Category: blogging

Your Adenoids are Showing!

Think of adenoids as little pillows that rest between your nose and your oral cavity.  These little “pillows” are one of your body’s best defenses against germs.  When they become swollen, however, they can cause a variety of issues, including drooling, poor articulation, snoring, sore throats, and ear infections.  As a parent, you never want to see your kid battling constant illness.  The alternative, surgery, is also not very appealing.  It is a difficult decision, and one that my cousin, Gavriella Lerner, and her husband had to make for their 2 year old.  Gavi, awaiting the birth of her second child, agreed to pass on some information to other parents to help make a more informed choice when it comes to your child’s swollen adenoids.

My baby cousin, aged 15 months here, with the author
My baby cousin (aged 15 months here) and me

Jocelyn: Tell me about your child (i.e. milestones, interests).
Gavriella: My 2.5 year old has always been somewhat low tone and has always been late when it came to physical milestones. He is very bright and eager to learn and is into typical toddler boy stuff- trucks, Thomas, Elmo etc. The low tone affects his mouth too- always hanging open, lots of drooling.

 J: When did he say his first words?
G: His first discernible words came right on schedule, at around 12 months.

J: When did “adenoids” first come up in conversation?
G:  The pediatrician mentioned it during a visit to treat what seemed like his gazillionth sinus infection.

J: Is there a family history ?
G: Yes. My husband had his tonsils and adenoids out at about the same age. For context, we’re in our mid-20s, so we’re not talking about the days where just about every kid got them out.

J: How long did you wait before seeking professional guidance?
G: We got a referral to an ENT from the pediatrician during that appointment. However, it is very difficult to get an appointment with a specialist when it’s not an emergency. Even though we called right away, it was about 3 months before we actually saw the ENT. We could not book an earlier appointment. And we tried more than one- they all had waiting lists about that long!

J: Did he get sick often?


G: He didn’t really get ear infections, but the sinus infections were constant. Every little germ he caught eventually morphed into a sinus infection.

J:Was he a noisy sleeper?
G: He was a snorer, but not a noisy one. That’s why we didn’t really notice for awhile. But the snoring definitely affected his sleep. He woke himself up from snoring several times a night, and if it happened past 5 AM, that was it, he was up for the day. Although he didn’t wake us up every time he woke up in the middle of the night, we realized it was a problem because he was not getting adequate sleep.

J: How did you end up treating the adenoids?
G: Surgical removal.

J: Was the surgery invasive?  What was your child like afterwards?
G: Not really- they go in through the mouth. It does require general anesthesia. When he woke up in recovery, it was pretty bad- he was inconsolable, and they had to give him pain medication through the IV which was still in. He calmed down, and we were able to go home about an hour or so later. He was cranky the rest of the day and required a few doses of baby motrin. The next day, however, I had half a mind to call the doctor and ask if he was sure he had operated- my son was pretty much back to himself and needed no painkiller. Just some ice cream as his throat was still a little scratchy from the tube that had been in there. He was begging to go to the park (doctor had said to keep him inside a few days). He did pull at his nose a bit like there was something in there he was trying to get at, but didn’t really complain otherwise. One annoying side effect was really stinky breath (no, brushing teeth could not get rid of it)- but we were warned that would happen. The only other side effect was some constipation from the anesthesia, but even that wasn’t so bad because he was also on antibiotics (to prevent possible infection) which generally has the opposite effect, so it mostly balanced out.

J: Since treating the adenoids, what changes have you noticed?

G: It’s only been 3 weeks, and the doctor said it takes 6-8 for real changes to kick in. I have noticed definite improvements, but only in the last week or so. For instance, he is definitely sleeping better. He is closing his mouth for longer periods of time and using his nose. He caught a cold and it DIDN’T morph into a sinus infection- it just cleared up on its own.

J: Is his articulation improving? Have you noticed changing in his drooling?

G: His articulation is getting better every day. A lot of people thought he was speaking jargon- turns out, he had plenty of real words, and we’re only now just starting to figure most of them out. There is still work to be done, but the difference is there. The drooling actually got worse the first week- since we weren’t going anywhere that first week, I kept him in just a diaper because he was soaking through his shirts. The second week, he was drooling in pre-surgery amounts (which was a lot, but better than that first week). Now, this third week, we are seeing less than his usual amounts, so there is improvement, and we expect it continue.

J: Will you seek speech therapy?
G: The ENT told us he would need it, so we got evaluated and were approved for free services through the NYC Early Intervention Program. We were actually able to start before the surgery. We expect to continue for at least the next 6 months.

J: Any final thoughts to share with our readers?

G: A lot of things make sense in retrospect. For instance, he never took a pacifier as a baby, and now it makes sense- he couldn’t close his mouth! Oddly enough, this never interfered with breastfeeding or eating solid foods- he’s always been an excellent eater. We knew he was cognitively very bright and when he was evaluated for speech therapy, it was pretty clear his issues were with articulation and not language. However, I do think his language acquisition was  somewhat hampered because people couldn’t understand him. I definitely spoke to him at probably a lower level than I should have simply because I didn’t understand him so well, and I suspect I wasn’t the only one. Chronic sleep deprivation probably also hindered him. He definitely takes more of an interest in his surroundings now that he’s well-rested. I just wish we could have figured this all out sooner than we did.

If this sounds like your child, make sure to get a referral to a pediatric ENT.
For more information on adenoids as they relate to speech and language development, send me an e-mail!

Tongue-Ties across the Ages

babyboy-thumb

Yes, tongue tie is a real thing, and for some, it is very painful.  The scientific term for a tongue tie is ankyloglossia, or restricted movement of the tongue.  A tie can occur in the anterior (front) or posterior (back) of the tongue. You may be surprised to learn that 10-20% of the population born in the United States have a tongue tie.    If you suspect a tongue tie, you should consult with a professional (speech language pathologist, dentist, ENT, pediatrician) to assess and determine the need for intervention.  There are many consequences of an untreated tongue tie that effect a person differently across the lifespan.

BABIES

Very often, I will do a speech and language consultation and the parent will tell me “Johnny had a difficult time latching when I tried to breastfeed him”.  Breastfeeding is very difficult for a baby with tongue tie.  Due to the restrictions of the child’s frenum, the tongue is unable to make the necessary movements, such as cupping, to latch and breast feed.  This causes stress not just for the baby, but also for the mother, who was looking forward to this important bonding experience for her child.  At this stage, it is very important to receive input from a lactation consultant, speech language pathologist, or a pediatric ENT or Dentist trained in tongue-tie detection.  For a list of trusted providers, you can consult the resources provided by the International Association of Tongue Tie Professionals.

TODDLERS

Now your baby is a toddler.  Either no one has picked up on the tongue tie, or you have decided not to have surgical intervention.  At this point, your child is learning to speak.  Due to restricted movements, you may find that your toddler is having difficulty forming a lot of sounds, or that what he is saying does not sound clear (although you know what he is saying!) Other issues may include difficulty accepting a wide variety of foods.  Having a tongue tie means that it is more troublesome for the tongue to move food back and forth in the mouth, a necessary movement for handling more complicated textures (i.e. meats, some vegetables). Now that your child is more receptive, it may be possible to do certain exercises to help lengthen the frenum and allow for more movement.  However, if the child does not respond to this type of intervention, it is important to consult with a professional about possible surgical intervention to prevent further difficulties from occurring.

 

SCHOOL-AGED CHILDREN

Your child has now figured out to eat and speak and it is time to go to school.  Although your child is bright and has a large vocabulary, he may have difficulty producing some sounds (/ch, sh, j, s, z/) because the restricted tongue is unable to make consistent contact with the upper portion of the mouth.  Speech therapy can be done at this point to correct the production of the sound, but the child may continue to have a “functional lisp” because the tongue is not reaching exactly where it needs to be.  Further, a restricted frenum may cause your tongue to block your airway, causing sleep disturbances and attention issues (see my previous post for more information on how sleep effects attention.  It is important to speak to your speech language pathologist at this time for a referral to further assess for ankyloglossia.

YOUNG ADULTS/ADULTS

At this point, you have no doubt learned to live with your tongue tie and the thought of having a piece of your tongue snipped is scary.  Did you know, however, that a restricted frenum may make you a bad kisser?!  This information is always helpful in convincing my more reluctant teen clients to go through with the procedure.

Check back next week for more information on Tongue Tie, and an interview with my client who had a frenectomy (tongue tie surgery) 2 months ago and is already reaping the benefits! Sign up for the mailing list so that you can see it first.

For more information on assessment and treatment of ankyloglossia (tongue-tie), contact me!

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

boy_sucking_thumb

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 jocelyn.m.wood@gmail.com 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!

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