't have to necessarily follow the Party Line. We don't have to say what everybody else is saying. We can really use just our experiences, and we all have had to take you. I didn't learn this in OT school. So you have to take a lot of classes and conferences and seminars and connecting with other professionals. You want to work with someone who's connected to other people in the oral restrictions world, but not to put too much, you know, pressure on you just call and ask Private Practice, OTS, Private Practice, speech therapist. You can Google that in your area. Ask, go on your, ask someone. Hey. Is anybody ever had a baby that had tongue-tied who you work with? And did it work out? Now, you know, there's going to be some people. There's a range of experience, and you want to just work with the people who are best suited for you. Okay, depending upon where you're at, and where you're listening from, it's going to be different people, but generically needed. If you're breastfeeding, we need lactation support. If you're bottle feeding, you can work with a therapist without lactation support. Not saying, like lactation Consultants can't work with bottle-feeding, but does there's not a big reason to match that up When if the OT or the speech therapist has good bottle feeding therapy skills You want to work with you know body work professionals. If you have a chiropractor, you work with, or osteopath that you see, or another body worker. And hopefully you maybe already have develop those relationships for yourself. But always still ask for the people who have specialty training with babies and ties, and you will find somebody they'll be able to connect you with somebody, and that's, you know, close. And there's people who now we'll do some Telehealth. I know we do for Tummy Time method. We do what we call Teletummies, and you can get on a virtual consult and learn how to do it at home with your baby. And it's really easy to do. But some people are doing your guiding. And I do it from time to time. But it's not what I want to spend all my time doing, because I like my hands on and doing teaching. But you can really do a lot Like I keep my doll here, and you know where to touch it. Teach a lot of face massage, and you know how to get a baby relax and tummy time, and how to help them really move their tongue without getting upset, and how to look at the tongue for what it should look like. I think that's it too we're not really sure what it looks like. You got to work with someone who could tell you like, Well, it's supposed to come all the way over here or look, it's coming all the way over here. And that's what it looks like comparing sides. But, you know, just work with the best people that you have, and ask a lot of good questions. 


00:45:45    Alyssa

Yeah, I think that you just pointed out something that I think is really crucial and important. And a reason why I think the village as a whole is so important Is that like I was I was just chatting with my friend the other day and was like, yeah, I can assess a child's development pretty quickly at this point, because I've worked with thousands of children and have assessed so many kids that I have a barometer for like, what's typical or what? I'm like. Oh yeah, I noticed that. But like, that's a yellow flag for me right now. Like I'm not actually paying attention to that right yet, or that's standing solo, and there's no other flags that go with it, Etc. And I think that this is thing that we have placed so much responsibility on parents who are trained to see this to know this, who haven't seen hundreds or thousands of kids to be able to compare that in the same way that, like, I don't know what the tongue should look like, or be doing like that. Something that is outside of my discipline that I will seek support to say like, is this how this should look like? I'm, I don't know. And I think that it's really important that we can acknowledge that It's not a parent sole responsibility to have all of this knowledge. And instead to say it does take a village and to be able to tap into a village and get that supported. Like, is this what this should look like? Is this developmentally appropriate? Yeah, even if you've had a couple of kids like they, it can vary so much kid to kiddo and things can show up so differently that I think that that's so important that you noted that and I think we put way too much pressure on parents to have all the answers. One of the phrases that drives me nuts Is the like, just trust your gut or trust your intuition. And I think that that can also put too much pressure on a parent. Okay, but my gut says, I don't know like this is my first kid or whatever. And I, yeah, I love that you tied the village in there. Actually we I see a chiropractor regularly. And one of the very first things I said up were planning a home birth. But one of the first things I was like, can you come to my house and do a home visit for this baby? It's probably going to be taking quite a journey outside the womb like that. Yeah, I love it. 


00:48:02    Michelle

But also, and I love Chiropractic. And that is really important in body work and all the things. But please don't put us above the biological imperative, which is making sure the baby gets a really proper breast crawl. 


00:48:16    Alyssa



00:48:17    Michelle

And that can take one to three hours before the baby crawls. And we do. This is our mammalian Instinct. And this is what we're capable of. And when we don't often use circuits and movements that we’re capable of, then we aren't, it doesn't optimize our feeding part of the breast crawl experience for a baby is to prepare them for the first natural latch. And so the moving side to side and stopping and sniffling and those crawling motions and digging their feet into your flesh and pushing up there, able to move independently to the breast. And that will be wonderful bodywork for your baby too, and also a very big, functional optimizer. And then by the time they get there, they've opened up any kind of restrictions from being tucked up in the womb, and, you know, coming out into gravity, because that's quite a big pressure change. Whoa, totally take that first big breath, the air and whoo. 


00:49:19    Alyssa

That makes total sense. I mean it. I think we would think of that with any other like workout. I wouldn't like just start sprinting. I would ease into it there, you know what I mean. Like we work our way into that. And so to just be like, you came out and now feed from this breast without any sort of movement beforehand that makes total sense to me.


00:49:40    Michelle

And they're not quite hungry yet, because they're, right now, they've been fed 24/7 by and the process of moving up there does get them hunger. And hunger is a motivator. 


00:49:50    Alyssa

Totally, a motivator for me let me tell you.


00:49:55    Michelle

I want to say one more thing before we end. 


00:49:57    Alyssa

Please, yeah. 


00:49:57    Michelle

I have so appreciated, Goodness, I'm going to start like, listening all the time. I really love your Vibe and what you're doing, and I can really tell you have a deep understanding of things, and it goes beyond like, you're saying the physical It's, it's who we are as people, and also the experience, The Human Experience, but social, emotional, interactional and emotional regulation and understanding co-regulation is how we all regulate our nervous system. And that Is the experience that our nervous system is wired too regularly with each other through our voice and our eye gaze and our facial expressions. But I want to say one more thing that I said a couple times why the tongue type process is intense. And I want to say why. 


00:50:43    Alyssa

Yeah, please. 


00:50:44    Michelle

Is that there's a special kind of healing that we do with the tongue tie. And that is called secondary healing intention. That means that we want to keep the wound beds separated. And we want them to heal open like an abrasion. And what the body is naturally trying to do is heal the edges, Yeah, and close it up and heal by primary healing. So we're going in essentially saying no to a normal process. So it's a very interesting Paradox, and it's and that is it has varying levels of intensity and discomfort. And remember, babies are learning through experience, And we want to take care, now. It can be done very well. I walk babies and families through this all the time. It can be done really Well. It can be done with respect and grace and love and and co-regulation, and right at the baby's intensity level, right? And as quick as we need to do it, as long as that takes. 


00:51:46    Alyssa

Yeah, just helpful to hear. And it makes sense again, that like right as you described, I was like, yeah, I picture it like closing back together, because that it's like, no, this is how we heal is right back together. 


00:51:59    Michelle

Yeah. And the parents have to go in three to four or more times a day, and really kind of open that up. And that is an intense process. And as a parent, I know it's a struggle for me, and I've done it many, many, many, many, many, many, many times over many years, and it's just it's an intense part, and I think it makes parents feel like a lot more confident when they've got their village and people that have taught them and equip them and educated them, but also empowered them, you know. So we're not here to just tell people what to do families with to do it. Once you educate people about what's going on, and and what needs to be done, that it does become a little bit more natural. And like you're saying, trust your gut thing doesn't work if they need more information, they can only trust their gut when they're provided with two or three options are like, okay, that feels right. You know, that's the gut feeling. It's not like I can't intuit the entire you know, capacity of what you've learned about ties over 10 years Michelle, you know, you got it. How do you pack that in simply? And so I really appreciated having this discussion. And let me have a little bit of an out-of-the-box thinking, because there are still a lot of people who just identify and send for release. And that happens, you know, everywhere. So Yeah, now we're getting to let parents know that there's something different out there. It's got better outcomes and is less intense, and it's better for your baby's nervous system. And it's better for their oral sensory processing and how they develop as people. 


00:53:29    Alyssa

Yeah, this is so so helpful. Where can people find you connect with your work, dive deeper if they'd like to? 


00:53:36    Michelle

Well, I'm on Instagram as @tonguetiebabies and @tummytimemethod. And that's a great place. Those are two great places. I love hanging out in that space. I don't stay around a lot. I don't follow a lot of accounts, but I do come and interact from time to time. And I'd like to maybe do a little bit more of that. But I'm a busy person. I'm also still actively parenting. Two of my children still live with me. And while they're young adults, They are still needing their mama, and I love them too. And I'm also trying to, you know, learn how to take a little bit slower, you know. And but there, @tonguetiebabies and @tummytimemethod are two really great places. 


00:54:21    Alyssa

Awesome. Thank you so much. I so appreciate you.  


00:54:23    Michelle

Thank you. I really enjoyed my time with you. Thank you so much. 


00:54:29    Alyssa

Thanks for tuning in to Voices of Your Village. Check out the transcript at voicesofyourvillage.com. Did you know that we have a special community over on Instagram hanging out every day with more free content? Come join us at seed.and.sew. Take a screenshot of you tuning in, share it on the gram and tag seed.and.sew to let me know your key takeaway. If you're digging this podcast, make sure to subscribe so you don't miss an episode. We love collaborating with you to raise emotionally intelligent humans.


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