Everybody Does It, Nobody Talks About It!


It is a well known fact that humans need to sleep.  It should not be a surprise to you that in our fast-paced, go-get-em world, we do not get enough of it.   According to the Center of Disease Control, close to 40% of adults aged over 16 years old reported that they get less than the minimum of 7 hours of sleep each night.  The same statistic is true for children, who require a much longer amount of sleep–around 12-14 hours for preschoolers and 11-12 hours for children in elementary school.  So, just what exactly are the risks of sleep deprivation?

Recently, there was an article in the New York Times which pointed to lack of sleep as a possible culprit for the overabundance of ADHD in children.  In adults, lack of sleep leads to excessive yawning, sleepiness, and sometimes falling asleep on the job.  In children, however, the effect is quite the opposite.  Children who receive less than the recommended 12 hours of shut-eye each night tend to be hyperactive, and sometimes even aggressive.  In the classroom, these kids are the ones who cannot sit still for the entirety of the lesson.  At times, they are disruptive to the rest of the class.  Their less than optimal sleep schedule puts them at risk for being (wrongly) diagnosed with a learning disability.
With school just around the corner, it is a great time to get your children on a solid sleep schedule so that they can have the most success this coming school year.

Maintain a Daily Sleep Schedule

Life is hectic, and with young children, there is always something going on!  Try to make bedtime a consistent routine for your family.  Bedtime is a great way to bond with your child by discovering a new favorite book.  To begin with, get children into their routine 30-45 minutes before their actual bed time so that they have time to relax (and ask for a 2nd book!)

Limit Electronics

There is a time and a place for technology.  The bedroom is not one of them.  Limit video games to 2 hours before bedtime, and if possible, eliminate the television, computers, cell phones and other electronics for your child’s bedroom.  By eliminating the light transmitted from these devices, children will have an easier time falling asleep.

Eliminate Caffeine

If properly fueled by sleep, children do not need external energy!

Make it Cozy

The bedroom should be a place your child wants to go to to relax after a long and tiring day.  Make sure the bedroom is dark, quiet, and cool by covering windows with opaque curtains and by running fans and heaters to maintain an optimal temperature.

By setting the foundation early, you will put your child on a path to success both at school and at home.

For more information on Childhood Sleep Disorders, visit Kids Sleep Disorders Awareness.


What your pediatrician hasn’t told you about sippy cups


As a speech therapist who works in feeding therapy, I have very strong opinions about cup drinking. Yes, teaching your toddler how to drink from a cup is a precursor to speech development, and making a smooth transition now will prevent problems down the road.

How Bottle Drinking Effects Tongue Position

We live in a bottle obsessed society.  Bottle feeding, rather than breast feeding, has become the norm.  As a result, children are having difficulty developing “natural” tongue patterns.  When breast feeding, the tongue presses upward to elicit liquid from a nipple.  During bottle feeding, the child’s tongue moves down.  So, from a very early age, children are being reconditioned on where to place their tongues.

Then come teeth…

Parents are very familiar with the mouthing and gnawing associated with teething.  But did you know that teeth come equipped with “sensors” that tell them when to stop growing?  Teeth will only grow until something disrupts their path (i.e. gums, other teeth, tongue).   So continuing to provide a bottle after teeth begin making their appearance may effect the growth of baby teeth.

But you said it can effect speech development?

So, bottle fed babies move their tongues down, bottles block teeth from growing to their full potential…down the road, children with prolonged bottle feeding may develop immature speech patterns that require a full course of therapy.  Because the child spent so long “mis-learning” tongue position, intervention is now required to retrain the tongue and strengthen lip, jaw, and tongue muscles.

Introducing Cup Drinking

This is where cup drinking comes into play.  Parents often ask when they should begin to introduce a cup and when I say “around 8-9 months or when the first teeth erupt”, they think I am crazy.  Cup drinking is MESSY!

Yes, cup drinking is messy for a few days.  But open cups are much easier to clean than sippy cups and straw cups.  By introducing an open cup so early, children are able to discover correct tongue positioning through a natural learning environment (drinking!) and avoid tooth and dental problems caused by cup drinking.

My clients have had the most success with the Oxo Training Cup, which can be found here.

For more information on infant and toddler feeding, contact me at or join the mailing list!

The Importance of a Multi-Disciplinary Team

One of the benefits of working in a school is the interaction between the various disciplines.  I work with a fabulous team of occupational therapists, physical therapists, psychologist, social worker, and special educators.  We are able to look at a child and each use a different perspective to help aid that child’s ability to learn.  Frequently, I find myself baby-hearing-protectionasking the physical therapist for advice on positioning and going to the occupational therapist for ideas on how to have a child better focus on reading and writing tasks. They come to me to learn about speech and language milestones and how to phrase questions to get better responses from their students.

This week, I had the opportunity to visit another important member of the multi-disciplinary team: the audiologist.  I am sure you remember your hearing screenings throughout the school years, but how many of you have actually been to an audiologist?  A visit to the audiologist is an important first step for any child with speech and language delays. Just imagine what it sounds like to listen to someone’s voice when you are underwater–hearing muffled voices  can make learning to speak a very difficult task for a 2-year-old! Recurrent ear infections, build-up of earwax, and reflux should all be followed up with a visit to an audiologist.

During my visit with audiologist Dr. Shirley Pollack, she walked me through the entire process of an audiological exam.  She takes a thorough case history, builds rapport with children, and makes test results “real” for children and their families.  Her office also provides Central Auditory Processing  Disorder (CAPD) testing for children over 5. I’m glad to have added another member to my multi-disciplinary team!

Look out for future postings with interviews with my team members!

For more information on audiological exams or language delays, contact Jocelyn M. Wood

Teachers need speech therapy too!

When meeting new people, one of the first questions I get asked is “What do you do for work?”  I respond by saying that I work in a school, but that I also work with babies to provide speech and feeding therapy.  99% of the time, the reply is “But how can you help babies to yellingtalk?!”
Through writing this blog, my primary goal is to open your eyes to the world of speech therapy.  As a profession, we can wear many different hats, and can reach out to many different populations.  Today, my focus is on my closest friends and colleagues—teachers!


A recent article in Advance Magazine focused on voice disorders in teachers.  It makes sense–the teachers I know are CONSTANTLY abusing their voices, by speaking for 6-7 hours per day (usually more!), addressing a growing class-size of 25-30 students, and not taking time out of their day to re-hydrate and drink water!  With parent teacher conferences next week, I know quite a few of my colleagues will return the next day with sore throats or lost voices.


Voice disorders do not have to be an occupational hazard, though.  Speech therapists can help!  If you are a teacher, you probably have a speech therapist working in your school, who you can reach out to for advice, voice exercises, or referrals to a specialized voice professional.  There is also a free online program offered by University of Iowa, that can help you to overcome your vocal misuse.


For a more tailored and personalized program, it is always best to contact a speech language pathologist with specific training in speech language pathology.


If you are a teacher who is tired of sore throats and raspy voices, contact me for more information or to set up an evaluation.  Your vocal cords (and students) will thank you!

Orofacial Myofunctional Therapy: Why Now?

cranio_logoJoy L. Moeller, R.D.H., B.S.
Volume 30 Issue 4 October 2012



It is said that timing is everything. You may have heard of orofacial myofunctional therapy (OMT) popping up here and there in the U.S. over the past few decades. In 1978, I ventured into this field eager to learn more about the mouth exercises my son had benefited from as a patient with TMD. I studied the therapy rigorously, attending several courses with Dan Garliner and others who, at the time, were leaders in this field. While U.S. institutional interest in the field over the past few decades has waxed and waned for various reasons, early OMT specialists have continued to practice, train others, and steadily build awareness through clinical success.

You may have seen an increase in discussion of the field in the last year or two. A quick search using Google will show a seven-fold rise in “myofunctional therapy” searches from 2011 to 2012. Why is this interdisciplinary field, which has shown promise of success yet not quite taken off as a profession, suddenly come into greater prominence? With new research from Brazil and OMTs proven efficacy in treating TMD1 and OSA,2 the field is poised to explode like never before.

Around the time I began, a few Brazilian speech pathologists, visionaries like Drs. Irene Queiroz Marchesan and Esther Mandelbaum Goncalves Bianchini, studied these same courses. Bringing this knowledge home, they enhanced and implemented OMT into academic environments and successfully fought for national recognition.

Three factors combined to make the profession take off: strategic leadership, the healthcare marketplace, and a vigorous research environment. These ingredients, under the banner of “Ordem e Progresso” have resulted in Brazil being the first and only country to have federal licensure in the field. With over 20 universities engaged in research, Brazil has effectively thrust OMT into the spotlight. We now have the evidence-based research we need to support the benefits of OMT as it relates to TMD and OSA. Just this year in June at the Brazilian Orofacial Myology Association Congress, hundreds of new OMT research posters were presented, and this November in Brazil at the Brazilian Speech Society (SBFa) Congress, there will be hundreds more.

OMT, also known as neuro-muscular re-education of the oral facial muscles, is a modality that promotes the stability of the stomatognathic system. Studies have been done for centuries to understand the relationship of form and function.3 When the tongue is resting against the hard palate (thus maintaining the proper oral volume) it enhances and/or creates stability for the TMJs. If the tongue is habitually resting down and forward in the mandible, as may happen with a lack of patency of airways and/or excessive use of bottles, pacifiers, digit sucking4 or a restricted frenum,5 normal form and function may be disrupted.6

While a primary function of the tongue is to protect the airway, improper oral resting posture of the tongue will have a negative influence on the development of the oral cavity. Add that to the modern diet of processed foods (soft foods may lead to low muscle tone by diminishing the frequency and intensity of mastication7), a smaller oral volume may not support proper upper airways, the stability of the TMJs, or the development of optimal dental arches.8

OMT specialists are trained to promote functional posture9 (in absence of mechanical obstruction) with behavior modification. The goals for the patient are to become aware of, and eliminate, noxious habits and achieve nasal breathing, lip seal, and proper mastication. OMT specialists also promote patient compliance in the proper care and use of oral appliances that treat TMD and OSA, as well as minimize muscular discomfort due to the use of those appliances.

Contributing to the creation of orofacial myofunctional disorders (OMDs) are restricted lingual frena.5 It used to be that a baby’s tongue was checked immediately upon birth to make sure the baby could breastfeed easily. Possibly due to the proliferation and universal acceptance of bottle-feeding, a restricted lingual frenum is not only overlooked by healthcare professionals, but its detrimental effects are not fully understood.

Tight lingual frena have a critical impact on normal function and the development of the orofacial complex. The restricted frenum not only may affect the oral resting posture of the tongue, but it also disrupts the tongue muscles, both intrinsic and extrinsic, of their normal functions. If the frenum is restricted, the genioglossus muscle may not function normally and may impact the airway patency and contribute to sleep disordered breathing.11 Furthermore, the attachments of the tongue to the mandible may restrict forward growth and development. Lingual frenectomies are essential if the tongue is restricted for a full range of mobility. And even more essential is the follow-up with an OMT specialist so that the patient who has just undergone a lingual frenectomy may be assured success. The OMT specialist will work with the patient to re-pattern the muscles, ensure full range of motion of the tongue, and make sure the tissues do not re-attach after surgery.

It is ideal to release the restricted frenum as early as possible-meaning at birth-because the tongue will achieve optimal function through the activity of breastfeeding. Breastfeeding promotes tongue-palatal contact and requires the back of the tongue to activate by making a suction seal. These actions promote optimal muscle function of the entire orofacial complex.

Much more research is needed in this field to fully embrace how we may all benefit from OMT, practitioners and the public alike. Not a week goes by where a patient doesn’t say, “How come I didn’t know about this sooner? It could have saved me so many years of pain.” It breaks my heart that more people don’t know about OMT. I dream of a day when the United States will “catch up” to Brazil and implement this field into academic arenas, where research is promoted, where studies open doors to more physicians, more dentists and more patients who need this treatment. We are poised to rapidly advance this field. In just the past year, several leading professional healthcare organizations have sought speakers on OMT, and several of our leading universities have begun discussions about starting research. If timing is everything, I feel like I’m finally arriving, but it took me 30 years to get here. Our patients are asking for help. Don’t we owe it to them to offer this adjunctive treatment?

Joy L. Moeller, R.D.H., B.S.

Orofacial Myofunctional Therapist

Pacific Palisades, California


1. de Felicio CM , de Oliveira Melchior M, Antonio M, da Silva MR: Effects of orofacial myofunctional therapy on temporomandibular disorders.

J Craniomandib Pract 2010; 28:249-259.

2. Guimaraes K, et al.: Effects of oropharangeal exercises on patients with moderate sleep apnea. Am J Respir Crit Care Med 2009; 179:962-966.

3. Levrini A, Favero L: The masters of functional orthodontics. Quintessence, 2003.

4. Romero C. et al.: Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition. J Appl Oral Sci 2011; 19:2:161-168

5. Northcutt M: Overview the lingual frenum. JCO 2009; 18:557-565.

6. Rogers AP: Exercises for the development of muscles of the face with view to increasing their functional activity. Dental Cosmos LX 1918; 59:857-876.

7. Rapley G, Murkett T: Baby-led weaning. England: Vermilion, 2008.

8. Price W, Pottenger F: Nutrition and physical degeneration: a comparison of primitive and modern diets and their effects. New York: P.B. Hoeber, 1939.

9. Okuro R., et al.: Mouth breathing and forward head postural effects on respiratory biomechanics and exercise capacity in children. J Bras Pneumol 2011; 37: 4:471-479.

10. Hsu H-Y, Yamaguchi K: Decreased chewing activity during mouth breathing. J Oral Rehabil 2012; 39(8):559-567.

11. Mathur R, et al.: Effect of breathing, pressure and posture on palatoglossal and genioglossal tone. Clin Sci (Lond), 1995; 89:441-445.

© 2009-2013: The Journal of Craniomandibular Practice. Site by Medium

Pediatric obstructive sleep apnea ~ critical role of oral-facial growth


Yu-Shu Huang1 and Christian Guilleminault2*

1Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taiwan, China
2Sleep Medicine Division, Stanford University, Redwood City, CA, USA

Aims: Review of evidence in support of an oral-facial growth impairment in the development of pediatric sleep apnea in non-obese children.

Method: Review of experimental data from infant monkeys with experimentally induced nasal resistance. Review of early historical data in the orthodontic literature indicating the abnormal oral-facial development associated with mouth breathing and nasal resistance. Review of the progressive demonstration of sleep-disordered-breathing (SDB) in children who underwent incomplete treatment of OSA with adenotonsillectomy, and demonstration of abnormal oral-facial anatomy that must often be treated in order for the resolution of OSA. Review of data of long-term recurrence of OSA and indication of oral-facial myofunctional dysfunction in association with the recurrence of OSA.

Results: Presentation of prospective data on premature infants and SDB-treated children, supporting the concept of oral-facial hypotonia. Presentation of evidence supporting hypotonia as a primary element in the development of oral-facial anatomic abnormalities leading to abnormal breathing during sleep. Continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB. load testing website Role of myofunctional reeducation with orthodontics and elimination of upper airway soft tissue in the treatment of non-obese SDB children.

Conclusion: Pediatric OSA in non-obese children is a disorder of oral-facial growth.

Create your own summer camp!

As school comes to a close and I meet with parents to report on their child’s progress and plan for the next school year, the question that comes up every time is “What can I do with my child this summer?” For many of the families that I work with, summer camp is not an option. Here is a list of some of the activities I suggest to families, to keep their children engaged and actively learning throughout the summer

1. Make ice pops

Who would have thought that an activity so simple could be such a rewarding language experience? You can bring your child to the market to pick out fresh fruits to use. You can talk about the different sizes and colors of the fruits and examine the seeds. Have the child tell you the steps you took to make the pops. At the end, everyone has a nice, cold ice pop to enjoy!

2. Visit a local museum, zoo, or aquarium

In Brooklyn, we have access to some of the world’s best art and culture. Take advantage of this, in a child-friendly way! Before going, you can read a book about some of the things you may see. For example, if going to the museum (on a rainy day, of course!), you could read “When Pigasso met Mootisse” by Nina Laden before going. This way, the child will have some background knowledge/new vocabulary before your adventure! Afterwards, you can talk about what you’ve seen and create your own artwork!

3. Create an outdoor scavenger hunt

Don’t keep the kids cooped up in the air-conditioned house! Send them out into the fresh air. Together with your child, you can create a list of things to find in your backyard/on a walk/in the park…For younger children, the list can be visual. For older children, you can make a list that they must read.

4. Keep a journal

Many of my students leave New York City for the summer months. This is a great time for them to record what they are doing. I advise children to tie together sheets of paper or to get their child a small notebook and a disposable camera. The child can then have fun taking pictures and writing about all the interesting things they saw. Plus, they will have something to share with their classmates when they return in September!

5. Go to the beach

Everyone goes to the beach at least once during the summer. Why not take the opportunity to enhance language skills? There are some great picture printouts that you can color and use before going.

Let your child enjoy and benefit from the summer months. These simple activities will help you both have a fun and rewarding summer.

For more information, contact Jocelyn M. Wood

American Speech-Language Hearing Association

About the American Speech-Language-Hearing Association (ASHA)

ASHA is the national professional, scientific, and credentialing association for more than 166,000 members and affiliates who are audiologists, speech-language pathologists, speech, language, and hearing scientists, audiology and speech-language pathology support personnel, and students. Audiologists specialize in preventing and assessing hearing and balance disorders as well as providing audiologic treatment, including hearing aids. whois . dns server Speech-language pathologists identify, assess, and treat speech and language problems, including swallowing disorders.

Making effective communication, a human right, accessible and achievable for all.

Empowering and supporting speech-language pathologists, audiologists, and speech, language, and hearing scientists by:

Advocating on behalf of persons with communication and related disorders
Advancing communication science
Promoting effective human communication

Visit their website at:

The National Association of Young People Who Stutter

If You Stutter…You have FRIENDS!

FRIENDS is the only national organization dedicated solely to empowering young people who stutter and their families. Our mission is to provide support and education to children and teens who stutter, their families and clinicians.

stutterFRIENDS is a non-profit, volunteer organization directed by Lee Caggiano, a mother of a son who stutters and a Speech-Language Pathologist specializing in stuttering. Founded by in 1997 by John Ahlbach, an adult who stutters and Lee Caggiano. Painfully aware of the urgent need of support for young people and their parents, and of the paucity of available services, FRIENDS was founded to provide this much needed support. Years of personal and professional involvement in the self-help/support movement have allowed us to create a compassionate, knowledgeable and empowering organization. Our members include the young people who are our focus, their parents and siblings but also adults who stutter and Speech Language Pathologists that have a special interest in stuttering.
visit their website at:

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